Ethical Challenges Encountered on International Military Surgical Engagements

Introduction: Military surgery has unique ethical challenges encountered in direct patient care, Department of Defense Global Health Engagement (DoD GHE). Ethical challenges have been noted in publications on individual DoD GHE; however, this study seeks to aggregate information across all types of engagements. Methods: Qualitative analysis was conducted of responses to survey questions about experiencing an ethical challenge during a DoD GHE. Further analysis was done on reports of complications and follow-up on patients. Finally, the frequency of pre-engagement ethical or cultural training was examined. Results: Responses were mostly from DoD GHE in the U.S. Southern Command (23) and U.S. Indo-Pacific Command (17) areas of operation. Out of 56 surgical DoD GHE, there were 11 ethical issues noted, and 72.7% (8/11) were reported from a hospital ship mission. Qualitative analysis revealed 4 main themes: cultural challenges, ethical dilemmas, systemic issues, and relational dynamics and trust. Conclusion: The study highlights the need for specific, direct patient care DoD GHE curriculum in ethics. Future research should focus on evaluating the long-term impact of pre-engagement training programs, identifying best practices for mitigating systemic and ethical challenges in different operational settings.