I am continuing the discussion about ethical issues associated with the military’s treatment of post-traumatic stress disorder and traumatic brain injury, with a focus on a perennial hot topic: confidentiality.
Or what commander need to know about the medical status of one of their troops.
The suicide of Specialist Mikayla Bragg in Afghanistan 10 months ago highlighted the challenges of determining what information should be shared, and with whom.
Apparently, according to news reports, she had a history of prior suicidal ideation and attempt. She had a long inpatient stay in the hospital at Fort Knox, Ky. However, she wanted very much to deploy. The available portions of the investigations suggest that her prior psychiatric history was not shared with her unit, or mental-health providers, in Afghanistan.
This case illustrates the dilemmas on deciding what information should be shared with command. By commanders, I mean the commanding officer of a company (usually a captain in the Army), or others up the chain of command.
Protected health information is not supposed to be shared with commanders.
However they do need to know if a service member is not able to do the mission, not able to deploy, and whether they are fit for duty.
If a Soldier has a broken leg, he or she cannot go on the mission or the deployment. Command needs to know. That is obvious.
If she is pregnant, command needs to know. Pregnant women should not be exposed to petroleum or other potentially toxic fumes, have modified physical fitness training, and are not allowed to deploy.
But here comes the grey area. If a Soldier has a history of PTSD or of suicidal ideation, does command need to know?
The command always says yes: “I want to care for my Soldier, and I need to know about their issues, so that I can look out for them,” the commander will insist.
The Soldier always (almost) says no: “I want to stay on active duty and get promoted.” The last thing they want is to have their command informed about their vulnerabilities, including PTSD, depression and substance abuse.
The current reality is that that if they display those weaknesses, they are not likely to stay in the military. This is a down-sizing Army, and those who go to the doctors frequently, and/or cannot deploy because of emotional problems, are not likely to be allowed to remain in uniform, at least on active duty.
I know that the Defense Department is saying that seeking help is a sign of strength. But that does not resonate with the young enlisted Soldier who wants to get promoted. He or she has heard enough tales about those who have been sent to mental health.
The military has been grappling with this issue for many years. There have been several policies and Department of Defense instructions to try to sharpen the lines about what command need to know. But, as illustrated by this sad case, it remains murky.
As usual, with ethical dilemmas, there are few bright lines—or else it would not be an ethical dilemma! But surfacing, and talking about, such sticky issues always helps.