Treating PTSD and TBI…Ethically

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This is the first in a series of posts on the ethical issues associated with treating post-traumatic stress disorder and traumatic brain injury.

These are the two so-called “signature wounds” of our post 9/11 wars. Unlike physical trauma, they can take years to surface. They’re also not as easy to diagnose as typical war wounds. Treating them is going to become a bigger challenge as the wars wind down and the 2.5 million young men and women who served in them come home.

By ethical issues, I mean areas where there are no clear right and wrong answers. There are often competing priorities, depending on whose viewpoint you look through.

By definition, military medical personnel serve two—or more—masters:

— There is the care of the service member.

— There are the needs of the military.

— There are the needs of the United States, including national security, the Congress and the taxpayer.

And physicians have the Hippocratic oath.

Medical ethics normally focus on four principles: autonomy, justice, beneficence and non-maleficence.

In simple terms, they mean: the right of the individual to make his or her own decisions; equal resources for all; do good for your patient; and do no harm. These same principles should be applied to military medical ethics.

Tomes have been devoted to discussion these principles, and it is perhaps dangerous to try develop a reasoned discussion in a post, or a series of posts. But although military physicians discuss these topics constantly, there is less discussion in the public space.

There are at least four ethical areas I would like to ponder:

— Whether to maintain someone in the battlefield or return them home.

— Whether to retain a service member on duty in the military, vs. recommending a medical board (medical discharge).

— Confidentiality, and/or what command needs to know.

— Disability and compensation issues, if diagnosed with PTSD.

These are all highly-charged issues. But I think they need an open, national discussion. I hope to do that here, in the next few posts.