Australian doctors and the war

To the Editor: Mervyn Archdall, reflecting on his Great War experience, wrote in 1941 that military doctors' “first consideration must always be the filling of gaps in the combatant ranks”.1 How relevant is this statement to the modern Australian Defence Force (ADF)?

The role of the Royal Australian Army Medical Corps remains “to contribute to the Army's operational capability through the conservation of manpower”.2 The Royal Australian Navy and Royal Australian Air Force are less prosaic but have similar intent. However, every ADF doctor is a non-combatant and remains obliged to treat all patients (including enemy combatants) equally and with primary regard to welfare rather than operational capability.3 For example, in a recent ADF operation, an enemy combatant suffered blast amputation of the hands and penetrating eye wounds when the improvised explosive device he was planting detonated. An ADF doctor performed lifesaving surgery, and the combatant was then evacuated for ophthalmic care.

Potential tension between the role of the organisation and that of its doctors is not dissimilar to a public hospital wanting to contain costs, in which doctors struggle to provide the “best care” to every patient. As in civilian health care, the theoretical tension is rarely problematic because, in reality, both civilian hospitals and ADF military hospitals want to achieve the best care for every patient. In the ADF, this is explicitly codified: “Medical personnel . . . cannot be . . . compelled to carry out any act incompatible with their humanitarian mission or medical ethics”.4 Further, the ADF “must care for the wounded, sick or shipwrecked members of enemy armed forces taken prisoner in the same way as [it does] for [its] own personnel”.5 Modern ADF health care therefore emulates civilian best practice, with clinical governance and peer review ensuring that prioritisation of operational capability does not occur at the expense of individual patient welfare.

In another marked departure from earlier times, ADF casualties requiring physical or psychological rehabilitation are encouraged to continue to serve and contribute to ADF capability to the extent that this is possible — an embodiment of what the British term the “military covenant”.

There may be a civilian lesson in the modern military approach. Explicit recognition of professional ethics within a civilian health care system that must also contain costs might become increasingly valuable if civilian doctors are to remain their patients' advocates rather than merely employees of “the system”.