title: 'A band of brothers'-an exploration of the range of medical ethical issues faced by British senior military clinicians on deployment to Afghanistan: a qualitative study.
abstract: OBJECTIVE
  To identify and explore features of ethical issues that senior clinicians faced as deployed medical directors (DMDs) to the British Field Hospital in Afghanistan as well as to determine the ethical training requirements for future deployments.
  
  
  METHODS
  A qualitative study in two phases conducted from November 2014 to June 2015. Phase 1 analysed 60 vignettes of cases that had generated ethical dilemmas for DMDs. Phase 2 included focus groups and an interview with 13 DMDs.
  
  
  RESULTS
  Phase 1 identified working with limited resources, dual conflict of meeting both clinical and military obligations and consent of children as the most prevalent ethical challenges. Themes found in Phase 2 included sharing clinical responsibilities with clinicians from other countries and not knowing team members' ways of working, in addition to the themes from Phase 1.
  
  
  CONCLUSIONS
  This study has drawn together examples of scenarios to form a repository that will aid future training. Recommendations included undertaking ethics training together as a team before, during and after deployment which must include all nationalities who are assigned to the same operational tour, so that different ethical views can be explored beforehand.
authors: Academic Department of Military Nursing, Royal Centre for Defence Medicine (Academia and Research) Medical Directorate, Birmingham, UK.
authors: Elizabeth M
authors: EM
authors: Bernthal
authors: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors: H J A
authors: HJA
authors: Draper
authors: The Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine (Academia and Research), Defence Medical Group North, Northallerton, UK.
authors: J
authors: J
authors: Henning
authors: Faculty of Health and Social Care, University of Hull, Hull, UK.
authors: J C
authors: JC
authors: Kelly
mesh_terms: D055826:Afghan Campaign 2001-; D000066491:Clinical Decision-Making / Q000941:ethics; D004608:Eligibility Determination / Q000941:ethics; D004992:Ethics, Medical; D017144:Focus Groups; D015276:Health Care Rationing / Q000941:ethics; D006801:Humans; D057828:Informed Consent By Minors / Q000941:ethics; D008887:Military Medicine / Q000941:ethics*; D008889:Military Personnel; D010820:Physicians; D036301:Qualitative Research; D011788:Quality of Life; D013727:Terminal Care / Q000941:ethics; D006113:United Kingdom
keywords: ACCIDENT & EMERGENCY MEDICINE; MEDICAL EDUCATION & TRAINING; MEDICAL ETHICS; QUALITATIVE RESEARCH