Military Health System Strategic Partnership with the American College of Surgeons

We congratulate Dr Edwards and her co-authors on her timely article summarizing the current challenges facing Army general surgeons who are increasingly being deployed with small expeditionary teams and who are rarely (thankfully) called on to provide surgical care for injured US troops. 1 Edwards M.A. White J.E. Remick K.N. et al. Army general surgery’s crisis of conscience. J Am Coll Surg. 2018; 226: 1190-1194 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar In fact, as stated in the article, when deployed with these units, the Army general surgeons perform fewer than 1 operative procedure per month. Additionally, during the year in-between deployments, most of these surgeons return to a low-acuity, low-volume practice stateside, contributing to the decay of operative skills. Army General Surgery's Crisis of ConscienceJournal of the American College of SurgeonsVol. 226Issue 6PreviewDual loyalty challenges are inherent in military medicine and have been the subject of ethical discourse throughout modern history.1-5 Such conflicts occur when the physician's obligations to their patient are deemed secondary to command orders. Although irreconcilable differences are rare, the scandals at Abu Ghraib and Guantanamo Bay about physician involvement in interrogation and force feeding of detainees provide evidence they occur.2-9 In such situations, our civilian peers and the public hold us to the standard of “physicians first, last and always.”8 Conversely, the military historically judges physicians under the rubric of military law first and moral obligations inherent to a physician second. Full-Text PDF