RESUMO
Transgender individuals have a long-standing history of honorable service in the United States Military. However, politics have had an impact on their ability to openly serve in uniform as policies continually change rapidly with each new administration. This article describes the shifting political landscape of policies related to whether (or not) transgender individuals can serve in the military, and how this has affected the health care experiences of transgender individuals and the ability for nurse practitioners to provide quality health care to the transgender population serving on active duty.
Assuntos
Medicina Militar/legislação & jurisprudência , Militares/legislação & jurisprudência , Pessoas Transgênero/legislação & jurisprudência , Humanos , Medicina Militar/métodos , Estados UnidosRESUMO
Within military operations, military physicians and nurses experience a dual loyalty to their professional identities. The moral frameworks of the medical and military professions are not similar, and require different kinds of choices and action from its members. But above all, the legal framework in which the healthcare personnel has to operate while deployed is different from the medical moral standards. Military necessity is prioritised over medical necessity. In debates on dual loyalty, legal frameworks should be considered as a more decisive factor in ethical decision-making processes. Legal frameworks, both general and mission-specific, support this prioritisation of military necessity, complicating the work of military physicians and nurses. During the post-Cold War era, in which neutrality and moral supremacy have served as legitimising factors for military peacekeeping or humanitarian missions, this misalignment between the moral and the legal framework is problematic. What is legally correct or justifiable may not be morally acceptable to either the medical professional standards or to the general public. The legal framework should be given more prominence within the debates on dual loyalty and military medical ethics. This paper argues that the misalignment between the legal and moral framework in which deployed healthcare personnel has had to operate complicated ethical decision-making processes, impeded their agency, and created problems ranging from military operational issues to personal trauma and moral injury for the people involved, and ultimately decreasing the legitimacy of the armed forces within society.
Assuntos
Tomada de Decisões/ética , Ética Médica , Medicina Militar , Médicos , Ética em Enfermagem , Humanos , Medicina Militar/ética , Medicina Militar/legislação & jurisprudência , Militares , Princípios Morais , Enfermeiras e Enfermeiros/legislação & jurisprudência , Médicos/ética , Médicos/legislação & jurisprudênciaRESUMO
This paper reviews changes in the ethical challenges that have arisen in military medicine over the past four decades. This includes the degree, if any, to which providers during the Vietnam conflict have carried out what we now refer to as harsh interrogation measures in an attempt to extract information from captured enemy soldiers, the extent, if any, to which the USA used medicine as a means to try to win over the hearts and minds of civilians in occupied territory and how providers should treat service members who return from the front with combat fatigue. An issue that arose during the first Gulf War in 1991 is discussed, namely US service persons being required to take botulism vaccine without their consent. Finally, present challenges are discussed including interrogation measures such as waterboarding and the ethical issues posed in the recent past by the exclusion of gay service members and those posed presently by the inclusion of transgender members. Two ethical values are suggested that have remained constant, namely giving priority to the individual needs of service personnel over those of the unit when there are no urgent combat needs and the reliance on individual virtue when what they should do is morally unclear.
Assuntos
Ética Médica/história , Medicina Militar/ética , Medicina Militar/história , Tomada de Decisão Clínica , História do Século XX , História do Século XXI , Humanos , Medicina Militar/legislação & jurisprudência , Militares , Prisioneiros , VacinaçãoRESUMO
The Department of Veterans Affairs (VA) is amending its medical regulations to clarify that VA will not bill third party payers for care and services provided by VA under certain statutory provisions, which we refer to as "special treatment authorities." These special treatment authorities direct VA to provide care and services to veterans based upon discrete exposures or experiences that occurred during active military, naval, or air service. VA is authorized, but not required by law, to recover or collect charges for care and services provided to veterans for non-service-connected disabilities. This rule establishes that VA will not exercise its authority to recover or collect reasonable charges from third party payers for care and services provided under the special treatment authorities.
Assuntos
Medicina Militar/economia , Saúde dos Veteranos/economia , Veteranos/legislação & jurisprudência , Contas a Pagar e a Receber , Humanos , Medicina Militar/legislação & jurisprudência , Estados Unidos , Saúde dos Veteranos/legislação & jurisprudênciaRESUMO
OBJECTIVES: To examine the role of Department of Defense policies in identifying theater-sustained traumatic brain injuries (TBIs). METHODS: We conducted a retrospective study of 48 172 US military service members who sustained their first lifetime TBIs between 2001 and 2016 while deployed to Afghanistan or Iraq. We used multivariable negative binomial models to examine the changes in TBI incidence rates following the introduction of Department of Defense policies. RESULTS: Two Army policies encouraging TBI reporting were associated with an increase of 251% and 97% in TBIs identified following their implementation, respectively. Among airmen, the introduction of TBI-specific screening questions to the Post-Deployment Health Assessment was associated with a 78% increase in reported TBIs. The 2010 Department of Defense Directive Type Memorandum 09-033 was associated with another increase of 80% in the likelihood of being identified with a TBI among soldiers, a 51% increase among sailors, and a 124% increase among Marines. CONCLUSIONS: Department of Defense and service-specific policies introduced between 2006 and 2013 significantly increased the number of battlefield TBIs identified, successfully improving the longstanding problem of underreporting of TBIs.
Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Medicina Militar/legislação & jurisprudência , Militares/estatística & dados numéricos , Campanha Afegã de 2001- , Humanos , Incidência , Guerra do Iraque 2003-2011 , Estudos Retrospectivos , Estados UnidosRESUMO
Recent advances in military-funded neurotechnology and novel opportunities for misusing neurodevices show that the problem of dual use is inherent to neuroscience. This paper discusses how the neuroscience community should respond to these dilemmas and delineates a neuroscience-specific biosecurity framework. This neurosecurity framework involves calibrated regulation, (neuro)ethical guidelines, and awareness-raising activities within the scientific community.
Assuntos
Tecnologia Biomédica/ética , Técnicas de Diagnóstico Neurológico/ética , Pesquisa de Uso Dual/ética , Invenções/ética , Medicina Militar/ética , Neurociências/ética , Conflitos Armados , Tecnologia Biomédica/legislação & jurisprudência , Interfaces Cérebro-Computador , Segurança Computacional , Técnicas de Diagnóstico Neurológico/efeitos adversos , Pesquisa de Uso Dual/legislação & jurisprudência , Humanos , Invenções/legislação & jurisprudência , Detecção de Mentiras , Medicina Militar/legislação & jurisprudência , Doenças do Sistema Nervoso/reabilitação , Doenças do Sistema Nervoso/terapia , Neurociências/legislação & jurisprudência , Tecnologia Assistiva/efeitos adversos , Tecnologia Assistiva/ética , Terrorismo , TorturaRESUMO
Seventy years after the Nuremberg Doctors' Trial, health professionals and lawyers working together after 9/11 played a critical role in designing, justifying, and carrying out the US state-sponsored torture program in the CIA "Black Sites" and US military detention centers, including Abu Ghraib, Bagram, and Guantanamo Bay, Cuba. We analyze the similarities between the Nazi doctors and health professionals in the War on Terror and address the question of how it happened that health professionals, including doctors, psychologists, physician assistants, and nurses, acted as agents of the state to utilize their medical and healing skills to cause harm and sanitize barbarous acts, similar to (though not on the scale of) how Nazi doctors were used by the Third Reich.
Assuntos
Ética Médica , Pessoal de Saúde/ética , Medicina Militar/ética , Prisioneiros de Guerra/história , Tortura/ética , Cuba , Alemanha , Pessoal de Saúde/história , História do Século XX , História do Século XXI , Humanos , Medicina Militar/história , Medicina Militar/legislação & jurisprudência , Socialismo Nacional/história , Papel Profissional/história , Papel Profissional/psicologia , Ataques Terroristas de 11 de Setembro , Tortura/história , Tortura/legislação & jurisprudência , II Guerra MundialAssuntos
Administração de Serviços de Saúde/legislação & jurisprudência , Hospitais Militares/organização & administração , Medicina Militar/organização & administração , Militares , Humanos , Medicina Militar/legislação & jurisprudência , Inovação Organizacional , Estados Unidos , United States Department of Defense , Recursos HumanosAssuntos
Medicina Militar/tendências , Traumatologia/tendências , Técnicas Hemostáticas , Humanos , Medicina Militar/legislação & jurisprudência , Pediatria/legislação & jurisprudência , Pediatria/tendências , Sociedades Médicas , Pesquisa Translacional Biomédica/tendências , Centros de Traumatologia/tendências , Traumatologia/legislação & jurisprudência , Estados UnidosRESUMO
The Federal Food and Drug Administration, or FDA is generally considered a powerful gatekeeper, able to deliver or withhold life-saving cures and create or destroy economic windfalls. As the decades go by, and technologies, diseases, public health demands, and politics evolve, we can identify patterns of change, action and inter-action among some of these traditional stakeholders in the FDA's policy sphere. A careful examination of this agency's colorful history can shed light on central features of the agency's policy process, which has been quite receptive to its stakeholders and adaptive to change over the decades and, in turn, show the way for development in lanes which do not fit neatly into the current paradigms offered by the agency. This paper will explore the history of FDA policy process, through examination of seminal moments in FDA history, the prominent actors and focusing events within them, and the outcomes of those events, in an attempt to illuminate a pattern of behavior or processes by which a struggling field of pharmaceutical development such as interventions for hearing loss can advance.
Assuntos
Aprovação de Drogas/legislação & jurisprudência , Descoberta de Drogas/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Perda Auditiva/tratamento farmacológico , Audição/efeitos dos fármacos , Doenças Profissionais/tratamento farmacológico , United States Food and Drug Administration/legislação & jurisprudência , Regulamentação Governamental , Perda Auditiva/diagnóstico , Perda Auditiva/fisiopatologia , Humanos , Comunicação Interdisciplinar , Medicina Militar/legislação & jurisprudência , Militares/legislação & jurisprudência , Doenças Profissionais/diagnóstico , Doenças Profissionais/fisiopatologia , Formulação de Políticas , Estados Unidos , United States Department of Defense/legislação & jurisprudênciaRESUMO
Henri Schmidt was, with his fellow the senator Paul Cazeneuve, the main defender of the mention of pharmacists and pharmacy students in the articles of the law voted in 1913 for the recruitment of the army. After the description of their interventions to attain this end, and a short biography of these two politicians, the paper explains the activities of the pharmaceutical parliamentary group, during the early years of the war, in view to obtain the admittance in the medical corps of the pharmacists and students unprovided of rank, for the new creation of «auxiliary pharmacists¼, for the appointment as soon as possible of the maximum number of colleagues at this rank, and then for their promotion to the rank of «aide-major¼, resolution that appeared more difficult to obtain.
Assuntos
Farmácias/história , Farmacêuticos/história , I Guerra Mundial , França , História do Século XIX , História do Século XX , Medicina Militar/história , Medicina Militar/legislação & jurisprudência , Unidades Móveis de Saúde/história , Unidades Móveis de Saúde/legislação & jurisprudência , Farmacêuticos/legislação & jurisprudênciaRESUMO
No disponible
Assuntos
Humanos , Medicina Militar/história , Medicina Militar/legislação & jurisprudência , Medicina Militar/métodos , Diplomacia/legislação & jurisprudência , Diplomacia/organização & administração , Segurança/legislação & jurisprudência , Hospitais Militares/legislação & jurisprudência , 51708/legislação & jurisprudência , 51708/métodos , Defesa Civil/história , Defesa Civil/legislação & jurisprudência , Advocacia em SaúdeRESUMO
This final rule modifies the TRICARE regulation to reduce administrative barriers to access to mental health benefit coverage and to improve access to substance use disorder (SUD) treatment for TRICARE beneficiaries, consistent with earlier Department of Defense and Institute of Medicine recommendations, current standards of practice in mental health and addiction medicine, and governing laws. This rule seeks to eliminate unnecessary quantitative and non-quantitative treatment limitations on SUD and mental health benefit coverage and align beneficiary cost-sharing for mental health and SUD benefits with those applicable to medical/surgical benefits, expand covered mental health and SUD treatment under TRICARE to include coverage of intensive outpatient programs and treatment of opioid use disorder and to streamline the requirements for mental health and SUD institutional providers to become TRICARE authorized providers, and to develop TRICARE reimbursement methodologies for newly recognized mental health and SUD intensive outpatient programs and opioid treatment programs.
Assuntos
Planos de Assistência de Saúde para Empregados/legislação & jurisprudência , Benefícios do Seguro/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Transtornos Mentais/terapia , Serviços de Saúde Mental/legislação & jurisprudência , Medicina Militar/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/terapia , Custo Compartilhado de Seguro/legislação & jurisprudência , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Transtornos Relacionados ao Uso de Opioides/terapia , Estados UnidosRESUMO
The article reflects the characteristics of the Plan of activities of the Ministry of Defence of the Russian Federation for 2016-2020--an important long-term planning document of the Armed Forces. It stressed the need for synchronization of activities for chain of command and deadline. Presented structure of the Medical Service Plan Military District operations (fleet) military medical organization. The attention is focused on the content of its sections. For example, a military hospital layouts presented an action plan and a schedule of events. Reflecting the requirements of the Minister of Defense for the development and adjustment plans, indicators of their performance.
Assuntos
Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Planejamento em Saúde , Medicina Militar/organização & administração , Medicina Militar/tendências , Atenção à Saúde/legislação & jurisprudência , Regulamentação Governamental , Planejamento em Saúde/legislação & jurisprudência , Planejamento em Saúde/métodos , Medicina Militar/legislação & jurisprudência , Federação RussaRESUMO
One of the priorities of the military health care is to improve the system of rationing medical equipment for the hospital unit of the medical service of the Armed Forces in wartime. This is determined the fact that the effectiveness of measures to provide military field hospitals with medical supplies depends on the quality of medical care for the wounded and sick, as well as the level of their return to duty. The article presents the characteristics of modern standards medical supplies procurement of military field hospitals included in the new regulatory legal act of the Russian Federation Ministry of Defence--"Standards of supplies medical supplies medical and pharmaceutical organizations (units) of the Russian Federation on the wartime armed forces", approved and put into effect in 2015 by order of the Minister of Defence of the Russian Federation.
Assuntos
Equipamentos e Provisões Hospitalares/normas , Hospitais Militares/provisão & distribuição , Administração de Materiais no Hospital/organização & administração , Medicina Militar/normas , Equipamentos e Provisões Hospitalares/tendências , Regulamentação Governamental , Hospitais Militares/legislação & jurisprudência , Hospitais Militares/organização & administração , Administração de Materiais no Hospital/legislação & jurisprudência , Medicina Militar/legislação & jurisprudência , Medicina Militar/organização & administração , Federação RussaRESUMO
Effective multilateral military operations such as those conducted by the North Atlantic Treaty Organization (NATO) require close cooperation and standardization between member nations to ensure interoperability. Failure to standardize policies, procedures, and doctrine prior to the commencement of military operations will result in critical interoperability gaps, which jeopardize the health of NATO forces and mission success. To prevent these gaps from occurring, US forces must be actively involved with NATO standardization efforts such as the Committee of the Chiefs of Medical Services to ensure US interests are properly represented when NATO standards are developed and US doctrine and procedures will meet the established NATO requirements.
Assuntos
Abastecimento de Alimentos/normas , Cooperação Internacional/legislação & jurisprudência , Política Organizacional , Abastecimento de Água/normas , Humanos , Medicina Militar/legislação & jurisprudência , Medicina Militar/organização & administração , Medicina Militar/normas , Militares/educação , Desenvolvimento de Programas , Serviço Veterinário Militar/normasRESUMO
The Department of Veterans Affairs (VA) published an Interim Final Rule on February 25, 2015, to amend its adjudication regulations to provide a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment for all veterans with service-connected amyotrophic lateral sclerosis (ALS) and servicemembers serving on active duty with ALS. The amendment authorized automatic issuance of a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment to all veterans with service-connected ALS and members of the Armed Forces serving on active duty with ALS. The intent of this final rule is to confirm the amendment made by the interim final rule without change.