Janne Lahtiranta and Kai Kimppa
Telemedicine, or use of ICT in health care, is a commonplace practice nowadays. Different applications and systems of telemedicine are widely employed in different institutions and they can be found in the pockets of a common person. Just to name few, these applications include smart personal assistants for certain specific disorders, such as diabetes, and early health recognition alarm telemonitoring systems (for these and other practical examples, see European Commission, 2003). As practically in every area related to ICT, its applications are becoming smaller, smarter and more integrated.
Globally, armed forces of different countries have employed different applications and systems of telemedicine from early days of maritime. For example, ship-to-shore telemedicine has been widely used by both civilian and military seafaring since establishment of Morse-code (International Telecommunication Union, 1997). However, use of telemedicine in individual (or small unit level) in military is a coming trend. Due to expenses and extensive requirements (weight, power consumption, weather proofing etc.) different applications and systems have mainly been used in the troop or platoon level, or they have been at the disposal of a selected individuals such as medical personnel.
At the moment, there are different military modernization programs executed world-wide. Some of these programs go beyond updating the used military hardware, modernizing the personal equipment of an individual warfighter. In these programs ICT is gradually harnessed to bring different applications and systems of telemedicine to personal and small unit level. For example, in the visionary Future Warrior program (U.S.) an individual warfighter is equipped with bio-sensors, which are aware of the warfighter’s current condition as well as current situation in the crisis area. In addition, the near-future equipment of an individual warfighter is capable for relaying the information from the integrated sensors to the commanding officers and to the military physicians, providing a real-time situational awareness of the conditions in the crisis area (for different military modernization programs, see Hellsten et al., 2002).
The members of military live a life, which is relatively controlled and regulated by the authorities. Thereof, the members of military are more prone to coercion than civilians (Beam & Howe, 2003). Furthermore, in a crisis situation it is not always possible or viable to seek the consent of each individual warfighter, let alone honor their refusals (FitzPatrick & Zwanziger, 2003). As the applications and systems of telemedicine become more advanced and integrated, providing real-time situational awareness to the commanding officers and military physicians, ethical problems related to the fundamental right of an individual warfighter for independent decision making start to emerge. In this article we look back to the history for some real-world examples on the coercive use of medicine in the military. Then we examine what kind of ethical risks and threats applications and systems of telemedicine in the military context may create in the future.
One way to approach the potential risks and threats is to consider them from three different viewpoints: individual warfighter, commanding officer and military physician (or other health care professional). From the perspective of an individual warfighter, the risks and threats include human performance enhancement, such as staying alert in the crisis area for a prolonged period of time by using psycho-stimulants, protection from battlefield conditions, such as from possible exposure from chemical weapons by using experimental drugs, and acting as a human test subject to serve purposes of science and common good irrespective of their will. While there are practical examples from early days of Nazi experiments to the Gulf War where individual’s basic right for independent decision making in these areas has been discarded, the consideration on the potential impact of new technologies has been left for lesser degree of attention.
Some of the ethical risks and threats discussed above may directly involve commanding officers and military health care professionals. However, there are issues that are more specific to their spheres of responsibilities. Potential risks and threats from the viewpoints of a commanding officer and military health care professional share a common factor: distancing. For example, the possibility of administration of medical substances into the system of and individual warfighter via robotic surgery may de-humanize health care by distancing the physician from the patient. This may affect to the decision making process of a military health care professional and change the formation and nature of the patient-physician relationship.
Distancing from the perspective of a commanding officer may occur when the real-time situational awareness of the conditions in the crisis area is enhanced. By using this information, the officers may falsely justify and rationalize their actions. For example, they may use the information to emotionally detach themselves from the troops under their command when prioritizing evacuations, or when ordering the use of force in the crisis area.
Some of the ethical issues presented in this article are applicable in the near-future when the results from a military modernization programs are institutionalized, while others are not. Hopefully this article provides some insight into potential ethical risk and threats the use of applications and systems of telemedicine in the military context may create in the future, and facilitates in avoiding them.
Beam, T.E. & Howe, E.G. 2003. A Look Toward The Future in Military Medical Ethics, 2003. pp: 831-850. URL: http://www.bordeninstitute.army.mil/
European Commission, 2003. Applications Relating to Health. Fifth Research and Development Framework Programme 1998-2002. Final Report.
FitzPatrick, W.J. & Zwanziger, L.L., 2003. Defending Against Biochemical Warfare: Ethical Issues Involving the Coercive Use of Investigational Drugs and Biologics in the Military. The Journal of Philosophy, Science & Law. Volume 3, March 2003.
Hellsten, M., Harriet, M. and Anttonen, H., 2002. Alykkyytta sotilaan kylmavaatetukseen. Alymatine projektin loppuraportti.
International Telecommunications Union, 1997. Telemedicine and Developing Countries. ITU-D Study Groups, Document 2/155 (rev. 2) -E. 5 August 1997. URL: http://www.unifesp.br/dis/set/disciplina/materialdeapoio