Military surgeon: treat enemy before own soldiers?

A military physician is the only surgeon in a small clinic near an active combat zone. An enemy soldier is brought in, badly injured and requiring surgery to save his life.

At the same time, a radio report says there’s a helicopter inbound with an injured soldier (on the doctor’s side), who also requires life-saving surgery. ETA: 20 minutes.

The highest ranking officer in the clinic is not a physician. He orders the doctor to wait for the incoming soldier, and not to treat the enemy soldier until the other has been operated on.

As a doctor, he has a medical, professional obligation to treat whoever is in front of him. As a military officer, he has an obligation to follow the legal orders of his superiors. He knows the enemy soldier before him right now will die without immediate surgery.

What should he do?

I don’t believe that an order to withhold medical care to a wounded enemy soldier is a legal order. Once the enemy soldier is not a threat they are entitled to full medical care. The doctor should make a medical triage decision if resources and staff are limited. That’s what the doctor *should *do. Triage is not a pure science, so other factors may come into play.

If feasible begin treating the enemy soldier until your own colleague arrives.

If for some reason that’s not possible and its a case of one or the other will live then withhold treatment for your own soldier.

I have no idea of the ethical and legal ramifications of that but it seems the right thing to do to me.

Edited because the second line is ambiguous, I mean with-hold treatment from the enemy soldier.

Make the decision on who to treat based on medical necessity, that seems to me the only ethical choice.

Needing “life saving surgery” doesn’t always mean it has to be done immediately.

I would say triage and stabilize the enemy soldier while waiting for your own to arrive. Triage and stabilize your own soldier when he/she arrives. Assess if one is able to wait for a period of time for his/her surgery. If the same or your comrade is worse, treat your soldier first. If the enemy is more desperate, and your soldier’s injuries can wait, report to commanding officer and ask if you are still to put your own soldier first.

That being said, I’ve never been in the military, so I don’t know if all that would end up getting someone in trouble for not following orders.

Do what you can to stabilize the enemy in the 20 minutes. When the comrade arrives, stabilize him and assess who is in the more serious need, and treat that one. If they are roughly equivalent, leave the enemy while you treat the comrade.

Basically this

except I wouldn’t ask.


Agree with Shodan.

It’s also the choice that complies with the law of war. From The Geneva Convention for the Amelioration of the Wounded and Sick in Armed Forces in the Field, Chapter II Article 12

The nationality of the wounded is not something that can be used for prioritization. That basically makes the OP question “How do you respond when given an unlawful order?”

The OP posits too many items which are not in accordance with reality to make any answers meaningful. Or at least meaningful enough for me to try to answer them.

The OP appears to be based on a real case. See the article from the journal Military Medicine. The article does not provide many more details on the facts of the case than the OP.

That also does not provide enough information either. Just because someone happens to be the highest ranking person in the building does not mean they have the authority to give a particular order. Even if the order was legal.

Those in command of medical units are medical officers for a reason. If an officer is not in the chain of command of the doctor then they have no authority to give orders like that. We have discussed the difference between command authority and general military authority many times in the past.

I stand corrected. I had thought the military had policies to be able to avoid such situations; it seems I was mistaken.

At the very least, it’s a gross violation both of medical ethics and of the rules of war to do nothing for the enemy patient in those 20 minutes. When the allied patient arrives, there’s at least a rationale for the officer to say “he’s more important”. But for the 20 minutes until then, there’s no such opportunity cost for treating the enemy patient, and ordering a doctor to just ignore him is no different, qualitatively, than just shooting him in the head.

Channeling Uncle Julio:

triage regardless of whatever clothing the wounded person is wearing. Ours, theirs, civilian, mother or child, whore or Mother Superior doesn’t matter; what matters is, you separate those we simply cannot treat, and within those we can treat, the ones whose future health is more dependent on being treated first get treated first; those who need a doctor more get treated by the doctors, those whose care can be handled by a paramedic or simply by a person with two working hands are handled by those.

That attitude got him promoted from (provisional) ensign to (provisional) captain and eventually major, so apparently it was the right one even if he wasn’t particularly good at “the whole strutting and saluting thing”.

To those who’d switch patients: take into account that depending on what step of treatment you’re in, that’s not really doable. If you’re mid-surgery you don’t leave the wound open to go treat someone else.

There are policies and regulations. That journal article is so vague I’m not convinced it’s true.

Like I said above, random officers do not have the authority to order around anyone not under their command about how to do their job. Doctors in the military have the authority to make medical decisions. Medical units are run by medical officers.

I voted for the surgeon to use the 20 minutes wisely to treat the other soldier until the helicopter arrives. In that time, the soldier could have been stablilised to the point where surgery could wait, he could then treat the incoming wounded and go back to the enemy soldier later.

I was about to say that I’m sure the military has a VERY clear policy on this kind of thing- it probably happens more often than we’d like to think.

I think the only logical way to answer this is to take the war situation out of it as well as the nationalities. Do whatever would be done in a civilian hospital if two people with the same injuries were to arrive at the same times as in the hypothetical war scenario and act accordingly. While you only have patient 1, stabilize him until patient 2 arrives, then use standard triage techniques to prioritize multiple patients.

This shouldn’t be a poll. It has a factual answer. Wounded personnel are treated according to necessity determined through triage by competent medical authority. That’s it. No one can order a person to act differently.

Correct. This was a real scenario that occurred in Iraq (exact time unknown) and was presented at a medical ethics seminar for discussion. The outcome for the US soldier was not disclosed. I actually know the author (he was not involved in the incident) and had an interesting conversation with him about this situation, which is why I presented it for discussion here.