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Dual Loyalty

Dual Loyalty. When the health care professional has duties both to the person being treated or evaluated and to an authority such as a military command. Dual Loyalty Conflict. When a superior gives a health care professional an order that conflicts with ethical practice. Duty to disobey.

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Dual Loyalty

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  1. Dual Loyalty When the health care professional has duties both to the person being treated or evaluated and to an authority such as a military command.

  2. Dual Loyalty Conflict When a superior gives a health care professional an order that conflicts with ethical practice.

  3. Duty to disobey In the name of mission priorities or security, superiors may give orders that violate health professional ethics and standards of good care, and the health care professional is confronted with whether to disobey the order.

  4. Assessing torture Diagnostic training and experience can be invaluable for assessing evidence of torture, for example, depression and post-traumatic stress disorder (PTSD)may be signs of severe abuse and long solitary confinement. 

  5. How to report abuse Health care professionals who witness torture or its signs and/or are told by patients about being tortured are faced with difficult questions about how to report it.

  6. Mandatory reporting of abuse Professional associations advise health care professionals to report inmate torture, but mandatory reporting is not currently enforced by the associations or state licensing boards.

  7. Dual Loyalty Q 1 Name four positions that are likely to involve dual loyalities.

  8. Dual Loyalty A 1 +Military or prison physician, psychologist, nurse, medic +Physician expert witness +Police psychologist

  9. Dual Loyalty Conflict Q 2 Give an example of a serious dual loyalty conflict.

  10. Dual Loyalty Conflict A 2 + Doctor ordered to force feed prisoners against their will. + Health insurance doctor required to disallow claims for emerging therapies. + Researcher working for company minimizing disclosure of drug risks.

  11. resolving Loyalty Conflicts Q 3 Give an example of dealing with a dual loyalty conflict by addressing it before treatment starts.

  12. resolving Loyalty Conflicts A 3 +A prison doctor explains that he/she must report information important for maintaining inmate or staff safety. +A psychotherapist in private practice explains how insurance reporting may affect confidentiality.

  13. Duty to disobey Q 4 A Is a military doctor ethically required to disobey when ordered to threaten a prisoner with injection of a psychoactive drug that will not actually be administered?

  14. Duty to disobey Q 4 B Is a military doctor ethically required to disobey when ordered to inject a harmless bolus of saline to a prisoner who fears he is receiving a lethal injection?

  15. Duty to disobey Q 4 C Is a military doctor ethically required to disobey when ordered to inject a lethal drug into a prisoner?

  16. Duty to disobey A 4 A, B, C All of the Above must be disobeyed Adapted from J. Wesley Boyd, et al, (2007)

  17. Assessing torture Q 5 When do you think solitary confinement is torture? 

  18. Assessing torture A 5 a The United Nations Rapporteur on Torture has declared that Solitary Confinement + can amount to torture for juveniles and persons with mental disabilities and should be abolished for them

  19. Assessing torture A 5 b The United Nations Rapporteur on Torture has declared that Solitary Confinement + can be a breach of article 1 or 16 of Convention against Torture depending on reasons, conditions, length

  20. Assessing torture A 5 c The United Nations Rapporteur on Torture has declared that Solitary Confinement + should be used only in very exceptional circumstances for as short a time as possible, and with numerous safeguards or it can become abusive* http://solitaryconfinement.org/uploads/SpecRapTortureAug2011.pdf

  21. How to report abuse Q 6 A Would this procedure be an effective way to report abuse in a military prison and why? + Report to the Army Inspector General.

  22. How to report abuse Q 6 B Would this procedure be an effective way to report abuse in a military prison and why? + Speak with International Committee of the Red Cross (ICRC) inspectors.

  23. How to report abuse Q 6 C Would this procedure be an effective way to report abuse in a military prison and why? + Contact a well-regarded investigative journalist

  24. Mandatory reporting Q 7 Bills before two state legislatures require that health providers report torture of prisoners and other vulnerable patients under penalty of loss of license. Guidelines and whistleblower protections are provided. What is the value of such bills?

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