the dying has brought with it a hos

the dying has brought with it a host of ethical difficulties.
In one scenario, a member of the local Afghan security forces
has suffered massive injuries from an improvised explosive
device. He has lost both his legs and both his forearms. The
blast has removed his entire face. Tourniquets are controlling
the bleeding from the legs. He is still alive. If he can be saved
by use of the coalition forces’ state of the art medical services,
what of his future once he is transferred to a local health centre,
whose facilities pale in comparison?
One Canadian paramedic working in Kandahar, Afghanistan,
in 2007 described the transfer of patients to the local hospital
as a “death sentence.”1 The hospital had no ventilators,
resuscitation equipment, laryngoscope, or monitoring devices.
Kevin Patterson, a Canadian doctor also posted to Afghanistan,
recalls a mass casualty incident involving a mixture of coalition
personnel and Afghans.2 The doctors were told not to intubate
any of the Afghans with burns exceeding 50%. Without a burns
unit, those patients would be doomed. The coalition patients,
on the other hand, could be repatriated to their home countries
to obtain high quality burn care. Such divergent treatment is
hard to bear and highlights the need to develop local healthcare
infrastructure, but what are the immediate alternatives?
Athena’s vials are exhaustible, and resources problems can also
plague the military medic. Beds, staff, and stocks are limited.
Our patient might singlehandedly drain the hospital’s blood
bank, leaving nothing in reserve for future casualties. The third
revision of the US Department of Defence’s manual Emergency
War Surgery states that “the decision to commit scarce resources
cannot be based on the current tactical/medical/logistical
situation alone.”3 Such decisions should be made with an eye
to the future.
If our Afghan patient is treated and survives to discharge, what
kind of life awaits him back in his village, where the realities
of survival and attitudes to profound disability may be a far cry
from our own? This question cannot be answered without an
understanding of the local culture, religion, and outlook. It is
morally dangerous to uniformly impose our interpretation of
when it is desirable to live or die, dismissing the patient’s views
as backward, barbaric, or misguided.
If the decision to treat is made, the patient will need to be
evacuated. A medical emergency response team (MERT)
helicopter can arrive within minutes to provide advance life
support and whisk our patient off to intensive care at a state of
the art “role 3” medical facility. Yet, there is another
consideration. Every excursion by the MERT carries risk. The
helicopter is vulnerable and prone to enemy ground fire, and
this additional danger must be factored into the decision.
There is another factor, relevant in this context but seldom
encountered in civilian medical ethics: morale. Dwight
Eisenhower called morale the “greatest single factor in
successful wars.”4 Allowing the soldier to die on the battlefield
can damage the morale of the troops. It smacks of abandonment.
The fact that the patient is Afghan provides an added reason to
evacuate him, for not doing so may cause other Afghans to lose
faith in the commitment of their fighting partners.
In October 2010 the Defence Medical Services organised a day
long meeting to discuss some of the ethical issues facing medical
personnel in the field, including scenarios such as the one set
out in this column. This was a significant step, a recognition
that pre-deployment training should include an appreciation of
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Results (Indonesian) 1:

the dying has brought with it a host of ethical difficulties.In one scenario, a member of the local Afghan security forceshas suffered massive injuries from an improvised explosivedevice. He has lost both his legs and both his forearms. Theblast has removed his entire face. Tourniquets are controllingthe bleeding from the legs. He is still alive. If he can be savedby use of the coalition forces’ state of the art medical services,what of his future once he is transferred to a local health centre,whose facilities pale in comparison?One Canadian paramedic working in Kandahar, Afghanistan,in 2007 described the transfer of patients to the local hospitalas a “death sentence.”1 The hospital had no ventilators,resuscitation equipment, laryngoscope, or monitoring devices.Kevin Patterson, a Canadian doctor also posted to Afghanistan,recalls a mass casualty incident involving a mixture of coalitionpersonnel and Afghans.2 The doctors were told not to intubateany of the Afghans with burns exceeding 50%. Without a burnsunit, those patients would be doomed. The coalition patients,on the other hand, could be repatriated to their home countriesto obtain high quality burn care. Such divergent treatment ishard to bear and highlights the need to develop local healthcareinfrastructure, but what are the immediate alternatives?Athena’s vials are exhaustible, and resources problems can alsoplague the military medic. Beds, staff, and stocks are limited.Our patient might singlehandedly drain the hospital’s bloodbank, leaving nothing in reserve for future casualties. The thirdrevision of the US Department of Defence’s manual EmergencyWar Surgery states that “the decision to commit scarce resourcescannot be based on the current tactical/medical/logisticalsituation alone.”3 Such decisions should be made with an eyeto the future.If our Afghan patient is treated and survives to discharge, whatkind of life awaits him back in his village, where the realitiesof survival and attitudes to profound disability may be a far cryfrom our own? This question cannot be answered without anunderstanding of the local culture, religion, and outlook. It ismorally dangerous to uniformly impose our interpretation ofwhen it is desirable to live or die, dismissing the patient’s viewsas backward, barbaric, or misguided.If the decision to treat is made, the patient will need to beevacuated. A medical emergency response team (MERT)helicopter can arrive within minutes to provide advance lifesupport and whisk our patient off to intensive care at a state ofthe art “role 3” medical facility. Yet, there is anotherconsideration. Every excursion by the MERT carries risk. Thehelicopter is vulnerable and prone to enemy ground fire, andthis additional danger must be factored into the decision.There is another factor, relevant in this context but seldomditemui di sipil Kedokteran etika: semangat. DwightEisenhower disebut semangat "terbesar satu faktor dalamsukses perang."4 memungkinkan tentara untuk mati di medan perangdapat merusak semangat pasukan. Itu menunjukan keberpihakan ditinggalkan.Fakta bahwa pasien Afghan menyediakan alasan yang ditambahkan untukmengevakuasi dia, untuk tidak melakukan hal itu dapat menyebabkan Afghan lainnya kehilanganiman dalam komitmen mereka mitra pertempuran.Pada bulan Oktober 2010 pelayanan medis pertahanan yang diselenggarakan hariLong pertemuan untuk membahas beberapa isu-isu etis yang dihadapi medispersonil di bidang, termasuk skenario seperti satu setdalam kolom ini. Ini adalah langkah yang signifikan, pengakuanbahwa pelatihan pra-penugasan harus mencakup [e-mail] ulang: http://

Results (Indonesian) 2:

sekarat telah membawa dengan itu sejumlah kesulitan etis.
Dalam satu skenario, anggota pasukan keamanan lokal Afghanistan
telah menderita luka besar dari bahan peledak improvisasi
perangkat. Dia telah kehilangan kedua kakinya dan kedua lengannya. The
ledakan telah dihapus seluruh wajahnya. Torniket mengendalikan
perdarahan dari kaki. Dia masih hidup. Jika dia bisa diselamatkan
dengan menggunakan negara pasukan koalisi 'dari pelayanan medis seni,
apa masa depannya setelah ia dipindahkan ke pusat kesehatan setempat,
yang fasilitas pucat dibandingkan?
Satu paramedis Kanada yang bekerja di Kandahar, Afghanistan,
pada tahun 2007 menggambarkan transfer pasien ke rumah sakit setempat
sebagai "hukuman mati." 1 Rumah sakit tidak memiliki ventilator,
peralatan resusitasi, laringoskop, atau perangkat monitoring.
Kevin Patterson, seorang dokter Kanada juga diposting ke Afghanistan,
mengingat insiden korban massal yang melibatkan campuran koalisi
personil dan Afghans.2 Para dokter diminta untuk tidak intubasi
salah Afghanistan dengan luka bakar lebih dari 50%. Tanpa luka bakar
satuan, pasien akan hancur. Para pasien koalisi,
di sisi lain, bisa dipulangkan ke negara asal mereka
untuk memperoleh kualitas tinggi membakar perawatan. Pengobatan berbeda seperti itu
sulit untuk melahirkan dan menyoroti kebutuhan untuk mengembangkan kesehatan setempat
infrastruktur, tapi apa saja alternatif langsung?
botol Athena adalah batasannya, dan masalah sumber daya juga dapat
mengganggu petugas medis militer. Tempat tidur, staf, dan saham terbatas.
Pasien kami mungkin sendirian mengalirkan darah rumah sakit
Bank, meninggalkan apa-apa di cadangan untuk korban di masa depan. Ketiga
revisi US Department of petunjuk Darurat Pertahanan
Perang Bedah menyatakan bahwa "keputusan untuk melakukan sumber daya yang langka
tidak dapat didasarkan pada / taktis saat medis / logistik
situasi saja. "3 Keputusan tersebut harus dilakukan dengan mata
ke masa depan.
Jika pasien Afghanistan kami diperlakukan dan bertahan untuk melepaskan, apa
jenis kehidupan menantinya kembali desanya, di mana realitas
hidup dan sikap untuk cacat yang mendalam mungkin jauh
dari kita sendiri? Pertanyaan ini tidak bisa dijawab tanpa
pemahaman tentang budaya lokal, agama, dan outlook. Hal ini
secara moral berbahaya untuk seragam memaksakan penafsiran kita tentang
saat itu diinginkan untuk hidup atau mati, menolak pandangan pasien
terbelakang, barbar, atau sesat.
Jika keputusan untuk mengobati dibuat, pasien perlu
dievakuasi. Sebuah tim tanggap darurat medis (Mert)
helikopter bisa tiba dalam beberapa menit untuk memberikan kehidupan muka
dukungan dan mengocok pasien kami pergi ke perawatan intensif di keadaan
seni "peran 3" fasilitas medis. Namun, ada lagi
pertimbangan. Setiap kunjungan oleh Mert membawa risiko. The
helikopter rentan dan rawan tembakan musuh tanah, dan
bahaya tambahan ini harus diperhitungkan dalam keputusan tersebut.
Ada faktor lain, yang relevan dalam konteks ini tetapi jarang
ditemui dalam etika kedokteran sipil: semangat. Dwight
Eisenhower disebut semangat "faktor tunggal terbesar dalam
perang yang sukses. "4 Membiarkan tentara untuk mati di medan perang
dapat merusak moral pasukan. Ini memukul ditinggalkan.
Fakta bahwa pasien Afghanistan memberikan alasan tambahan untuk
mengevakuasi dia, untuk tidak melakukannya dapat menyebabkan warga Afghanistan lainnya kehilangan
kepercayaan pada komitmen mitra pertempuran mereka.
Pada bulan Oktober 2010 Layanan Medis Pertahanan diselenggarakan hari
yang panjang pertemuan untuk membahas beberapa isu-isu etis yang dihadapi medis
personil di lapangan, termasuk skenario seperti yang ditetapkan
dalam kolom ini. Ini adalah langkah penting, pengakuan
bahwa pelatihan pra-penyebaran harus mencakup apresiasi
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