The Liaison Committee on Medical Education accredits medical schools in the US. LCME consequently sets the minimum standards for content in medical education. Every medical school must offer some training in medical ethics. As you might guess the training is variable. The retention of ethical principles as well as the use in practice are more variable still.

Since 9/11 and the declaration of the war on terror the role of physicians in armed conflict, including the treatment of prisoners and detainees, has received increased attention. Military medical ethics is rarely taught in a formal manner in civilian medical schools. But then why should it be? Few practicing civilian physicians really need to know specifics of the protections offered by the Geneva Conventions.

For the military physician, however, the issue is fundamentally one of identifying primary role. For example: if a military physician is first soldier who happens to have a medical degree then the expectation might reasonably be that he/she act as a soldier. Yet if he/she is actually a physician in uniform the perhaps healthcare ethics should control behavior. Over 2000 years ago it was recognized the no one can serve two masters. The “dual responsibility” is largely a fiction.

The World Medical Association seems to implicitly accept this fact when it prohibits physicians from participating in “practice of torture or other forms of cruel, inhuman or degrading procedures… .” No provision is made for the possibility of a military physician.

Conflicts of interest may extend into civilian medical care. Insurance plans may allow higher compensation for physicians who use less laboratory testing and fewer referrals. The entire industry devolted to “cardiac care” is poorly supported by objective data. Yet few physicians will reveal economic arrangements that may compromise care and fewer still cardiologists will reveal the medical management is equivalent to interventional cardiology (stenting) or cardiac surgery for coronary artery disease. Why would this be? These simple conflicts of interest can’t possibly be based on lack of information since the information is readily available even in the lay press.

You should always discuss your physicians conflicts of interest.