Medical ethics surveillance in the armed forces

Modern defense services depend on a policy of the vigorous promotion of res earch to ensure that they retain an advantage in any future operational con text. Research involving personnel within the armed forces, however, has ce rtain constraints with respect to contemporary, best-practice medical ethic s. Service members are one example of a class of "captive subjects" mho req uire special protection in the context of medical research. (Prisoners, stu dents, children, and the intellectually disabled are other such examples.) The majority of national defense forces now have ethical watchdog groups-in stitutional ethics committees-that oversee research involving service membe rs. Such groups monitor the special considerations and constraints under wh ich subjects in uniform can volunteer for biological research. These commit tees audit particularly the ethical themes of confidentiality, equality, an d justice. Themes inherent in medical research in the military include the standard Beauchamp-Childress paradigm of autonomy, beneficence, nonmalefice nce, and justice, to which are added the traditional military values of loy alty, respect, courtesy, and chivalry. Contemporary thinking is that the ge neral principle of affording service members the opportunity to volunteer f or research should be maintained within the constraints of compromised trai ning time, national security, and operational necessity. Most biological re search land its outcome) does not in practice compromise confidentiality or military security, This paper presents an audit of the functioning of one national military medical ethics committee, the Australian Defence Medical Ethics Committee, and presents a discussion of its philosophies and influen ce within the broader military context. The Australian Defence Medical Ethi cs Committee believes that most research should, as an a priori condition o f approval, be intended for open publication in peer-reviewed journals.