Ar 190 31: Fill & Download for Free

Q. Is it ethical for a doctor to treat war criminal/terrorist in conflict zones? Aren't they helping terrorist to get up and kill more people?They are treating those who are responsible for the killing of civilians, for them to get well soon and pick up weapon to kill more civilians. I don’t think this is more ethical at all than those who sell weapons to terrorists.A2A:The Geneva Convention for the Amelioration of the Wounded and Sick in Armed Forces in the Field states that belligerents must care for the sick and wounded without any adverse distinction founded on sex, race, nationality, religion, political opinions, or any other similar criteria. Only medical urgency can justify priority in the order of treatment.Medical care and treatment must be provided with impartiality and without discrimination. This means that detainees must be given the same quality and standard of care as all other patients. In accordance with the principle of equivalence, the ethical standards required of doctors apply equally to the treatment of detainees as to all other patients.Care of Enemy Prisoners of War/Internees (US Armed Forces)IntroductionHealthcare personnel of the armed forces of the United States have a responsibility to protect and treat, in the context of a professional treatment relationship and universal principles of medical ethics, all detainees in the custody of the armed forces. This includes enemy prisoners of war (EPWs), retained personnel, civilian internees, and other detainees. For the purposes of this chapter, all such personnel are referred to as internees. Department of Defense (DoD) healthcare personnel should make every effort to comply with “Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment”—adopted by the United Nations General Assembly Resolution 37/194, December 18, 1982 (see Appendix 1 in this book)—and all applicable DoD policies.The Geneva Conventions Define medical personnel as those individuals “exclusively engaged in the search for, or the collection, transport, or treatment of the wounded or sick, or in the prevention of disease; and staff exclusively engaged in the administration of medical units and establishments” (Geneva Convention for the Amelioration of the Wounded and Sick in Armed Forces in the Field [GWS]). Medical personnel of enemy forces are not considered internees, but are classified as “retained” in order to treat other EPWs. Internees are also entitled to the protections afforded under the provisions of the Geneva Convention Relative to 462 Emergency War Surgery the Treatment of Prisoners of War (GPW). Detained persons who are not protected under GWS and GPW, may be protected under the provisions of the Geneva Convention Relative to the Protection of Civilian Persons in Time of War. The Geneva Convention for the Amelioration of the Wounded and Sick in Armed Forces in the Field states that belligerents must care for the sick and wounded without any adverse distinction founded on sex, race, nationality, religion, political opinions, or any other similar criteria. Only medical urgency can justify priority in the order of treatment.The signing of the Geneva Convention of 1864.WorkloadThe number of internees and retained/detained personnel requiring medical in-processing and/or medical care can be staggering. Coalition forces captured over 62,000 internees during Operation Desert Storm.During the 1-week ground war, until the end of March 1991, 8,979 internees were treated. The most common internee medical condition reported during Operation Desert Storm was dental disease (24%). Other common medical illnesses were unexplained fever, nephrolithiasis, peptic ulcer disease, and malaria. Wounds in internees may be different than those seen in friendly forces due to differences in personal protective gear, preexisting diseases, malnutrition, and neglect.Medical Care of Internees Healthcare providers have a responsibility to report information that constitutes a clear and imminent threat to the lives and welfare of others. Whenever possible, internees should receive medical care equal to that given to our own troops. o Providers should report any suspected abuse or maltreatment of an internee. o Providers should inform the theater internment facility chain of command of internee physical limitations. Medical recommendations concerning internee activities are 463 Care of Enemy Prisoners of War/Internees nonbinding. Decisions concerning internee activities are made by the chain of command. Healthcare providers charged with the care of internees should not be actively involved in interrogation, advise interrogators how to conduct interrogations, or interpret individual medical records/medical data for the purposes of interrogation or intelligence gathering. Healthcare personnel ordered to perform duties they deem unethical should request to be recused through his or her chain of command. If the situation is not resolved satisfactorily, healthcare providers may contact their Command Surgeon or the Inspector General. Requirements for internee care are provided in AR 190-8/ OPNAVINST 3461.6/AFJI 31-304/MCO 3461.1. Internees must have an examination upon arrival at the detention facility, as well as a chest radiograph (tuberculin skin test for children up to age 14 years). Sick call must be available daily, and each internee must be weighed at least once per month. Sanitation and hygiene must be maintained at all times (AR 190-8). Medical records.o Internee medical records are the property of the US Government. Internees are entitled to a copy of their medical records upon release. Original records are retained.o The Health Insurance Portability and Accountability Act (HIPAA) does not apply to the medical records of internees (DoD Instruction 6025.18 and DoD 6025.18R). However, the handling, disposition, and release of all types of medical records are governed by regulation. Commanders and others who have an official need to know can access information contained in internee medical records by following the procedures given in AR 40-66, using DA Form 4254. Patient consent is not required. The medical treatment facility commander or designee, usually the patient administrator, determines what information is appropriate for release. Only specific medical information required to satisfy the terms of a request will be disclosed. Healthcare providers should expect that released medical information will be used by the chain of command, to include interrogators. Medical information. o Releasable medical information includes that which is necessary to supervise the general state of health and cleanliness of internees, to detect contagious diseases, and to provide for the safety and security of the facility.Setup/Planning Develop plans for prisoners on a hunger strike or who refuse treatment. Enemy forces may have preexisting medical conditions requiring medication. Ensure that any internee/retained/detained person evacuated to the medical treatment facility for treatment is escorted by an armed guard, as designated by the nonmedical (echelon) commander. The guard must remain with the patient while in the medical evacuation and treatment chain. When possible, keep internees segregated from friendly forces patients. Internees requiring evacuation will receive an internee identification number upon entry into the detainee reporting system. Medical personnel do not search, guard, or interrogate internees. It is critical that medical personnel not enter the general EPW holding area, but have patients brought out to them for sick call and any medical treatment. NATO STANAG 2131, Multinational Phrase Book for Use by the NATO Medical Services—AMedP-5, provides basic medical questions in a number of NATO languages. Use other retained persons/internees (especially medical personnel) as translators. Detainees may feign mental illness to avoid interrogation.Screening Guards should ensure internees are screened for hidden weapons and other potentially dangerous materials. Medical personnel, however, must remain vigilant of these threats and mentally prepared should a threat or attack occur.Care of Enemy Prisoners of War/Internees During transfer, release, and/or repatriation, another medical examination should be performed. Final documentation of any ongoing medical, surgical, or wound care problem is completed and forwarded to the gaining facility or to the appropriate medical records repository.Supply The internment facility must enforce field hygiene and sanitation principles. Plan for personal hygiene requirements and protective measures (insect netting, insect repellent, sunscreen). Coordinate with the supporting medical headquarters for additional preventive medicine support (pest management, potable water, dining facility sanitation, and waste disposal) and Veterinary Services support for food safety as required.Medical Staffing The facility should be staffed to ensure that detainees receive the same standard of care as US forces. Retained medical personnel should be utilized for care of their compatriots in conformity with the Geneva Conventions.Legal When possible, signed permission should be obtained for all surgical or invasive procedures. The patient’s identity should be absolutely clear in each photograph. Photographs are invaluable should there be a claim of unnecessary surgery or amputation. A high-quality camera is important. Any patient who requires amputation or major debridement of tissue should be photographed (face as well as wound images).Internee Advocate The military physician is often the commander’s advisor for medical ethics. The physician should be alert for potential and actual ethical conflicts, and make efforts to resolve them. They must also strive to maintain a “moral distance” from participating in any proceeding potentially adverse to the patient’s interest. Personal safety should never be taken for granted by the medical team, regardless of familiarity with internees and surroundings.Security There is always an element of danger to the medical staff in treating internees.  Physical security will be provided by nonmedical personnel designated by the appropriate leadership. It is the capturing line unit’s responsibility to provide security for EPWs/detainees until arrival at an internment facility. Security personnel must accompany all internees whenever they are in a treatment or holding area. In forward areas, it may not be possible to have separate and secure medical treatment/ holding areas for internees. When possible, internees should be segregated from allied, coalition, and US forces. When possible, avoid taking medical equipment into the patient wards for security reasons (ie, bring the patient to the equipment). Following treatment, the provider should alert internment medical personnel of any special needs the internee may have.For Clinical Practice Guidelines, go to http://usaisr.amedd.army.mil/clinical_practice_ guidelines.htmlhttp://www.cs.amedd.army.mil/FileDownloadpublic.aspx?docid=8ee7a717-3fd1-4395-9371-063b3917d21fBritish Medical Association GuidanceWhat are doctors’ responsibilities in providing medical support to detainees?Medical care and treatment must be provided with impartiality and without discrimination. This means that detainees must be given the same quality and standard of care as all other patients. In accordance with the principle of equivalence, the ethical standards required of doctors apply equally to the treatment of detainees as to all other patients.A doctor’s role in relation to detainees should be restricted to assessing, protecting or improving the physical and mental health of patients. As well as providing direct medical support to detainees, doctors also have responsibilities in monitoring the standards of health and hygiene within a detention facility, such as access to food and water, sanitation, heating, lighting and ventilation.Whenever a doctor considers that a detainee’s physical or mental health will be harmed by continued detention, or by the conditions in detention, this should be reported to the commander.Ethical decision-making for doctors in the armed forces: a tool kit of the detention facility and to the medical authorities.Doctors also have a duty to ensure that their patients are not being abused while in detention, and to act on any evidence of abuse.The Duty to Provide Care for a Wounded or Sick Enemy

Copied from Memory Alpha. These are the officially recognized “Rules of Acquisition”. There are others which may simply be Ferengi aphorism.1 Once you have their money, you never give it back.DS9: "The Nagus", "Heart of Stone"3 Never spend more for an acquisition than you have to.DS9: "The Maquis, Part II"6 Never allow family to stand in the way of opportunity.DS9: "The Nagus"; ENT: "Acquisition"7 Keep your ears open and your eyes on the mark.DS9: "In the Hands of the Prophets"9 Opportunity plus instinct equals profit.DS9: "The Storyteller"10 Greed is eternal.DS9: "Prophet Motive"; VOY: "False Profits"16 A deal is a deal.DS9: "Melora"17 A contract is a contract is a contract... but only between Ferengi.DS9: "Body Parts"18 A Ferengi without profit is no Ferengi at all.DS9: "Heart of Stone", "Ferengi Love Songs"21 Never place friendship above profit.DS9: "Rules of Acquisition"22 A wise man can hear profit in the wind.DS9: "Rules of Acquisition"; VOY: "False Profits"23 Nothing is more important than your health... except for your money.ENT: "Acquisition"31 Never make fun of a Ferengi's mother.DS9: "The Siege"33 It never hurts to suck up to the boss.DS9: "Rules of Acquisition", "The Dogs of War"34 War is good for businessDS9: "Destiny", "The Siege of AR-558"35 Peace is good for business.TNG: "The Perfect Mate"; DS9: "Destiny"45 Expand or die.ENT: "Acquisition"; VOY: "False Profits"47 Don't trust a man wearing a better suit than your own.DS9: "Rivals"48 The bigger the smile, the sharper the knife.DS9: "Rules of Acquisition"57 Good customers are as rare as latinum. Treasure them.DS9: "Armageddon Game"59 Free advice is seldom cheap.DS9: "Rules of Acquisition"62 Profit is its own reward.DS9: "Rules of Acquisition", "Little Green Men", "Business as Usual", "Starship Down"74 Knowledge equals profit.VOY: "Inside Man"75 Home is where the heart is, but the stars are made of latinum.DS9: "Civil Defense"76 Every once in a while, declare peace. It confuses the hell out of your enemies.DS9: "The Homecoming"94 Females and finances don't mix.DS9: "Ferengi Love Songs", "Profit and Lace"95 Expand or die.VOY: "False Profits"; ENT: "Acquisition"98 Every man has his price.DS9: "In the Pale Moonlight"102 Nature decays, but latinum lasts forever.DS9: "The Jem'Hadar"103 Sleep can interfere with...DS9: "Rules of Acquisition"109 Dignity and an empty sack is worth the sack.DS9: "Rivals"111 Treat people in your debt like family... exploit them.DS9: "Past Tense, Part I", "The Darkness and the Light"112 Never have sex with the boss's sister.DS9: "Playing God"125 You can't make a deal if you're dead.DS9: "The Siege of AR-558"139 Wives serve, brothers inherit.DS9: "Necessary Evil"168 Whisper your way to success.DS9: "Treachery, Faith and the Great River"190 Hear all, trust nothing.DS9: "Call to Arms"194 It's always good to know about new customers before they walk in your door.DS9: "Whispers"203 New customers are like razor-toothed gree-worms. They can be succulent, but sometimes they bite back.DS9: "Little Green Men"208 Sometimes the only thing more dangerous than a question is an answer.DS9: "Ferengi Love Songs"211 Employees are the rungs on the ladder of success. Don't hesitate to step on them.DS9: "Bar Association"214 Never begin a business negotiation on an empty stomach.DS9: "The Maquis, Part I"217 You can't free a fish from water.DS9: "Past Tense, Part I"223 (incomplete, but presumably concerned the relationship between "keeping busy" and "being successful")DS9: "Profit and Loss"229 Latinum lasts longer than lust.DS9: "Ferengi Love Songs"239 Never be afraid to mislabel a product.DS9: "Body Parts"263 Never allow doubt to tarnish your lust for latinum.DS9: "Bar Association"285 No good deed ever goes unpunished.DS9: "The Collaborator", "The Sound of Her Voice"(Unknown) A man is only worth the sum of his possessions.ENT: "Acquisition"

The following ships at Peral Harbor were undamaged:USS San Francisco (CA-38), Heavy CruiserUSS Detroit (CL-8), Light CruiserUSS Phoenix (CL-46), Light CruiserUSS Allen (DD-66), DestroyerUSS Schley (DD-103), DestroyerUSS Chew (DD-106), DestroyerUSS Ward (DD-139), DestroyerUSS Dewey (DD-349), DestroyerUSS Farragut (DD-348), DestroyerUSS Macdonough (DD-351), DestroyerUSS Warden (DD-352), DestroyerUSS Dale (DD-353), DestroyerUSS Monaghan (DD-354), DestroyerUSS Selfridge (DD-357), DestroyerUSS Phelps (DD-360), DestroyerUSS Reid (DD-369), DestroyerUSS Case (DD-370), DestroyerUSS Conyngham (DD-371), DestroyerUSS Tucker (DD-374), DestroyerUSS Blue (DD-387), DestroyerUSS Mugford (DD-389), DestroyerUSS Ralph Talbot (DD-390), DestroyerUSS Patterson (DD-392), DestroyerUSS Jarvis (DD-393), DestroyerUSS Narwhal (SS-167), SubmarineUSS Dolphin (SS-169), SubmarineUSS Cachalot (SS-170), SubmarineUSS Tautog (SS-190), SubmarineUSS Turkey (AM-13), MinesweeperUSS Bobolink (AM-20), MinesweeperUSS Rail (AM-26), MinesweeperUSS Tern (AM-31), MinesweeperUSS Grebe (AM-43), MinesweeperUSS Vireo (AM-52), MinesweeperUSS Gamble (DM-15), Destroyer-MinelayerUSS Ramsey (DM-16), Destroyer-MinelayerUSS Montgomery (DM-17), Destroyer-MinelayerUSS Breese (DM-18), Destroyer-MinelayerUSS Tracy (DM-19), Destroyer-MinelayerUSS Preble (DM-20), Destroyer-MinelayerUSS Sicard (DM-21), Destroyer-MinelayerUSS Pruitt (DM-22), Destroyer-MinelayerUSS Zane (DMS-14), High Speed MinesweeperUSS Wasmuth (DMS-15), High Speed MinesweeperUSS Trever (DMS-16), High Speed MinesweeperUSS Perry (DMS-17), High Speed MinesweeperUSS Sacramento (PG-19), GunboatUSS Whitney (AD-4), Destroyer TenderUSS Avocet (AVP-4), Small Seaplane TenderUSS Swan (AVP-7), Small Seaplane TenderUSS Hulbert (AVD-6), Seaplane Tender (Former Destroyer)USS Thornton (AVD-11), Seaplane Tender (Former Destroyer)USS Ramapo (AO-12), Fleet OilerUSS Neosho (AO-23), Fleet OilerUSS Medusa (AR-1), Repair ShipUSS Riegel (AR-11), Repair ShipUSS Pelias (AS-14), Submarine TenderUSS Widgeon (ASR-1), Submarine Rescue ShipUSS Solace (AH-5), Hospital ShipUSS Castor (AKS-1), General Stores Issue ShipUSS Ontario (AT-13), Seagoing TugUSS Sunnadin (AT-28), Seagoing TugUSS Keosanqua (AT-38), Seagoing TugUSS Argonne (AG-31), Miscellaneous AuxiliaryUSS Cockatoo (AMc-8), Coastal MinesweeperUSS Crossbill (AMc-9), Coastal MinesweeperUSS Condor (AMc-14), Coastal MinesweeperUSS Rebird (AMc-30), Coastal MinesweeperUSS Hoga (YT-146), Harbor TugUSCGC Taney (WHEC-37), Coast Guard High Endurance CutterThe following ships at Pearl Harbor received only minor damage:USS Tennessee (BB-43), BattleshipUSS Maryland (BB-46), BattleshipUSS New Orleans (CA-32), Heavy CruiserUSS Honolulu (CA-48), Heavy CruiserUSS St. Louis (CL-49), Light CruiserUSS Hull (DD-350), DestroyerUSS Alwyn (DD-355), DestroyerUSS Cummings (DD-365), DestroyerUSS Bagley (DD-386), DestroyerUSS Helm (DD-388), DestroyerUSS Henley (DD-391), DestroyerUSS Dobbin (AD-3), Destroyer TenderUSS Curtiss (AV-4), Seaplane TenderUSS Tangier (AV-8), Seaplane TenderUSS Pyro (AE-1), Ammunition ShipUSS Rigel (AR-11), Repair ShipUSS Sumner (AGS-32), Survey Ship