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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

Here are five regulations, not all of which are in the spotlight, that can affect delivery and administration of healthcare in the United States on a daily basis:1. HIPAA. Originally enacted to protect health insurance coverage for workers who lost or changed jobs, the Health Insurance Portability and Accountability Act of 1996 is now most associated with the privacy of patient healthcare information. Under HIPAA, the Department of Health and Human Services (HHS) establishes boundaries on the use and release of health records. It also outlines safeguards to protect patients’ information and establishes civil and criminal penalties for violations. The law applies not just to hospitals and medical practices but also to chiropractors, dentists, nursing homes, pharmacies, and psychologists, as well as to business associates such as third-party administrators, pharmacy benefit managers for health plans, billing and transcription companies and professionals performing legal, accounting, or administrative work. The law’s provisions are far reaching.“All healthcare entities and organizations that use, store, maintain or transmit patient health information are expected to be in complete compliance with the regulations of the HIPAA law,” according to an article on Datica, a digital health platform. “When completely adhered to, HIPAA regulations not only ensure privacy, reduce fraudulent activity and improve data systems but are estimated to save providers billions of dollars annually. By knowing of and preventing security risks that could result in major compliance costs, organizations are able to focus on growing their profits instead of fearing these potential audit fines.”HIPAA applies to verbal, written, and electronic patient records – and the use of electronic health records (EHR) is increasing. With more medical providers using EHRs, data breaches have increased. Some 329 breaches of more than 500 records, for a total exposure of more than 16.4 million patient records, had been reported as of February 6, 2017, according to the HIPAA Journal article, “Largest Healthcare Data Breaches of 2016.” Stolen data is frequently used for identity theft and fraud.Congress decided that additional regulations – and stronger penalties – were needed to address EHR and cloud-based medical records issues, which led to the HITECH Act.2. The HITECH Act. The Health Information Technology for Economic and Clinical Health (HITECH) Act, was signed into law in February 2009 to promote the “adoption and meaningful use of health information technology,” according to the HHS website. It mandates audits of healthcare providers to determine whether they are in compliance with HIPAA privacy rules related to privacy and security rules.The HITECH Act has been called the teeth and claws of HIPAA. Because healthcare records, unlike credit cards, can’t be canceled, changed, or reset in the event of a breach, healthcare providers have increasingly become the target of hackers.The act provided financial incentives for providers to offset the initial costs of switching to EHRs – and also tougher data security requirements and penalties for both healthcare organizations and their business associates. Under the regulations, patients must be notified of any unauthorized access or use of their information. Protected health information (PHI) can only be shared by secured methods. Using traditional, unsecured email – a common way to share PHI electronically – can put an organization’s HIPAA compliance in jeopardy.The costs of non-compliance can be high. Organizations can face fines as high as $1.5 million per calendar year for each violation. They also can incur losses related to notifying patients affected by a breach, investigations and legal issues, and audits.Administrators should assess security compliance of their practice or organization, make sure proper electronic PHI procedures are in place, and update their HIPAA privacy and security policies.The federal government also concerns itself with compensation for physicians and healthcare providers.3. MACRA. The Medicare Access & CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 addresses payment for doctors as well as cost controls for Medicare Part B. Part of an overall shift to value-based reimbursement, MACRA moves away from the Sustainable Growth Rate (SGR) payment formula and toward a treatment model based on quality of care and use of EHRs by the medical practice or facility.4. Medical Necessity. Medical necessity is one of the most important aspects of contemporary healthcare administration, even though it has no regulatory definition at the federal level or in the majority of states. The concept of medical necessity states that if a treatment is not medically necessary, the payer – generally an insurance company, but also Medicare or Medicaid – won’t cover the cost.“Understanding medical necessity and how to document it is an important part of medical billing, because it is why an insurance company actually pays for a claim,” said the article, “Documenting Medical Necessity,” on MB-Guide, a website for medical billers and coders. “If it’s not documented, it never happened.”Not all procedures are medically necessary. A practice administrator needs to understand the coverage policies for services to help avoid denied claims.5. Chain of Custody. A “Chain of Custody” form, also known as a CCF or CoC, refers to “ a document or paper trail showing seizure, custody, control, transfer, analysis, and disposition of physical and electronic evidence of a human specimen test,” according to the American Alliance Drug Testing website, which details Department of Transportation (DOT) drug testing procedures. The CCF is considered a legal document and can be invalidated if the specimen shows evidence of tampering.Labs that perform DNA or paternity testing follow similar documentation procedures and legal requirements. In-home curiosity DNA tests such as those available from 23andMe and similar companies may be prohibited in some states because no chain of custody can be established.

I think this is really an inquisitive query as nowadays customers have to face many unanticipated difficulties while buying drugs from a pharmacy store and in this circumstances, the drug testing rules that have been proposed by HIPAA is really should be implemented for a better ailment of patient I believe. HIPAA violation penalty laws give a massive concern on workplace drug testing and substance abuse management which may apply to many collection facilities, laboratories, Medical Review Officers and other service providers who analyze and review applicants' and employees' drug and alcohol test results.Briefly, drug test results, like all medical information about employees, should be kept confidential. According to the Equal Employment Opportunity Commission (EEOC), "if the results of a drug test reveal the presence of a lawfully prescribed drug or other medical information, such information must be treated as a confidential medical record. There are many WHO-affiliated drugs which test results are protected by HIPAA as there have some penalty rules.Drug test results may also be critical in determining eligibility for a state and employer-sponsored benefits. Many laws recognize these situations. The U.S. Department of Transportation (DOT) regulations on testing procedures permit the release of DOT drug test results for investigatory proceedings