Ethical Bylaws and Protections for Medical Officers

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The medical officer is morally and professionally obligated to provide medical assistance to whoever needs it, wherever it is needed. At first glance, this seems at direct odds with the goals of StarFleet as a military organization, for a medical officer must aid the wounded in both sides of a conflict, whereas providing such aid to an enemy would constitute treason for any other StarFleet officer. Furthermore, the medical officer will often encounter personal conflicts of morality in the practice of his or her profession. In these situations, often there will not be an easy solution, but remember that the good of the patient, no matter who the patient is, should always be the first consideration.

Medical personnel are noncombatants aboard a starship and as such are accorded special protection under the Articles of War. They may not in any way bear arms against an enemy. When involved in combat operations, all medical personnel must wear a brassard or a shoulder patch on the leftmost appendage with identifying insignia (typically a red cross) to mark them as such. While detached for away team duty, medical personnel may carry such weapons as are determined necessary for self-defense against non-sentient habitants of the specified planet; however, they may not use deadly force against any sentient being, except in cases of direct, extreme threat to life or limb.

Medical personnel are bound by the highest considerations for the sanctity of all sentient life. They may not purposefully cause, or cause by withholding care or treatment, the death of any sentient being defined as alive, i.e. capable of sustaining purposeful cardiac function, respiratory function, and central nervous function, as ascertained by the appropriate testing procedures. This rule applies to all such beings, regardless of their dependence on a second sentient for basic needs of life.

Two exceptions exist to this rule. If the death of one living sentient engaged in a physiologically symbiotic relationship will save the life of another living sentient in that relationship, i.e. transplant surgery to save a Trill symbiont at the expense of the host or vise versa, the medical officer is allowed to act to save that life, even if his or her action will result in the death of that other sentient being. Also, if a sentient being in sound mind has either personally expressed a wish to end its medical care, or filed an advance care directive allowing for cessation of treatment within certain pre-determined standards of health, the medical officer must follow the patient's pre-stated wishes, even if doing so means causing the death of the patient by withholding treatment.

The medical officer, except in cases of extreme exigency as mandated by a superior officer according to the regulations of StarFleet Command and StarFleet Medical, must respect the wishes of his or her patients as to the nature and duration of their care. If a patient in sound mind refuses care for a specific illness or condition, the medical officer must respect the patient's wishes, even if refusing care will hasten the end of the patient's life. In cases where the patient cannot express his or her own wishes, does not have an advance care directive on file, and/or is a legal minor under the care of a parent or guardian, the patient's parent, guardian, or next of kin is authorized to make decisions regarding the care of the patient. These decisions carry the same weight as the patient's own decisions and must be accorded the same respect by the medical officer.

The medical officer must obtain informed consent for any medical or surgical procedure performed in the care of a patient. In cases of emergency threatening life or limb, or if the patient cannot express his or her own wishes and has no designated next of kin or due to distance and time constraints no next of kin can be consulted to make decisions on his or her behalf, the medical officer may assume that the patient would consent if able to do so (implied consent) and proceed with such care as he or she deems to be in the best interest of the patient.

In cases where a medical officer or other medical professional stands accused of ethical misconduct, the case will be tried before a panel of three active StarFleet officers, at least one of whom must be a medical officer. The panel will report its findings to StarFleet Medical and issue a proposal on further handling of the case. An ethics panel may impose sanctions up to and including loss of professional status within StarFleet. A further recommendation from the StarFleet Judge Advocate General is required to expel from StarFleet service a medical professional convicted of ethics violations.

REV SD 239108.17