If a patient is not motivated to return to duty, which of the following is an ethical way to approach the decision? Discuss the potential benefits of attempting to return to duty.

Case 4

A 25-year-old Marine infantryman was in an extended firefight one month ago and lost two buddies. He is experiencing insomnia, psychomotor agitation, and poor concentration and reports that he can’t stop remembering and thinking about what happened to his friends. He reports increased anxiety for his own safety, in addition to survivor’s guilt. His commanding officer insists that his skills are needed for an upcoming mission.

4.1: When contemplating the patient’s return to duty, which factor should NOT be a consideration?

A. The patient’s motivation to return to duty
B. The level of dysfunction the patient is experiencing related to psychiatric symptoms
C. The risk of retraumatizing the patient
D. The critical nature of the mission
E. If medications are used, their effect on his ability to function

4.2: If a patient is not motivated to return to duty, which of the following is an ethical way to approach the decision?

A. Allow the patient to choose not to return to duty, because requiring him to do so would be unethical due to the risk of being traumatized again.
B. Require the patient to return to duty once he is able to function at a level needed to perform his duties.
C. Discuss the potential benefits of attempting to return to duty.
D. A mental health provider should not be weighing in on these kinds of decisions. This is a decision for the commander.
E. Evacuate the patient from the combat zone whether he wants to or not.