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Concept: Conscription


Lead (Pb) is a toxic substance with well-known, multiple, long-term, adverse health outcomes. Shooting guns at firing ranges is an occupational necessity for security personnel, police officers, members of the military, and increasingly a recreational activity by the public. In the United States alone, an estimated 16,000-18,000 firing ranges exist. Discharge of Pb dust and gases is a consequence of shooting guns.

Concepts: United States, Poverty in the United States, U.S. state, Toxicology, Photography, Police, Conscription, Information security


In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession.

Concepts: Medicine, Physician, Conscientious objector, Conscription


Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds; that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases (either for themselves or for their children); second, if so, to what constraints or requirements should conscientious objection (CO) to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO to military service. We argue that conscientious objectors to vaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease(s), its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible.

Concepts: Immune system, Infectious disease, Vaccination, Smallpox, Inoculation, Conscientious objector, Conscription, Military service


Parents' antisocial behavior is associated with developmental risks for their offspring, but its effects on their children’s cognitive ability are unknown. We used linked Swedish register data for a large sample of adolescent men (N = 1,177,173) and their parents to estimate associations between fathers' criminal-conviction status and sons' cognitive ability assessed at compulsory military conscription. Mechanisms behind the association were tested in children-of-siblings models across three types of sibling fathers with increasing genetic relatedness (half-siblings, full siblings, and monozygotic twins) and in quantitative genetic models. Sons whose fathers had a criminal conviction had lower cognitive ability than sons whose fathers had no conviction (any crime: Cohen’s d = -0.28; violent crime: Cohen’s d = -0.49). As models adjusted for more genetic factors, the association was gradually reduced and eventually eliminated. Nuclear-family environmental factors did not contribute to the association. Our results suggest that the association between men’s antisocial behavior and their children’s cognitive ability is not causal but is due mostly to underlying genetic factors.

Concepts: Family, Psychology, Parent, The Association, Crime, Criminal law, Twin, Conscription


IMPORTANCE Young-onset dementia (YOD), that is, dementia diagnosed before 65 years of age, has been related to genetic mutations in affected families. The identification of other risk factors could improve the understanding of this heterogeneous group of syndromes. OBJECTIVE To evaluate risk factors in late adolescence for the development of YOD later in life. DESIGN We identified the study cohort from the Swedish Military Service Conscription Register from January 1, 1969, through December 31, 1979. Potential risk factors, such as cognitive function and different physical characteristics, were assessed at conscription. We collected other risk factors, including dementia in parents, through national register linkage. PARTICIPANTS All Swedish men conscripted for mandatory military service (nā€‰=ā€‰488 484) with a mean age of 18 years. SETTING Predominantly Swedish men born from January 1, 1950, through December 31, 1960. EXPOSURE Potential risk factors for dementia based on those found in previous studies, data available, and quality of register data. MAIN OUTCOMES AND MEASURE All forms of YOD. RESULTS During a median follow-up of 37 years, 487 men were diagnosed as having YOD at a median age of 54 years. In multivariate Cox regression analysis, significant risk factors (all Pā€‰<ā€‰.05) for YOD included alcohol intoxication (hazard ratio, 4.82 [95% CI, 3.83-6.05]); population-attributable risk, 0.28), stroke (2.96 [2.02-4.35]; 0.04), use of antipsychotics (2.75 [2.09-3.60]; 0.12), depression (1.89 [1.53-2.34]; 0.28), father’s dementia (1.65 [1.22-2.24]; 0.04), drug intoxication other than alcohol (1.54 [1.06-2.24]; 0.03), low cognitive function at conscription (1.26 per 1-SD decrease [1.14-1.40]; 0.29), low height at conscription (1.16 per 1-SD decrease [1.04-1.29]; 0.16), and high systolic blood pressure at conscription (0.90 per 1-SD decrease [0.82-0.99]; 0.06). The population-attributable risk associated with all 9 risk factors was 68%. Men with at least 2 of these risk factors and in the lowest third of overall cognitive function were found to have a 20-fold increased risk of YOD during follow-up (hazard ratio, 20.38 [95% CI, 13.64-30.44]). CONCLUSIONS AND RELEVANCE In this nationwide cohort, 9 independent risk factors were identified that accounted for most cases of YOD in men. These risk factors were multiplicative, most were potentially modifiable, and most could be traced to adolescence, suggesting excellent opportunities for early prevention.

Concepts: Cohort study, Epidemiology, Proportional hazards models, Blood pressure, Sweden, Intoxication, Conscientious objector, Conscription


An analogy is sometimes drawn between the proper treatment of conscientious objectors in healthcare and in military contexts. In this paper, I consider an aspect of this analogy that has not, to my knowledge, been considered in debates about conscientious objection in healthcare. In the USA and elsewhere, tribunals have been tasked with the responsibility of recommending particular forms of alternative service for conscientious objectors. Military conscripts who have a conscientious objection to active military service, and whose objections are deemed acceptable, are required either to serve the military in a non-combat role, or assigned some form of community service that does not contribute to the effectiveness of the military. I argue that consideration of the role that military tribunals have played in determining the appropriate form of alternative service for conscripts who are conscientious objectors can help us to understand how conscientious objectors in healthcare ought to be treated. Additionally, I show that it helps us to address the vexed issue of whether or not conscientious objectors who refuse to provide a service requested by a patient should be required to refer that patient to another healthcare professional.

Concepts: Conscientious objector, Civilian Public Service, Jehovah's Witnesses, Conscription, Military service, Conscientious objection to military taxation, Conscientious objection


The purpose of the present study was to investigate changes in physical fitness and anthropometry of young men entering the military service in Finland during the years 1975-2015.

Concepts: Conscription


Smoking in military settings is of major concern. We aimed to assess the association between personal, family, and military factors and smoking behavior change during compulsory military service in Israel.

Concepts: The Association, Conscription, Military service


In a recent (2015) Bioethics editorial, Udo Schuklenk argues against allowing Canadian doctors to conscientiously object to any new euthanasia procedures approved by Parliament. In this he follows Julian Savulescu’s 2006 BMJ paper which argued for the removal of the conscientious objection clause in the 1967 UK Abortion Act. Both authors advance powerful arguments based on the need for uniformity of service and on analogies with reprehensible kinds of personal exemption. In this article I want to defend the practice of conscientious objection in publicly-funded healthcare systems (such as those of Canada and the UK), at least in the area of abortion and end-of-life care, without entering either of the substantive moral debates about the permissibility of either. My main claim is that Schuklenk and Savulescu have misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors. However, I acknowledge Schuklenk’s point about differential access to lawful services in remote rural areas, and I argue that the health service should expend more to protect conscientious objection while ensuring universal access.

Concepts: Health care, Medicine, United Kingdom, Conscientious objector, Conscription


The aim of the present study was to assess associations between physician diagnosed unspecified low back pain (LBP) during compulsory military service and self-reported LBP and physical fitness measured on average four years after military service. From a total of 1155 persons who had been pass medical examination for military service and who had completed physically demanding military training between 1997 and 2007, 778 men participated in a refresher military training course and physical tests. In this study, the association between LBP during military service and LBP in later life in addition to the association between LBP and physical fitness were examined. A total of 219 out of 778 participants (28%) had visited a physician due to some musculoskeletal symptom (ICD-10 M-diagnosis) during their military service. Seventy-four participants (9.5%) had visited a physician due to unspecified LBP during their service, and 41 (5.3%) had temporarily been absent from duty due to LBP. At the follow-up examination, 122 (15.7%) had reported LBP during the past month. LBP during military service was associated with self-reported LBP in the follow-up (p = 0.004). Of those who had been absent from duty due to LBP during their military service, 13 (31.7%) reported LBP during the past month. In risk factor analysis, no initial health behaviour and physical performance variables were associated with baseline LBP in the follow-up. The main finding of the present study was that unspecified LBP during military service predicts LBP in later life. On the basis of previous literature, it is also known that LBP is a common symptom and thus, one cannot expect to be symptomless the entire life. Interestingly, none of the health behaviours nor the physical performance studied in the follow-up were associated with baseline LBP. It appears that individuals prone to LBP have symptoms during physically demanding military service and also later in their life.

Concepts: Spinal disc herniation, Low back pain, Back pain, Symptoms, Acupuncture, Massage, Military, Conscription