Counseling Youth About Military Service Options and Selective Service
Registration: An Integral Part of Anticipatory Guidance of Adolescents: In
Reply
To the Editor,
Dr. Carl Stafstrom’s insightful commentary(1), on the consideration
of military service by our nation’s youth, reviews issues critical to the
lives of these adolescents. Dr Stafstrom highlights the moral duty we
have to protect and nourish the health and well-being of our teenagers.
His call to better inform potential recruits fits easily into the mission
of the American Academy of Pediatrics, being “committed to the attainment
of optimal physical, mental, and social health and well-being for all
infants, children, adolescents and young adults”.
I must respectfully differ from the P3R response of Jed J. Jacobson,
MD, FAAP(2), commenting that “our roles as honest brokers of useful
information can be compromised when we present unbalanced information
about divisive issues…” I feel that there is a moral obligation of
disclosure, and these issues must be raised with parents and patients. Sir
William Osler stated, “The practice of medicine is an art, not a trade; a
calling, not a business; a calling in which your heart will be exercised
equally with your head. Often the best part of your work will have nothing
to do with potions and powders, but with the exercise of an influence of
the strong upon the weak, of the righteous upon the wicked, of the wise
upon the foolish.”
I cannot remain neutral about such an important threat as the
possible death and disability of adolescents and young adults serving in
Operations Iraqi Freedom and Enduring Freedom. The adolescents of my
practice who consider military service deserve full disclosure of all
threats, and all options available to them.
Recently, military fatalities surpassed 3900 deaths, and wounded
totaled over 28,000(3). Blast exposures are now the most common form of
injury. Data from the Joint Theater Trauma Registry (US Army) reveals
that 22% of injured soldiers coming through the military’s Landstuhl
Regional Medical Center in Germany reported injuries to the head, face and
neck(4). Many of these soldiers have Traumatic Brain Injury (TBI), with
lasting neuropsychological impairments. Additionally, estimates of
psychological stress are summarized in “The Psychological Needs of U.S.
Military Service Members and Their Families: A Preliminary Report,”
American Psychological Association, February 2007(5). Psychological issues
due to combat experiences are estimated between 11 and 18%. The most
common disorder is Post-Traumatic Stress Disorder, and it is found with
greater frequency amongst soldiers with longer deployments.
As Pediatricians, we must remember the additional risks to the
children and families of these soldiers during and after deployments.
This APA report states that there are 1.2 million dependent children of
our 1.4 million soldiers in active duty. Amongst the National Guard and
the Reserve, there are 700,000 dependent children for the 900,000 forces.
These children suffer the psychological burden of deployment, or the death
or disability of a parent, and deserve our attention.
Finally, we must not forget the untold suffering of the children of
Iraq and Afghanistan. As fellows of the Academy, our moral and
professional responsibility is to advocate for the health and well-being
of our community’s children. But, in this modern age, the community of
our children must extend to the youth of all nations. We must speak out
and promote open discussion about the war. We must fully inform our
adolescent patients about military service. And we must support our
returning servicemen and women, and their dependent families, in their
struggle of readjustment. We cannot be frozen by a desire to maintain
professional neutrality.
Albert Einstein, the renown physicist of German birth, was sixty
years old in 1939. He was already living in the United States, and was
granted US citizenship in the following year. He stated “the world is a
dangerous place, not because of those who do evil, but because of those
who look on and do nothing.”
References
1. Stafstrom, Carl E. “Counseling Youth About Military Service
Options and Selective Service Registration: An Integral Part of
Anticipatory Guidance of Adolescents” Pediatrics 2007; 119: 1199-1203.
http://pediatrics.aappublications.org/cgi/content/full/119/6/1199
2. Jacobson, J. “Counseling Youth About Military Service Options …”
June 1, 2007
http://pediatrics.aappublications.org/cgi/eletters/119/6/1199#8118
3. US Department of Defense, June 19, 2007
http://www.defenselink.mil/news/casualty.pdf
4. Okie,S., “Traumatic Brain Injury in the War Zone” NEJM, Vol.
352:2043-2047 May 19, 2005 Number 20
http://content.nejm.org/cgi/content/full/352/20/2043
5. Johnson, SJ, et al., in “The Psychological Needs of U.S. Military
Service Members and Their Families: A Preliminary Report,” American
Psychological Association, Presidential Task Force on Military Deployment
Services for Youth, Family and Service Members. February 2007
www.apa.org/releases/MilitaryDeploymentTaskForceReport.pdf
Conflict of Interest:
None declared
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