I was talking to a builder

of bridges and asked

how he built the structure

that brings two warring elements

together. This was his answer.

What is a bridge?

A land divided, or the gap

between?Footnote 1

As we compile this issue, our editorial group is not alone in being increasingly challenged by the tragic conflicts around the world, especially the events in Israel and Gaza since the attacks of October 7, 2023. Meanwhile the war in Ukraine has somehow become dangerously normalized over the last two years. What should the response of this journal be to conflict, and its possible resolutions? Do we stand by in collective horror, throw up our hands and leave it to diplomacy, politics, law, military strategic studies, foreign policy analysts, and historians? What does an academic community of scholars and practitioners working with the rights and wrongs of conduct in the life and health sciences have to say about war, violence, retribution, national security (and its absence), civilian “collateral” death and suffering, military conduct, and international law? What can ethics and bioethics specifically add to the debates and analyses in a dangerously divided and ideologically polarized world, where strong emotions have stifled true dialogue and blocked most potential routes to peace?

Our starting point is one of deploring the cruel attacks in southern Israel on October 7 and the performative violence perpetrated on that day in the Hamas attack and nothing we would argue or say is intended to defend in any way those acts. On the other hand, we are appalled too at the loss of life and inhuman living conditions that have resulted from the attacks on Gaza by the Israeli Defence Force in response. We are unanimous in our support for the rights of Israelis and Palestinians to live in peace and security but hold no collective view about the political structure of what that peace might look like. What we do seek to contribute, in the true spirit of the academic bioethics space we work in, and therefore guided primarily by humanitarian principles, is an ethical analysis of the big concepts at play in the often-bitter arguments that have followed these desperate events as they continue to unfold.

This author has often reflected that the biggest event in his life ended nine years before he was born in 1954. In the twentieth century the two world wars dominated family life and grief journeys for many over several generations. The first world war (1914–1918) was conducted in a very different world of patriotic and imperial values (see Fussell 1975 and 2000), but any moral justification is rarely argued to have been worth the appalling loss of life, and there is more genuine historical moral ambiguity than would have been the case nearer the time. No such ambiguity has existed until recently for World War II (1939–1945) where most of us in Britain were brought up on the legend of Churchillian resistance, the spirit of the blitz, reinforced by German war crimes and the holocaust. Only in recent years has allied conduct been questioned.

There are rules of war, and we know that western democracy military forces often consult lawyers before attacking targets. If something is “legal” it is of course not necessarily ethical, as history has shown us all too often. Is it an ethical act if you bomb a building after giving a warning? We often hear the term genocide deployed when there are large numbers of deaths in armed attacks and the term has a specific definition in international law and conventions. But is it a helpful term when so much death and misery can be inflicted without reaching the definitional threshold of intentionality? What constitutes ethnic cleansing and how does it compare to genocide? What are the ethical justifications for pre-emptive strikes, punitive raids, and self-defence as a force majeure? Is collective punishment ever justified even if spoken of as collateral damage? What is proportionality in terms of casualties, what is the exchange rate? Is a war ever “just,” can a jihad ever be so classified and therefore justified? All these concepts are deployed in exchanges about conflicts and have been particularly prominent in considerations of the Gaza “war.”

What is the definition of a terrorist act as opposed to a "legitimate" act of war? Would we label as terrorism for instance Special Operations Executive (SOE) acts of sabotage in World War II (see Wieviorka 2019), by resistance fighters (note the Germans called them terrorists, we all them fighters), the atom bombs dropped on Japan (suddenly back in popular culture with the film “Oppenheimer”) or the fire-bombing of Hamburg and Dresden, and if not, what is the definition (or do you need to believe you have a god on your side as Bob Dylan sang?). And if you talk about Dresden (see Taylor’s excellent history of this event, Taylor 2004), you cannot forget the London blitz in 1940 or Coventry, or any one of hundreds of cities bombed in terror around the world (Rotterdam, Warsaw, Nanking, and so on). Can we build on the work of Michael Ignatieff, Jonathan Glover, and Michael Burleigh in understanding nationalism, tribalism, fascism, and morality of war (Ignatieff 1994; Glover 2001; Burleigh 2010)?

It is easy to forget the war in Ukraine. Habermas has questioned the whole United States/western alliance’s role in maintaining the war by supplying Ukraine with equipment and thereby being an active party to the war. He is in no way a supporter of Russian aggression, but he critiques what he sees as the “thoughtless and short-sightedness” of the wholesale emotional engagement with the war by most of Europe and the United States. This weakens an already questionable western moral higher ground stance vis-à-vis Russia (Habermas 2023), that in turn relies on its own interpretation of a complex history with Ukraine and other western neighbours (Snyder 2022).

We acknowledge that the field of bioethics is diverse. Whilst there may be many consensuses there are also strong disagreements. This journal recognizes that whilst on the one hand we would hope to achieve consensus on many core principles, on the other hand we need to hear the other voices, and in everything we are strongly focussed on the rights and freedoms of the individual voice too. It is fundamental to the ethos of the journal that scholarship and opinion has always been sought from multiple disciplines and backgrounds. It is this broad and inclusive approach that we wish to bring to the present state of conflict in the world. We therefore propose a symposium that will follow, asking philsophers, historians, economists, people who are Jewish and Muslim or who have no faith position, from the global north and south, to address the ethical aspects of conflict and the promotion of peace. We at the JBI continue to believe that ethics is genuinely a region of foment and that it benefits from intellectual breadth, inclusiveness, and diversity. In other words, in the perhaps overused aphorism, to model the change we wish to see. To start the process, in this issue we publish an article by our board chair, Paul Komesaroff (2024). Paul has a long history of involvement in ethics and peaceful dialogues in various parts of the world in addition to his medical work as an academic and physician in Melbourne. He has a special interest in the Middle East and knows the region well. He also traces some of his ancestors back to Ukraine in the early twentieth century. His exploration of pathways to peace is a hopeful examination of the possibilities at a time when hopelessness is easy to embrace. The article introduces a forthcoming conversation leading to a special issue on conflict in geopolitical contexts. We have invited authors who we think have something original to say in this fraught space because of their past publications or experience. We will also be inviting you, our readers, to contribute your thoughts. We are hopeful that the symposium will stimulate vigorous debate in the ethics community. To facilitate this, we are linking it to a forum at which readers can view published articles and post comments and more formal responses. The forum can be accessed via the JBI website (https://bioethicalinquiry.com/) or directly (at https://aidxchange.org/). All readers of the JBI are invited to participate! We are not seeking to enter a political battle over the rights and wrongs, there is more than enough of that out there, but rather to see if our field of bioethics can help to find ways out of hatred, revenge, and escalating “horrorism” (after the late Martin Amis) in which deeply traumatized communities continue to try and outdo each other with acts of violence to provoke the other into ever bigger reactions for tactical gain.

Whether you like it or not, unless unconditional surrender such as the ending of WWII, you have to negotiate with your enemy however labelled, including the terrorist. No matter how bad the violence and bitter the hatred, the rights and the wrongs, back channels usually exist and eventually have to find a way to the table. Apparent peace bought at the end of a gun will often be a sleeping volcano only to erupt again when least expected.

We should also recognize the role of medical and health worker advocacy exemplified by the Medical Association for Prevention of War (MAPW) and International Physicians against Nuclear War (IPPNW) over many decades. This apolitical voice that points out the myriad health consequences of conflict has been influential in world affairs and is needed now more than ever to drive home the appalling results of war and all forms of conflict not just in terms of casualties but also the wider public health damage.

There can be few more frightening fates than to end up than a locked-in state. Poppe and Elger (2024) discuss how brain-computer techniques might be employed to communicate end-of-life and even voluntary assisted dying (VAD) wishes. They suggest that enabling such conversations may paradoxically lengthen rather than shorten these lives. This is consistent with the wider VAD literature where is well documented that people who go through the process often do not end up taking the medication and die of other causes.

There are huge pressures and deep divisions about vaccination. For young people under eighteen there are jurisdictional differences in the threshold for consent to medical treatment, usually in common law jurisdiction based on so-called Gillick competence. Brusa and Barilan (2024) argue that there is no ethical or legal reason why parental consent should be required and that most objections are based on notions of individual liberty. There would no doubt be a vocal minority who would not share the view about individual health risk despite the disputed nature of vaccine harms evidence. It would be unwise to underestimate the influence of religion either.

It is something of a surprise that COVID-19 vaccinations for prisoners should be controversial. Rashi (2024) presents the issue from a Jewish ethics perspective and derives both a moral and religious imperative to give equal treatment to prisoners regardless of their conviction. In most countries, jails were identified early on as places of potentially disastrous viral spread but where also the solitary confinement that ensued must have been nearly as bad for many as the disease. Vaccination policies notwithstanding, prisoners are entitled to equal treatment for health matters with the general public, although they of course tend to have worse health and mental health and higher rates of addiction issues than the general public.

Allen et al. (2024) have studied the evidence submitted to a recent Australian senate enquiry into mitochondrial donation law reform. They point out the advocacy from people affected by inherited mitochondrial disease was most influential and objections were either to the technology in general or its implementation. The enquiry findings will inform the future developments in the field and the process demonstrates the utility of a well-informed public consultation. In a related topic, Khan and Drabiak (2024) report on ways that proponents attempt to undermine the scientific consensus against human germline modifications at the initiation of pregnancy.

The topic of reanalysis of genomic sequencing results in the light of new genomic research is probably not well known to those outside the field of clinical genetics. At present the practice is ad hoc and clearly can have big impacts for people and their families. Outram et al. (2024) have interviewed forty-seven “underserved” families and propose that systems need to be put in place to ensure amongst other things, that the well-off aren’t the only ones who can avail themselves of reanalysis of their results as new evidence is gathered.

Clearly the days of anonymous sperm donation in many jurisdictions are now over. Symons and Kha (2024) write in favour of the bans on anonymity and suggest a central register of donors. Given that some jurisdictions have even retrospectively removed anonymity provisions, it must make potential donors think twice about participating. It remains to be seen what the long-term effects will be of these trends on assisted reproduction and any positive effects on some of the unethical donor behaviours.

Assisted reproduction technologies (ART) are now usually argued to be made available as a matter of reproductive “right.” Hall (2024) challenges this and suggests uncoupling the reproductive acts and the intention to rear with consequences for both biological and rearing parents and that rearing parents cannot claim reproductive rights and biological parents cannot have their rights automatically extinguished either.

As the 2021–2022 COVID-19 pandemic recedes into history (ongoing infectious trend vigilance notwithstanding), there is more weighing up of risk and infringements of liberty. Although the prevailing public mood is still very much precautionary, more questions are being asked about the widespread lasting harm to young people and the economically vulnerable. Fehross et al. (2023) have conducted a critical interpretive literature review to identify and discuss the underlying values underpinning the decisions taken at the time. It is widely held that some governments on reflection may have delayed lock downs and other restrictive measures too long initially, but on the other hand the length of the lockdowns, the coercion about vaccinations, and the restrictions in every walk of life are finally being critiqued about effectiveness and ethical justification. Some governments clearly made political capital out of public death anxiety.

Drewett (2024) reports that we are now prepared to discuss deliberate infection trials in humans. This study method has of course been taboo for decades due to some wildly unethical studies done without consent (notably with prisoners) in the early and mid-twentieth century. We now have WHO guidelines for the conduct of studies. How times change and change again.

Anyone visiting a supermarket these days will notice the expansion of the non-meat meat section, with burgers, mince and various “cuts” of plant-based synthetic meat-like products.

Anomaly et al. (2024) discuss the opposition to these products and suggest a social rather than legal mechanism to improve acceptance of this fundamental shift in dietary habits. One should hope so too as the longer-term health effects of manufactured foods will need close study. Despite all the negatives of mass meat production and the animal welfare and environmental issues at stake, it is far from clear that less natural food sources are without other health consequences.

Azcárraga and Derive (2024) describe the process of setting up of an ethics committee for a mental health clinic in a private university in Mexico. They particularly highlight the potential conflicts of interest that can arise between individual patient/student rights and the corporate interests of the university and provide a list of the issues encountered.

Most jurisdictions, and certainly English common law ones have tended to retain legal provisions that forbid “aiding and abetting” a suicide in any circumstances. Swiss law modified its criminal code in 1942 to allow assistance in suicide provided such assistance is solely altruistic and this has allowed centres that provide assisted dying to develop. Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 has now made a similar provision. Riva (2024) analyses this change and critiques some of the perceived procedural weaknesses, notably with regard to the role of regional ethics committees.

Autonomy is often presented in almost absolutist terms in health ethics. A group of researchers from Quebec have conducted a survey of adolescent sexual health service access in Colombia. Brisson, Ravitsky, and Williams-Jones (2024) report that whereas hitherto the main issue is seen as a need for young people to be able to access these services without parental involvement or knowledge, a more nuanced picture emerged from the semi-structured interviews with young people accessing a Colombian sexual health clinic. Parental and family support was appreciated and perhaps a more social understanding was required. This finding is important as it questions an assumption whilst also accepting that confidentiality and consent are also key values in any clinical context and must always be carefully respected and negotiated with the patient.

There is an ongoing tension around genetic modification. On the one hand researchers are keen to press ahead with scientific research and developments in genetic engineering that have enormous potential benefits, but on the other nobody wants to see harmful uses and eventual adverse outcomes. So the balance between impeding good research by over-zealous regulation and ensuring ethical practice is a delicate one. In the regular Recent Developments column, Soni (2024) reports on the The Third International Summit on Human Genome Editing, which was convened by the U.K. Royal Society, U.K. Academy of Medical Sciences, U.S. National Academies of Sciences and Medicine, and the World Academy of Sciences. It is noted that specific legal regulation of gene editing is lacking internationally and that effective regulation (rather than banning) of such research based on a South African legislative model maybe worth replicating in other jurisdictions. In a letter to the journal Moustafa (2024) also urges caution concerning the use of CRISPR cas9 genome editing, after initial excitement about its possibilities, caution is required lest it be put to unethical uses and in a worst case scenario, eugenic purposes.

Although the pandemic now seems to feel like another time, its legacy lives on in every walk of life, including social harmony. McLachlan (2024) takes Shaw to task for his admonishment of others for neglecting personal COVID-19 protection measures in that anxious time and argues that the appeal to good manners applied to both sides.

Finally, we would like to express our thanks to two departing associate editors: Adrian Carter, Associate Editor for Emerging Technologies (since 2018) and Alexander Holden, Associate Editor for Ethics and Oral Health (since 2018). We recognize that all of our roles are “for a season,” and as personal and professional lives evolve, colleagues come and go as they need to. We cannot function without our team of Associate Editors and on your behalf we thank them all for the hard work they do, usually “off the side of the desk,” to ensure that the best academic standards are maintained at our journal. We wish Adrian and Alexander all the best for the future and hope they will remain a part of the wider JBI community.