Medical rules of eligibility permit severely injured Iraqi and Afghan nationals to receive care in Coalition medical facilities only if bed space is available and their injuries result directly from Coalition fire. The first rule favors Coalition soldiers over host-nation nationals and contradicts the principle of impartial, needs-based medical care. To justify preferential care for compatriots, wartime medicine invokes associative obligations of care that favor friends, family, and comrades-in-arms. Associative obligations have little place in peacetime medical care but significantly affect (...) wartime medicine. The second rule suggests liability for collateral harm that is unsupported by international law and military ethics. Absent liability, there are pragmatic reasons to offer medical care to injured local civilians if it quells resentment and cements support for Coalition forces. In contrast to peacetime medicine, military necessity and associative obligations outweigh distributive principles based on medical need during war. (shrink)
Asymmetric conflict is changing the way that we practise and think about war. Torture, rendition, assassination, blackmail, extortion, direct attacks on civilians, and chemical weapons are all finding their way to the battlefield despite longstanding international prohibitions. This book offers a practical guide for policy makers, military officers, students, and others who ask such questions as: do guerillas deserve respect or long jail sentences? Are there grounds to torture guerillas for information or assassinate them on the battlefield? Is there room (...) for nonlethal weapons to subdue militants and safeguard the lives of noncombatants? Who are noncombatants in asymmetric war? What is the status of civilians who shelter and aid guerillas? And, do guerillas have any right to attack civilians, particularly those who aid and shelter members of the stronger army? If one side can expand the scope of civilian vulnerability, then why can't the other? (shrink)
Because the goal of military medicine is salvaging the wounded who can return to duty, military medical ethics cannot easily defend devoting scarce resources to those so badly injured that they cannot return to duty. Instead, arguments turn to morale and political obligation to justify care for the seriously wounded. Neither argument is satisfactory. Care for the wounded is not necessary to maintain an army's morale. Nor is there any moral or logical connection between the right to health care (a (...) universal human right) and the duty to defend one's nation (a local political duty). Once badly wounded, soldiers enjoy the same right to medical care as any similarly ill or injured individual. National health care systems grasp this point and offer few additional health care benefits to veterans. In the United States, however, lack of universal health coverage skews the debate to focus on special entitlements for veterans without considering the health care rights that other citizens enjoy. (shrink)
Responsible citizens are expected to combine ethical judgement with judiciously exercised social activism to preserve the moral foundation of democratic society and prevent political injustice. But do they? Utilizing a research model integrating insights from rational choice theory and cognitive developmental psychology this book carefully explores three exemplary cases of morally inspired activism: Jewish rescue in wartime Europe, abortion politics in the United States, and peace and settler activism in Israel. From all three analyses a single conclusion emerges: the most (...) politically competent individuals are, most often, the least morally competent. This is the central paradox of political morality. These findings cast doubt on strong models of political morality characterized by enlightened moral reasoning and concerted political action while affirming alternative weak models that fuse activism with sectarian moral interests. They provide empirical support to further upend the liberal vision of democratic character, education, and society. (shrink)
Unlike most Western nations, Israel does not recognize full separation of church and state but seeks instead a gentle fusion of Jewish and democratic values. Inasmuch as important religious norms such as sanctity of life may clash with dignity, privacy, and self-determination, conflicts frequently arise as Israeli lawmakers, ethicists, and healthcare professionals attempt to give substance to the idea of a Jewish-democratic state. Emerging issues in Israeli bioethics—end-of-life treatment, fertility, genetic research, and medical ethics during armed conflict—highlight this conflict vividly.
Although the abortion debate continues to simmer in many places, the general issue of a woman's right to an abortion, at least in the Western democracies, is largely settled. In its place, the question of late-term abortion begins to assume a prominence only recently attributed to abortion itself. The advent of sophisticated fetal screening techniques makes possible detection of potentially severe fetal anomalies that in many cases are detected only late in the pregnancy, resulting in the need for late-term abortion.
Military medical ethics is garnering growing attention today among medical personal in the American and other armies. Short courses or workshops in “battlefield ethics” for military physicians, nurses, medics, social workers, and psychologists address the nature of patient rights in the military, care for detainees, enemy soldiers and local civilians, problems posed by limited resources, ethical questions arising in humanitarian missions, as well as end-of-life issues, ethics consultations, care for veterans, advance directives, and assisted suicide. Although many of these issues (...) are the core subjects of any bioethics curriculum, military medical ethics presents unique challenges to bioethics educators. (shrink)
ABSTRACTAre all forms of guerilla warfare apprehensible? Or can there be such a thing as just guerilla warfare? If so, what would be the reasonable requirements we would make of guerillas in order to consider them just? The remarks below, based on my new book The Ethics of Insurgency; A Critical Guide to Just Guerilla Warfare, summarize my attempts to answer those questions, discussing such issues as legitimate authority, just cause, and compliance with the laws of armed conflict, including the (...) use of human shields and ‘soft-war’ tactics such as cyber warfare. Three commentators thereafter delve into some of the most central critical questions and objections, to which I subsequently reply. (shrink)
Gaucher disease is a rare, chronic,ethnic-specific genetic disorder affecting Jewsof Eastern European descent. It is extremelyexpensive to treat and presents difficultdilemmas for officials and patients in Israelwhere many patients live. First, high-cost,high-benefit, but low volume treatment forGaucher creates severe allocation dilemmas forpolicy makers. Allocation policies driven bycost effectiveness, age, opportunity or needmake it difficult to justify funding. Processoriented decision making based on terms of faircooperation or decisions invoking the ``rule ofrescue'''' risk discriminating against minoritieswho may already suffer from inequitabledistribution of (...) heath care resources. Apartfrom cost, Gaucher disease prompts questionsabout abortion. Unlike severe geneticdisorders, Gaucher offers no grounds forabortion and, in many ways, is analogous togender based abortions that are prohibitedregardless of fetal age. Finally, Gaucherraises concerns about the disclosure of geneticinformation. These affect potential carriersasked to participate in population studies andcarriers and patients who must considerdisclosure to others. These concerns weigh theright to privacy against communal interests andbilateral commitments. (shrink)
Military Medical Ethics for the 21st Century is the first full length, broad-based treatment of this important subject. Written by an international team of practitioners and academics, this book provides interdisciplinary insights into the major issues facing military-medical decision makers and critically examines the tensions and dilemmas inherent in the military and medical professions. In this book the authors explore the practice of battlefield bioethics, medical neutrality and treatment of the wounded, enhancement technologies for war fighters, the potential risks of (...) dual-use biotechnologies, patient rights for active duty personnel, military medical research and military medical ethics education in the 21st Century. (shrink)
Just war theory focuses primarily on bodily harm, such as killing, maiming, and torture, while other harms are often largely overlooked. At the same time, contemporary international conflicts increasingly involve the use of unarmed tactics, employing 'softer' alternatives or supplements to kinetic power that have not been sufficiently addressed by the ethics of war or international law. Soft war tactics include cyber-warfare and economic sanctions, media warfare, and propaganda, as well as non-violent resistance as it plays out in civil disobedience, (...) boycotts, and 'lawfare.' While the just war tradition has much to say about 'hard' war - bullets, bombs, and bayonets - it is virtually silent on the subject of 'soft' war. Soft War: The Ethics of Unarmed Conflict illuminates this neglected aspect of international conflict. (shrink)
Medical ethics prohibits caregivers from discriminating and providing preferential care to their compatriots and comrades. In military medicine, particularly during war and when resources may be scarce, ethical principles may dictate priority care for compatriot soldiers. The principle of nondiscrimination is central to utilitarian and deontological theories of justice, but communitarianism and the ethics of care and friendship stipulate a different set of duties for community members, friends, and family. Similar duties exist among the small cohesive groups that typify many (...) military units. When members of these groups require medical care, there are sometimes moral grounds to treat compatriot soldiers ahead of enemy or allied soldiers regardless of the severity of their respective wounds. (shrink)
Communities are the chief source of philosophical sloppiness these days. Varying endlessly across the entire range of human experience, communities raise the specter of moral relativism that makes ethics sometimes seem a misguided and futile enterprise. Yet the language of communities and their multitude of norms, preferences, and principles present an opportunity, and challenge, to confront abiding moral problems in immeasurably richer and more novel ways. But neither the opportunities nor the challenges were always obvious. On the contrary, the origins (...) of the Enlightenment coincide with an assault on the disharmony posed by restless and unruly communities. (shrink)
Because we are often nagged by the thought that we might not have behaved any differently than those good citizens whose respect for the law and fear of punishment led them to support the Nazi regime, we are fascinated with the behavior of ordinary Germans. Careful to first strip away the pathological explanations of German behavior, Pellegrino and Thomasma ask simply whether ordinary Germans could have reasoned and, by implication, acted differently. Although their affirmative answer is consistent with the activism (...) we have all come to demand of the Germans, it is not clear whether we, ourselves, can lay full claim to the moral high ground. (shrink)
During asymmetric war, state armies must care for their local allies, detainees and the civilian population in two contexts: acute care for those wounded during military operations and medical care for the general population as required by the Geneva Conventions. Constrained by scarce resources, state armies face a number of moral dilemmas that affect care on the ground.Triage. As they deploy, state armies allocate in-theater medical resources to care for their soldiers. In-theater care does not provide for long-term treatment. Its (...) purpose is to return warfighters to active duty or to quickly evacuate them to the US or Europe for comprehensive medical care. Limited beds and personnel make it impossible to provide the local population with the level of care that Western soldiers receive. As a result, the US and other armies develop complex and often arbitrary rules to treat civilians. The inability to provide high-level care to all, creates tensions with local civilians and host country allies.Ensuring local medical care. The Geneva Conventions require occupying armies to “ensure the medical needs of the civilian population.” Specifying these needs is a medical and moral challenge. What level satisfies this requirement? How much aid should the occupying power provide? How best to distribute existing resources? How should state armies protect NGOs that provide significant medical care and often find themselves under attack by insurgents?Medical Diplomacy. While the purpose of medical care is to treat the sick and injured, medical care also serves security needs. Medical care is a long-established tool to win the hearts and minds of the local population. Since the Vietnam War, however, critics have charged that medical diplomacy subverts the purpose of medicine, places medical personnel in the service of war and provides poor medical care. (shrink)