Bioethics and Armed Conflict: Moral Dilemmas of Medicine and War (Basic Bioethics)

401 Pages·2006·1.17 MB·English

by  Michael L. Gross

Bioethics and Armed Conflict
Basic Bioethics
Glenn McGee and Arthur Caplan, editors
Peter A. Ubel, Pricing Life: Why It’s Time for Health Care Rationing
Mark G. Kuczewski and Ronald Polansky, eds., Bioethics: Ancient Themes in
Contemporary Issues
Suzanne Holland, Karen Lebacqz, and Laurie Zoloth, eds., The Human Embryonic Stem
Cell Debate: Science, Ethics, and Public Policy
Gita Sen, Asha George, and Piroska Östlin, eds., Engendering International Health: The
Challenge of Equity
Carolyn McLeod, Self-Trust and Reproductive Autonomy
Lenny Moss, What Genes Can’tDo
Jonathan D. Moreno, ed., In the Wake of Terror: Medicine and Morality in a Time of
Crisis
Glenn McGee, ed., Pragmatic Bioethics,2nd edition
Timothy F. Murphy, Case Studies in Biomedical Research Ethics
Mark A. Rothstein, ed., Genetics and Life Insurance: Medical Underwriting and Social
Policy
Kenneth A. Richman, Ethics and the Metaphysics of Medicine: Reflections on Health
and Beneficence
David Lazer, ed., DNA and the Criminal Justice System: The Technology of Justice
Harold W. Baillie and Timothy K. Casey, eds., Is Human Nature Obsolete? Genetics,
Bioengineering, and the Future of the Human Condition
Robert H. Blank and Janna C. Merrick, eds., End-of-Life Decision Making: A Cross-
National Study
Norman L. Cantor, Making Medical Decisions for the Profoundly Mentally Disabled
Margrit Shildrick and Roxanne Mykitiuk, eds., Ethics of the Body: Post-Conventional
Challenges
Alfred I. Tauber, Patient Autonomy and the Ethics of Responsibility
David H. Brendel, Healing Psychiatry: Bridging the Science/Humanism Divide
Jonathan Baron, Against Bioethics
Michael L. Gross, Bioethics and Armed Conflict: Moral Dilemmas of Medicine and War
Bioethics and Armed Conflict
Moral Dilemmas of Medicine and War
Michael L. Gross
The MIT Press
Cambridge, Massachusetts
London, England
© 2006 Massachusetts Institute of Technology
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Library of Congress Cataloging-in-Publication Data
Gross, Michael L., 1954–
Bioethics and armed conflict : moral dilemmas of medicine and war / Michael
L. Gross.
p. cm.—(Basic bioethics)
Includes bibliographical references and index.
ISBN 0-262-07269-6 (alk. paper)—ISBN 0-262-57226-5 (pbk. : alk. paper)
1. Medical ethics. 2. Military ethics. 3. War. 4. Medicine, Military—Moral
and ethical aspects. I. Title. II. Series.
R724.G76 2006
2005056158
10 9 8 7 6 5 4 3 2 1
For my brother, Larry, who fought disease valiantly

Contents
Series Foreword xi
Preface xiii
1 Setting the Stage 1
The Role of Medicine in Armed Conflict 3
Military Ethics and Humanitarian Law 6
Contemporary Biomedical Ethics 11
Moral Dilemmas of Medicine and War 14
2 The Ethics of Medicine and the Ethics of War 27
Life, Dignity, and Utility 28
The Right to Life 32
Autonomy and Dignity 44
Dignity: An Absolute Moral Right? 49
Utility: Limiting Harm and Achieving Good 56
Bioethics, War, and Necessity 62
3 Medical Care for the Wounded 65
Evacuating and Treating the Wounded 67
Why Treat the Wounded? 70
Medical Care and Military Necessity 71
Medical Care and Morale 76
Medical Care and Political Obligation 84
The Limits of Military Medical Care 99
4 Patient Rights for Soldiers 101
Informed Consent during Armed Conflict 102
Confidentiality 116
viii Contents
Battlefield Euthanasia and the Right to Die 125
Patient Rights in War and Peace 134
5 Wartime Triage 137
The Moral Dilemmas of Triage 138
Triage, Medical Need, and Military Utility 141
Distributing Medical Knowledge to the Enemy 154
Alternatives to Triage 166
Tragedy and Triage: A Second Look 171
6 Medical Neutrality 175
Medical Neutrality and Armed Conflict 175
Medical Neutrality and Unconventional Conflict 181
Medical Immunity in the Palestinian-Israeli Conflict 187
Medical Impartiality in the Vietnam War 198
The Challenge of Medical Neutrality 208
7 Torture, Ill-Treatment, and Interrogation 211
The Dilemma of Torture 212
Torture, Ill-Treatment, and Terror 215
Justifying Torture and Ill-Treatment 218
Torture and the Role of Physicians 230
The Shame of Torture 242
8 Chemical and Biological Warfare 245
Historical Overview 247
The Inhumanity of Chemical and Biological Weapons 252
Bioethics and Unconventional Deterrence 263
Nonlethal Chemical and Biological Weapons 271
Weapons Development and the Medical Community 281
9 Bioethics and the End of Armed Conflict 287
Pacifism, Peace, Medicine, and War 287
Vocational Pacifism 289
Physician-Assisted Draft Evasion 297
Medicine and Pacificism: The Quest for World Peace 309
The Lure of Pacifism and Peace 318
10 The Moral Dilemmas of Medicine and War 323
The Transformation of Ethics during War 323
Contents ix
The Transformation of Medical Ethics during War 325
Armed Conflict and Professional Obligation 332
Notes 339
References 343
Index 367