Military Medical Ethics in Contemporary Armed Conflict: Mobilizing Medicine in the Pursuit of Just War

by Michael L. Gross

Overview

Beleaguered countries struggling against aggression or powerful nations defending others from brutal regimes mobilize medicine to wage just war. As states funnel medical resources to maintain unit readiness and conserve military capabilities, numerous ethical challenges foreign to peacetime medicine result. Force conservation drives combat hospitals to prioritize warfighter care over all others. Civilians find themselves bereft of medical attention; prison officials force feed hunger-striking detainees; policymakers manage healthcare to win the hearts and minds of local nationals; and scientists develop neuro-technologies or nanosurgery to create super soldiers.

When the fighting ends, intractable moral dilemmas rebound. Post-war justice demands enormous investments of time, resources and personnel. But losing interest and no longer zealous, war-weary nations forget their duties to rebuild ravaged countries abroad and rehabilitate their war-torn veterans at home.

Addressing these incendiary issues, Military Medical Ethics in Contemporary Armed Conflict integrates the ethics of medicine and the ethics of war. Medical ethics in times of war is not identical to medical ethics in times of peace, but a unique discipline. Without war, there is no military medicine, and without just war there is no military medical ethics. Military Medical Ethics in Contemporary Armed Conflict revises, defends, and rebuts wartime medical practices, just as it lays the moral foundation for casualty care in future conflicts.

Product Details

ISBN-13:	9780190694944
Publisher:	Oxford University Press
Publication date:	06/04/2021
Pages:	352
Product dimensions:	6.40(w) x 9.50(h) x 0.90(d)

About the Author

Michael L. Gross is Professor of Political Science at The University of Haifa, Israel, specializing in military ethics and military medical ethics and related questions of national security. His articles have appeared in numerous prominent journals, and his books include Ethics and Activism (Cambridge, 1997), Bioethics and Armed Conflict (MIT Press, 2006), Moral Dilemmas of Modern War (Cambridge, 2010); The Ethics of Insurgency (Cambridge, 2015) and two edited volumes, Military Medical Ethics for the 21st Century (Routledge, 2013) and Soft War (Cambridge, 2017). He is editor of the Routledge book series War, Conflict and Ethics and has led workshops on battlefield ethics, medicine, and national security for the Dutch Ministry of Defense, The US Army Medical Department, the Defence Medical Services (UK), The US Naval Academy, the Israel Defense Forces and the International Committee of Military Medicine.

Table of Contents

Introduction
Part I: THEORY: Military Medical Ethics and Just War
Chapter 1: The Principles of Military Medical Ethics
Chapter 2: Patient Rights and Practitioner Duties
Chapter 3: Moral Reasoning in Military Medical Ethics

Part II: ON THE BATTLEFIELD: Caring for the Wounded of War
Chapter 4: Military Medicine in Contemporary Armed Conflict: Iraq and Afghanistan Revisited
Chapter 5: Combat Casualty Care
Chapter 6: Detainees and Prisoners of War
Chapter 7: Care and Compensation for Civilian Victims of War

Part III: OFF THE BATTLEFIELD: Medicine as Weapon of War
Chapter 8: Military Medical Research and Experimentation
Chapter 9: Warfighter Enhancement: Research and Technology
Chapter 10: Medical Diplomacy and the Battle for Hearts and Minds

Part IV: AFTERWAR: Post-War Justice and the Responsibility to Rebuild
Chapter 11: Post-War Health Reconstruction
Chapter 12: Veteran Healthcare
Conclusion: Military Medical Ethics and Just War: The 21st Century

Editorial Reviews

"Gross's book will undoubtedly serve as a mainstay among practitioners and theorists alike. Though it focuses almost exclusively on the United States and the United Kingdom in the Middle Eastern wars of the past two decades, much of the discussion applies to a host of other contexts as well. Though the book is capacious in its treatment of topics pertaining to military ethics, there is a univocal thesis animating the discussion at each turn: the idea that military medical ethics is not a disjunctive discipline with Janus-faced loyalties to medical ethics on the one hand and to military ethics on the other, but instead a sui generis discipline in its own right, which he painstakingly develops... Gross's book will, I believe, set the agenda among practitioners and theorists of medical ethics in war for years to come. It is a monumental achievement." — Bioethics

"Philosophically sophisticated, well written, and thoroughly researched, this comprehensive exploration of military medical ethics will interest students of medical ethics more generally and be a particularly valuable contribution for scholars seeking to explore the ethics of war and the often-overlooked medical ramifications of just-war thinking." — L. Steffen, CHOICE

"Michael Gross has dared to do what few have done—bring the ethics of going to war in line with the obligations of modern medicine. This is no simple merger of military and medical ethics. It is a new field. And those who study war, go to war, or provide medical care for those injured in war will be indebted to Gross's meticulous scholarship and lucid and critical analysis of scores of complex case studies from recent wars." — Nancy Sherman, author Stoic Wisdom: Ancient Lessons for Modern Resilience and University Professor and Professor of Philosophy, Georgetown University

"Michael L. Gross has developed the most comprehensive framework for the analysis of bioethics issues in the military setting. This book, taking into account the changing nature of armed conflict in the 21st century, will be the authoritative reference point for many years to come." — Jonathan D. Moreno, David and Lyn Silfen University Professor, University of Pennsylvania

From the Publisher

Reviewer: Donal O'Mathuna, PhD, MA (The Ohio State University College of Nursing)
Description: This book addresses the medical ethical issues that arise during war. The premise is that medical ethics cannot just be adapted to war settings, or that military ethics can simply be merged with medical ethics. Rather, the book describes military medical ethics as radically different from civilian medical ethics. The author's approach is that military medical ethics develops out of the principles of just war. Without just war, military medicine does not have ethical moorings. The book develops this argument in both theoretical and practical detail.
Purpose: The purpose of this book is to guide those involved with war on any level on how medicine ought to be used during the war. The book examines some of the challenging ethical dilemmas of medicine during war, such as how to distribute limited resources, how to decide which injured people should receive care first, whether medical research should be conducted during war, whether medical care should be used to win local hearts and minds, etc. The book also seeks to examine how the realities of 21st-century armed conflict impact military medical ethics. These are important goals and challenges given how recent wars have turned healthcare providers and facilities into military targets. Twenty-first century wars have also made it more difficult to distinguish between civilians and combatants, with humanitarian medical care organizations getting caught in the middle. These and many other dilemmas are tackled in this book, with the author providing a helpful and practical approach to addressing them. In this way, the book meets its objectives very well.
Audience: The book is written for those leading and studying military medicine. The book provides an excellent theoretical and practical exploration of the ethical dilemmas that will be faced by anyone delivering or managing health care in a war setting. Graduate students in bioethics will also find this an excellent book to explore medical ethics in far-from-ideal circumstances. The book will provide readers with both an excellent and thorough theoretical grounding in military medical ethics, along with practical ways to implement its approach. The author has an extensive background in ethics during war. He has written many articles and books in the area and has also provided training to numerous military medical services in Israel, Europe, and the U.S.
Features: The book is divided into four main parts. Part I addresses the theoretical foundations of the book. The author describes the principles of just war and elaborates on their impact with two principles that are significant for military medical ethics. One is broad beneficence, which expands the concern for individual good in medical ethics to include the good of others, including all those impacted by war. The second is military-medical necessity, which directs military-medical ethics in pursuing the least costly means of pursuing a just war. These principles extend the focus of medical ethics beyond the individual patient to collective welfare and introduce distinct ethical dilemmas around patient rights and providers' duties during war. Part II examines the ethical challenges that arise when caring for the wounded during war. This section examines how the recent wars in Iraq and Afghanistan impacted medical care and brought novel ethical dilemmas. These include deciding who to care for when patients encompass one's own forces, those of hostile forces, and civilians. The revelations from Abu Ghraib raised questions about the ethical treatment of detainees. Other ethical dilemmas arose from the injuries and illnesses of civilians and the ethical responsibilities of military medicine facilities when civilian healthcare facilities have been decimated. Part III looks at ways medicine can be used as a tool for war. One chapter examines the ethical issues with medical research during war where the goal is developing better therapeutic interventions for treating war injuries and trauma. Another focuses on enhancement research where the goal is not therapy, but enhancement of natural skills and abilities. Some of these include new pharmaceuticals, and others the use of external and invasive devices to improve fighters' effectiveness. Also examined are the ethical issues with using medical care as a tool of diplomacy or to win the hearts and minds of civilians. Part IV examines some of the ethical issues that arise after war. These include those arising from efforts to reconstruct healthcare systems after war, and the care of veterans of the war.
Assessment: The book achieves an excellent balance in providing theoretical grounding for the multiple ethical dilemmas addressed. While other dilemmas exist, the decision-making approach is well-demonstrated in the several examples chosen. The book is very well written, organized effectively, and maintains an engaging approach to presenting important background details to allow non-military readers to understand the dilemmas.

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