In 2004, the World Medical Association declared that “medical ethics in times of armed conflict is identical to medical ethics in times of peace.” Gross, an ethicist at the University of Haifa, takes issue with this conclusion. “Military personnel do not enjoy a right to life, personal autonomy, or a right to self-determination to any degree approaching that of ordinary patients,” he observes. While bioethics focuses on the rights of an individual, military necessity places paramount authority in the state.
Many bioethicists, insulated by peace, wallow in theory and philosophy. Living in Israel—in Haifa, at that—and facing war, Gross infuses his study with reality. As commentators and human rights activists criticize U.S. participation in Iraq and Israeli actions, Gross examines a number of bioethical quandaries that have consequences for contemporary militaries and physicians. He offers rich historical background.
While doctors pledge to do no harm, war creates dilemmas. Is it right for surgeons to operate in order to enable soldiers to return to harm’s way? The Geneva Conventions imply triage to be based upon the principle of need, but the North Atlantic Treaty Organization (NATO) prioritizes triage by ability to salvage soldiers. More broadly, Gross examines whether policymakers have an obligation to always preserve soldiers’ lives, or whether soldiers forfeit a right to life when they enlist. Can policymakers sacrifice soldiers or order them to take extreme risks? He also explores ethical dilemmas of resource allocation in cases where having more doctors means skimping on essential nonmedical equipment.
For Middle East specialists, Gross’s treatment of asymmetric warfare and the distinctions between combatants and noncombatants is a must-read. He illustrates theoretical discussions with examples drawn from the Iran-Iraq war and the Arab-Israeli conflict. For example, how should armies balance the need to protect medical facilities in combat zones when Palestinian terrorists use them as firing bases? What obligation is Israel under to allow medical access to besieged cities when terrorists ferry weapons and personnel in U.N. ambulances?
Gross also addresses issues such as the role of medical professionals in interrogations and ethical dilemmas posed by torture. With real-world examples, he explores the ethics behind the “ticking bomb scenario” when rigorous interrogation has prevented attacks by Palestinian terrorists. Also interesting is his discussion of the ethics of non-lethal chemical or biological weapons. Can doctors participate in studies that determine the greatest non-lethal level of incapacitation enemy soldiers can endure in the course of battle? What if such weapons affect civilians in urban combat?
The real value of Gross’s book, though, is that he neither preaches nor resorts to demolishing straw-man arguments but rather seeks to outline contrasting arguments fairly. He discusses preexisting academic theories but does so without excessive jargon, making his book accessible to a wide audience. As such, Bioethics and Armed Conflict becomes an invaluable manual addressing some of the ethical issues of the day, useful not only for Middle Eastern specialists and military commanders but also for physicians and the general reader.
