Bioethics and Armed Conflict: Mapping the Moral Dimensions of Medicine and war‪.‬

Medical ethics in time of armed conflict are identical to medical ethics in time of peace," declares the World Medical Association. (1) Were this the case, wartime and peacetime medicine would turn on the same principles and present similar dilemmas. But war fundamentally transforms the major principles and central issues that engage bioethics. A patient's rights to life and self-determination contract; human dignity strains under the barrage of military necessity; and the interests of the state and political community may outweigh considerations of patients' welfare. Also, actors and interests multiply. Combatants and noncombatants, enemies and allies, states and individuals, citizens and soldiers, prisoners of war, the wounded and the dying, those who can return to combat duty and those who cannot--all of these litter the battlefield. Armed conflict augments the general principles of bioethics with those peculiar to the conduct of war. For instance, states are obliged to recognize noncombatant immunity, minimize collateral damage, and adhere to a principle of proportionality, when fighting threatens to take the lives of civilians and destroy their property, if difficult bioethical dilemmas arise when fundamental moral principles conflict, war adds novel dimensions of its own, as competing bioethical principles must contend not only with one another, but also with the overriding "reason of state" and military necessity that animate any issue of military ethics and may overwhelm other fundamental moral obligations.