You are struggling to justify your country’s involvement in a war you · Medical

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5 You are struggling to justify your country’s involvement in a war you believe to be unwinnable. How do you cope?

Specific Topic(s):

• The covers the legality of ‘going to war’, ‘conduct in war’, the issue of personal conscience and finally the challenge of ‘coping’.

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’ –

Serials:

3. The primary task of health-care personnel is to preserve human physical and mental health and to alleviate suffering.

5. No matter what arguments may be put forward, health-care personnel never accept acts of torture or any other form of cruel, inhuman or degrading treatment under any circumstances, including armed conflict or other emergencies. They must never be present at and may never take part in such acts.

12. In fulfilling their duties and where they have the legal right, health-care personnel are identified by internationally recognized symbols such as the Red Cross, Red Crescent or Red Crystal as a visible manifestation of their protection under applicable international law.

Geneva Conventions:

This question considers both the legal basis by which states decide to go to war (jus ad bello) and then by which they conduct war (jus in bello). The four Geneva Conventions and Additional Protocols cover the behaviours of parties in conflict and so they are all relevant to this question.

ICRC material on War and Law is at: https://www.icrc.org/en/war-and-law

Customary IHL:

See above

Ethical principles:

WMA STATEMENT ON ARMED CONFLICTS at: https://www.wma.net/policies-post/wma-statement-on-armed-conflicts/

2. Physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequences, including the impact on health, of their decisions on the commencement or continuation of armed conflict.

7. Physicians should seek, during conflicts, to influence parties in order to alleviate the suffering of populations.

Discussion:

Review of the question: this question encourages you to consider your personal motivations, choices and coping behaviours during service in the armed forces including during conflict.

Interpretation of the principles/policy from the references:

• Military healthcare personnel are present on the battlefield to alleviate suffering, their presence is not a justification of the conflict.

• Military healthcare personnel are afforded rights and responsibilities under international humanitarian law (IHL) in order to enable them to fulfil their role.

• Military medical personnel are not ethically obliged to agree with the decision to go to war but are obliged to follow legal military orders to be employed in support of military operations.

• Military medical personnel are ethically and legally obliged to comply with the Geneva Conventions.

Framework for answering the scenario/question:

• Consider the stages in your decision to become a healthcare worker in conflict zone: recruitment to the armed forces (or your parent organization), choice of career field, choice of assignment, choice for deployment, choice to remain in service?

• What are the differences in personal choices between a conscript force and a volunteer force?

• What are your obligations under military law to serve on military operations?

• What are your separate obligations as a protected person under IHL?

• How might you express your disagreement with government or military policies?

• Should you resign from the armed forces?

• How might you protect your mental health?

Further discussion points:

• What aspects of the WMA Statement on Armed Conflicts would conflict with the duties of a health professional in the armed forces?

• What is ‘moral injury’, how does the concept link to this scenario?

Author: Professor Martin Bricknell