Abstract

In lieu of an abstract, here is a brief excerpt of the content:Editors’ NoteJames M. DuBois, Ana S. Iltis, and Heidi A. Walsh“A terrible and awful morning found me on duty in this hospital near Kharkov—the sounds of explosions, shock waves, the smell of burning—and all at the same time. My thoughts turned into a swarm of bees. This is a war,” relays Artem Riga, a general surgeon living and working in Ukraine. “Within a short time after the explosions, adults and children with numerous injuries and wounds began to enter the hospital. How to help so many wounded at the same time? There was an acute shortage of medical personnel, medical materials, and painkillers. It was difficult for me to sort the patients according to the severity of their injuries. I was the only surgeon on duty.”This final NIB issue of volume 13 includes 12 stories written by people who have worked—or are currently working—to help the sick and injured receive healthcare during armed conflicts. The authors include physicians, health researchers, medical laboratory workers, an emergency medical technician who is now a physician, and a cancer care non-profit director. Three additional powerful narratives from a pediatric palliative care physician, a family physician and manager of an international humanitarian organization, and a psychotherapist are published in the online supplement.“This symposium sought to bring attention to the courageous men and women who serve in these difficult circumstances,” write Dónal O’Mathúna, Thalia Arawi, and Abdul Rahman Fares, the symposium editors. “We wanted to give them a place to have their voices heard as they describe how they have faced their challenges and ethical dilemmas.”The symposium includes four expert commentary articles written by Melissa McRae & Maria Guevara, Esime A. Agbloyor, Michael L. Gross, and Kim Thuy Seelinger. The commentary authors are experts in armed conflict and forced displacement, political science, military medical ethics, and the moral dilemmas of modern war. Agbloyor imparts that “The greatest lesson we can come away with from these stories is that we must not be silent— these stories are about people; people with names, faces, and families; and people who lose their lives in war. They are not just statistics. Beneath the statistics are actual people.”Thank you to the Neiswanger Institute for Bio-ethics, the Departments of Physiology and Medical Education, and the Graduate School of Loyola University Chicago, the Ohio State University College of Nursing, and the Salim El-Hoss Bioethics & Professionalism Program, American University of Beirut for sponsoring the symposium.This issue of NIB includes two case studies. The first, “Jehovah’s Witnesses and the Normative Function of Indirect Consent,” was submitted through our case study partnership with the Ethics Center at UCLA Health. The author, Joanna Smolenski, explores the case of Mr. A, a 65-year-old Jehovah’s Witness with chronic vertebral osteomyelitis—a spine infection often caused by Staphylococcus aureus bacteria. Mr. A needs surgery to remove the infected tissue; however, before going to the OR, he is unwilling to either consent to or refuse blood transfusion. The team anticipates that Mr. A will lose 1–2 liters of blood during the surgery, so the necessity of a transfusion is near certain. [End Page vii] By refusing to sign the consent form permitting transfusion or the consent form denying it, Mr. A seemingly wishes to delegate the decision to his healthcare team. Because of this, the ethics team is brought in to help determine if it is morally justifiable to proceed with blood transfusion without Mr. A’s explicit, documented consent. Smolenski argues that indirect consent—delegating decision-making without explicitly consenting to any course of action—may be sufficient for discharging the clinician’s ethical obligation to obtain consent. The author writes, “This type of setup could mitigate the feeling of burden associated with making a challenging or controversial choice by shifting the perceived responsibility for the decision to someone else. It can also protect vulnerable decision-makers from being blamed or punished for making choices that might be seen as wrong by somebody else.”The second case study in this issue was submitted through our new partnership with the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s...