Now I know why so many stories have been written with the theme: “everything changed in one moment.” More than 1,000 days have come and gone, and I still remember one Sunday morning and still follow and feel the effects of one decision.

This paper examines the question whether physicians are obligated by their professional ethos to defend a pacifist position. The question is a more concrete and applied formulation of the general thesis that there are what I will call “pacifist professions”: professions whose ethos requires their members to act in a pacifist way. Since the present paper is rather one in applied philosophy than a theoretical one about the foundation of pacifism, it will concentrate on the practical issue of whether and (...) how physicians can execute their profession in or during war. Theoretical questions on the nature and extent of pacifism will be considered only to the extent necessary to treat the main issue. The introductory section will give a short overview of some histori- cal aspects of physicians’ participation in war and show the relevance of the issue with recent examples. The remainder of this section will thus serve to set the stage and to outline the connections between the medical profession and questions of war and peace. The paper will then be divided into three other main parts: the first part will be devoted to defining in a general manner so-called “professional pacifism”. The second part will investigate whether and to what extent the medical profession can be classified as a pacifist profession, and the third part will look at the consequences of such a classification. (shrink)

On October 25, 1946, three weeks after the International Military Tribunal at Nuremberg entered its verdicts, the United States established Military Tribunal I for the trial of twenty-three Nazi physicians. The charges, delivered by Brigadier General Telford Taylor on December 9, 1946, form a seminal chapter in the history of medical ethics and, specifically, medical ethics in war. The list of noxious experiments conducted on civilians and prisons of war, and condemned by the Tribunal as war (...) crimes and as crimes against humanity, is by now more or less familiar. That list included: high-altitude experiments; freezing experiments; malaria experiments; sulfanilamide experiments; bone, muscle, and nerve regeneration and bone transplantation experiments; sea water experiments; jaundice and spotted fever experiments; sterilization experiments; experiments with poison and with incendiary bombs. What remains less familiar is the moral mindset of doctors and health care workers who plied their medical skill for morally questionable uses in war. In his 1981 work, The Nazi Doctors, Robert Jay Lifton took up that question, interviewing doctors, many of whom for forty years continued to distance themselves psychologically from their deeds. The questions about moral distancing Lifton raised have immediate urgency for us now. Military medical doctors, psychiatrists and psychologists serve in U.S. military prisons in Guantánamo, Abu Ghraib, Kandahar, and, until very recently, in undisclosed CIA operated facilities around the world where medical ethics are again at issue. Moreover, they serve in top positions in the Pentagon, as civilian and military heads of command, who pass orders and regulations to military doctors in the field, and who are in charge of the health of enemy combatants, as well as U.S. soldiers. Because we recently marked the sixtieth anniversary of the judgment at Nuremberg, I want to awaken our collective memory to the ways in which doctors in war, even in a war very different from the one the Nazis fought, can insulate themselves from their moral and professional consciences. (shrink)

The controversy over abusive interrogations of prisoners during the war against terrorism spotlights the need for clear ethics norms requiring physicians and other clinicians to prevent the mistreatment of prisoners. Although policies and general descriptions pertaining to clinical oversight of interrogations in United States' war on terror prisons have come to light, there are few public records detailing the clinical oversight of an interrogation. A complaint by the Federal Bureau of Investigation (FBI) led to an Army investigation of an (...) interrogation at the United States prison at Guantanamo Bay. The declassified Army investigation and the corresponding interrogation log show clinical supervision, monitoring and treatment during an interrogation that employed dogs, prolonged sleep deprivation, humiliation, restraint, hypothermia and compulsory intravenous infusions. The interrogation and the involvement of a psychologist, physician and medics violate international and medical norms for the treatment of prisoners. (shrink)

There are a range of ethical issues that confront physicians in times of war, as well as some of the uses of physicians during wars. This book presents a theoretical apparatus which undergirds those debates, namely by casting physicians as being confronted with dual-loyalties during times of war. While this theoretical apparatus has already been developed in other contexts, it has not been specifically brought to bear on the ethical conflicts that attain in wars. Arguably, wars thrust physicians into ethical (...) conflicts insofar as these wars create a tension between a physician's obligation to heal and an obligation to serve some other good (e.g., military chain of command, national security, the greater good, etc.). Alternatively, we can debate whether this conception is appropriate. For example, one could argue that that non-medical duties cannot attach to physicians (e.g., due to nonoverlapping spheres of justice), thus abrogating the dual-loyalty challenge. Or else one could argue that these medically-trained personnel do not act qua physicians at all (but rather partisan advocates) and therefore duties that would otherwise attach to physicians do not attach here. In the first part of this book, these issues are debated. In the second part of the book, the dual-loyalities frame is used to explore various substantive debates that obtain when the military makes use of physicians. Physician involvement in torture is a heated topic, and certainly the most visible element of the debate. Also, however, we could use the dual-loyalties framework to explore issues in other arenas, such as: development of chemical and biological weapons, medical neutrality/battlefield triage, and so on. In each of these cases, the same tensions arguably exist: physicians have duties both to their patients and elsewhere (which, depending on the details of the view, could be any of the above-mentioned ends). (shrink)

Changing faces of war and war-like situations have led in recent years to new forms of military deployment. They range from the so called "war on terrorism" with e.g Operation Enduring Freedom or humanitarian interventions (e.g. Kosovo 1999) to deployments within disaster relief missions as lately in Haiti. These pose not only moral, legal, and organizational challenges to states and the international community but also put individual soldiers and military (medical) personnel in situations that their classical formation does not (...) prepare them for. For they face (i) situations not sufficiently covered/ regulated by international humanitarian (IHL) law and/or (ii) tasks that are not within the range of the "classical soldier". These changing needs require new forms of education in the military and highlight the role of ethical education as many of the dilemmas cannot be resolved by sole reference to the IHL. In addition to a solid knowledge of the law of armed conflict (LOAC), military personnel should therefore acquire fundamental skills of ethical reasoning in dilemma situations. Our article aims at (i) outlining the goals of a military medical ethics education that responds to these needs and the practical challenges of present-day military deployment and (ii) present how the ICMM tries to integrate these goals in its educational program. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Ethics in a Time of De-CommunizationRobert Baker (bio)Ethics is often treated as a matter of ethereal principles abstracted from the particulars of time and place. A natural correlate of this approach is the attempt to measure actual codes of ethics in terms of basic principles. Such an exercise can be illuminating, but it can also obscure the circumstances that make a particular codification of (...) morality a meaningful response to specific historic circumstances. This is particularly true of the codes of medical ethics beginning to emerge from the post-Communist societies of Eastern Europe, which are, perhaps, best understood as artifacts of an era, rather than as expressions of abstract principles.The era in question is post-Communist. It is an era informed by a reaction to decades of Communism, which, of course, was more than an economic system or even an ideology; it was a form of life that permeated every aspect of civil society—advertising, art, literature, music. Medicine was not exempt. I recall entering an oncology ward in East Berlin and finding the patients seated around a large table making posters. Wondering whether this was a form of art therapy, I asked the head nurse what the patients were doing. She replied: it is "Party time—the portion of each week every citizen donates to the people and the Party." I looked again at the posters and saw that they honored Karl Marx on the 100th anniversary of his death: "1883-1983, The Struggle Goes On." The Party, the struggle, the people, were everywhere, and they penetrated and informed daily life even for terminal patients on a cancer ward.The interweaving of Communist practices into the warp and woof of daily life has profound implications for the post-Communist era. It means that East Europeans cannot simply rebuild; they must unweave Communist thought patterns—what might be called the ideostructure of Communism—from the fabric of their lives through a deliberate process of deCommunization. What remains after de-Communization depends upon [End Page 363] the historical relationship each country had with Communism. In Russia, removing Communist ideostructure sets the conceptual calendar back to 1918. For the Czechs, the calendar advances to the 1930s, leaving them with thought patterns that are Western, industrial, and democratic. In the rest of Eastern Europe the conceptual clock also tends to turn back to the 1930s, but at that time the conceptual frameworks were nationalist, anti-Western, and frequently fascist, or even Nazi.In Poland the situation is different. World War II opened with the Nazi invasion of the country—which Hitler (later joined by Stalin) subsequently occupied. After the war, the Soviet army controlled the country, which became a captive player in the Soviet sphere of influence (aptly denominated, "the Warsaw Pact"). Poland's pre-Communist thought patterns are nationalist, West-leaning, accepting of parliamentary structures, but also of authoritarian government. They are also Catholic.Catholicism to Poles is not merely a religion, it is a posture of opposition to their German (Nazi, antichristian) and Russian (Orthodox or atheist) occupiers. I toured Polish hospitals several times during the Communist period —always accompanied by one or more "tour guides." (Westerners were not allowed to roam Communist countries unescorted.) Almost all of my guides wore little pins adorned with the face of Lenin (not the hammer and sickle—a symbol of Soviet occupation). Most doctors and nurses, however, adorned themselves with Catholic icons—typically a crucifix. Their conspicuously displayed crosses symbolized less their embrace of Catholicism than their rejection of Communism. Catholicism, in the Polish context, was thus an affirmation of individual and national independence.De-Communizing Polish Medical Ethics: The Abortion ControversyIn Poland, de-Communization was initiated through a series of negotiations between Lech Walensa's Solidarity and the Communist Government. The Polish Code of Medical Ethics is an indirect consequence of these negotiations, which stipulated the dissolution of Communist medical organizations. They were to be replaced by a Polish Medical Chamber—a type of quasi-governmental body, common in Eastern Europe, which combines the functions of a governmental licensing agency with those of a national medical association. Medical chambers also set standards of professional conduct and (unlike... (shrink)

We write in response to the original article by Rennie and Rudland published in the April 2003 edition of this journal.1 Current and former Dundee Medical School students are concerned at the media misinterpretation of the study and the consequences that this branding of “dishonesty” will have on Dundee Medical School’s reputation and also on individuals embarking on their ….

Eduard Seidler sets his discussion of the teaching of medical ethics in the Federal Republic of Germany against an historical background. Immediately after the Second World War the freshness of the memory of the 'Nuremberg Medical Trials' influenced the way in which moral dilemmas were treated in Germany. At the present time no systematic instruction in medical ethics is provided in either undergraduate or postgraduate or continuing medical education. As a result of this, an (...) inquiry was set up in 1977/78. Questionnaires were sent out with a view to collecting information on how subjects referring to medical ethics are treated during medical training. The inquiry showed that no special discipline can claim to be the only competent one for medical ethics, but that everyone has something to contribute. Dr Seidler concludes by stating that basic curricula related to the problems of medical ethics would have to be developed and should be carried on continuously within the training programme. (shrink)

Introduction: making the invisible visible -- The nobility of the material -- Research at war -- The guilded age of research -- The doctor as whistle-blower -- New rules for the laboratory -- Bedside ethics -- The doctor as stranger -- Life through death -- Commissioning ethics -- No one to trust -- New rules for the bedside -- Epilogue: The price of success.

The “Universal Declaration of Human Rights” and the “Geneva Declaration” by the World Medical Association, both in 1948, were preceded by the foundation of the United Nations in New York (1945), the World Medical Association in London (1946) and the World Health Organization in Geneva (1948). After the end of World War II the community of nations strove to achieve and sustain their primary goals of peace and security, as well as their basic premise, namely the health of (...) human beings. All these associations were well aware of the crimes by medicine, in particular by the accused Nazi physicians at the Nuremberg Doctors Trial (1946/47, sentence: August 1947). During the first conference of the World Medical Association (September 1947) issues of medical ethics played a major role: and a new document was drafted concerning the values of the medical profession. After the catastrophe of the War and the criminal activities of scientists, the late 1940s saw increased scrutiny paid to fundamental questions of human rights and medical ethics, which are still highly relevant for today’s medicine and morality. The article focuses on the development of medical ethics and human rights reflected in the statement of important persons, codes and institutions in the field. (shrink)

This book debates competing approaches to ethical decision-making for members of the armed forces of liberal-democratic states. In this volume, four prominent thinkers propose and debate competing approaches to ethical decision-making for military personnel. Deane-Peter Baker presents and expounds the 'Ethical Triangulation' model, an ethical decision-making method he has employed through much of his career as an applied military ethicist. Rufus Black advocates for a natural law-based approach, one which has heavily influenced the framework formally adopted by the Australian Defence (...) Force. Roger Herbert outlines the 'Moral Deliberation Roadmap', the moral reasoning framework recently adopted by the US Naval Academy. Iain King then sets out a model of quasi-utilitarian decision-making developed in several post-conflict settings and refined at the UK's Royal College of Defence Studies. After the opening chapters in which each author outlines their favoured decision-making approach, the four contributors then evaluate each other's proposals, often critically. Philosopher David Whetham offers some concluding thoughts in which he summarises areas of agreement between the authors, identifies key areas of difference, and suggests directions for future research. This book will be of great interest to students of military ethics, the ethics of war, moral philosophy, and International Relations, as well as military professionals. (shrink)

Questions concerning the role of doctors, abortion, mercy killings and genetics are troubling and highly problematic. They require a thorough examination and careful probing. This volume takes a step towards tackling them. Its design is both interdisciplinary and comparative, offerin g philosophical, legal and medical perspectives of scholars from North America, Europe and Israel who analyze how their respective countries try to cope with and find answers for pressing concerns.

1988 : Does being a Christian physician really matter? / Edmund D. Pellegrino, response by John Robinson -- 1989: Clinical medical ethics: a review of the first decade / Mark Siegler, response by Maura Ryan -- 1990 : Who or what is an embryo? / Richard McCormick, response Margaret Monahan Hogan -- 1991: Euthanasia: Where is the debate going? / Daniel Callahan, response by Paul Weithman -- 1992: The moral inevitability of two tiers of health care / H. (...) Tristram Engelhardt, Jr., response by Joel James Shuman -- 1993: Compasionate care of the dying / James F. Bresnahan, response by John Young. (shrink)

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation, or signs of torture. Mounting information from many sources, including Pentagon documents, the International Committee of the Red Cross, Amnesty International, Human Rights Watch, etc., indicate that medical personnel failed to maintain (...) medical records, conduct routine medical examinations, provide proper care of disabled and injured detainees, accurately report illnesses and injuries, and falsified medical records and death certificates. Medical personnel and medical information was also used to design and implement psychologically and physically coercive interrogations. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism. (shrink)

I end with another parable, but it is also a true story. Harvey Gushing, the famous surgeon after whom the Gushing Lectures are named, made an international reputation in his allegiance to quality. He badgered his profession to a higher standard of self-effacement and railed against the debasement of clinical skills and overemphasis on research and pursuit of personal gain. We honor him to this day because those were, and remain, important points. Yet, Harvey Gushing served as a surgeon during (...) World War I and at Ypres. Although the Allied mortality was as much as 50,000 soldiers a day, not counting the wounded, Gushing refused to operate on any more than two patients each day, arguing that to do so would have lowered his standard of care for his patients a – standard that made sense in one time but that became strikingly insensitive, and I suggest even unethical, in another when confronted with a different reality. (shrink)

This book examines the extremely important issue of the consistency of medical involvement in ending lives in medicine, law and war. It uses philosophical theory to show why medical doctors may be involved at different stages of the capital punishment process. The author uses the theories of Emmanuel Kant and John S. Mill, combined with Gerwith's principle of generic consistency, to concretize ethics in capital punishment practice. This book does not discuss the moral justification of capital punishment, (...) but rather looks at the possible forms of involvement and shows why consistency would demand medical involvement. The author takes a general approach, using arguments that may apply universally. The book broaches different academic fields, such as medicine, ethics, business, politics and defense. The Ethics of Medical Involvement in Capital Punishment is of interest to students, teachers, lecturers and researchers working in the areas of capital punishment, medical, legal and business ethics, and political philosophy. (shrink)

In Morality and Ethics of War, which includes a foreword by Major General Susan Coyle, ethicist Deane-Peter Baker goes beyond existing treatments of military ethics to address a fundamental problem: the yawning gap that exists between the diverse moral frameworks defining personal identity in a multicultural society on the one hand, and the professional military ethic on the other. Baker argues that overcoming this chasm is essential to minimising the ethical risks that can lead to operational and strategic (...) failure for military forces engaged in today's complex conflict environment. He contends that spanning the gap is vital in preventing moral injury from befalling the nation's uniformed servants. Drawing on a revised account of what he calls 'the Just War Continuum', Baker develops a bridging framework that combines conceptual clarity and rigour with insights from cutting edge psychological research and creates a practical means for military leaders to negotiate the moral chasm in military affairs. (shrink)

As the implementation of new approaches and procedures of medical ethics is as complex and resource-consuming as in other fields, strategies and activities must be carefully planned to use the available means and funds responsibly. Which facilitators and barriers influence the implementation of a medical ethics decision-making model in daily routine? Up to now, there has been little examination of these factors in this field. A medical ethics decision-making model called METAP was introduced on (...) three intensive care units and two geriatric wards. An evaluation study was performed from 7 months after deployment of the project until two and a half years. Quantitative and qualitative methods including a questionnaire, semi-structured face-to-face and group-interviews were used. Sixty-three participants from different professional groups took part in 33 face-to-face and 9 group interviews, and 122 questionnaires could be analysed. The facilitating factors most frequently mentioned were: acceptance and presence of the model, support given by the medical and nursing management, an existing or developing ethics culture, perception of a need for a medical ethics decision-making model, and engaged staff members. Lack of presence and acceptance, insufficient time resources and staff, poor inter-professional collaboration, absence of ethical competence, and not recognizing ethical problems were identified as inhibiting the implementation of the METAP model. However, the results of the questionnaire as well as of explicit inquiry showed that the respondents stated to have had enough time and staff available to use METAP if necessary. Facilitators and barriers of the implementation of a medical ethics decision-making model are quite similar to that of medical guidelines. The planning for implementing an ethics model or guideline can, therefore, benefit from the extensive literature and experience concerning the implementation of medical guidelines. Lack of time and staff can be overcome when people are convinced that the benefits justify the effort. (shrink)

International Humanitarian Law mandates that all wounded in war, no matter which party they belong to, shall receive aid in accordance with their medical condition, and that “there shall be no distinction among them founded on any grounds other than medical ones.” This principle of impartiality is endorsed by various other military and civilian institutions worldwide to include the ICRC, the US Department of Defense, and the American Medical Association. In this essay, I argue that in some (...) cases, we ought, morally speaking, to triage based on factors beyond one’s medical condition. More specifically, I argue that in these cases, we ought to triage, at least partly, based on one’s moral responsibility for one’s current medical predicament. I call this view Triage by Moral Responsibility (TMR). I support my argument for TMR by demonstrating its plausibility when applied to cases of medical treatment and disaster relief, and by drawing parallels between these situations and those considered in the ethics of defensive harming. I conclude by discussing the practicality of my moral conclusion for the practice of medical triage in pandemics and war. (shrink)

Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to (...) follow, and offer a retrospective critical reflection in this paper. The hospital’s first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats. (shrink)

Medical ethics has been described as a thread woven into the fabric of the Nottingham curriculum. There exist a wide variety of relevant learning experiences, occurring at intervals throughout each of the five years of the course. The introduction of the students to clinical method from the start creates the need for early consideration of ethical aspects of professional behaviour and this in turn stimulates spontaneous discussion and inquiry amongst the students. The school has chosen to rely on (...) having a sufficient number of medical teachers from various disciplines willing to discuss in all the necessary detail their own clinical decisions. (shrink)

In this book, Ramsey addresses the moral problems of medicine, life and death and not merely to those who share his faith.

As part of an effort to improve the teaching of medical ethics in the College of Medicine, Lagos University two-day workshops were organised. Participants included people from various walks of life, for example politicians, lawyers, doctors, and patients. The workshops were quite successful, and have led to more extensive teaching of medical ethics in the college.

The goal of military medicine is to conserve the fighting force necessary to prosecute just wars. Just wars are defensive or humanitarian. A defensive war protects one's people or nation. A humanitarian war rescues a foreign, persecuted people or nation from grave human rights abuse. To provide medical care during armed conflict, military medical ethics supplements civilian medical ethics with two principles: military-medical necessity and broad beneficence. Military-medical necessity designates the medical means (...) required to pursue national self-defense or humanitarian intervention. While clinical-medical necessity directs care to satisfy urgent medical needs, military-medical necessity utilizes medical care to satisfy the just aims of war. Military medicine may therefore attend the lightly wounded before the critically wounded or use medical care to win hearts and minds. The underlying principle is broad, not narrow, beneficence. The latter addresses private interests, while broad beneficence responds to the collective welfare of the political community. (shrink)

For centuries medical schools in Britain and elsewhere had a fairly static curriculum based on what might be called the 'three Rs' of medicine, and consequently had to make room for new subjects as the need arose in a fashion which was sometimes makeshift. However, Southampton University has only had a medical school for six years, and therefore their course on medical ethics and legal medicine was carefully integrated into the curriculum after some preliminary experiments carried (...) out by a subcommittee which is continually reviewing the situation. Medical ethics has now a definite place in the fourth year, preceded by an introduction to ethical problems encountered in medicine in the first year. Not only do members of the medical faculty participate in this teaching but also members of the faculties of law and the arts. (shrink)

Medical Ethics, Law and Communication at a Glance presents a succinct overview of these key areas of the medical curriculum. This new title aims to provide a concise summary of the three core, interlinked topics essential to resolving ethical dilemmas in medicine and avoiding medico-legal action. Divided into two sections; the first examines the ethical and legal principles underpinning each medical topic; while the second focuses on communication skills and the importance of good communication. Medical (...) Ethics, Law and Communication at a Glance offers an accessible introduction to the fundamentals of good medical practice, and will provide indispensable support for undergraduate medical students and nurses, as well as newly qualified healthcare professionals. (shrink)

This book challenges fundamental doctrines of established medical ethics. It is argued that the routine practice of stopping life support technology causes the death of patients and that donors of vital organs (hearts, liver, lungs, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. Although these practices are ethically legitimate, they are not compatible with traditional medical ethics: they conflict with the norms that doctors must not intentionally (...) cause the death of their patients and that vital organs can be obtained only from dead donors. The aim of this book is to undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. This involves exposing the misconception that stopping life support merely allows patients to die from their medical conditions, that there is an ethical bright line separating withdrawal of life support from active euthanasia, and that determination of death of hospitalized patients prior to vital organ donation is consistent with the established biological conception of death. A novel ethical justification is required for procuring vital organs from still-living donors. It is contended that in the context of plans to withdraw life support, donors of vital organs are not harmed or wronged by organ procurement prior to death, provided that valid consent is obtained for stopping treatment and organ donation. In view of serious practical difficulties in facing the truth regarding organ donation, an alternative pragmatic account is developed for justifying current practices that relies on the concept of transparent legal fictions. In sum, it is the thesis of this book that to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics. (shrink)

Readers are invited to contact Greg S. Loeben in writing at Midwestern University, Glendale Campus, Bioethics Program, 19555 N. 59th Ave., Glendale, AZ 85308 regarding books they would like to see reviewed or books they are interested in reviewing.

Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims’s medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using (...) primary historical source material and concludes that the charges that have been made against Sims are largely without merit. Sims’s modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a “vulnerable population” in the 19th century American South, the evidence suggests that Sims’s original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time. (shrink)

Winner of the Los Angeles Times Book Prize With a new preface by the author In his most powerful and important book, renowned psychiatrist Robert Jay Lifton presents a brilliant analysis of the crucial role that German doctors played in the Nazi genocide. Now updated with a new preface, The Nazi Doctors remains the definitive work on the Nazi medical atrocities, a chilling exposé of the banality of evil at its epitome, and a sobering reminder of the darkest side (...) of human nature. (shrink)

This article looks at the context of research in treating burns at the dawn of the atomic age. Funded by the Army and other defense agencies, burn research increased as concerns over an atomic attack on an American city intensified.

On September 23, 1949, President Harry Truman announced that the Soviet Union had successfully detonated an atomic bomb. The news that the Soviet Union had done this came as little surprise to a number of American scientists and to some members of the intelligence community who had predicted that the Soviets would quickly acquire this advanced weapons technology. But for many Americans this news was disturbing. Truman’s announcement was taken up by, among others, a young Baptist evangelist named Billy Graham. (...) Opening a tent revival in Los Angeles just two days after the President’s report, Graham preached how the news of the Soviet bomb test had “startled the world” and launched an “arms race unprecedented in the history of the world.” President Truman, he informed his listeners, said that we “must be prepared for any eventuality at any hour….” Perhaps even more ominously he asked the crowd, “Do you know the area that is marked out for the enemy’s first atomic bomb? New York! Secondly, Chicago; and thirdly, the city of Los Angeles!” It was not only evangelical preachers who foresaw catastrophic implications from a growing arsenal of atomic weapons. (shrink)

Doctors have been treating infectious diseases for hundreds of years, but the risk they and other medical professionals are exposed to in an epidemic has always been high. At the front line of the present war against COVID-19, medical teams are endangering their lives as they continue to treat patients suffering from the disease. What is the degree of danger that a medical team must accept in the face of a pandemic? What are the theoretical justifications for (...) these risks? This article offers answers to these questions by citing opinions based on Jewish ethical thought that has been formulated down through the ages. According to Jewish ethics, the obligation to assist and care for patients is based on many commandments found in the Bible and on rulings in the Responsa literature. The ethical challenge is created when treating the sick represents a real existential danger to the caregivers and their families. This consideration is relevant for all dangerous infectious diseases and particularly for the coronavirus that has struck around the world and for which there is as yet no cure. Many rabbis over the years have offered the religious justifications for healing in a general sense and especially in cases of infectious diseases as they have a bearing on professional and communal obligations. They have compared the ethical expectations of doctors to those of soldiers but have not sanctioned taking risks where there is insufficient protection or where there is a danger to the families of the medical professionals. (shrink)

in a scientific way, and takes the patient and his family into his confidence. Thus he learns something from the sufferer, and at the same time instructs the invalid to the best of his power. He does not give his prescriptions until he has won the patient's support, and when he has done so, he steadilY aims at producing complete restoration to health by persuading the sufferer in to compliance (Laws 4. 720 b-e, [28]). This passage shows the perennial nature (...) of the problems of treating the patient as a person. It shows as well the historical'depth of philosophical interest in medicine. The history of philosophy includes more reflections upon medical ethics than the casual reader might suspect. Many of these reflections are pertinent to contemporary issues such as abortion and population control. Plato, for example, recommends abortion in cases of incest (Republic 5. 461c); and Aristotle argues for letting seriously deformed children die, while forbidding infanticide as a means of popUlation control, suggesting instead the use of early abortions. 'As to the exposure in rearing of children, let there be a law that no deformed child shall live, but that on the ground of an excess in the number of children... let abortion be procured before sense and life have begun; what mayor may not be lawfully done in these cases depends on the question of life and sensation' (Politics VII, 16,335 b20-26, [4]). (shrink)

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990–1991) and the War on Terror (2001–). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non-therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of (...) trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military-civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency. (shrink)

This paper investigates the efficiency of application of medical ethics principles in the practice of artificial insemination by donors in China, in a culture characterised by traditional ethical values and disapproval of AID. The paper presents the ethical approach to AID treatment as established by the Reproduction and Genetics Hospital of CITIC-Xiangya in the central southern area of China against the social ethical background of China and describes its general features. The CITIC-Xiangya Approach facilitates the implementation of ethical (...) relations between clinicians and patients participating in AID treatment procedures in Hunan-Yale. (shrink)

In recent years, ethical concerns have emerged among psychologists, psychiatrists, and physicians about interrogating inmates detained at U.S. military prison camps, such as Guantanamo Bay, or consulting on such interrogations. These concerns have escalated to levels necessitating the three major associations—the American Psychological Association, the American Psychiatric Association, and the American Medical Association—to formulate position statements on these issues. Within the psychological community, two divergent schools of thought have developed, and this article explores the role of psychologists in these (...) types of interrogations and the related ethical concerns. Specifically, this article provides an overview of psychologists' roles in this area, presents an analysis of the ethical guidelines, discusses the implications of the American Psychological Association's position statement, and offers suggestions to reconcile the current ethical debate. (shrink)

Justice at Nuremberg traces the history of the Nuremberg Doctors' Trial held in 1946-47, as seen through the eyes of the Austrian bliogemigrbliogé psychiatrist Leo Alexander. His investigations helped the United States to prosecute twenty German doctors and three administrators for war crimes and crimes against humanity. The legacy of Nuremberg was profound. In the Nuremberg code--a landmark in the history of modern medical ethics--the judges laid down, for the first time, international guidelines for permissible experiments on humans. (...) One of those who helped to formulate the code was Alexander. Justice at Nuremberg provides a detailed insight into the origins of human rights in medical science and into the changing role of international law, ethics and politics. (shrink)