This book challenges the World Medical Association’s (WMA) International Code of Ethics statement in 2004, which declared that ‘medical ethics in armed conflict is identical to medical ethics in times of peace’. This is achieved by examining the professional, ethical, and legal conflicts in British Military healthcare practice that occur in three distinct military environments. These are (i) the battlefield, (ii) the operational environment and (iii) the non-operational environment. As this conflict is exacerbated by the need to achieve Operational Effectiveness, this book also explores the dual loyalty conflict that Military Health Care Professionals (MHCPs) encounter between following military orders and professional codes of practice. The method used to challenge the WMA’s statement and explore these conflicts is the use of real-life problem-solving vignettes, which mirror actual ethical and professional conflicts and dilemmas that may occur in the three environments. The areas of law analysed similarly reflect the difficulties that MHCPs face when caring for the sick and wounded in violent locations when under attack. In particular, the book questions whether it is right for a MHCP to owe their patients a duty of care in hostile environments. This leads on to questioning if any MHCP could be protected by combat immunity where no duty of care is owed to fellow soldiers in the battlefield. The book also questions whether the standard of care should be variable in hostile environments. It also explores the dual loyalty conflict of a wounded senior officer refusing treatment from a junior officer. In addition, it examines the difficulties of a doctor maintaining patient confidentiality when a soldier refuses treatment for a psychological injury but wishes to redeploy to the battlefield. The book successfully challenges the WMA’s statement. It also concludes by suggesting that neither a military-focused approach nor a professional healthcare-focused approach towards military healthcare is the best way to solve the dual loyalty conflict.

Is medical ethics in times of armed conflict identical to medical ethics in times of peace, as the World Medical Association declares? In Bioethics and Armed Conflict, the first comprehensive study of medical ethics in conventional, unconventional, and low-intensity war, Michael Gross examines the dilemmas that arise when bioethical principles clash with military necessity—when physicians try to save lives during an endeavor dedicated to taking them—and describes both the conflicts and congruencies of military and medical ethics. Gross describes how the principles of contemporary just war, unlike those of medical ethics, often go beyond the welfare of the individual to consider the collective interests of combatants and noncombatants and the general interests of the state. Military necessity plays havoc with such patients' rights as the right to life, the right to medical care, informed consent, confidentiality, and the right to die. The principles of triage in battle conditions dictate not need-based treatment but the distribution of resources that will return the greatest number of soldiers to active duty. And unconventional warfare, including current "wars" on terrorism, challenges the traditional concept of medical neutrality as physicians who have sworn to "do no harm" are called upon to lend their expertise to "interrogational" torture or to the development of biological or chemical weapons. Difficult dilemmas inevitably arise during armed conflict, and medicine, Gross concludes, is not above the fray. Medical ethics in time of war cannot be identical to medical ethics in peacetime.

As asymmetric ’wars among the people’ replace state-on-state wars in modern armed conflict, the growing role of military medicine and medical technology in contemporary war fighting has brought an urgent need to critically reassess the theory and practice of military medical ethics. Military Medical Ethics for the 21st Century is the first full length, broad-based treatment of this important subject. Written by an international team of practitioners and academics, this book provides interdisciplinary insights into the major issues facing military-medical decision makers and critically examines the tensions and dilemmas inherent in the military and medical professions. In this book the authors explore the practice of battlefield bioethics, medical neutrality and treatment of the wounded, enhancement technologies for war fighters, the potential risks of dual-use biotechnologies, patient rights for active duty personnel, military medical research and military medical ethics education in the 21st Century.

Beleaguered countries struggling against aggression or powerful nations defending others from brutal regimes mobilize medicine to wage just war. As states funnel medical resources to maintain unit readiness and conserve military capabilities, numerous ethical challenges foreign to peacetime medicine result. Force conservation drives combat hospitals to prioritize warfighter care over all others. Civilians find themselves bereft of medical attention; prison officials force feed hunger-striking detainees; policymakers manage healthcare to win the hearts and minds of local nationals; and scientists develop neuro-technologies or nanosurgery to create super soldiers. When the fighting ends, intractable moral dilemmas rebound. Post-war justice demands enormous investments of time, resources and personnel. But losing interest and no longer zealous, war-weary nations forget their duties to rebuild ravaged countries abroad and rehabilitate their war-torn veterans at home. Addressing these incendiary issues, Military Medical Ethics in Contemporary Armed Conflict integrates the ethics of medicine and the ethics of war. Medical ethics in times of war is not identical to medical ethics in times of peace, but a unique discipline. Without war, there is no military medicine, and without just war there is no military medical ethics. Military Medical Ethics in Contemporary Armed Conflict revises, defends, and rebuts wartime medical practices, just as it lays the moral foundation for casualty care in future conflicts.

Although working on the sidelines of armed conflicts, physicians are often at the centre of attention. First Do No harm: Medical Ethics in International Humanitarian Law was born from the occasionally controversial role of physicians in recent armed conflicts and the legal and ethical rules that frame their actions. While international humanitarian, human rights and criminal law provide a framework of rights and obligations that bind physicians in armed conflicts, the reference to ‘medical ethics’ in the laws of armed conflict adds an extra-legal layer. In analysing both the legal and the ethical framework for physicians in armed conflict, the book is invaluable to practitioners and legal scholars alike.

The Elements of War Crimes will assist the International Criminal Court (ICC) in the interpretation and application of the articles of the ICC Statute defining the crimes under its jurisdiction. These will not only be necessary for the future work of the ICC in interpreting the crimes provisions, but also for national courts, which have primary responsibility in the prosecution of international crimes under the Rome Statute. This commentary provides a critical insight into the travaux préparatoires of the Preparatory Commission leading to the adoption of the elements of war crimes. It contains an analysis of existing case law related to each war crime in the Statute. It will provide States, judges, prosecutors and international and national lawyers with key background information to implement international humanitarian law in future cases dealing with war crimes under the ICC. A unique, indispensable tool for prosecuting and defense lawyers working in international criminal law.

This book is written in memory of Avril McDonald, who passed away in April 2010. Avril was an inspired and passionate scholar in the fields of international humanitarian law, international criminal law, human rights law and law in the field of arms control and disarmament. What in particular made Avril’s work special, was her strong commitment with the human aspects throughout. Fourteen scholars and practitioners have contributed to this liber amicorum, which has led to a rich variety of topics within the disciplines of Avril’s expertise. They all have in common that they deal with the human perspectives of the discipline of law at hand. They concentrate on the impact of the developments in international law on humans, whether they are civilians, victims of war or soldiers. This human perspective of law makes this book an appropriate tribute to Avril McDonald and at the same time a unique and valuable contribution to international legal research in the present society. A society that becomes more and more characterized by detailed legal systems, defined by institutions that may frequently lack sufficient contact with the people concerned.

Annex I is commented by Philippe Eberlin.