Peter Olsthoorn

Military doctors and nurses, working neither as pure soldiers nor as merely doctors or nurses, may face a ‘role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command’. This conflict is commonly called dual loyalty. This chapter gives an overview of the military and the medical ethic and of the resulting dual loyalty problem for medical personnel working in the military. It considers how dual loyalties relate to being a professional, something medical personnel are the paradigmatic examples of, but also something military personnel claim to be. Against that background, the chapter elaborates on the medical rules of eligibility used in Afghanistan, and on the policies concerning military involvement in local healthcare, to see what the existing rules and policies are, and whose interests they serve.

Utilitarianism is the strand of moral philosophy that holds that judgment of whether an act is morally right or wrong, hence whether it ought to be done or not, is primarily based upon the foreseen consequences of the act in question. It has a bad reputation in military ethics because it would supposedly make military expedience override all other concerns. Given that the utilitarian credo of the greatest happiness for the greatest number is in fact agent-neutral, meaning that the consequences to everyone should weigh equally, this critique of utilitarianism is not entirely fair. By focusing on some anomalies in both the principle of double effect and in our tendency to give priority to the interests of those who are near and dear to us, this article argues that there is something to be said for a military ethic that attaches less weight to intentions, and more to the consequences.

The aim of this paper is to examine the usefulness of the somewhat related notions of integrity, moral courage, and Innere Führung (the leadership concept used by the German military) as a means of making military personnel behave ethically. Of these three notions, integrity is mentioned most often within military organizations, and the largest part of what follows is therefore devoted to a description of what integrity is, and what the drawbacks of this notion are for the military. This will lead us to conclude that integrity in its most common meaning is too vague and subjective to be of much use to the military. It is because of these drawbacks that this paper looks into moral courage and Innere Führung as possible alternatives for integrity.

Integrity is generally considered to be an important military virtue. The first part of this article tries to make sense of integrity’s many, often contradicting, meanings. Both in the military and elsewhere, its most common understanding seems to be that integrity requires us to live according to one’s personal principal values and principles we have a moral obligation to do so, and it is a prerequisite to be able to ‘look ourselves in the mirror.’ This notion of integrity as upholding personal values and principles is a very problematic one in itself, especially to those working in the military. For several reasons, perhaps the role that the virtue of integrity has in a military organization could in fact be better played by other virtues.

This book examines the role of military virtues in today's armed forces. Although long-established military virtues, such as honor, courage and loyalty, are what most armed forces today still use as guiding principles in an effort to enhance the moral behavior of soldiers, much depends on whether the military virtues adhered to by these militaries suit a particular mission or military operation. Clearly, the beneficiaries of these military virtues are the soldiers themselves, fellow-soldiers, and military organizations, yet there is little that regulates the behavior of soldiers towards civilian populations. As a result, troops trained for combat in today's missions sometimes experience difficulty in adjusting to the less aggressive ways of working needed to win the hearts and minds of local populations after major combat is over. It can be argued that today's missions call for virtues that are more inclusive than the traditional ones, which are mainly about enhancing military effectiveness, but a convincing case can be made that a lot can already be won by interpreting these traditional virtues in different ways. This volume offers an integrated approach to the main traditional virtues, exploring their possible relevance and proposing new ways of interpretation that are more in line with the military tasks of the 21st century. The book will be of much interest to students of military ethics, philosophy, and war and conflict in general.

In addition to the traditional reliance on rules and codes in regulating the conduct of military personnel, most of today’s militaries put their money on character building in trying to make their soldiers virtuous. Especially in recent years it has time and again been argued that virtue ethics, with its emphasis on character building, provides a better basis for military ethics than deontological ethics or utilitarian ethics. Although virtue ethics comes in many varieties these days, in many texts on military ethics dealing with the subject of military virtues the Aristotelian view on virtues is still pivotal. Developing virtues is by some authors seen as the best way to prevent misconduct by military personnel, it being considered superior to rules or codes of conduct imposed from above. The main argument these authors offer is that these solutions are impotent when no one is around, and lack the flexibility often thought necessary in today’s world. Finally, rules and codes try to condition behavior, leaving less room for personal integrity. At first sight, then, there is a great deal to say in favor of virtue ethics as being the best way of enhancing the chances of soldiers behaving morally. However, this preference for steering conduct by means of promoting certain desirable dispositions is not without any problems that, as it stands, are hardly ever addressed. To begin with, there are a few practical concerns. For instance, even if we assume that military virtues can assist military personnel to do their work in a morally sound manner, it is still not clear to what extent virtues can, in fact, be taught to them. It is an assumption of virtue ethics that they can, but is this really the case? And if so, how should they be taught? – virtues are supposedly developed by practicing them, yet how much room is there for practicing virtues in for instance the ethics education as followed in military academies and school battalions? Secondly, it appears that the traditional military virtues, such as honor, loyalty, courage, and obedience, are, especially in their common interpretation, mainly beneficial to colleagues and the organization, not so much to the local population of the countries military personnel are deployed to. Changes in the military’s wider environment have led to a shift from traditional of self-defense tasks to new, more complex tasks, and especially in today’s missions one could expect that the proper virtues are not necessarily solely the more martial ones.

The first section of this article argues that the best-known definition of physical courage, stemming from Aristotle's Nicomachean Ethics, is less than fit for today's military. Having done so, a short outline is given of more scientific approaches to physical courage, drawing mainly on insights offered by psychologists, and of the problems that are inherent to these approaches. Subsequently, the article turns to a topic that is often paid lip service to in the military, yet remains somewhat hard to pin down: moral courage. Although both forms of courage are intertwined, they are so in a less straightforward manner than is often thought. The way the development of physical courage in today's military is undertaken, for instance, contributes little to the development of moral courage

This article deals with the notion of honor and its role in today’s military as an incentive in combat, but also as a check on the behavior on both the battlefield and in modern “operations other than war.” First, an outline will be given of what honor is and how it relates to traditional views on military courage. After that, the Roman honor-ethic, stating that honor is a necessary incentive for courageous behavior and that it is something worth dying for, is contrasted with today’s prevailing view which sees honor as something obsolete and archaic and not as a legitimate motive. The article then addresses the way honor continues to have a role in today’s military, despite its diminishing role in society at large. Subsequently, the drawbacks of the military’s use of the honor ethic are addressed, focusing also on the current operation in Iraq. The final section tries to find a solution to these problems.

Military doctors and nurses, employees with a compound professional identity as they are neither purely soldiers nor simply doctors or nurses, face a role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command (London et al. 2006). In the context of military medical ethics this is commonly called dual loyalty (or, less commonly, mixed agency). Although other professionals in the military, for instance counsellors or lawyers, might experience similar problems of dual loyalties, it seems that the dual loyalties experienced by military medical personnel are particularly testing.