Daniel Messelken

In this volume, the concept of "medical neutrality," which states that medical services should not be interfered with during armed conflicts and other emergencies, is challenged based on the experience and expertise of the authors, who come from diverse military, humanitarian, and academic backgrounds. The principle of medical neutrality is grounded in International Humanitarian Law as well as in Human Rights Law and it can be justified by ethical rationales such as the principle of Humanity and ordinary medical ethics. Health workers often understand medical neutrality as an obligation not to engage in anything else other than medical outcomes. In this book, a variety of problems and ethical issues in the application of medical neutrality in the professional practice of healthcare personnel are analyzed. The contributors expand the debate around “medical neutrality” and aim at better-informing policy and operational decisions regarding the application of medical ethics, the protection of medical missions in conflict, and the training of healthcare professionals to operate ethically and safely in volatile environments. The volume is of great interest to academics, practitioners, policymakers, and students who are looking for analyses and guidance regarding medical neutrality.

This introductory chapter examines some of the interpretations of the concept of medical neutrality that it has received from a variety of authors. It distinguishes three frequently used approaches (or interpretations) of “medical neutrality”. The first is neutrality as part of humanitarian principles to be applied in humanitarian action in general, while the second is linked to the exclusivity of the medical mission, ensuring the protected status of medical personnel and objects as non-combatants. The last approach is related to medical ethics and respect for human rights as obligations that medical personnel should fulfill. The introductory chapter aims to provide a framework for the subsequent discussion by outlining the key distinctions between the various contributions to the book.

Scenarios are a key tool for education, training and research in ethics. The presented collection of scenarios in military medical ethics constitutes a valuable resource for trainers and researchers. It shall support deploying military medical personnel and those who organise training and education to better prepare for missions. To achieve this aim, the MME scenario collection • collects and publishes experiences, reports, and scenarios in a searchable database and • provides an opportunity for those returning from missions to (anonymously) contribute their experiences and to share it with others. • Introductory texts and teaching and/or self-learning material shall be added over time. • The thematic scope of the scenario collection could be extended to include ethical challenges of humanitaMrian actors, which are often similar to the experiences of their military counterparts.

Modern medicine consumes vast amounts of resources, ranging from human to technological and financial. In a well-functioning and well-equipped health system, resource allocation considerations rarely impact clinical decision-making as all patients that need care will (eventually) receive it. In light of this, health care providers (HCPs) are often taught to focus on the patient in front of them, driven by a type of patient-centred ethics (of care) that prioritizes the individual person’s well-being above the aggregate. Informed by the principle of autonomy and respect for individual self-determination, patients in well-resourced health systems often have the autonomy to make decisions that require high resource utilization with little concern directed to how these choices may impact the care provided to other patients or groups of patients. In fact, it is generally accepted that if resources are sufficient, patients and their providers should be able to make medical decisions unencumbered by considerations related to broader resource allocation (with some caveats related to personal or national health insurance schemes). This means that the average HCP in the best case and in their daily routine spends little time considering how their clinical choices might impact the care available to others—concerns related to how resources are allocated, and who receives care are far removed from clinical interaction and related medical decision-making.

In emergency situations and while medical resources are sufficient, doctors are expected to prioritize and treat patients according to medical criteria only. In MASSCAL situations and when medical resources become insufficient, patient selection and prioritization changes. Rules of triage are applied with the aim of getting the best result possible under the circumstances, e.g., saving the largest number; collective health outweighs individual health. Still, according to the standard ethical principles, non-medical criteria should never influence the doctors’ decision of who will be treated. In military contexts, so-called medical rules of eligibility (MROE) provide rules that include non-medical criteria. This chapter aims to analyze if, why, and under what circumstances it may be ethically acceptable to prioritize patients according to non-medical criteria.

This book focuses on resource allocation in military and humanitarian medicine during times of scarcity and austerity. It is in these times that health systems bend, break, and even collapse and where resource allocation becomes a paramount concern and directly impacts clinical decision-making. Such times are challenging and this book covers this very important, yet, scarcely researched topic within the field of bioethics. This work brings together experts and practitioners in the fields of military health care, philosophy, ethics, and other disciplines to provide analysis on a variety of related topics ranging from case studies and first-hand experiences to policy and philosophical analysis. It is of great interest to to academics, practitioners, policy makers and students who are looking for analyses and guidance regarding the fair provision of medical care and the use of medical rules of eligibility under adverse conditions.

Outbreaks of epidemics like Ebola trigger difficult ethical challenges for civilian and military health care personnel. This book offers theoretical reflections combined with reports from recent military and NGO missions in the field. The authors of this volume focus on military medical ethics adding a distinct voice to the topic of epidemics and infectious diseases. While military health care personnel are always crucially involved during disaster relief operations and large-scale public health emergencies, most of the current literature treats ethical issues during epidemics from a more general perspective without taking into account the specifics of the military context. The contributions in this volume provide first-hand insights into some of the ethical issues encountered by military health care personnel in missions during the Ebola outbreak in 2014/2015. This practical perspective is complimented by academic analyses and theoretical reflections on ethical issues associated with epidemics.

This chapter introduces to the main topic of the volume, namely the influence of the changing nature of warfare on the provision of medical care and the ethical challenges that occur. It presents the main ideas of relevant concepts such as asymmetrical warfare, hybrid warfare, and complex emergencies before illustrating the ethical challenges that new forms of warfare create for military and humanitarian health care providers. Examples of ethical challenges include embedding medical personnel in combating forces, questions regarding the treatment of detainees, the need to uphold medical neutrality, and pitfalls of using medicine to non-medical ends. The chapter concludes with a synopsis of the volume.

Philosophie nach Georg Meggle zeichnet sich aus durch kommunikative Offenheit, durch begriffliche Unbestechlichkeit und durch ihr Engagement in der Welt. Die Beiträge in diesem Band orientieren sich an diesem Philosophieverständnis und sind aus Anlass eines Symposiums zu Ehren von Georg Meggle als Originalbeiträge geschrieben worden. Der Band verbindet die theoretischen und praktischen Aspekte der analytischen Philosophie: So sind die Essays zur Hälfte der theoretischen, meist sprach-analytischen, zur Hälfte der praktischen, meist praktisch-politischen Philosophie zuzuordnen. Die Texte vereint das Ideal des Strebens nach begrifflicher Klarheit und welthaltiger Relevanz, nach Dialog. Sie beschreiten neue Wege der analytischen Philosophie und weisen somit den Weg in die Zukunft der Philosophie als gesellschaftlich relevanter Disziplin. Mit Beiträgen u.a. von: Franz von Kutschera, Peter Singer, Wolfgang Lenzen, Wolfgang Spohn, Reinhard Merkel, Rainer Hegselmann, Peter Rohs und Georg Meggle.

This book sheds light on various ethical challenges military and humanitarian health care personnel face while working in adverse conditions. Contexts of armed conflict, hybrid wars or other forms of violence short of war, as well as natural disasters, all have in common that ordinary circumstances can no longer be taken for granted. Hence, the provision of health care has to adapt, for example, to a different level of risk, to scarce resources, or uncommon approaches due to external incentives or requirements. This affects the practice of health care as well as its ethics. This book offers a panoramic overview on various challenges healthcare faces in extraordinary situations and provides new insights from practitioners’ as well as from academic scholars’ perspectives.

Das Spektrum dessen, was als Gewalt bezeichnet wird, ist groß. Es reicht von paradigmatischen Fällen wie kriegerischen Konflikten und Terrorismus über Mord durch Erschlagen und Körperverletzungen bis hin zu umstritteneren Beispielen wie struktureller, sozialer, psychologischer oder verbaler Gewalt. Gewalt muss daher als eine anthropologische Konstante bezeichnet werden: Die Fähigkeit, andere zu verletzen, und die Eigenschaft, von anderen verletzt zu werden, sind Teile der menschlichen Natur. Gewalt ist auch als „Universalsprache“ bezeichnet worden.

Ideally, the (ethical) principles of medical care remain unaltered during armed conflict and can be interpreted as a remnant of peace during war. Healthcare providers also support future peace by not discriminating according to the conflict roles between enemy and friend or fighter and civilian, but by respecting everybody, in a non-conflict logic, as human beings. The antithetical view identifies medical care for wounded soldiers as a contribution to a threat. This chapter rejects such an interpretation, which can be found in parts of the revisionist just war theory, because it carelessly ignores the non-conflict logic, which is fundamental to the medical role. The aim of this chapter is twofold: (i) to show that and for which reasons medical care should not count as a contribution to a threat and (ii) to point out how medical care should be conceived in order to implement and defend its inherent peace-logic.

In der philosophischen Literatur finden sich eine ganze Reihe von Positionen zur Definition und zur moralischen Bewertung von Terrorismus. Die meisten Philosophen definieren Terrorismus als eine Form politischer Gewalt. Viele heben die Angsterfahrung der Opfer hervor, die das erste Ziel der Gewalt ist, und unterscheiden sie von weiteren Zielen wie Nötigung oder politischen Veränderungen. In Bezug auf die moralische Bewertung von Terrorismus herrscht Uneinigkeit sowohl was die Grundlage der Bewertung angeht, als auch hinsichtlich des Urteils selbst. Konsequenzialisten bewerten Terrorismus, wie auch andere Handlungen, im Licht seiner Konsequenzen. Deontologen argumentieren hingegen, dass die moralische Bewertung nicht von den Folgen abhängt, sondern vor allem davon, was Terrorismus ausmacht. Folglich schwanken die Positionen zur Moralität von Terrorismus von seiner Rechtfertigung bis hin zu seiner vollkommenen Verurteilung. All diese Positionen kommen in diesem Band zu Wort, der eine Auswahl an philosophischen und politikwissenschaftlichen Essays aus den letzten drei Jahrzehnten versammelt. Die praktische Bedeutung des Themas muss nicht betont werden. Aber Terrorismus ist auch von großem theoretischen Interesse. Denn er liefert eine besonders dramatische Fassung der Frage der Legitimität politischer Gewalt. Und er spitzt eine grundlegende ethische Frage beispielhaft zu: Sollen basale ethische Verbote wie das Verbot des Tötens oder Verstümmelns Unschuldiger als absolute Verbote angesehen werden, oder können sie in Ausnahmefällen angesichts extrem gewichtiger Konsequenzen überschrieben werden?

Over the last few years, virtually all forms of non-state violence have been labeled as “terrorism”. As a result, differences between various forms of war and violence are lost in the analysis. This article proposes a conceptual distinction between terrorism and guerrilla warfare by analyzing their differences and similarities. Definitions of terrorism and guerrilla warfare are presented. Starting with these definitions, the question of the legitimacy of terrorism and guerrilla violence is answered with reference to just war theory. Particular attention is paid to the issue of the so called “innocent victims” of terrorism.

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.

Battlefield euthanasia, the purposeful killing of wounded soldiers (or even civi- lians) in order to hasten their foreseeable death, has been an issue in military medicine and in soldiers’ moral codes at all times. During conflicts since anti- quity, there have been severely wounded who would not die immediately but whose fate seemed clear, nevertheless. But can it ever be morally justified to kill those wounded out of mercy in order to end their suffering? Can death ever be the better option? And if so, what conditions have to be fulfilled? This paper investigates some of the moral aspects of battlefield euthanasia. Analogies to physician-assisted suicide in civil settings will be drawn and contrasted with the additional aspects that the military environment adds to the problem.

Der Einfluss der Lehre vom gerechten Krieg bzw. der Idee des gerechten Friedens auf den Umgang mit heutigen Konflikten lässt sich besonders gut anhand der so genannten „humanitären Interventionen“ und dem aus dieser Praxis entwickelten neuen Ansatz der „Responsibility to Protect“ (RtoP/ R2P) bzw. Schutzverantwortung zeigen. Bei der Be- gründung als humanitär erachteter Interventionen seit den 1990er Jahren wurde und wird auf die Kriterien des gerechten Krieges bzw. gerechten Friedens zurückgegriffen. Nachfolgend spielten diese auch bei der Formulierung des Prinzips der Schutzverantwor- tung eine wichtige Rolle und sind so erneut für die Ausbildung völkerrechtlicher Normen herangezogen worden. Im Folgenden soll zunächst kurz das Kernproblem humanitär begründeter Interventionen skizziert werden und in einem zweiten Schritt dann gezeigt werden, wie die Konzepte von gerechtem Krieg und gerechtem Frieden in der Denkweise und den Prinzipien der Schutzverantwortung verankert sind.