John Dorsch

This paper is going to explore the adverse effects of exposure to combat death on medics’ holistic well-being, which, if ignored could decrease individual readiness and negatively impact the mission. We rely on the experience of United States Air Force Special Operation Surgical Teams (AF SOST) whose exposure to mass casualty scenarios in austere environments could serve as approximations of conditions of future battlefields. Over the past two decades, the ability to deliver advanced medical care on and off the battlefield along with a rapid casualty evacuation platform has allowed for unprecedented survival rates exceeding 90%. While laudable, these medical achievements have also set up a casualty management paradigm in which medical decision-making singularly focuses on life-saving care. Confronting peer-peer adversaries in large scale combat operations (LSCO) on a multi-domain battlefield will make casualty management frighteningly more complex by introducing major infrastructural, personnel, and resource constraints. When considering the high number of casualties expected in LSCO alongside enormous limitations in medical resource and resupply capability, the current casualty management paradigm will not be sustainable. The resource constrained environment in LSCO will shift medical decision-making away from a singular focus on life-saving care to triage, which hinges on the ability to determine futile medical interventions—a skill that has been lost in the past two generation of combat medics. As such, a broad ethical challenge that arises in preparation for LSCO is the need to set new expectations concerning dying and death. However, medical decision-making focused on death and dying has not been explicitly addressed in military medical training, research, or policy. Relying on a body of literature known as terror management theory (TMT) and ethnographic data from our study with AF SOST medics, we are going to argue that it is important to expose medics to death in mass casualty and triage training.

On the basis of Descartes’s account of the passions of the soul, we argue that current interoception-based theories of emotions cannot account for the hallmark of a passion of the soul, i.e., that its effects are felt as being in the soul itself. We also pay attention to the epistemic functions of the passions and to Descartes’s category of emotions that are caused and occur in the soul alone. Certain passions of the soul and certain internal emotions are similar to what are today called ‘epistemic feelings’ and ‘epistemic emotions.’ Descartes’s work reflects another challenge for contemporary embodied cognition: how might epistemic affect be embodied? Since the signature of embodiment is increasingly understood as interoceptive, the challenge to interoceptive research is demonstrating the degree to which affect results from interoception. This challenge also implies that the locus of emotional experience is taken into account.