Michael L. Gross

Unlike most Western nations, Israel does not recognize full separation of church and state but seeks instead a gentle fusion of Jewish and democratic values. Inasmuch as important religious norms such as sanctity of life may clash with dignity, privacy, and self-determination, conflicts frequently arise as Israeli lawmakers, ethicists, and healthcare professionals attempt to give substance to the idea of a Jewish-democratic state. Emerging issues in Israeli bioethics—end-of-life treatment, fertility, genetic research, and medical ethics during armed conflict—highlight this conflict vividly

Following Russia's occupation of Eastern Ukraine, local health care professionals, particularly hospital administrators and public health officials, have faced criminal charges of medical collaboration for taking senior managerial positions in the occupation regime and allocating resources to the Russian army. Although Ukraine is entitled to prosecute collaborators who threaten its national security, the grounds for criminalizing medical administration during military occupation are much weaker and essentially indefensible. During occupation, international humanitarian law requires Russia to maintain adequate health care services with the assistance of local officials, protects these officials from prosecution, and ensures their independence as they weigh their professional duties to maintain essential health care for the civilian population. An analysis of representative legal cases charging health care professionals with treason and collaboration demonstrates the shortfalls of Ukrainian policy that (a) does not clearly differentiate between charges of collaboration, aiding and abetting the enemy, and treason, (b) rejects public health officials’ duty to cooperate with an occupation regime, and (c) ignores health care administrators’ right to condition their decision to cooperate on its attendant costs and benefits. Recognizing a policy of humanitarian cooperation rectifies these deficiencies by highlighting the independence of health care officials, their protection from prosecution by Ukrainian and Russian authorities, and each party's duty to maintain adequate medical care for the local population during military occupation.

Medical rules of eligibility permit severely injured Iraqi and Afghan nationals to receive care in Coalition medical facilities only if bed space is available and their injuries result directly from Coalition fire. The first rule favors Coalition soldiers over host-nation nationals and contradicts the principle of impartial, needs-based medical care. To justify preferential care for compatriots, wartime medicine invokes associative obligations of care that favor friends, family, and comrades-in-arms. Associative obligations have little place in peacetime medical care but significantly affect wartime medicine. The second rule suggests liability for collateral harm that is unsupported by international law and military ethics. Absent liability, there are pragmatic reasons to offer medical care to injured local civilians if it quells resentment and cements support for Coalition forces. In contrast to peacetime medicine, military necessity and associative obligations outweigh distributive principles based on medical need during war.

Because we are often nagged by the thought that we might not have behaved any differently than those good citizens whose respect for the law and fear of punishment led them to support the Nazi regime, we are fascinated with the behavior of ordinary Germans. Careful to first strip away the pathological explanations of German behavior, Pellegrino and Thomasma ask simply whether ordinary Germans could have reasoned and, by implication, acted differently. Although their affirmative answer is consistent with the activism we have all come to demand of the Germans, it is not clear whether we, ourselves, can lay full claim to the moral high ground

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.

Responsible citizens are expected to combine ethical judgement with judiciously exercised social activism to preserve the moral foundation of democratic society and prevent political injustice. But do they? Utilizing a research model integrating insights from rational choice theory and cognitive developmental psychology this book carefully explores three exemplary cases of morally inspired activism: Jewish rescue in wartime Europe, abortion politics in the United States, and peace and settler activism in Israel. From all three analyses a single conclusion emerges: the most politically competent individuals are, most often, the least morally competent. This is the central paradox of political morality. These findings cast doubt on strong models of political morality characterized by enlightened moral reasoning and concerted political action while affirming alternative weak models that fuse activism with sectarian moral interests. They provide empirical support to further upend the liberal vision of democratic character, education, and society.

In its American context the case of baby Messenger, a preterm infant disconnected from life-support by his father and allowed to die has generated debate about neonatal treatment protocols. Limited by the legal and ethical norms of the United States, this case did not consider treatment protocols that might be available in other countries such as Denmark and Israel: threshold protocols whereby certain classes of newborns are not treated, and preemptive abortion allowing one to choose late-term abortion rather than risk delivery. Each offers a viable and ethically sound avenue for dealing with the economic and social expense of anomalous newborns by aborting or not treating those most likely to burden the health care system. Objections that these protocols are antithetical to American bioethical principles are considered but rejected as each policy answers to economic justice, utility and respect for autonomy

abstract During the current round of fighting in the Middle East, Israel has provoked considerable controversy as it turned to targeted killings or assassination to battle militants. While assassination has met with disfavour among traditional observers, commentators have, more recently, sought to justify targeted killings with an appeal to both self‐defence and law enforcement. While each paradigm allows the use of lethal force, they are fundamentally incompatible, the former stipulating moral innocence and the latter demanding the presumption of criminal guilt. Putting aside the paradigm of law enforcement which demands due process and forbids extra‐judicial execution, the only possible avenue for justifying named killings lies in self‐defence. While named killings might be defensible on the grounds that there are no other ways to disable combatants when they fight without uniforms, the costs, including the cost of targeted killing emerging as an acceptable convention in its own right, should be sufficient to view the practice with a good deal of caution.

Both trolleys and war leave innocent victims to suffer death and injury. Trolley problems accounting for the injured, and not only the dead, tease out intuitions about liability that enhance our understanding of the obligation to provide compensation and medical care to civilian victims of war. Like many trolley victims, civilians in war may suffer justifiable, excusable, or negligent harms that demand compensation. Chief among these is collateral harm befalling civilians. Collateral harm is endemic to war and comprises permissible but unavoidable death or injury following necessary and proportionate military operations. Although state armies sometimes offer condolence payments for civilian death, injury, and property loss, they deny liability. Instead, they use compensation to enhance counterinsurgency efforts and assuage feelings of agent regret. As part of the medical rules of eligibility, Coalition forces in Iraq and Afghanistan also provided medical care to victims of collateral harm. However, they denied care to similarly sick or injured civilians. While compensation is often justified to cure the harm civilians suffer, the differential use of medical resources is not. Rather, medical care remains subject to the principle of beneficence and medical need. The duty to provide civilian healthcare in war, particularly in wars of humanitarian intervention, is far-reaching and imposes significant costs that military and medical ethics are yet to recognize.

Since 2022, the EU, US, and other nations have imposed medical sanctions on Russia to block the export of pharmaceuticals and medical devices and curtail clinical trials to degrade Russia’s military capabilities. While international law proscribes sanctions that cause a humanitarian crisis, an outcome averted in Russia, the military effects of medical sanctions have been lean. Strengthening medical sanctions risks violating noncombatant and combatant rights to healthcare. Each group’s claim is different. Noncombatants and severely injured soldiers who cannot return to duty enjoy the right to adequate health care that sanctions cannot undermine. Combatants falling captive enjoy the same medical care that adversaries provide their own troops. Combatants yet to renounce hostilities, however, have no claim to medical attention and remain subject to sanctions. Nevertheless, medical sanctions prove unworkable in this complex environment of conflicting rights and command no place in a sustainable sanction regime.

Mirko Garasic's book investigates the principle of autonomy and, in an oblique way, joins the chorus of voices disenchanted with the tyranny of autonomy. I say oblique because he does not simply reorder the four famous principles of bioethics by trying to knock respect for autonomy from its pedestal, but employs a number of practical cases to demonstrate what I, not he, might call the abuse or misuse of autonomy. Apart from its rarefied formulations by Kant and, to a lesser extent Mill, autonomy has distinct social and political dimensions that shape its outsized role in bioethical deliberations. This is not a new argument but Garasic puts the case much more bluntly: the bioethical and medical community respect autonomy when it enhances their power, and disrespect autonomy when it diminishes their power. These claims appear early on but are most pronounced in the last two chapters of the book devoted to the dilemmas of force-feeding hunger strikers. In a compelling fourth chapter, Garasic juxtaposes the Dax case (where medical authorities disrespected his autonomy not only to save his live but because he was, presumably, a compatriot) and the case of …

Medical rules of eligibility permit severely injured Iraqi and Afghan nationals to receive care in Coalition medical facilities only if bed space is available and their injuries result directly from Coalition fire. The first rule favors Coalition soldiers over host-nation nationals and contradicts the principle of impartial, needs-based medical care. To justify preferential care for compatriots, wartime medicine invokes associative obligations of care that favor friends, family, and comrades-in-arms. Associative obligations have little place in peacetime medical care but significantly affect wartime medicine. The second rule suggests liability for collateral harm that is unsupported by international law and military ethics. Absent liability, there are pragmatic reasons to offer medical care to injured local civilians if it quells resentment and cements support for Coalition forces. In contrast to peacetime medicine, military necessity and associative obligations outweigh distributive principles based on medical need during war.

Asymmetric conflict is changing the way that we practise and think about war. Torture, rendition, assassination, blackmail, extortion, direct attacks on civilians, and chemical weapons are all finding their way to the battlefield despite longstanding international prohibitions. This book offers a practical guide for policy makers, military officers, students, and others who ask such questions as: do guerillas deserve respect or long jail sentences? Are there grounds to torture guerillas for information or assassinate them on the battlefield? Is there room for nonlethal weapons to subdue militants and safeguard the lives of noncombatants? Who are noncombatants in asymmetric war? What is the status of civilians who shelter and aid guerillas? And, do guerillas have any right to attack civilians, particularly those who aid and shelter members of the stronger army? If one side can expand the scope of civilian vulnerability, then why can't the other?

ABSTRACTAre all forms of guerilla warfare apprehensible? Or can there be such a thing as just guerilla warfare? If so, what would be the reasonable requirements we would make of guerillas in order to consider them just? The remarks below, based on my new book The Ethics of Insurgency; A Critical Guide to Just Guerilla Warfare, summarize my attempts to answer those questions, discussing such issues as legitimate authority, just cause, and compliance with the laws of armed conflict, including the use of human shields and ‘soft-war’ tactics such as cyber warfare. Three commentators thereafter delve into some of the most central critical questions and objections, to which I subsequently reply