Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-25T06:24:43.687Z Has data issue: false hasContentIssue false
  • English
  • Français

Medical ethics in peacetime and wartime: the case for a better understanding

Published online by Cambridge University Press:  07 May 2014

Vivienne Nathanson
Get access Rights & Permissions [Opens in a new window]

Abstract

Health-care workers face ethical dilemmas in their decision-making in every clinical intervention they make. In times of armed conflict the decisions may be different, and the circumstances can combine to raise ethical tensions. This article looks at the tensions in peacetime and in times of armed conflict and examines the types of cases that doctors and other health-care workers will face. It also discusses the common ethical decision-making framework and the role of communication within both clinical care and ethical analysis.

Keywords

ethical dilemmaethical analysisdecision makingconsentconfidentialitycommunicationtrust
Type
Research Article
Information
International Review of the Red Cross , Volume 95 , Issue 889: Violence against health care Part I: The problem and the law , March 2013 , pp. 189 - 213
Copyright
Copyright © icrc 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 British Medical Association (BMA), Medical Ethics Today: the BMA's Handbook of Ethics and Law, 3rd edition, BMJ Books, London, February 2012Google Scholar; Williams, J. R., World Medical Association Medical Ethics Manual, 2nd edition, WMA, Ferney-Voltaire, 2009Google Scholar; International Committee of the Red Cross (ICRC), Health Care in Danger: the Responsibilities of Health-Care Personnel Working in Armed Conflicts and Other Emergencies, ICRC, Geneva, 2012Google Scholar.

2 WMA Declaration of Geneva, adopted September 1948, last revised May 2006.

3 WMA International Code of Medical Ethics, adopted October 1949, last amended October 2006.

4 WMA Regulations in Times of Armed Conflict and Other Situations of Violence, adopted October 1956, last revised October 2012.

5 For case law relevant to the question of medical consent, see references in BMA, above note 1, especially chapters 2, 3, and 4.

6 See Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12), adopted on 11 August 2000, E/C.12/2000/4, para. 1 (emphasis added).

7 For a summary of IHL and human rights law rules related to the respect and protection of health care, see ICRC, ‘Respecting and protecting health care in armed conflicts and in situations not covered by international humanitarian law’, Legal Fact Sheet, 31 March 2012, available at: www.icrc.org/eng/resources/documents/legal-fact-sheet/health-care-law-factsheet-2012-03.htm (last visited November 2012).

8 Ministry of Defence, Medical Support to Persons Detained by UK Forces Whilst on Operations, Joint Service Publication 950, leaflet 1-3-4, March 2011Google Scholar.

9 BMA, Ethical Decision-Making for Doctors in the Armed Forces: a Tool Kit, London, 2012Google Scholar.

10 WMA Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects, adopted June 1964, last amended October 2008.

11 For more information, see the website of the Health Care in Danger project: www.icrc.org/eng/what-we-do/safeguarding-health-care/solution/2013-04-26-hcid-health-care-in-danger-project.htm (last visited May 2013).

12 In situations of international armed conflict, prisoners of war and civilian detainees are protected by the Third Geneva Convention relative to the Treatment of Prisoners of War, and the Fourth Geneva Convention relative to the Protection of Civilian Persons in Time of War, as well as by customary rules (see ICRC, Customary International Humanitarian Law, Vol. I: Rules, Jean-Marie Henckaerts and Louise Doswald-Beck (eds.), Cambridge University Press, Cambridge, 2005, specifically chapter 37). In situations of non-international armed conflict, persons deprived of liberty for reasons related to the conflict are protected by Article 3 common to the Geneva Conventions, and by the Protocol Additional to the Geneva Conventions of 12 August 1949 and relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), as well as by applicable customary rules.

13 For more information about the responsibilities of health-care personnel working in armed conflicts and other emergencies, see ICRC, above note 1.

14 WMA Declaration of Tokyo, Guidelines for Physicians Concerning Torture and other Cruel, Inhuman and Degrading Treatment or Punishment in relation to Detention and Imprisonment, October 1975, adopted by the 29th World Medical Assembly, Tokyo, Japan, October 1975, and last revised at the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006, available at: www.wma.net/en/30publications/10policies/c18/ (last visited November 2012).

15 WMA Declaration of Hamburg, Concerning Support for Medical Doctors Refusing to Participate in, or to Condone, the Use of Torture or Other Forms of Cruel, Inhuman or Degrading Treatment, adopted by the 49th WMA General Assembly, Hamburg, Germany, November 1997, and reaffirmed by the 176th WMA Council Session, Berlin, Germany, May 2007.

16 See BMA, above note 9; and ICRC, above note 1.