This paper presents the real case of a military surgeon who is the only one working at a small hospital in Iraq. The military surgeon can only operate on one wounded soldier due to limited medical resources. The first wounded soldier to arrive is the enemy. The second wounded soldier to arrive shortly after the enemy is a compatriot. Both soldiers will die without lifesaving surgery. The military surgeon is ordered by his superior not to operate on the enemy. Under (...) the Geneva Conventions, physician-soldiers are legally required to give medical attention impartially. The only exception is urgent medical need. Both soldiers, friend and foe, have an urgent medical need. Dual-loyalty dilemmas such as this one can arise for military medical practitioners when loyalty to patients comes into conflict with loyalty to third parties such as the state. In this paper, several solutions to the dual-loyalty dilemma are considered and rejected. Solutions to the dual-loyalty dilemma ultimate fail because they rest on the physician-as-healer model which grounds contemporary medical ethics. The view that the ultimate objective of physicians and medicine is winning battles is defended. Physicians are non-neutral and partial fighters who sometimes must do harm. Medicine is a weapon that physicians use to fight an enemy. The only relevant differences between a soldier and physician are the kind of enemy, location of the enemy, and the type of weapons used against the enemy. The paper concludes that physician-soldiers are doctors with borders. There is no dual-loyalty dilemma on the physician-as-fighter model. The military surgeon should obey his orders and not operate on the enemy. Implications of the physician-as-fighter model for mass casualty triage and physician-soldier participation in non-lethal weapons development are considered. (shrink)

In this paper, I take a critical stance on the emerging field of nanoethics. After an introductory section, “Conceptual Foundations of Nanotechnology” considers the conceptual foundations of nanotechnology, arguing that nanoethics can only be as coherent as nanotechnology itself and then discussing concerns with this latter concept; the conceptual foundations of nanoethics are then explicitly addressed in “Conceptual Foundations of Nanoethics”. “Issues in Nanoethics” considers ethical issues that will be raised through nanotechnology and, in “What’s New?”, it is argued that (...) none of these issues is unique to nanotechnology. In “It’s a Revolution!”, I express skepticism about arguments which hold that, while the issues themselves might not be unique, they nevertheless are instantiated to such a degree that extant moral frameworks will be ill-equipped to handle them. In “What’s Different?”, I draw plausible distinctions between nanoethics and other applied ethics, arguing that these latter might well identify unique moral issues and, as such, distinguish themselves from nanoethics. Finally, in “What Now?”, I explore the conclusions of this result, ultimately arguing that, while nanoethics may fail to identify novel ethical concerns, it is at least the case that nanotechnology is deserving of ethical attention, if not a new associative applied ethic. (shrink)

The war on terror is commonly characterized as a fundamentally different kind of war from more traditional armed conflict. Furthermore, it has been argued that, in this new kind of war, different rules, both moral and legal, must apply. In the first part of this paper, three practices endemic to the war on terror -- torture, assassination, and enemy combatancy status -- are identified as exceptions to traditional norms. The second part of the paper uses these examples to motivate a (...) generalized account of exceptionalism; a taxonomy of different exceptionalisms is derived, including temporal, spatial, and group-based exceptionalisms. The third part of the paper considers the ethical status of exceptionalism, paying particular attention to the group-based exceptionalisms that are argued to be prevalent in the war on terror. It is concluded that there is nothing inherently wrong with group-based exceptionalism and, furthermore, that the proper locus of ethical evaluation lies not with the norms that are being excepted, but rather with the groups that are being excepted from them. (shrink)

Health has been called the first wealth, and global health justice and governance call us to consider how justly and ethically to share this wealth. In formulating a proper political theory for glo...

This paper explores the relationships that various applied ethics bear to each other, both in particular disciplines and more generally. The introductory section lays out the challenge of coming up with such an account and, drawing a parallel with the philosophy of science, offers that applied ethics may either be unified or disunified. The second section develops one simple account through which applied ethics are unified, vis-à-vis ethical theory. However, this is not taken to be a satisfying answer, for reasons (...) explained. In the third section, specific applied ethics are explored: biomedical ethics; business ethics; environmental ethics; and neuroethics. These are chosen not to be comprehensive, but rather for their traditions or other illustrative purposes. The final section draws together the results of the preceding analysis and defends a disunity conception of applied ethics. (shrink)

In response to Michael Gross (2008), this article explores the supposition that the goals of military medicine either are or should be characterized as returning wounded soldiers to duty and issues some comments on the negative part of Gross’s project (i.e., why military medicine does not have special obligations to soldiers who will not return to the battlefield).

This paper argues that bioethics as a field should broaden its scope to include the ethics of war, focusing on war’s public health effects. The “Introduction” section describes the bioethics literature on war, which emphasizes clinical and research topics while omitting public health. The section, “War as a public health crisis” demonstrates the need for a public health ethics approach by framing war as a public health crisis. The section, “Bioethics principles for war and public health” proposes six bioethics principles (...) for war that address its public health dimensions: health justice, accountability, dignified lives, public health sustainability, nonmaleficence, and public health maximization. The section, “Justifying and applying bioethical principles” shows how these principles inform ethical analysis, including just war theory and military ethics. The section, “From principles to practice” envisions ways in which bioethicists can promote these principles in practice through research, teaching, and service. The “Conclusion” section urges bioethicists to engage with war as a public health crisis, including calling attention to war’s impact on civilians, especially women, children, and other vulnerable groups. (shrink)

The purpose of this article is to provide a moral foundation for Heilig’s argument that physician participation in torture is a violation of medical ethics. The argument needs a moral foundation because it is unconventional by the standards of academic biomedical ethics. There is little about the “principles of bioethics”, the nature of medicine, the physician-patient relationship, the physician’s “social role,” or the like. Instead, Heilig rests his argument primarily on the AMA’s Code of Ethics —what most bioethicists tend to (...) treat as mere custom, etiquette, law, or statements of opinion . This article explains why the AMA Code of Ethics can set the standard for ethical conduct for physicians—given a certain understanding of “ethics” and “profession” largely absent from biomedical ethics but common in professional ethics generally. The article also responds to six likely objections. (shrink)