Historical Reflections on the Ethics of Military Medicine

Abstract

The battlefield and wartime conditions often challenge physicians as to their understanding and commitment to the ethics of medicine. In Homer's Iliad we read of the first physicians on the battlefield before the walls of Troy, the sons of Asclepius, Machaon, and Podalirius. In his 16th century autobiography, Ambroise Pare recounts the first case of battlefield euthanasia of the wounded and of posttraumatic stress disorder and was renowned for his skill and humanity in the care of his soldiers. Dominique Larrey established the principles of triage of the wounded during the Napoleonic wars. It is out of warfare that the Geneva Convention and the Red Cross emerged. But what does history tell us about the ethical dilemmas of the military physician? Should prisoners receive care equal to that given to one's own troops? Can torture be used to extract information that may save lives? Is it ethical to enslave captured soldiers? Is the doctrine of the double effect valid as originally applied to war? Should a physician's ethics require him or her to speak out against perceived violations? This paper explores these issues from a historical perspective and I seek the voices of soldiers in the field wherever possible.