COMMENTARIES

Is bioethics meaningless in conflict zones?

Julian Sheather

DOI: 10.20529/IJME.2019.068

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Jafarey’s criticisms are wide ranging. Attacks on the venality and self-interest of academic bioethicists mingle with accusations of naiveté, of misguided beliefs that somehow ethical guidelines will “make all the evil things go away.” More cogently perhaps, he talks of a gulf between the exhortations of bioethicists – and their guidelines – and the reality to which they try, and in his view woefully fail, to speak. He also writes of a certain, I assume patronising, tendency among “parachute bioethicists”, to nod to the sometimes wide cultural distance between bioethicists and their audiences by adding a “sprinkle” of “some local masala” to ‘“indigenise” the discussion.’

As someone who has worked for many years in the ethics of humanitarian crises, including conflict zones, and as a fair example of Jafarey’s “parachute bioethicist,” I am interested in, and alert to, his criticisms. If we set aside questions of the virtues of individual bioethicists, it seems to me that, underlying his approach there are two possible arguments at play. The first is that there is something wrong with the bioethics we are practising. If there is the gulf Jafarey describes between the available bioethics, and the harsh reality of conflicts, then we need to do our bioethics differently. We don’t need, and, assuming conflict zones remain a never-ending supply of harsh ethical questions, cannot afford, to abandon bioethics. Health professionals will continue to struggle to bring relief to victims, researchers will continue to puzzle over what works, and all will confront, at times, wrenching moral challenges. Instead of abandoning bioethics, we need to bring our thinking closer to the reality it addresses, whatever the intellectual or moral challenge. Bioethics is not futile – it is awry, or underpowered. As someone who works in bioethics, someone who has “conducted more research ethics workshops than (he) cares to remember,” it is a shame that Jafarey doesn’t address this question. It would be good to hear his views on bridging the divide he identifies.

To speak of the “futility” of bioethics in war zones is to evoke the shades of another argument ‒ Thucydides’ account of the dialogue between the Athenian generals and the besieged Spartan colony of Melos during the Peloponnesian war – the Melian Dialogue. To paraphrase – and to risk disastrously oversimplifying – the argument, which is a species of realism, states that when it comes to armed conflict, morality in any ordinary understanding simply does not apply. As Werner Jaeger puts it “the principle of force forms a realm of its own, with laws of its own.” (2)

Among the reasons for the enduring appeal of the realist argument is surely that it speaks to the awful confusion of war. For ordinary moral actors – health professionals, researchers, humanitarian responders, even civilians – the outlandishness and anarchy of warfare must inevitably, as a matter of lived experience, at least call into question the adequacy of ordinary moral norms. What place the niceties of fully-informed consent where cities are being strafed, gassed and barrel-bombed? Research ethics developed for the hushed and white-coated order of a modern research facility will surely be mocked in the chaos of armed conflict. What point is there to rules in the absence of enforcement? What place for moral niceties where tanks are on the street? There has to be some, possibly a great deal, of truth in this. Where ordinary moral injunctions against killing are torn apart in the general devastation, when our deepest moral convictions seem violated, what place can there be for something as luxurious, as ephemeral, as research ethics? When Jafarey speaks of the scepticism around the room regarding the self-serving “parachute bioethicists”’ at his bioethics seminar for Palestinians, some form of this disjuncture may have been on their minds. Bioethics is futile because morality itself, upon which bioethics is parasitic, has been swept aside.

But there is a problem. War may upend the world, but human beings caught up in the maelstrom still need to make decisions – and some of them will be ethical. Consider a doctor serving with the military in a combat zone. Following a firefight, some seriously injured local insurgents are brought into the camp. The doctor’s commanding officer demands that she prioritises her own, much less seriously injured colleagues. Like it or not she has a decision to make, and it is a moral one – and one to which the ethics of her profession – and international law – speak. Yes, there will be times in war where choice disappears, where people act under extreme duress, where they are driven by overwhelming circumstance. But it is not universally so. Anybody seeking to bring care to those wounded by war, anyone trying to bring relief to those displaced by it will face ethical decisions. And hence the need for guidance remains. Bioethics is not futile – it is inescapable.