Call for renewal of bioethics in military

Bioethicist Steven Miles, of the University of Minnesota in Minneapolis, has called for a renewal of military medical ethics in the US. Writing in the journal Bioethics, he says that medical ethics in the US “has not articulated a vision to strengthen the military-civilian dialogue to ensure that standards of medical ethics do not evolve simply according to the dictates of military policy.” The trial of Nazi medical leaders at Nuremberg “had a profound effect on research ethics”, and US experiences – including exposing soldiers to thermonuclear blasts – during the Cold War “all led to debate and policy change.” However, he is concerned that lessons have not been learned from more recent violations of medical ethics in the US military.

Miles criticised how the American Medical Association (AMA) responded to the mistreatment of prisoners at Abu Ghraib prison in Iraq. He also claimed that prophylactic drugs were administered to “two hundred and fifty thousand deployed soldiers” to protect them from potential exposure to chemical or biological weapons in combat – but that the efficacy of these drugs “was theoretically plausible but not clinically proven.”

“Asserting that informed consent would obstruct the program and thereby harm military readiness, United States’ regulations were amended to enable the drug to be given to soldiers without their informed consent. This regulation, as quoted and discussed in Annas and Grodin, violated the Nuremberg code provision that no experiment could be done without informed consent.” 

Miles continued:

“A new kind of forum to sustain a dialogue between civilian medical ethics and military leaders is needed. Such a forum might be established in the National Academy of Sciences or some other comparable group. The aim of this dialogue would be to assure that medical professional norms inform the development of policies for military clinicians and the use of tactics that threaten the health of civilians or demobilized soldiers. Such a forum would have three functions: (1) to deliberate in an appropriately transparent manner on health-relevant war tactics and policies; (2) to ensure that policies governing the roles of military clinicians conform to relevant standards of medical professionalism; and (3) to serve as a venue for scholarship of military medical ethics.” ~ Bioethics, Jul 13

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