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The moral questions of war

BMJ 2003; 326 doi: (Published 12 April 2003) Cite this as: BMJ 2003;326:f
  1. Richard Smith (rsmith{at}, editor

    “Morality,” said Gandhi, “is contraband in war.” It may come down to nothing more than kill or be killed, maim or be maimed. But war constantly throws up moral questions.

    Some argue that war can never be morally justified, and Benjamin Franklin, one of America's founding fathers, believed: “There never was a good war or a bad peace.” International law accepts the notion of a just war, but it's worth remembering the seven conditions of such a war. The cause must be just. A lawful authority must decide to resort to force. The intention of the war must accord with international law. The use of force must be a last resort. The probability of success should be high. (This condition seems to favour the powerful. Norman Cousins observed that: “The possibility of war increases in direct proportion to the effectiveness of the instruments of war.”) The cost benefit ratio should be positive. The means used must conform with international humanitarian law.

    Amnesty International has argued that the British and the Americans have violated international humanitarian law by using cluster bombs (p 780). The history of such bombs, says Glenda Jackson, a Labour member of parliament, “is that the greatest danger is wreaked upon civilians, particularly children.”

    What about torture? Can this be justified if it will lead to information that will prevent atrocities like the attacks on New York and Washington? The Americans think so. The New York Times has published accounts of the torturing of Al Qaeda suspects. The techniques include deprivation of food, water, sleep, and light; forcing prisoners to stand or kneel in unnatural positions in extreme cold or heat; and denial of medical attention. Derek Summerfield argues that torture is itself a form of terrorism and that doctors should speak out against it (p 773).

    Moral questions also arise over depicting the images of war (p 828). Some argue that nobody should be sheltered from the horror of war, and Al-Jazeera, the Arab television channel, routinely shows pictures that would be unacceptable in Britain. The Guardian after intense debate put on its front page a picture of an Iraqi baby killed in a bombing raid, whereas the New York Times picture editor judged the picture too much for her paper's taste.

    Jerome Singh and Tania DePellegrin discuss the role of doctors in the production of pictures of war victims in hospitals (p 774). They argue that “doctors who permit footage of this nature to be captured fail in their legal and ethical duty to protect their patients.”

    What are we all thinking as we are immersed in the images and words of war? Ralph Crawshaw, a retired psychiatrist from Oregon, has identified a new syndrome—“9/11 thinking” (p 829). Doctors in the United States, he suggests, are confused and full of fear, which stops them reflecting on their patients and so makes good clinical judgment more difficult.


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