Dr. John O. Pastore Past President, Physicians for Social Responsibility Medical Staff President Caritas St. Elizabeth's Medical Center, Boston

Ethics, War, and the Health Care Professional Physicians for Social Responsibility 2007

In the matter of war itself, health professionals may be on the horns of a dilemma: Are we war enablers as well as war protesters?

Lysistrata and the health professional: What if they started a war and we (all of us.. all sides) didn’t come?

There is a long and honored tradition that we do treat the victims of war, even the “enemy”

So, our anti-war activism is focused on Preventing wars and working to end them

Hiroshima and Nagasaki, 1945

Hiroshima: the devastation of a city

Urakami Cathedral, Nagasaki (1945)

There is no honor in the possession of nuclear weapons

The moral and ethical concept of “just war” The true pacifist believes that war is never justified The non-pacifist who abhors war believes that on rare occasion violent force may be needed to prevent or put an end to a greater evil (e.g., the holocaust) Nevertheless, the concept of “proportionality” is central to just war theory

Even those (e.g., Roman Catholic theologians) who will allow for the possibility of “just wars” proscribe conflicts in which non-combatants bear the brunt of the damage. That is precisely why the US Catholic bishops issued their warning about nuclear deterrence and nuclear war during the standoff between the Soviet Union and the United States.

Proportionality It precludes the targeting and certainly the destruction of civilian cities. It is the concept that makes mutual assured destruction and nuclear deterrence immoral a priori, whatever their putative political utility.

Mortality after the 2003 invasion of Iraq: a cross-sectional cluster sample survey The Lancet online, October 11, 2006 Pre-invasion mortality rates were 5.5 per 1000 people per year, compared with 13.3 per 1000 people per year in the 40 months post-invasion. “We estimate that as of July, 2006, there have been 654,965 excess Iraqi deaths as a consequence of the war, which corresponds to 2.5% of the population in the study area.” 601,027 of the post-invasion deaths were due to violence, the most common cause being gunfire.

But the waste of soldiers’ lives and of precious resources that might be used for socially necessary purposes is also immoral. To sacrifice the health needs of millions of the disadvantaged to secure a political goal is deeply immoral.

PSR has also drawn attention to the severe medical and psychological damage suffered by our own troops who have been maimed by the combat in Iraq. The role of the health care professional is to show war as it is, without the sugar- coating of political spin.

Through March 2007

New England Journal Medicine photo essay on US casualties in Iraq sent by PSR to every member of Congress on March 17, 2006

Message to senators and representatives: “powerful, clinical evidence of the devastating nature of the non-fatal wounds sustained by our casualties who survive to deal with extremely debilitating and obviously life-altering injuries.” “shows the trauma without the interposition that may be necessary to keep these images from the eyes of children. But you and we stopped being children long ago.”

PSR to Congress … continued “photos should be remembered when appropriations bills to support this generation’s veterans come to your desk. These young men and women will be struggling with the aftermath of this devastation for decades after the world has moved on to other concerns. It will be up to you to remember to honor their sacrifices with rehabilitation, job training, and financial support long after the last trumpet from this war has sounded.”

and finally … “there are no pictures here of post-traumatic stress syndrome, nor of broken marriages and families as a result of the trauma suffered in this war. The psychiatrists in our VA hospital system deal with these problems daily and talk with us about what they see and hear. Those messages must also be heard when decisions bearing on the yes or no of prolonged military involvement in Iraq come before you.”