Abstract
The topic of this volume, the Ethics of medical innovation, experimentation, and human enhancement in military and humanitarian contexts, is a vast subject area that gives rise to many ethical issues of very different kinds. The purpose of this introductory chapter is to give a panoramic overview and to provide points of reference together with an initial outline of the ethical questions that arise.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
See the chapter of Jack Taylor in this book for more examples of innovation in (military) medicine and for a discussion of related ethical issues.
- 2.
Exceptions may apply (as in ordinary clinical contexts) when a medical condition poses an immediate risk to the patient or his/her environment as for example with highly infectious diseases or certain psychological conditions.
- 3.
In more detail, the issue is also discussed in the chapters of Coleman and of Eagan/ Eagan in this volume.
- 4.
The original document has been signed and endorsed by the International Committee of the Red Cross (ICRC), the World Medical Association (WMA), the International Committee of Military Medicine (ICMM), the International Council of Nurses (ICN) and the International Pharmaceutical Federation (FIP). Meanwhile, other organization and bodies like the World Health Organization (WHO) but also the Chiefs of Medical Services (COMEDS) within NATO have joined as advocates of the principles proposed by this document.
- 5.
See namely the chapters of Eisenstein/ Draper, of S. Eagan, and of Stevens/ Gilbert.
- 6.
In this volume, the chapters contributed by Sandvik and also by Smith et al. discuss similar questions that arise within the context of humanitarian action.
- 7.
This issue will be discussed in some detail in this volume by Coleman and by S. Eagan in their respective chapters.
- 8.
A general overview on these questions and some related ethical challenges is given in the chapter of Puscas. More concrete examples will be discussed in the three chapters of Miletic, of Stevens/ Gilbert, and the chapter of Marijn/ Liivoja.
- 9.
For a discussion of several definitions of enhancement, see also the chapters of Vongehr and of Fischer in this volume.
- 10.
Similar questions are also raised in the chapters of Fischer and of P. Gilbert.
References
Allhoff, Fritz, et al. 2010. Ethics of human enhancement: 25 questions & answers. Studies in Ethics, Law, and Technology 4 (1): 1.
Amoroso, Paul J., and Lynn L. Wenger. 2003. The human volunteer in military biomedical research. In Military medical ethics, ed. Thomas E. Beam and Linette R. Sparacino, vol. 2, 563–603. Washington, DC: Office of The Surgeon General, United States Army.
Annas, Catherine L., and George J. Annas. 2008. Enhancing the fighting force: Medical research on American soldiers. The Journal of Contemporary Health Law and Policy 25: 283.
Annas, George J., and Michael A. Grodin, eds. 1992. The Nazi doctors and the Nuremberg code human rights in human experimentation. Vol. XXII, 371 S. New York/Oxford: Oxford University Press.
———. 2008. The Nuremberg code. In The Oxford textbook of clinical research ethics, 136–140. New York: Oxford University Press.
Beauchamp, Tom L. 2008. The Belmont report. In The Oxford textbook of clinical research ethics, 21–28. Oxford: Oxford University Press.
Beauchamp, Tom L., and James F. Childress. 2009. Principles of biomedical ethics. 6th ed. Oxford: Oxford University Press.
Blackbourne, Lorne H., et al. 2012. Military medical revolution: Military trauma system. Journal of Trauma and Acute Care Surgery 73 (6): S388–SS94.
Bonham, Valerie H., and Jonathan D. Moreno. 2008. Research with captive populations: Prisoners, students, and soldiers. In The Oxford textbook of clinical research ethics, ed. Ezekiel J. Emanuel, 461–474. Oxford: Oxford University Press.
Bostrom, Nick, and Rebecca Roache. 2008. Ethical issues in human enhancement. In New waves in applied ethics, ed. Jesper Ryberg, Thomas Petersen, and Clark Wolf, 120–152. Basingstoke: Palgrave Macmillan.
Bower, Eric A., and James R. Phelan. 2003. Use of amphetamines in the military environment. The Lancet 362: s18–s19.
Brown, Vincent, et al. 2008. Research in complex humanitarian emergencies: The Médecins Sans Frontières/epicentre experience. PLoS Medicine 5 (4): e89.
Calain, Philippe. 2016. The Ebola clinical trials: A precedent for research ethics in disasters. Journal of Medical Ethics 44 (1): 3–8.
Calain, Philippe, et al. 2009. Research ethics and international epidemic response: The case of Ebola and Marburg hemorrhagic fevers. Public Health Ethics 2 (1): 7–29.
Caldwell, John A., and J. Lynn Caldwell. 2005. Fatigue in military aviation: An overview of US military-approved pharmacological countermeasures. Aviation, Space, and Environmental Medicine 76 (7): C39–C51.
Council of Europe. 2005. Additional protocol to the convention on human rights and biomedicine, concerning biomedical research, Council of Europe treaty series–no. 195. Strasbourg: Council of Europe.
Daniels, Norman. 2000. Normal functioning and the treatment-enhancement distinction. Cambridge Quarterly of Healthcare Ethics 9 (3): 309–322.
De Lorenzo, Robert A. 2004. Emergency medicine research on the front lines. Annals of Emergency Medicine 44 (2): 128–130.
Emanuel, Ezekiel J., et al. 2004. What makes clinical research in developing countries ethical? The benchmarks of ethical research. Journal of Infectious Diseases 189 (5): 930–937.
———. 2008. The Oxford textbook of clinical research ethics. Oxford: Oxford University Press.
Fabre, C. 2009. Guns, food, and liability to attack in war. Ethics 120 (1): 36–63.
Ford, N., et al. 2009. Ethics of conducting research in conflict settings. Conflict and Health 3: 7.
Friedl, Karl E. 2015. US Army research on pharmacological enhancement of soldier performance: Stimulants, anabolic hormones, and blood doping. The Journal of Strength & Conditioning Research 29: S71–S76.
Frisina, Michael E. 1990. The offensive-defensive distinction in military biological research. Hastings Center Report 20 (3): 19–22.
———. 2003. Medical ethics in military biomedical research. In Military medical ethics, ed. Thomas E. Beam and Linette R. Sparacino, vol. 2, 533–561. Washington, DC: Office of The Surgeon General, United States Army.
Gilman, Robert H., and Hector H. Garcia. 2004. Ethics review procedures for research in developing countries: A basic presumption of guilt. Canadian Medical Association Journal 171 (3): 248–249.
Givens, Melissa, Andrew E. Muck, and Craig Goolsby. 2017. Battlefield to bedside: Translating wartime innovations to civilian emergency medicine. The American Journal of Emergency Medicine 35 (11): 1746–1749.
Greene, Marsha, and Zubin Master. 2018. Ethical issues of using CRISPR technologies for research on military enhancement. Journal of Bioethical Inquiry 15 (3): 327–335.
Gross, Michael L. 2006. Bioethics and armed conflict. Moral dilemmas of medicine and war, xv, 384. Cambridge, MA: MIT Press.
Haider, Adil H., et al. 2015. Military-to-civilian translation of battlefield innovations in operative trauma care. Surgery 158 (6): 1686–1695.
Harris, Sheldon H. 2003. Japanese biomedical experimentation during the World-War-II era. In Military medical ethics, ed. Thomas E. Beam and Linette R. Sparacino, vol. 2, 463–506. Washington, DC: Office of The Surgeon General, United States Army.
Henckaerts, Jean-Marie, and Louise Doswald-Beck. 2005. Customary international humanitarian law. Cambridge: Cambridge University Press.
Hodgetts, Timothy J. 2014. A roadmap for innovation. Journal of the Royal Army Medical Corps 160 (2): 86–91. (British Medical Journal Publishing Group).
International Committee of the Red Cross (ICRC), et al. 2015. Ethical principles of health care in times of armed conflict and other emergencies. Geneva: ICRC.
Juengst, Eric, and Daniel Moseley. 2016. Human enhancement. In The Stanford encyclopedia of philosophy, ed. Edward N. Zalta. Stanford: Stanford University.
Kitchen, Lynn W., and David W. Vaughn. 2007. Role of US military research programs in the development of US-licensed vaccines for naturally occurring infectious diseases. Vaccine 25 (41): 7017–7030.
Ko, Henry, et al. 2018. A systematic review of performance-enhancing pharmacologicals and biotechnologies in the Army. Journal of the Royal Army Medical Corps 164 (3): 197–206.
Leaning, Jennifer. 2001. Ethics of research in refugee populations. The Lancet 357 (9266): 1432–1433.
Lederer, Susan E. 2003. The cold war and beyond: Covert and deceptive American medical experimentation. In Military medical ethics, ed. Thomas E. Beam and Linette R. Sparacino, vol. 2, 507–533. Washington, DC: Office of The Surgeon General, United States Army.
Liivoja, Rain. 2017. Biomedical enhancement of warfighters and the legal protection of military medical personnel in armed conflict. Medical Law Review 26 (3): 421–448.
Ling, Geoffrey S.F., Peter Rhee, and James M. Ecklund. 2010. Surgical innovations arising from the Iraq and Afghanistan wars. Annual Review of Medicine 61: 457–468.
McManus, John, et al. 2005. Informed consent and ethical issues in military medical research. Academic Emergency Medicine 12 (11): 1120–1126.
Messelken, Daniel. 2017. Medical care during war: A remainder and prospect of peace. In The nature of peace and the morality of armed conflict, ed. Florian Demont-Biaggi. Cham: Palgrave Macmillan.
Messelken, Daniel, and David T. Winkler, eds. 2018. Ethical challenges for military health care personnel: Dealing with epidemics, Military and defence ethics. London: Routledge.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1979. The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. Washington, DC: Department of Health, Education, and Welfare, National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.
Rasmussen, Nicolas. 2011. Medical science and the military: The Allies’ use of amphetamine during World War II. Journal of Interdisciplinary History 42 (2): 205–233.
Ratto-Kim, Silvia, et al. 2018. The US military commitment to vaccine development: A century of successes and challenges. Frontiers in Immunology 9: 1397.
Reade, Michael C. 2013. Military contributions to modern trauma care. Current Opinion in Critical Care 19 (6): 567–568.
Rid, A., and E.J. Emanuel. 2014. Ethical considerations of experimental interventions in the Ebola outbreak. Lancet 384 (9957): 1896–1899.
Schopper, D., et al. 2009. Research ethics review in humanitarian contexts: The experience of the independent ethics review board of Médecins Sans Frontières. PLoS Medicine 6 (7): e1000115.
Schrager, Jason J., Richard D. Branson, and Jay A. Johannigman. 2012. Lessons from the tip of the spear: Medical advancements from Iraq and Afghanistan. Respiratory Care 57 (8): 1305–1313.
Swiss Academy of Medical Sciences. 2015. Research with human subjects. A manual for practitioners. Bern: Swiss Academy of Medical Sciences.
———. 2017. Distinguishing between standard treatment and experimental treatment in individual cases. Bern: Swiss Academy of Medical Sciences.
Wolfendale, Jessica. 2008. Performance-enhancing technologies and moral responsibility in the military. The American Journal of Bioethics 8 (2): 28–38.
World Health Organization. 2011. Standards and operational guidance for ethics review of health-related research with human participants. Geneva: WHO.
World Medical Association. 2013 (1964). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Geneva: World Medical Association.
Acknowledgments
We could not have completed this book without the continued support of a number of people to whom we would like to express our gratitude.
Our first and profound thanks go to the contributors of this volume who wrote and revised their chapters with diligence and who were open enough to share their knowledge and own experiences with a broader audience.
We are thankful to Major General Dr. Andreas Stettbacher, Major General Dr. Roger van Hoof, and Prof. Peter Schaber under the patronage of whom the workshop was organized during which most of the chapters of this volume were first discussed. Financial support for the work on this volume was granted by the Centre of Competence for Military and Disaster Medicine of the Swiss Armed Forces to the Center for Military Medical Ethics at Zurich University.
Finally, we would like to thank the two anonymous referees for their feedback and constructive comments on the first manuscript, as well as Floor Oosting and Christopher Wilby from Springer for their advice and support throughout the conception and production of this volume.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Messelken, D., Winkler, D. (2020). Ethics of Medical Innovation, Experimentation, and Enhancement in Military and Humanitarian Contexts. Introduction to the Volume. In: Messelken, D., Winkler, D. (eds) Ethics of Medical Innovation, Experimentation, and Enhancement in Military and Humanitarian Contexts. Military and Humanitarian Health Ethics. Springer, Cham. https://doi.org/10.1007/978-3-030-36319-2_1
Download citation
DOI: https://doi.org/10.1007/978-3-030-36319-2_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-36318-5
Online ISBN: 978-3-030-36319-2
eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)