This textbook is a two-volume work that represents, by any measure, a body of significant scholarship on the broad subject of medical ethics. Indeed, its military dimension adds substance to what it has to offer, and I recommend it to those general and forensic psychiatrists who have any interest in medical ethics. The editors had the foresight to use the early chapters to establish a solid foundation of reading in medical ethics before turning to the sharply focused context of medical ethics and its application to the military situation. Furthermore, the structure of the text reminds us that medical ethics has progressed precisely because of what has transpired in the military domain.
The two volumes are divided into four sections: Medical Ethics, Military Ethics, the Synthesis of Medicine and the Military, and Medical Ethics in the Military. These sections in turn comprise many different chapters that explicate subject areas, some of which will be familiar to physicians and other health professionals, while others will be unknown territory. Of course, what is mundane and what is unusual will also be, to some extent, a function of our individual interest and our preference for reading about one aspect of medical ethics as opposed to another.
This book reminded me about the inherent complexity of ethics, a discipline that requires us constantly to weigh different interests as we contemplate the best way to solve a particular situation or to get ourselves out of a complicated dilemma. The reader is in fact provided with case examples that facilitate use of the theoretical principles explored in the text. Part of the problem that is created by the juxtaposition of medicine and the military is the opposing viewpoints that each profession has traditionally held on some of the most basic subjects encountered in our daily lives. After all, soldiers kill people; they do so with expert efficiency. That act is permitted and, in some instances, even encouraged. The physician-soldier is by definition, therefore, a profound contradiction. Still, this text thoughtfully explains, first of all, the necessity of having standing armies and then the rationale for the existence of the physician-soldier. I say again that there is serious scholarship in this text, and it puts to shame the cavalier attitude of present-day policy makers who would dispense with, for example, the Laws of War, a precept that is meant to keep the necessary act of war within some ethics-derived boundary.
The early chapters on the moral foundations of the patient-physician relationship and on the theories of medical ethics are lucidly and expertly written. They will serve well every training program looking for a solid reference source on these topics. Similarly, the chapters entitled “Physician-Soldier: A Moral Dilemma” and “Mixed Agency in Military Medicine” describe aspects of the forensic psychiatrist's work that are already known to many of us. But what is intriguing here is to put ourselves full force into the military context. The older physicians among us probably served in the military when the draft was in effect. The younger doctors may never have worn a military uniform. That experiential difference may have everything to do with the reader's reaction to these chapters.
I knew little about Japanese biomedical experimentation that occurred during World War II. I also had no knowledge of the fact that while Americans were making so much of the Nuremberg trials of Nazi doctors, they were deliberately covering up the acts that Japan's military and medical leadership had perpetrated on their prisoners. That is because Americans wanted the exclusive knowledge and use of the Japanese research results. Over the years, I'd also come to know about the evils of American biomedical experimentation reported in occasional articles here and there. But this text, sponsored as it is by a government agency, deserves praise for its thorough reminder of what Americans have done in medicine when attention to ethics was dissipated. Yes, this book is a necessary counter-balance to those professors, for example, who still believe that medical researchers should be unfettered by the constraints of ethics.
My enthusiasm about this book is related to its relevance both to medicine and to the general war context that so surrounds us these days. The pithy, simplistic arguments advanced to support or to criticize the participation of military physicians in torture lose their credibility when read in light of the methodological and analytic rigor advanced in this text. It is for that reason it makes so much sense for our trainees to read at least certain of the chapters—to sharpen the ability to weigh thoughtfully the reasons for and against carrying out a particular medical decision.
- American Academy of Psychiatry and the Law
