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Doctors and war: a conflict in itself

2013; Elsevier BV; Volume: 381; Issue: 9870 Linguagem: Inglês

10.1016/s0140-6736(13)60660-1

1474-547X

Anthony Redmond,

Torture, Ethics, and Law

The Saving Lives: Frontline Medicine in a Century of Conflict exhibition at Manchester's Imperial War Museum North stands in celebration of the skill and bravery of the medics who place themselves in harm's way to care for and treat those injured in the military service of their country. It is what the exhibition sets out to do and does well—that more Victoria Crosses have been awarded to the Royal Army Medical Corps than any other section of the British Army is a testimony to the courage and selflessness of these service men and women. I was impressed by the range of exhibits and the sheer technical brilliance of what can be offered to those injured on the battlefield, from the pioneering plastic surgery of Archie McIndoe to the space age da Vinci robotic surgery, and the recognition of how such advances in war eventually benefit medical care in peacetime. Emphasis is placed on how war has driven such technical developments, although the pecuniary and personal costs are not explored—there is only limited mention of the important issue of mental health care for soldiers. An element of “action man” was probably inevitable with the “chop chop” of helicopter blades playing in the background. The friends and colleagues I know who do this work though are, if anything, self-effacing, quiet, and thoughtful. More of their rounded reflection here would have been welcome. The presence of a doctor, in uniform, under orders, in the battlefield has always provoked conflicting concerns; this exhibition stirred them up and set them spinning. The skill and bravery of those treating the wounded and the horror of the wounds endured can only beg the question: why? For it is war itself that must be confronted and no amount of volunteering, heroism, and selflessness will mask its bloody reality and that it always involves a choice. That choice may be to attack, defend, resist, or intervene. It may be to do nothing. However hard the choice—and true pacifism is neither common nor for the faint-hearted—a decision to go to war, join a war, support a war, or even not to go to war at all, can mean that many will die and more will suffer. I try to understand the concept of a just war, the idea of a greater good, and I understand the personal urge to protect and the United Nations’ call for a state's “responsibility to protect”. I also understand that an eye for an eye will leave the world blind. Life is complex, though death remains pathetically simple. The location of “frontline medicine” in a war museum where there is a missile, a fighter plane, and even debris of the twin towers, only serves to further stir this dissonant mix of thoughts and feelings. There is a thin line between celebrating the heroism and skill of those in war and glorifying war itself. The Imperial War Museum doesn't do this consciously, but my quiet observation of those who visited revealed a man photographing the twisted debris of a car bomb from Baghdad. What had been the vehicle to bring death and untold misery exploding into the streets of Iraq was now a curio and another one for the album. I am more afraid perhaps of normalising horror than I am of its glorification. The ethical complexities of war, and within this the role of doctors, are not addressed directly in this exhibition, but the fact that we are reminded that success in the treatment of an injured soldier is described as a return to combat duties, illustrates more than anything perhaps that medical support to the military is primarily support to the successful prosecution of war. This excellent exhibition of medical skill and bravery is located literally and metaphorically within the wider context of war itself. And war is waged by everyone, either actively in combat or passively through support or silence. We might not have shared their experiences of war but we all share the moral responsibility for its consequences.