Issues relating to voluntary euthanasia that are currently being debated by Australian society are distinctly different from those encountered by battlefield doctors.
Doctors in war undertake to treat those affected by conflict; their participation in euthanasia challenges the profession’s definition of “duty of care”.
Euthanasia must be distinguished from “triage” and medical withdrawal of care (which are decided within a medical facility where, although resources may be limited, comfort care can be provided in the face of treatment futility).
Battlefield euthanasia is a decision made, often immediately after hostile action, in the face of apparently overwhelming injuries; there is often limited availability of pain relief, support systems or palliation that would be available in a civilian environment. The battlefield situation is further complicated by issues of personal danger, the immediacy of decision making and difficulties with distinguishing civilians from combatants.
Regardless of the circumstances on a battlefield, doctors, whether they are civilians or members of a defence force, are subject to the laws of armed conflict, the special provisions of the Geneva Conventions and the ethical codes of the medical profession.
- 1. Pellegrino ED. Societal duty and moral complicity: the physician’s dilemma of divided Loyalty. Int J Law Psychiatry 1993; 16: 371-391.
- 2. Neuhaus SJ, Bridgewater F, Kilcullen D. Military medical ethics: issues for 21st century operations. Aust Defence Force J 2001; 151: 49-58.
- 3. 1 Samuel 31: 2-4: The holy Bible. New century version. Dallas Tex: Word Publishing, 1991: 276.
- 4. Keynes G, editor. The apologie and treatise of Ambroise Paré —1585. New York: Dover Press, 1968: 21.
- 5. Peterson RKD. Insects, disease, and military history: the Napoleonic Campaigns and historical perception. Reprinted and adapted from Am Entomol 1995; 41: 147-160. http://entomology.montana.edu/historybug/napoleon/napoleon.htm (accessed Feb 2011).
- 6. Keneally T. Schindler’s list. New York: Simon & Schuster, 1982.
- 7. Masters J. The road past Mandalay. New York: Harper and Brothers, 1961: 253-254.
- 8. Forced abandonment and euthanasia: a question from Katrina. Goliath Business Knowledge on Demand, 2007. http://goliath.ecnext.com/coms2/gi_0199-6523854/Forced-abandonment-and-euthanasia-a.html (accessed May 2010).
- 9. Harris, NM. The euthanasia debate. J R Army Med Corps 2001; 147: 367-370.
- 10. Reade MC. Medical assistance to civilians during peacekeeping operations: wielding the double edged sword. Med J Aust 2000; 173: 586-589. <MJA full text>
- 11. Baker R, Strosberg M. Triage and equality: an historical assessment of ultilitarian analyses of triage. Kennedy Inst Ethics J 1992; 2: 103-123.
- 12. Rachels J. The sanctity of life. In: Humber H, Almeida R, Clifton NJ, editors. Biomedical ethics review. Clifton, NJ: Humana Press, 1983: 29-42.
- 13. Gillion R. Suicide and voluntary euthanasia: historical perspective. In: Downing AB, editor. Euthanasia and the right to death: the case for voluntary euthanasia. London: Peter Owen, 1969.
- 14. Beam TE, editor. Military medical ethics volume 2. Section IV: Medical ethics in the military. Falls Church, Va: Office of The Surgeon General, United States Army, 2003: 384-394. http://www.bordeninstitute.army.mil/published_volumes/ethicsVol2/ethicsVol2.html (accessed May 2010).
- 15. Tak PJP. The Dutch criminal justice system. Organization and operation. 2nd revised edition. Den Haag: Wetenschappelijk Onderzoek en Documentatiecentrum, 2003.
- 16. Lifton RJ. The Nazi doctors; medical killing and the psychology of genocide. New York: Basic Books, 1989: 4-6.
- 17. Swann SW. Euthanasia on the battlefield. Mil Med 1987; 152: 545-549.
- 18. United States v Rogelio M. Maynulet Criminal App No. 20050412 United States Courts of Appeals for the Armed Forces. Decided March 3, 2010. http://www.armfor.uscourts.gov/opinions/2009SepTerm/09-0073.pdf (accessed Nov 2010).
- 19. National Defence and the Canadian Forces. Courts martial results. 5 Oct 2010. R v Capt Semrau. http://www.jmc-cmj.forces.gc.ca/rcm-cmr/2010-eng.asp (accessed Nov 2010).
- 20. Jurisevic C. Blood on my hands: a surgeon at war. Melbourne: Wild Dingo Press, 2010.
- 21. Moskop JC. A moral analysis of military medicine. Mil Med 1998; 163: 76-79.
- 22. Australian Government Department of Defence. Defence Support Group. Defence Legal. Directorate of international agreements & arrangements (digaa) links. Status of forces agreement (SOFA). http://www.defence.gov.au/legal/dagts2.html (accessed Oct 2010).
- 23. Australian Government. ComLaw. Euthanasia laws act 1997. Act — C2004A05118. http://www.comlaw.gov.au/Details/C2004A05118 (accessed Feb 2011).
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.