In war, medical ethics becomes immediate and vital

Conflict zones can be the most unpredictable and demanding environments in which to practice medicine as material deprivation, physical danger and health worker shortages have to be navigated in real time. They also disproportionately affect children, older adults and refugees. Meanwhile, the notion of war as a temporal event—with a clear beginning and end—has become outdated. For example, conflicts in Afghanistan, Iraq and Central America have become decades-long affairs, each with no end in sight.

The June issue of AMA Journal of Ethics^® (@JournalofEthics) explores patient, health professional and health care infrastructure challenges in areas of conflict. The themed issue spans cases and commentary, medical education, health law, original research and social issues.

Articles include:

1. “How Should Military Health Care Workers Respond When Conflict Reaches the Hospital?”

   1. Crises can require all clinicians to modify practice priorities during extreme circumstances.

2. “Everyone Is Harmed When Clinicians Aren’t Prepared.”

   1. Decolonization of curricula in health professions is key to preparing clinicians to respond with care and competence to vulnerabilities and disease burden exacerbated by conflict.

3. “Why We Need Stricter Oversight of Research Involving Human Subjects Affected by Conflict.”

   1. Systematic analysis of extant research ethics guidance is needed for conflict-affected countries and UN agencies.

4. “What Does Ethics Demand of Health Care Practice in Conflict Zones?”

   1. Traditional clinical and public health ethical obligations are insufficient for practice under attack, threat and coercion or amid civilian abuse.

At the 2022 AMA Annual Young Physicians Section Meeting, AMA Journal of Ethics editor-in-chief Audiey Kao, MD, PhD, and Zaher Sahloul, MD, spoke at an education session, “The Role of Medicine in Armed Conflict: Ethical and Professional Impacts.”

The journal’s June “Ethics Talk” podcast features a discussion with Thalia Arawi, PhD, founding director of the Salim El-Hoss Bioethics and Professionalism Program at the American University of Beirut Faculty of Medicine and Medical Center in Lebanon. Arawi discusses the rise of states of chronic emergency, how health care workers can be protected when working in conflict zones, and how the international community should move beyond declarations to support people affected by war and conflict.

The June issue also features six author-interview podcasts. Listen to previous episodes of the “Ethics Talk” podcast or subscribe in iTunes or other services.

These AMA Journal of Ethics CME modules are each designated by the AMA for a maximum of 1 AMA PRA Category 1 Credit™:

• “Should Children Be Enrolled in Clinical Research in Conflict Zones?”
• “How Should Access to Military Health Care Facilities Be Controlled in Conflict?”
• “How Should Military Health Care Workers Respond When Conflict Reaches the Hospital?”
• “How Should Health Systems Help Clinicians Manage Bias Against Ex-combatants?”
• “Everyone Is Harmed When Clinicians Aren’t Prepared.”
• “Survivor-Centered Approaches to Conflict-Related Sexual Violence in International Humanitarian and Human Rights Law.”
• “Why We Need Stricter Oversight of Research Involving Human Subjects Affected by Conflict.”
• “Traumatic Imagination in Traditional Stories of Gender-Based Violence.”
• “What Does Ethics Demand of Health Care Practice in Conflict Zones?”

Additionally, the CME module “Ethics Talk: Chronic Emergency and the Limits of Peace-Time Bioethics” is designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit.

The offerings are part of the AMA Ed Hub™, an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards. 

Learn more about AMA CME accreditation.

Upcoming issues of the journal will focus on arts-based research in health care, inequity and iatrogenic harm, and what is owed to low-wage heath care workers. Sign up to receive email alerts when new issues are published.