What ethics of care in times of war?
If doctors have a specific role to play in times of war, little by little a code of rights and duties has been put in place.
In times of conflict, any person who does not take part in it - soldier hors de combat, prisoner, non-belligerent civilian - must "benefit in all circumstances from humane treatment, and in particular receive care if he is wounded or sick". This is the main meaning of the four Geneva Conventions signed in 1949. The doctor - like all medical personnel - engaged on the scene of combat is particularly protected.
A privilege which is granted only at the time, it is exclusively assigned to a humanitarian task: "the search, the removal, the transport, the treatment of the wounded or sick or the prevention of disease" (art 24 1st Geneva Convention) . This privilege which he cannot renounce, even partially. In practice, this concerns army health personnel, including "soldiers specially trained to be employed as nurses or stretcher-bearers", and that of "voluntary relief companies recognized and authorized by their government" (e.g.: Red Cross) .
All are submitted - even if they are civilians - to military laws and regulations, i.e. they may be obliged by their government to remain with the wounded if the enemy attacks… Medical aid organizations - such as Doctors Without Borders - are a priori excluded from this privilege, except with the express agreement of their government or if they work under cover of the International Committee of the Red Cross...
Protected personnel is facilitated in the accomplishment of his task: right of access to victims, carrying light weapons for his own defense or for that of the wounded and sick, right to refuse to provide information on the wounded and sick of whom he is occupies (unless it is the State of which he is the national which requests it or for communicable diseases requiring compulsory notification), the right to be repatriated quickly in the event of capture. Reprisals against him or the injured are strictly prohibited. Even if a party to the conflict exercises it, the other party is not entitled to do the same. Finally, the symbol of the Red Cross (or the red crescent) - also affixed to the sanitary facilities - allows it to be quickly identified, even from afar. A relative protection that depends on the goodwill of the fighters.
In échange, the doctor must remain neutral ; he must abstain "from any interference in military operations and from any religious, national, racial, political or social discrimination". He must respect medical ethics more strictly than usual: act when a victim requests care and in his sole interest, respect his will, keep the secret entrusted. Medical or "scientific" experimentation is totally prohibited, whether under the effect of threat - the 2nd World War left its mark! - or "at the request" of the victim. Only blood transfusion and skin removal are tolerated with the consent of the donor and for therapeutic purposes only.
© Nicolas GROS / Panorama of the Doctor (1993)