{"id":1736,"date":"2022-06-08T08:00:06","date_gmt":"2022-06-08T08:00:06","guid":{"rendered":"https:\/\/blogs.bmj.com\/spcare\/?p=1736"},"modified":"2022-11-23T11:07:58","modified_gmt":"2022-11-23T11:07:58","slug":"war-morality-palliative-care","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/spcare\/2022\/06\/08\/war-morality-palliative-care\/","title":{"rendered":"War, morality, palliative care"},"content":{"rendered":"

By Dr Matthew Dor\u00e9, Palliative Care Consultant in NI Hospice and Royal Victoria Hospital Belfast, Chair of the PCC<\/em><\/p>\n

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Are there moral similarities between War and Palliative care?<\/p>\n

Did you notice Vladimir Putin felt he had to justify the war in Ukraine by describing it as a \u2018just cause\u2019? \u2013 by Russia liberating the tyranny of the neo-Nazis ruling Ukraine(2). Why did he feel he had to do this?<\/p>\n

As you know on Feb 4th<\/sup> Vladimir Putin\u2019s Russia invaded Ukraine. What has, and is, happening is horrific, tragic and very close to home. But we haven\u2019t just watched the events, billions of pounds has been pushed into Ukraine purchasing weapons and the largest ever cohort of sanctions issued against Russia. The biggest question has been how should we react; are we pacifists and only provide humanitarian aid? Should we actively deploy militarily? Or, is there a middle ground, the so called \u2018just war theory\u2019.<\/p>\n

I personally take the middle ground of a \u2018just war\u2019, although I don\u2019t like the term as its implication is one side is correct and the other wholly wicked, which is often too \u2018black or white\u2019. Although, albeit the War in Ukraine is as clear cut as I have ever witnessed in its unjustifiable nature. Yet, moral justification is attempted, why?<\/p>\n

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Can War be morally correct? \u00a0I would state the example of those liberated from Auschwitz in Jan\u201945, the prisoners of the concentration camps certainly believed a liberating force was good, so there are examples of a \u2018just\u2019 war.<\/p>\n

Interestingly there are international rules drawn up, the so called \u2018jus ad bellum\u2019 (Right to War) which constitutes many principles to consider and weigh. These include: a just cause, comparative justice, competent authority, right intention, probability of success, last resort and proportionality.(1)<\/p>\n

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What is remarkable is how the \u2018jus ad bellum\u2019 requirements for justification of war are remarkably similar with our medical bioethics, weighing up our treatments, particularly in palliative care, oncology or surgery, but you can easily apply this to everything from ICU, PEG, NIV even antibiotics.<\/p>\n

Two radically different spheres, but both asking the question, should we intervene? Why is the underlying morality defining our ethics so similar, irrespective of scale?<\/p>\n

That is not to discount unspoken motives, even lies and deceit, but in a honest discussion we have the same acceptable justifications. i.e. who disagrees with the \u2018jus ad bellum\u2019 itself? \u2013 next to no-one. Indeed we all agree cancer is bad, never thinking from the cancers perspective that the surgeon is bad.<\/p>\n

Thus, does humanity have a shared underlying structure of morality? Broadly speaking differences are differences in the weighing, but not the underlying morality?<\/p>\n

Is this a naive outlook, that underneath it all we actually share a common morality? I hope not, and I\u2019m not alone, certainly the argument for the universal declaration of human rights(3) is trying to do this, indeed there is a notion within law (legal jurisprudence) called \u2018natural law\u2019(4), outlining this exact point, that there is law which is distinct from culture or society and can be deduced from intrinsic human values and rationality. Other moral authorities such as main stream religions share almost all key moral aspects, albeit differ in their mechanics. Historically, more than one would expect, cultures separated by 1000\u2019s of years and geography generally share a remarkably similar moral compass.<\/p>\n

Thus, is this how we are built? Do we intrinsically have a right and wrong hard-wired deep inside us? Hence our justifications? This differs substantially from the postmodernist idea of self-defining morality and relativism. Are we far more similar than we are different?<\/p>\n

To quote C.S.Lewis \u201cA man does not call a line crooked unless he has some idea of a straight line\u201d<\/p>\n

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References:<\/strong><\/p>\n