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Exitus Acta Probat?

To the Editor: In "Medicalized Weapons and Modern War" (Jan-Feb 2010), political scientist Michael L. Gross argues that physicians would not violate their oath to do no harm by helping to develop and test weapons that induce physical pain, abnormal psychological states, or unconsciousness to temporarily incapacitate a victim. Because of their potential utility in asymmetric warfare, he writes, such weapons are justified in order to save the lives of civilians caught in battle.

When an individual considers a weapon necessary to a just war, according to Gross, "the duties of citizenship supersede professional obligations." This negates the very essence of the physicians' oath. We should not lightly abandon two thousand years of ethical practice in medicine to serve the political and military goals of the moment.

A central question is whether it would be possible to develop and employ weapons that can incapacitate human beings without serious consequences. Whatever the developer's intent, the outcome will always be uncertain. The safe, effective dose of an incapacitant varies from person to person; at the average incapacitating dose, more sensitive individuals, those with compromised health, or those unable to flee could be permanently injured or killed. And the dose delivered during battle will rarely be controllable. This was demonstrated in one of the few documented cases of incapacitant use: the 2002 Moscow theater siege, in which over 15 percent of the hostages died from--and many more were permanently injured by--the anesthetic used to incapacitate the hostage-takers. For comparison, the overall lethality of gunshot wounds inflicted in battle is 20 to 27 percent, according to the International Committee of the Red Cross.

Whether incapacitating weapons save civilians or not, "force multiplication" seems intrinsic to their use. The U.S. Army plans to use its new "nonlethal" microwave weapon "to deny the enemy the use of its weapons" when attacking targets populated by combatants and civilians. Similarly, in Vietnam, the United States justified the immense quantities of tear gas used as a humane way to target enemy troops mixed with civilians. Yet the army's exhaustive study of after-action reports found not a single instance of "humanitarian" use. Instead, the gas was used to force enemy troops from cover, to break contact during an ambush, or to deny terrain. Resulting public revulsion led the negotiators of the Chemical Weapons Convention of 1993 to prohibit riot control agents in warfare. Chemical agents, both "nonlethal" and lethal, are now explicitly illegal as weapons of war. But other types of incapacitating weapons are now being developed that use, for example, acoustics or electromagnetic radiation.

Incapacitating weapons take advantage of the knowledge that medical scientists and practitioners have accumulated throughout history for the purpose of healing. They target intimate aspects of the human person in specific, recondite ways without consent and for hostile purposes, setting fearsome precedents for physiological manipulation. And as they become more widely available, despots, terrorists, criminals, and torturers will likely find them more useful than responsible governments.

We have finally succeeded in outlawing toxic chemicals and biological agents as weapons of war. It would be a grave folly to undermine these achievements--and the foundation of medical ethics--by pursuing weapons of war that have such potential for abuse.

To the Editor: Michael L. Gross believes that physicians are not ethically prevented from developing--and may even be ethically obligated to develop--"medicalized" weapons for use in armed conflict. As a major case in point, he advocates

developing pharmacological "calmatives" that could incapacitate combatants. The general reader may not appreciate that this ethical issue arises for only a very limited number of physicians--specifically, those practicing in Israel, Myanmar, Angola, North Korea, Egypt, Somalia, and the Syrian Arab Republic. This is because all other physicians work in nations that are state parties to the Chemical Weapons Convention. This treaty unequivocally bans not only use but also development or possession of any chemical weapon, regardless of its lethal potential, unless it is suitable for and used only in domestic, civilian law enforcement applications. Gross proposes developing and using weapons outlawed by the CWC in scenarios that clearly involve military armed conflict, not police activity.

Gross does not claim his proposed uses are for police purposes. He uses the Marwaheen convoy incident in the 2006 Lebanon War as an example of where he would use pharmacological weapons. This would have required aircraft-delivered chemical munitions--a clear breach of the CWC. Moreover, because most of the world has adopted the CWC, it has achieved the status of international law. This means that even though Israel did not ratify the CWC, it would still have violated international law if it used chemical or pharmacological weapons in that attack.

The CWC stipulates that state parties must criminalize development or production of these kind of weapons by persons and entities under their legal control. Such "implementing legislation" has been widely adopted. For instance, the legislation in the United States (Public Law 105-277, 1998) provides for a maximum of life imprisonment for any person convicted of developing or possessing a weapon outlawed by the CWC, and the possibility of the death penalty if such a weapon kills. So except for persons in the abovementioned seven countries, participating in the development of a "pharmacological cluster bomb" is a serious criminal act that renders moot the narrow ethical question Gross attempts to raise.

Michael L. Gross, replies:

Martin Furmanski is rightly concerned that nonlethal chemical weapons may upend the consensus achieved by the CWC. For this reason, chemical weapons will likely be the least aggressive aspect of nonlethal weapons development when compared to neuroscience and electromagnetic technologies. But two points deserve attention.

First, the CWC, unlike the Biological Weapons Convention, only regulates the development and use of chemical weapons. It does not prohibit them. The CWC allows for the use of riot control agents for law enforcement purposes. However, no clear guidelines distinguish modern, asymmetric war from law enforcement. War and law enforcement are endpoints on a continuum. In between are military operations other than war, international peacekeeping and peace enforcement, international law enforcement, and the war on terror. No one agrees about how to apply the CWC in these contexts.

Second, nations interpret the CWC differently. The United States, for example, permits the use of riot control agents when "civilians are used to mask or screen attacks" and "in rear echelon areas to protect convoys from civil disturbances, terrorists and paramilitary organizations." In contemporary warfare, where human shields and rearbased terror attacks are the norm, this offers a wide arena for deploying nonlethal weapons without violating the CWC. Given the exigencies of modern warfare, it is no surprise that the world did not condemn Russia's use of a calmative agent when storming a Moscow theater in 2002, or that the 2008 Second Review Conference on the CWC could not agree on the status of incapacitating chemical weapons. Incapacitants remain an open question.

Nevertheless, the slippery slope is always present, as is the potential for misuse. Chemical weapons were certainly abused in Vietnam. Unfortunately, this was not the only failing of that war. Fighter bombers using conventional explosives and napalm destroyed civilian targets and infrastructures. Targeted killings took the lives of over ten thousand Vietnamese, of whom probably less than 10 percent were enemy combatants. Yet aerial bombing and targeted killing remain vital tactics in the war in Iraq and Afghanistan. Vietnam taught us to be wary of how weapons and military resources are used, but it also provided the impetus to rein in abuse and prevent excessive harm to civilians.

Barbara H. Rosenberg

Center for Arms

Control and Non-Proliferation

Washington, D.C.

Martin Furmanski,

Ventura, California
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Title Annotation:letters
Author:Rosenberg, Barbara H.; Furmanski, Martin; Gross, Michael L.
Publication:The Hastings Center Report
Article Type:Letter to the editor
Date:Sep 1, 2010
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