War Is a Public Health Crisis: Why Bioethics Must Evolve
In our era of global instability, one truth grows ever more urgent: war is not just a political or military issue—it is a profound and escalating public health crisis. In their provocative article and reply to critics, Nancy Jecker, Caesar Atuire, Vardit Ravitsky, Kevin Behrens, and Mohammed Ghaly make a compelling case for bioethics to confront this reality head-on.
Their central claim is straightforward but radical: war devastates the health of populations, especially civilians, and must be treated by bioethicists with the same rigor as pandemics, environmental disasters, and systemic inequality. For too long, bioethics has largely focused on issues at the bedside—autonomy, consent, medical technology—while ignoring the macro-level violence that undercuts the very conditions required for health and dignity.
The authors propose five bioethical principles to reframe war through a public health lens:
1. Health Justice – mitigating war’s disproportionate toll on vulnerable groups, especially women and children.
2. Accountability – holding all warring parties responsible for the health consequences of conflict.
3. Dignified Lives – safeguarding minimal human capabilities, such as access to healthcare, shelter, and clean water.
4. Public Health Sustainability – redefining military “success” to include lasting health outcomes.
5. Public Health Maximization – weighing war’s health costs against nonviolent alternatives.
The reply to peer commentaries is particularly illuminating. Rather than shying away from critique, the authors engage in a rich dialogue that reveals the breadth of bioethics' potential—and its current blind spots.
For instance, the rise of autonomous weapons and AI-driven warfare, as highlighted by Greenbaum, poses new ethical dilemmas. These technologies increase the lethality of conflict while shielding their human operators from both physical and moral consequences. This distance, the authors warn, risks normalizing atrocity. Bioethics must evolve in real time to address these emerging threats.
Other scholars, like Pikulytska and Anderson, stress the importance of warzone clinicians' voices in shaping ethical analysis. Their first-hand accounts of treating traumatized children in Ukraine are not just heart-breaking—they are a call to center the lived realities of those most affected.
The debate over conscription, taken up by Hurley O’Dwyer and colleagues, forces a re-examination of the combatant/non-combatant distinction. Conscripts, coerced into violence, suffer immense physical and psychological harm. While the authors maintain a necessary focus on civilian suffering, they acknowledge the moral weight of soldierly sacrifice—and the ethical tensions therein.
This blog is based on the paper: Jecker, N.S., Atuire, C., Ravitsky, V., Behrens, K. and Ghaly, M., 2025. Bioethics Must Consider War as a Public Health Crisis: Reply to Commentaries. The American Journal of Bioethics, 25(5), pp.W4-W7.
We were assisted by AI in the writing of this blog.