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II. Chemical Weapons
III. Biological Weapons
A. Difficulties of Surveillance
IV. Ethical Issues for Biomedical Scientists
V. Ethical Issues for Physicians
The development, production, storage, transfer, use, and destruction (demilitarization) of chemical and biological weapons (CBW) pose a number of ethical issues. First, those weapons, like nuclear weapons, are largely indiscriminate in their effects and are generally more effective against vulnerable noncombatants than against combatants; they therefore are known as weapons of mass destruction, and their use generally is considered a violation of the proportionality principle of a just war. Second, CBW, also like nuclear weapons, are the subject of intensive international arms-control efforts involving problems of definition, verification, and enforcement. Third, biomedical scientists and physicians may be called on to participate in research and development on more effective CBW as well as on methods for defense against them and the treatment of their victims.
II. Chemical Weapons
Chemical weapons (CW), which have been known since antiquity, are designed to inflict direct chemical injury on their targets, in contrast to explosive or incendiary weapons, which produce their effects through blast or heat. In the siege of Plataea in 429 B.C.E., for example, the Spartans placed enormous cauldrons of pitch, sulfur, and burning charcoal outside the city walls to harass the defenders. Although nations that signed the 1899 Hague Declaration promised not to use CW, during World War I those weapons, including in descending order of use tear gas, chlorine gas, phosgene, and mustard gas, were employed. Overall, 125,000 tons of CW were used during World War I, resulting in 1.3 million casualties. One-quarter of all casualties in the American Expeditionary Force in France were caused by them (Harris and Paxman; Sidel and Goldwyn; Sidel, 1989; United Nations; World Health Organization).
In 1925 twenty-eight nations negotiated the Geneva Protocol for the “prohibition of the use in war of asphyxiating poisonous or other gases and of all analogous liquids, materials or devices and of bacteriological methods of warfare” (Wright, p. 368). In fact, however, the protocol prohibited only the use, not the development, production, testing, or stockpiling, of those weapons. Furthermore, many of the nations that ratified the protocol reserved the right to use those weapons in retaliation, and the protocol became in effect a “no first use” treaty with no verification or enforcement provisions. The United States was one of the initial signers, but the Senate did not ratify the treaty until 1975 (Sidel, 1989; Wright).
Despite the protocol, the use of CW continued. Italy used mustard gas during its invasion of Abyssinia (Ethiopia), and Japan used mustard and tear gases in its invasion of China. Germany, with its advanced dye and pesticide industries, developed acetylcholinesterase inhibitors known as nerve gases, and the United States and Britain stockpiled CW during World War II; transportation and storage accidents caused casualties (Infield), but there was no direct military use. After World War II CW were used by Egypt in Yemen, mustard and nerve gases were used in the Iran-Iraq war in the 1980s, and Iraq used CW against Kurdish villages in its territory. CW stockpiles and production facilities in Iraq were ordered destroyed by the United Nations after the 1991 Persian Gulf War. The United States and Russia are known to have maintained CW stockpiles, and a number of other countries have stockpiles or facilities for rapid CW production (Harris and Paxman; Sidel, 1989).
Troops can be protected against those weapons for limited periods through the use of gas masks and impenetrable garments. That protective gear, however, reduces the efficiency of troops by as much as 50 percent and damages morale, and so the use or threat of use of CW may continue to be considered effective against troops. Civilian populations, in contrast, cannot be protected adequately. Israel, for example, provides every civilian with a gas mask and a self-injectable syringe filled with atropine, a temporary antidote to nerve gas. However, that protection is inadequate against weapons, such as mustard gas, that attack the skin and against longer-term exposure to nerve gas. Furthermore, poorly trained civilians are likely to injure themselves with equipment such as self-injectable syringes (Amitai et al.).
The production of CW has been associated with serious accidents to workers and high levels of pollution in the production sites and nearby communities. Tests of mustard gas, nerve agents, and psychochemicals, including lysergic acid diethylamide (LSD), during and after World War II involved thousands of military personnel, many of whom later claimed disabilities from the exposure. The records of participation and effects are so poor that only a small fraction of those who participated can be identified. Even the destruction of the weapons is dangerous because toxic ash is produced by their incineration (Sidel, 1993).
A Chemical Weapons Convention (CWC) that prohibits the development, production, storage, and transfer of those weapons and calls for their demilitarization was approved by the United Nations General Assembly in 1992. The Organization for the Prohibition of Chemical Weapons (OPCW), which is responsible for ensuring the implementation of the CWC, was established in the Hague after the entry into force of the CWC in 1997. By 2003 a total of 151 “states parties” (nations) had ratified or acceded to the BWC. The First Review Conference of the States Parties to the CWC was held in the Hague in April 2003, and Kofi Annan, secretary general of the United Nations, urged that “membership in the CWC be extended to all nations in the world and that enough funds be provided to accelerate complete chemical disarmament.”
In the 1960s and 1970s the United States used both tear gas and herbicides in Vietnam. Although most nations that are parties to the Geneva Protocol considered tear gas and herbicides to be CW and thus prohibited under the provisions of the protocol, the United States until recently rejected that interpretation (Sidel and Goldwyn; Sidel, 1989). Many countries use tear gas to quell civil disorders (Hu et al.). The signatories to the CWC have agreed not to use riot-control agents or herbicides as weapons of war.
In 2002 Russia used derivatives of fentanyl, a potent opium-based narcotic, to subdue Chechen rebels who had occupied a theater in Moscow and taken 800 hostages. Although Russia formally considered the chemical agent “nonlethal” and its use permissible under the CWC, a total of 117 people died as a result of its use (“Russia Names Moscow Siege Gas”).
In 1984 members of a cult in Oregon intentionally contaminated the salad bars in local restaurants with salmonella bacteria. More than 700 people became ill, but there were no reported deaths. In 2001, shortly after the attack on the World Trade Center, anthrax spores were disseminated through the U.S. mail. Approximately twenty people became ill, and five people died.
III. Biological Weapons
Biological weapons (BW) depend for their effects on the ability of microorganisms to infect and multiply in the attacked organism. In this regard they differ from toxins, which, as biological products used as chemicals, are covered under CW as well as BW treaties. BW are very hard to defend against and are not as controllable and predictable in their use as are CW (Harris and Paxman; Geissler, 1986; Sidel and Goldwyn; Sidel, 1989; United Nations; World Health Organization, 1970).
The effects of BW were characterized officially by a U.S. government agency in 1959: “Biological warfare is the intentional use of living organisms or their toxic products to cause death, disability, or damage in man, animals, or plants. The target is man, either by causing sickness or death or through limitation of his food supplies or other agricultural resources.… Biological warfare has been aptly described as public health in reverse” (U.S. Department of Health, Education, and Welfare).
BW have been known since antiquity. Persia, Greece, and Rome used diseased corpses to contaminate sources of drinking water. In 1347 Mongols besieging the walled city of Caffa (now called Feodosiya), a seaport on the east coast of the Crimea, began to die of the plague. The attackers threw the corpses into the besieged city; the defenders, who were Genoans, fled back to Genoa and carried the plague farther into Europe. During the French and Indian Wars Lord Jeffrey Amherst, commander of the British forces at Fort Pitt, gave tribal emissaries blankets in which smallpox victims had slept (Harris and Paxman; Geissler).
During World War I Germany is alleged to have used the equine disease glanders against the cavalries of eastern European countries (Harris and Paxman, p. 74). According to testimony at the Nuremberg trials, prisoners in German concentration camps were infected during tests of BW. Great Britain and the United States, fearing that the Germans would use BW in World War II, developed their own BW. The British tested anthrax spores on Gruinard Island off the coast of Scotland; the island remained uninhabitable for decades. The United States developed anthrax spores, botulism toxin, and other agents as BW but did not use them (Bernstein).
In the 1930s Japanese troops dropped rice and wheat mixed with plague-carrying fleas from planes, resulting in plague in areas of China that previously had been free of it. During World War II Japanese laboratories conducted extensive experiments on prisoners of war, using a wide variety of organisms selected for possible use as BW, including anthrax, plague, gas gangrene, encephalitis, typhus, typhoid, hemorrhagic fever, cholera, smallpox, and tularemia (Wright). Unlike the Soviet Union, which in 1949 prosecuted twelve people who had been involved in that work, the United States never prosecuted any of the participants. Instead, U.S. researchers met with Japanese biological warfare experts in Tokyo and urged that the experts be “spared embarrassment” so that the United States could benefit from their knowledge (Powell; Williams and Wallace).
A. Difficulties of Surveillance
After World War II the development of BW continued. None of the numerous allegations of BW use have been substantiated or even investigated fully, but it is known that extensive BW testing was done. In the 1950s and 1960s, for example, the University of Utah conducted secret large-scale field tests of BW, including tularemia, Rocky Mountain spotted fever, plague, and Q fever, at the U.S. Army Dugway Proving Ground. In 1950 U.S. Navy ships released as simulants (materials believed to be nonpathogenic that mimic the spread of BW) large quantities of bacteria in the San Francisco Bay area to test the efficiency of their dispersal. Some analysts attributed subsequent infections and deaths to one of those organisms. During the 1950s and 1960s the United States conducted 239 top-secret open-air disseminations of simulants, involving areas such as the New York City subways and Washington National Airport (Cole). The U.S. military developed a large infrastructure of laboratories, test facilities, and production plants related to BW. By the end of the 1960s the United States had stockpiles of at least ten biological and toxin weapons (Geissler). A 1979 outbreak of pulmonary anthrax in the Soviet Union is said to have been caused by accidental release from a Soviet BW factory. Recent disclosures by Russian scientists indicate extensive environmental contamination and medical problems caused by CW production (“Russian Experts Say Many Died Making Chemical Weapons”).
In 1969 the Nixon administration, with the concurrence of the U.S. Defense Department, which declared that BW lacked “military usefulness,” unconditionally renounced the development, production, stockpiling, and use of BW and announced that the United States would dismantle its BW program unilaterally. In 1972 the Soviet Union, which had urged a more comprehensive treaty that would include restrictions on CW, ended its opposition to a separate BW treaty. The United States, the Soviet Union, and other nations negotiated the Convention on the Prohibition of the Development, Prevention and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction (BWC). The BWC prohibits, except for “prophylactic, protective and other peaceful purposes,” the development or acquisition of biological agents or toxins as well as weapons carrying them and means of their production, stockpiling, transfer, and delivery. The U.S. Senate ratified the BWC in 1975, the same year it ratified the Geneva Protocol of 1925. As of 1987, 110 nations had ratified the BWC and an additional 25 had signed but not yet ratified it (Wright).
Invoking the specter of new biological weapons and unproven allegations of aggressive BW programs in other countries, the Reagan administration initiated intensive efforts to conduct “defensive research,” which is permitted under the BWC. The budget for the U.S. Army Biological Defense Research Program (BDRP), which sponsors programs in a wide variety of academic, commercial, and government laboratories, increased dramatically during the 1980s. Much of that research work is medical in nature, including the development of immunizations and treatments against organisms that might be used as BW (Piller and Yamamoto; Wright).
Although research on and the development of new BW are outlawed by the BWC, it is possible that they will occur in the future. Novel dangers lie in new genetic technologies that permit the development of genetically altered organisms that are not known in nature. Stable, tailor-made organisms used as BW could travel long distances and still be infectious, rapidly infiltrate a population, cause debilitating effects very quickly, and be resistant to antibiotic treatment (Piller and Yamamoto).
IV. Ethical Issues for Biomedical Scientists
Biologists, chemists, biomedical scientists, and physicians have played important roles in CBW research and development. Fritz Haber, who was awarded the 1918 Nobel Prize in chemistry for his synthesis of ammonia, is known as the father of Germany’s chemical weapons program in World War I. In his speech accepting the Nobel Prize Haber declared poison gas “a higher form of killing” (Harris and Paxman, 1982). By contrast, during the Crimean War the British government consulted the noted physicist Michael Faraday on the feasibility of developing poison gases; Faraday responded that it was entirely feasible but that it was inhumane and he would have nothing to do with it (Russell).
Many scientists who explicitly acknowledge the ethical conflicts involved in work on weapons argue that a higher ethical principle—the imperative of defending one’s country or helping to curb what is perceived as evil or destructive— permits or even requires participation in such work. Dr. Theodor Rosebury, who worked on BW during World War II, based his participation on his belief that crisis circumstances that were expected to last for only a limited time required that he act as he did. “We were fighting a fire, and it seemed necessary to risk getting dirty as well as burnt,” he later wrote (Rosebury, 1963). Rosebury refused to participate in BW work after the end of the war (Rosebury, 1949).
Other scientists resolved their ethical dilemma by arguing that their work on weapons was designed to reduce the devastation of war. For example, while working on “nonlethal” CBW in the 1960s Dr. Knut Krieger argued that his research would lead to decreased fatalities: “If we do indeed succeed in creating incapacitating systems and are able to substitute incapacitation for death it appears to me that, next to stopping war, this would be an important step forward” (Reid).
Relevant ethical concerns about “defensive research” on BW by biomedical scientists include issues of content, safety, context, and locus (Lappe).
The Japanese laboratory established in 1933 to develop BW was called the Epidemic Prevention Laboratory. One of its activities was supplying vaccines for troops bound for Manchuria, but its major work was developing and testing BW (Powell). Military forces today could conduct research on the offensive use of BW under the cover of defensive research because offensive and defensive research are joined inextricably in at least some phases of the work (Huxsoll et al.). In the parts of the work in which offensive and defensive efforts are parallel new forms of organisms may be found or developed that would be more effective as biological weapons. The possibility that offensive work on BW is being done in the United States under the cover of defensive work has been denied by the leaders of the BDRP, who point out the areas in which the two types of research diverge (Huxsoll et al.). Critics nonetheless raise questions about the ambiguity of BDRP research, arguing that “these efforts are highly ambiguous, provocative and strongly suggestive of offensive goals” (Jacobson and Rosenberg; Piller and Yamamoto; Wright).
Many analysts believe that CW or BW research, even if it is truly defensive in intent, may be dangerous to surrounding communities if toxic materials or virulent infectious organisms are released accidentally.
CW or BW research, even if it is defensive in intent, can be viewed by a potential military adversary as an attempt to develop protection for a nation’s military forces or noncombatants against weapons that that nation might wish to use for offensive purposes, thus permitting that nation to protect its own personnel in a CW or BW first strike. In fact, the military justification for preparing altered organisms is that they are needed for the preparation of defenses. It is therefore impossible for adversaries to determine whether a nation’s defensive efforts are part of preparations for the offensive use of weapons.
Fears in this area usually are based on military sponsorship of defensive BW research. Even if that research is relatively open, other nations may view with suspicion the intense interest of military forces rather than civilian medical researchers in vaccines and treatments against specific organisms. Those fears can feed a continuing BW arms race.
More generally, concern has been expressed about the militarization of genetic engineering and biology in general. Characterization of biological weapons as “public health in reverse” therefore may have an even broader and more sinister meaning: The entire field of biology, along with and aspects of it such as the use of human genome research to design weapons to target specific groups, may be in danger of military use for destructive ends (Piller and Yamamoto; Wright). The imprisonment of a chemist by the Russian government and the revocation of his university diploma for publishing an article describing the development of new, highly toxic CW illustrate the restrictions that are placed on scientists who do CBW research (Janowski).
V. Ethical Issues for Physicians
The first question that arises is whether it is constructive to view certain ethical responsibilities as unique to the physician’s social role. Theodor Rosebury described the response to physician participation in work on BW during World War II: “There was much quiet but searching discussion among us regarding the place of doctors in such work … a certain delicacy concentrated most of the physicians into principally or primarily defensive operations.” Rosebury went on to point out that the modifiers principally and primarily are needed “because military operations can never be exclusively defensive” (Rosebury, 1963). What is seen as the special responsibility of physicians is based largely on an ethical responsibility not to use the power of the physician to do harm (primum non nocere). Although the Hippocratic oath seems to apply to the relationship of the physician to an individual patient, its meaning has been broadened by many to proscribe physician participation in actions harmful to nonpatients.
In regard to research on offensive weapons of war there seems to be a consensus that physicians participate in such research at their ethical peril even if their country demands it or they think it useful for deterrence or other preventive purposes. However, because of the ambiguity of defensive work on BW, the dilemma for the physician is not easily resolved even for those who believe that defensive efforts are ethically permissible.
Some proponents of defensive research on BW have argued that it is entirely ethical—that in fact it is obligatory— that physicians work on it. According to this perspective, not only will defenses be needed if such weapons are used against the United States, that work also may be useful in developing protection against naturally occurring diseases (Crozier; Huxsoll et al.; Orient). Other analysts believe that it is unethical for physicians to play a role in military-sponsored BW research because it has a strong potential for intensifying a BW arms race and helping to militarize the science of biology, thus increasing the risk of the use of BW and the destructiveness of their effects if they are used (Jacobson and Rosenberg; Nass, 1991; Sidel, 1991).
The question is: Where on the slippery slope of participation in preparing for the use of BW should physicians draw the line? If physicians engage in civilian-sponsored research on disease control that carries an obligation to report all findings in the open literature even if the research may have implications for BW, that participation, most analysts agree, cannot be faulted on ethical grounds. However, when physicians engage in military-sponsored research in which the openness of reporting is equivocal and the purposes are ambiguous, it is difficult to distinguish their work ethically from work on the development of weapons.
As was noted above, the BWC prohibits any “development, production, stockpiling, transfer or acquisition of biological agents or toxins” except for “prophylactic, protective and other peaceful purposes.” The responsibility for government-sponsored medical research for prophylactic, protective, and other peaceful purposes in the United States lies largely with the National Institutes of Health (NIH) and the Centers for Disease Control (CDC). The NIH or the CDC therefore might be given the responsibility and the resources for medical research of this type. The U. S. Army still may want to conduct nonmedical research and development on defense against BW, such as work on detectors, protective clothing, and other barriers to the spread of organisms. Under this proposed division of effort that research is less likely to be seen as offensive, provoke a BW race, pervert the science of biology, and involve physicians (Sidel, 1989).
A different type of ethical issue related to CBW arose during the Persian Gulf War in 1991. The United States provided protective measures such as immunization against botulinum toxin and anthrax for its military forces. Despite the fact that some of those measures were experimental, no informed consent procedures were used and compliance often was required. Furthermore, the measures were made available to military forces but not to noncombatants in the area (Annas; Howe and Martin).
In addition to the ethical dilemmas involved in these decisions it may be unethical for physicians to ignore the issues involved in CBW. One of the greatest dangers of those weapons may be the apathy of the medical profession toward them. The fact that BW are the weapons with which physicians may become engaged and the ones about which they have specialized knowledge gives physicians a special responsibility not only to refuse to work on them but also actively to work to reduce the threat of their development or use.
Physicians and biomedical scientists should support methods for international epidemiological surveillance to detect the use of BW and investigate incidents in which use has been alleged after an unexplained disease outbreak (Geissler, 1986; Nass, 1992a, 1992b) and support the Vaccines for Peace Programme for the control of “dual-threat” agents (Geissler and Woodall). Support also might be given for measures to strengthen the BWC through the introduction of the verification proposals that were put forth at the 1991 BWC Review Conference (Falk; Rosenberg and Burck; Rosenberg). With regard to chemical weapons, biomedical scientists and physicians might support effective implementation of the 1993 CWC (Smithson).
More broadly, physicians may wish to explore the connection between CBW and nuclear weapons. It has been argued that by refusing to reduce their vast stockpiles of nuclear weapons substantially and refusing to agree to verifiable cessation of nuclear weapons testing and production, the nuclear powers provoke nonnuclear powers to contemplate the development and production of CBW for deterrence against nuclear weapons. The U.S. Defense Intelligence Agency reported that “third world nations view chemical weapons as an attractive and inexpensive alternative to nuclear weapons” (U.S. General Accounting Office; Zilinskas, 1990a, 1990b). There is much that physicians can do, for example, through the International Physicians for the Prevention of Nuclear War, the organization that received the 1985 Nobel Peace Prize, and its affiliates in many countries to reduce the provocation and proliferation of weapons of mass destruction caused by the continuing nuclear arms race.
Individual physicians and scientists can add to the awareness of the dangers of CBW by signing the pledge sponsored by the Council for Responsible Genetics “not to engage knowingly in research and teaching that will further development of chemical and biological warfare agents.” U.S. physicians also may wish to support legislation to transfer all medical aspects of biological defense from the military to the NIH or the CDC. Physicians may help awaken the medical profession to the dangers of CBW and nuclear weapons by adding a clause to the oath taken by medical students upon graduation from medical school, similar to the oath for medical students in the former Soviet Union, requiring them “to struggle tirelessly for peace and for the prevention of nuclear war” (Cassel et al., p. 652). The clause might be worded as follows: “Recognizing that nuclear, chemical, and biological arms are weapons of indiscriminate mass destruction and threaten the health of all humanity, I will refuse to play any role that might increase the risk of use of such weapons and will, as part of my professional responsibility, work actively for peace and for the prevention of their use.”
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