INTRODUCTION

It is well recognized that physicians in the military confront ethical challenges emerging from the dual loyalties of the role of physician, to protect and promote the health-related interests of the patient, and that of the military officer, to protect and promote the legitimate interests of the state through the application of organized violence (or threat of same). The justification for military physicians using medical knowledge for purposes of state interests other than healing patients becomes an ethical challenge, especially when the health or even lives of patients or others are put at risk when physicians pursue such purposes (see Chapters 53 and 57). The role of military medicine in South Africa during apartheid provides a crucial case study of military medical ethics during the post-World War Ⅱ period. The purpose of this chapter is to explore the ethical issues raised by the conduct of physicians in the service of the South African state and its policies of apartheid.

This chapter examines critically the “just war” justification of using medical knowledge and skill for purposes of the state other than healing patients. This justification is found wanting in the context of international statements on medical ethics that make the role of physician and its moral obligations primary. For example, the Declaration of Geneva commits a physician to not using “medical knowledge contrary to the laws of humanity” (WMA 1948, 1).