Ethical Implications of War-Borne Disabling Casualties

ABSTRACT

Questions of justice in the face of diverse casualties require attention to soldiers and civilians with disabilities: the silence that surrounds both the deaths and disabling casualties of soldiers and civilians occurring at rapid pace in war is scandalous; healthcare services must be responsive to the needs of soldiers with disabling casualties returning from their tours of duty. The tradition of Catholic social teaching and its preferential option for the poor provides an effective decision-making matrix in determining the response to these needs. The crises in healthcare may be relieved by universal access based on the option for those who are disabled.

KEYWORDS:

• Post-traumatic stress disorder
• traumatic brain injury
• justice
• preferential option for the poor
• silence
• universal healthcare

Notes

1. For the most recent statistics reported by the Department of Defense, see http://siadapp.dmdc.osd.mil/personnel/CASUALTY/oif-wounded-total.pdf (accessed.)]

2. National Institute of Mental Health, http://www.nimh.nih.gov/publicat/ptsdfacts.cfm (site no longer active), for more information on PTSD and other anxiety disorders, see http://www.nimh.nih.gov/health/publications/anxiety-disorders/nimhanxiety.pdf

3. The Disabled Soldiers Support System, established by law April 30, 2004 for Army veterans, was renamed in November 10, 2005 as the Armed Forces “Wounded Warrior Program.” http://www.arfp.org/skins/ARFP/display.aspx?ModuleID=8cde2e88-3052-448c-893d-d0b4b14b31c4&Action=display_user_object&Modeequals;user&ObjectID=6deafffe-6639-46b0-8086-27b5457fcf30&AllowSSL=true. By an Act of the 108th Congress, 2d Session, S.3002: “2 (1)to honor the members of the Armed Forces by ensuring that those members who are severely disabled after September 11, 2001, while in the military service and the family members receive the assistance they need in undergoing the transition from military to civilian life and from care provided by thee Department of Defense to care provided by the Department of Veterans Affairs; and (2) in order to carry out the purpose stated in paragraph (1), to expand the scope of the program of the Army known as Disabled Soldiers Support System to provide transition assistance as described in paragraph (1) for all eligible severely disabled members of the Army and to extend that program to all branches of the Armed Forces.”

4. To get this figure, I multiplied the total number of non-US deaths (600,000) by 15, the low-end statistically proportionate number of people with disabilities in any given population. For statistics on the percentages of people with disabilities in the US, see, AFLCIO, “Fast Facts, People With Disabilities” (2006), http://www.aflcio.org/issues/civilrights/upload/disables.pdf.

5. Projection based on 2008 figures compiled by the Henry J. Kaiser Family Foundation, Available at http://facts.kff.org/chart.aspx?ch=203 (accessed May 19, 2008).

6. As of the 2000 US Census, California has the largest population with 36,132,147 people. Add to this population the total the population of the New England states (Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont) to reach the 51 million mark (U.S. Census Bureau, 2008b).

7. Underinsured people represent 24% of the total US population (Consumer Affairs.com, 2007)

8. Think also about the US median income and the monthly expenses soon outpace income at current levels: A $60,000 annual income would require $15,000 set aside for insurance purposes. How is a middle class family to make ends meet?

9. This figure contradicts the 1,279 reported by the Rural Assistance Center (2008) at http://www.raconline.org/info_guides/hospitals/cahfaq.php# howmany (accessed); however, the link to the list of Critical Access Hospitals (CAH) number 1,288. Hospitals qualify for CAH only if they have a requisite number of beds for acute care and are located in mountainous or isolated terrain or 35 miles from another hospital facility.

10. The VA website lists 1,265 facilities; a glance at one high-density population in comparison to low-density population yields this suggested distribution (United States Department of Veterans Affairs, 2008)

11. It wasn't any different to be killed in World War II then it was during the Civil War or World War I. However, if the World War II GI was wounded by a bullet, shrapnel or fallen by a disease such as malaria, without killing him, his chances for survival were much greater then his ancestor in the Civil War. During the Civil War, 50 percent or more of the men admitted to hospitals died, during World War I, it was 8 percent, World War II, 4 percent. During World War II drugs such as sulfa (Sulfanilamide) and penicillin were discovered and advanced surgical techniques were introduced to make these improvements possible, but the first reason for such successes in improving the mortality rate was the speed with which wounded men were treated. It began with the frontline combat medics… . The main objective of the medic was to get the wounded away from the front lines. Many times this involved the medic climbing out from the protection of his foxhole during shelling or into no-man's-land to help a fallen comrade. Once with the wounded soldier, the medic would do a brief examination, evaluate the wound, apply a tourniquet if necessary, sometimes inject a vial of morphine, clean up the wound as best as possible and sprinkle sulfa powder on the wound followed by a bandage. Then he would drag or carry the patient out of harms way and to the rear. This was many times done under enemy fire or artillery shelling” (Steinert, 2000).

12. For example, in 1930, the then three offices dedicated to veteran's benefits were consolidated into the Veterans Administration; from 54 hospitals in 1930, the VA includes 171 medical centers, 350+ outpatient/community/outreach clinics, 126 nursing homes, and 35 residential domiciles (United States Department of Veterans Affairs, 2006).

13. The United States has the most comprehensive system of assistance for veterans of any nation in the world. This benefits system traces its roots back to 1636, when the Pilgrims of Plymouth Colony were at war with the Pequot Indians. The Pilgrims passed a law which stated that disabled soldiers would be supported by the colony” (United States Department of Veterans Affairs, 2006).

14. Perhaps unsurprisingly, care for soldiers wounded in battle enjoys an ancient history. “In the Roman History, Livy offers three reasons for treating the wounded: “military necessity” [presumably to return them to the fight], “patriotic duty” [as the nation's debt], and the need to prevent “the demoralization of the fighting line by the misery of the wounded” [considering the morale of the front line soldiers and their concern for injuries they may also suffer]” (Gross, 2006, p. 70.).

15. For a more detailed consideration of the historical development of healthcare in the US, from the nations' founding through the 20th century, see Lavastida (2000), especially chapter one.

16. For a fuller yet succinct discussion of the just war traditions, see Allen, 2001.

17. For a critical consideration of Jesus' third way, that of non-violence, see Wink, 1987.

18. Although 80 million is a rough estimate based on a community survey conducted in 2003 by the US Census Bureau, the estimate reflects a wide range of disabling conditions from sensory to physical, developmental, emotional, and medical disabilities (US Census Bureau, 2003).

19. In a first encounter with another person, a tremendous amount of information must be organized and interpreted simultaneously: each participant probes the explicit for the implicit, determines what is significant for particular purposes, and prepares a response that is guided by many cues, both subtle and obvious. When one person has a disability, however, it almost always dominates and skews the normate's process of sorting out perceptions and forming a reaction. The interaction is usually strained because the nondisabled person may feel fear, pity, fascination, repulsion, or merely surprise, none of which is expressible according to social protocol… Perhaps most destructive to the potential for continuing relations is the normate's frequent assumption that a disability cancels out other qualities, reducing the complex person to a single attribute” ( Thomson, 1997, p. 12).

20. For a comprehensive interactive overview of how people with disabilities have been treated and the start of the disabilities movement, see the series of exercises produced by the Minnesota Governor's Council on Developmental Disabilities at http://www.mncdd.org/parallels2/index.htm (Minnesota Governor's Council on Developmental Disabilities, 2006).

21. “Are you “myopic” or do you wear glasses? Are you “cancerous” or do you have cancer? Are you “freckled” or do you have freckles? Is a person “handicapped/disabled” or does she have a disability?”(quotation markes in original).

22. People with disabilities fill social roles that work to distract the non-disabled from their own shortcomings: they are sick, sub-human, dangerous, pitiable, burdens, jesters, saints (Wolfensberger, 2000)

23. Just as there were many who were astonished at him—so marred was his appearance, beyond human semblance, and his form beyond that of mortals… He was despised and rejected by others; a man of suffering and acquainted with infirmity; and as one from whom others hide their faces he was despised, and we held him of no account… he was oppressed, and he was afflicted… By a perversion of justice he was taken away” (Is 52:14; 53:3, 7, 8).

24. I must admit that this debt has not, in recent memory, been readily acknowledged and fulfilled. The experience of veterans returning from Vietnam is a case in point: few parades, incivility, and silence. That this war in Iraq is increasingly unpopular (recent polls suggest 70% and more of the American public disapprove of the Bush plan to deploy 20,000 additional troops and are not confident that this addition will reduce the violence—or win the war—in Iraq) does not inspire confidence that the debt to these veterans will be paid. For poll information, see ABC.com (2008).

25. As the Disability Movement reminds, anyone can (and most will) become disabled as a result of accident, age, or disease. “The fact that we will all become disabled if we live long enough is a reality many people who consider themselves able-bodied are reluctant to admit … That anyone can become disabled at any time makes disability more fluid, and perhaps more threatening, to those how identify themselves as normates than such seemingly more stable marginal identities as femaleness, blackness, or nondominant ethnic identities” (Thomson, 1997, p. 14).

26. Disability has functioned historically to justify inequality for disabled people themselves, but it has also done so for women and minority groups. That is, not only has it been considered justifiable to treat disabled people unequally, but the concept of disability has been used to justify discrimination against other groups by attributing disability to them … Thus, while disabled people can be considered one of the minority groups historically assigned inferior status and subjected to discrimination, disability has functioned for all such groups as a sign of and justification for inferiority [as well] (Longmore & Umansky, 2001, p. 34).

27. The Revised Standard Version and other translations omit the response, “Yes” (Holladay, 1986, p. 288).

28. The identity of the specific “balm” in Gilead is uncertain… Opinion now seems to favor the mastic. Such resins were widely used in healing in ancient times; they were not only soothing, but their pleasant aromas counteracted the smell of putrefying wounds … Such a cure, in the Old Testament understanding, would have consisted of the rising of “new flesh” at the wounded spot” (Holladay, 1986, p. 294).

29. For a full commentary on Jeremiah 8, see Holladay (1986, p. 271–295).