Medical ethics and non-lethal weapons.

On October 23, 2002, over 700 people attended the musical Nord-Ost in a Moscow theater with the clunky Soviet-era name House of Culture of the State Ball-Bearing Plant Number 1. During act two 40 Chechen terrorists demanding Russian withdrawal from Chechnya stormed the building, taking patrons and performers hostage. The terrorists made it clear in a videotape that they would die rather than surrender. Conditions over the next several days were miserable as the hostages, including dozens of children, were deprived of food and water. The terrorists spread explosives throughout the building to ensure catastrophe if they were attacked. On the morning of October 26, Russian commandos piped an anesthetic gas called fentanyl through a hole in the wall, hoping to incapacitate the hostage-takers. The action succeeded in putting many of the terrorists to sleep and disrupting the rest. All of the Chechans were killed, some shot at point-blank range. Although dozens of ambulances were standing by and hospital emergency rooms were at the ready, the medical personnel were unprepared for the problems they actually faced, not injuries due to bullets or shrapnel but unconscious men, women and children. Authorities had not told them what type of gas had been used, though it is a familiar agent in operating rooms and its effects could have been managed. As it was, 128 people died of the combined effects of the fentanyl and dehydration. In response, President Vladimir Putin declared a national day of mourning and decided to step up Russia’s grip on the Muslim province. In 2004 hundreds more Russians were killed in multiple suicide attacks, including two downed passenger aircraft, as part of the continuing Chechen resistance. In Washington, the same day as the unfolding tragedy in Moscow, the National Academy of Sciences released a report on the prospects for effective military use of “non-lethal weapons,” including fentanyl. The Academy’s committee concluded that the Chemical Weapons Convention was ambiguous enough to permit the use of some non-lethal chemical weapons. Among the recommendations of the report, entitled “An Assessment of Non-Lethal Weapons Science and Technology,” was that the Pentagon’s Joint Non-Lethal Weapons Directorate should establish “centers of excellence” in the weapons’ development (http://www.mindfully.org/ Reform/2002/Non-Lethal-Weapons-AssessmentNAS4nov02.htm). Proponents of “non-lethal” weapons (NLWs) claim that they will obviate the need to kill or maim. These weapons are actively being sought by all branches of the U.S. military and come in a dazzling variety, from “incapacitants” or chemicals that put people to sleep, acoustic and light-pulsing devices that disrupt cognitive and neural processes; odors so disgusting they sicken; sudden colored fog that creates panic; optical equipment that causes temporary blindness; and mechanisms that stimulate nerve endings as though they are fire, among dozens of others. A striking fact about this list is that so many are related to the human brain and nervous system. Growing concerns about terrorism have fed interest in NLWs. The modern nation-state’s typical arsenal is designed for cold war-style fighting between peers. The use of such weapons in the places terrorists like to operate often results in high levels of non-combatant casualties that may be politically as well as morally unacceptable. Hence NLWs seems to advance one of Augustine’s requirements for just war: that only as much force be used as is necessary for the task. A year after the tragedy Robin Coupland of the International Committee of the Red Cross published a commentary in The Lancet in which he raised a number of questions for the medical community about their relationship to so-called non-lethal weapons, including whether health professionals should be trained to take care of people exposed to them and whether they should they allow themselves to be part of developing weapons that require medical and scientific expertise. Coupland noted that one medical research group suggested that international standards of conduct with regard to such weapons be developed (Coupland 2003). To