The concept of "duty to act" is one of the central tenets of medical ethics. If your medical skillset has a reasonable chance at improving a dire situation, you must use it. Someone who's trained in first aid is legally obligated to help if someone isn't breathing. With our nation's bolus of strengths and a seeming lack of alternatives, we face a similar obligation to the world. But even if the ethics are similar, a civil war is not a human body.
Again and again, Doctor America sees herelf as the only doctor in the house, or lifeguard on the shore. The good doctor has mighty military and massive diplomatic and economic clout, but unlike a person whose heart has stopped, the clinical signs that present themselves in geopolitical conflicts are often vague and conflicting. She gets some things right, messes other things up, and sometimes interferes where she isn't wanted. She also has her own self interests to consider. But for the better part of a century the world has turned to us for help.
With the power we have, we face stark moral choices. Here's one: 1,400 civilians were gassed by a tyrannical regime in the middle of an existential battle that has now killed over 100,000. In the tickertape of atrocities that continue to pile at our feet, this one is pretty bad, at least by recent standards. What do we do? There are people dying in an interminable civil war. There are international laws to consider, regional allies, rivals, and foes. The world and our own consciences scream, "we have to do something."
Another central tenet of medical ethics is "do no harm," but again, even if the ethics are similar, a civil war is not a human body. Assad is a nasty illness, but he's present in the essential organs of the nation, and he isn't the patient's only problem. Diplomacy was going nowhere. An airstrike against certain targets may or may not improve the situation for the Syrian people. We aren't willing to engage in a full-scale war, and even if we were, there are serious doubts if it would help. With the muddle surrounding major strategic decisions there is seldom a clear diagnosis or treatment plan. We look at a country at war and understand the history fairly well, and we measure our decisions based recent experiences. Even after all is said and done, we can't know the counterfactuals. We never can be sure if we made the right decisions.
This case is different than any one I can remember. For the first time in my memory Doctor America is coming to believe that the weight of the world doesn't rest on her shoulders alone. She isn't Doctor Quinn, practicing her basic medicine and shooting wolves to keep the patient safe. She is part of a team of trained physicians who must coordinate themselves between conflicting interests, massive egos, and differential diagnoses. She is part of a geopolitical health system; with institutions that are supposed to help smooth out the bumps between these powerful people and arrive at a consensus. For the first time ever, those systems appear to be doing their jobs. The United Nations has provided a valuable forum for decisionmaking between the US, Russia, Syria and its neighboring states. Allies like France have stepped up to offer their own solutions. Syria's neighbors and family are pitching in where they can. Suddenly we are saved from the terrible decisions we felt we had to make on our own.
The prognosis in Syria is a long, long way from improving, and our responsibility for its eventual recovery is far more limited than a doctor's to her patient, but something fundamental has changed in our approach. Maybe we're realizing the limits to our skills. Maybe we're trying some new approaches. And maybe, for the first time in a long time, we feel like we have help.
