From Ethics to Obligation: Analyzing the Position of Medical Ethics Principles in International Humanitarian Law

Document Type : Research Paper

Authors

1 MA. Student in International Law, Department of Public and International Law, Faculty of Law and Political Sciences, University of Mazandaran, Babolsar, Iran

2 Associate Prof. of International Law, Department of Public and International Law, Faculty of Law and Political Sciences, University of Mazandaran, Babolsar, Iran

3 Ph.D. in Private Law, Department of Private Law, Faculty of Law and Political Sciences, University of Mazandaran, Babolsar, Iran. Postal address: Iran, Mazandaran, Babolsar

Abstract

Introduction
The four fundamental principles of medical ethics—autonomy, beneficence, non-maleficence, and justice—are regarded as the cornerstone of professional conduct in the medical field. However, the application of these principles in the context of armed conflicts faces significant challenges. In such situations, physicians and healthcare personnel are often confronted with ethical dilemmas, including conflicts between military orders and professional obligations, as well as pressure to discriminate in the treatment of wounded enemy combatants. This study aims to analyze the normative status of these principles within the framework of international humanitarian law. The main research question of this study is whether these principles, within the framework of international law, go beyond the status of ethical recommendations and become binding rules.
 
Methods
This study employs a descriptive-analytical method and relies on library-based sources, including authoritative texts, international instruments (both treaties and soft law), the case law of international courts and tribunals, and interpretations provided by competent bodies such as the International Committee of the Red Cross. The study systematically examines the issue, and the information derived from these sources is analyzed using an analytical-interpretative approach.
 
Results and Discussion
The findings indicate that the principles of medical ethics have been widely reflected in international humanitarian law instruments and have acquired a degree of criminal enforceability. In this regard, an examination of the Geneva Conventions and their Additional Protocols shows that these principles are explicitly or implicitly embedded within the framework of humanitarian law. For example, the principles of non-maleficence and beneficence are reflected in provisions that require "humane treatment" and the protection of the wounded and sick (such as Article 12 of the First and Second Geneva Conventions). The principle of autonomy is respected through provisions emphasizing the prohibition of medical procedures without consent (Article 11(5) of Additional Protocol I) and the requirement of medical confidentiality (Article 16 of Additional Protocol I). The principle of justice is clearly reflected in rules governing "non-discriminatory treatment" and prioritization based solely on medical criteria (such as Article 12 of the First Geneva Convention and Article 10(2) of Additional Protocol I). Furthermore, non-binding instruments such as the "Ethical Principles of Health Care (2015)" contribute to the articulation and strengthening of ethical standards in complex wartime situations by fostering an international professional consensus. Through their flexibility and capacity for updating, these instruments address legal gaps and serve as highly effective practical guidelines for healthcare personnel and military commanders. An analysis of international judicial decisions also demonstrates that serious violations of medical ethical principles may give rise to individual criminal responsibility. The prosecution of Nazi physicians during the Nuremberg Trials for unethical medical experiments marked a turning point in the development of criminal accountability for medical professionals. In subsequent cases, such as the Čelebići case before the International Criminal Tribunal for the former Yugoslavia, the deliberate denial of medical care to detainees was recognized as a violation of international humanitarian law. Moreover, jurisprudence in cases such as Ntakirutimana and Stakić indicates that a physician's abuse of their professional position to commit crimes is not considered a mitigating factor; rather, it is regarded as an aggravating circumstance in sentencing. These judgments recognize adherence to medical ethics as a legal obligation. It is also noteworthy that medical ethical principles and the fundamental principles of international humanitarian law—namely humanity, neutrality, and professional independence—share a common foundation, namely the protection of human dignity.

Conclusions
 The findings of this study indicate that the principles of medical ethics have moved beyond the realm of voluntary ethical recommendations and have been consolidated as binding norms within the framework of international humanitarian law. This process of the "transformation from ethics into law" can be traced through three main pathways: codification in binding instruments, reinforcement through soft-law instruments, and the establishment of criminal enforcement via judicial practice. Today, adherence to the four fundamental principles of medical ethics by healthcare personnel in situations of armed conflict is not merely an ethical choice, but a legal obligation. Accordingly, it can be concluded that medical ethics and international humanitarian law are inextricably linked, together forming a robust safeguard against injustice in situations of war.

Keywords

Main Subjects

References

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Journal of Legal Studies
Volume 18, Issue 3 - Serial Number 58
October 2026
Pages 431-470

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