In war, the state defends “its collective, political life.” If it is to succeed, military necessity needs to be given enough room. In this context, Michael L. Gross believes, the state is entitled to discriminate against individual interests. After all, “armies go to war to win,” so their own soldiers need the best possible medical care. As a result, enemy soldiers quickly become last in line for treatment. Yet, following this logic, Gross also attaches a different value to the welfare of one’s own soldiers. Resources should be used primarily for those soldiers who will be soonest able to contribute to the war effort again.
From an international law perspective, this approach is problematic. Can it ever be permissible to violate international law or medical ethical principles out of military necessity? For Gross, there are “sometimes” sufficient reasons. In his view, apart from national security interests, the close bonds between fellow soldiers are the crucial factor.
Gross believes that “primary bonds" among companions-in-arms are not substantially different than bonds between family members or friends. He is convinced that the ethics of care does provide good reasons for saving people close to oneself first, and hence, for giving preferential medical treatment to fellow soldiers. American medics justify their belief in treating fellow soldiers first from a similar perspective: “Because he’s our brother.” This intuitive justification, Gross says, is always morally understandable.
But in that case, what limits with regard to ethics and international law – if any – still apply to military doctors and medics in the field? Gross takes care to point out that the ethics of care does not permit any reckless transgression of "fundamental moral norms.” Assistance should be provided even to foreigners and enemies in emergencies. Ultimately, he writes, military doctors and medics constantly face the challenge of reconciling their duties as soldiers and helpers.