Treating the innocent victims of trolleys and war

Michael L. Gross

Research output: Contribution to journalArticlepeer-review


Both trolleys and war leave innocent victims to suffer death and injury. Trolley problems accounting for the injured, and not only the dead, tease out intuitions about liability that enhance our understanding of the obligation to provide compensation and medical care to civilian victims of war. Like many trolley victims, civilians in war may suffer justifiable, excusable, or negligent harms that demand compensation. Chief among these is collateral harm befalling civilians. Collateral harm is endemic to war and comprises permissible but unavoidable death or injury following necessary and proportionate military operations. Although state armies sometimes offer condolence payments for civilian death, injury, and property loss, they deny liability. Instead, they use compensation to enhance counterinsurgency efforts and assuage feelings of agent regret. As part of the medical rules of eligibility, Coalition forces in Iraq and Afghanistan also provided medical care to victims of collateral harm. However, they denied care to similarly sick or injured civilians. While compensation is often justified to cure the harm civilians suffer, the differential use of medical resources is not. Rather, medical care remains subject to the principle of beneficence and medical need. The duty to provide civilian healthcare in war, particularly in wars of humanitarian intervention, is far-reaching and imposes significant costs that military and medical ethics are yet to recognize.

Original languageEnglish
Early online date22 Feb 2024
StateE-pub ahead of print - 22 Feb 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. Bioethics published by John Wiley & Sons Ltd.


  • collateral harm
  • compensation
  • just war
  • liability
  • medical rules of eligibility
  • military necessity

ASJC Scopus subject areas

  • Health(social science)
  • Philosophy
  • Health Policy


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