Caution before condemnation: rethinking responsibility for Gaza's healthcare scarcity

In a recent exchange in this journal on responsibility for healthcare scarcity in Gaza, McMahan argues that bioethicists should unconditionally condemn Hamas yet insists that the group's actions do not diminish the protections owed to civilians. He further argues that Israel bears the greatest responsibility for civilian suffering, having violated the principles of proportionality, necessity and discrimination. On this basis, he maintains that while all parties must be held accountable for breaches of ethical and humanitarian norms, Israel's conduct should be condemned as unjust, impermissible and as carrying the primary burden of responsibility. In this response, I argue that McMahan's position suffers from several shortcomings: it relies on controversial sources while not engaging with credible alternatives, and it privileges a particular strand of just war theory while failing to present alternative frameworks, many of which are likely unfamiliar to bioethicists. This is unsurprising, given that McMahan has developed one of the most influential contemporary theories of just war. Nevertheless, if bioethicists are to issue judgements on the allocation of responsibility in armed conflict and to condemn the conduct of warring parties, they would be better equipped to do so through rigorous engagement with the full range of available evidence and through measured consideration of the diverse ethical frameworks that govern war and armed conflict.