Medical Ethics in Extreme and Austere Environments.

American society has a history of turning to physicians during times of extreme need, from plagues in the past to recent outbreaks of communicable diseases. This public instinct comes from a deep seated trust in physician duty that has been earned over the centuries through dedicated and selfless care, often in the face of personal risks. As dangers facing our communities include terroristic events physicians must be adequately prepared to respond, both medically and ethically. While the ethical principles that govern physician behavior-beneficence, nonmaleficence, autonomy, and social justice-are unchanging, fundamental doctrines must change with the new risks inherent to terroristic events. Responding to mass casualty disasters caused by terrorists, natural calamities, and combat continue to be challenging frontiers in medicine. Preparing physicians to deal with the consequences of a terroristic disease must include understanding the ethical challenges that can occur.

Terrorism and lethal moralism in the United States and United Kingdom, 1970-2017.

The current paper examines terrorism as a special form of moralistic violence, with several key features that distinguish such behaviour from other types of violence. The theory of lethal moralism highlights the importance of social polarization, characterized by vast differences in social space and inequality between adversaries as crucial to explaining deadly terrorist attacks. Where the differences are more permanent or chronic - and the groups in question define and justify their existence specifically in contradistinction to 'other' groups - then the polarization intensifies and attacks tend to be more lethal. In contrast, groups that appeal to broader audiences or the general public as potential allies more often use non-lethal terrorism to their strategic advantage. The study examines the United States and the United Kingdom to classify each of more than 8,000 attacks between 1970 and 2017 in terms of their ideological orientations. The evidence highlights the arc of terrorism in relation to different types of groups, as well as confirms the more lethal nature of terrorism linked especially to radical Islam, right-wing religious extremists, hate groups, ethno-nationalist sectarian violence, and anti-government anarchists. Yet apart from the extensive use of terrorism associated with 'The Troubles' in Northern Ireland, the majority of terrorist attacks in the US and the UK have not produced deaths. Most terrorism instead has been perpetrated by groups aiming to rally support for a general cause and has been far less deadly on balance. The implications of these findings are discussed with a view toward developing more powerful explanatory models that focus on the socio-cultural contexts and justification frameworks that inspire extremism and the use of lethal moralism to settle disputes.

The Unabomber's ethics.

In this paper, I present and criticize Ted Kaczynski's ("The Unabomber") theory that industrialization has been terrible for humanity, and that we should use any means necessary, including violent means, to induce a return to pre-industrial ways of living. Although Kaczynski's manifesto, Industrial society and its future, has become widely known, his ideas have never before been subject to careful philosophical criticism. In this paper I show how Kaczynski's arguments rely on a number of highly implausible philosophical premises. I further make the case that, although his theory as a whole should be rejected, Kaczynski raises a number of worries about technological development that ought to receive serious attention. Some of these worries have recently come to be shared by prominent defenders of human enhancement, including Nick Bostrom and Julian Savulescu. In the last section I indicate why I believe it is important that academic philosophers scrutinize ideas that motivate acts of violence.

Should we prioritise victims over terrorists in medical triage?

Whether injured terrorists should receive equal consideration in medical triage as their victims is a morally and emotionally challenging issue for healthcare providers. Against the conventional approach, some commentators have argued for a 'victims-first' principle in which severely injured victims should always be prioritised over an injured terrorist even if the terrorist is worse off based on justice ideas. This paper argues that supporters of 'victims-first' fail to sufficiently justify the subversion of the equal rights of terrorists to treatment and the role and professional ethics of healthcare providers in the allocation of scarce medical resources. Accordingly, they fail to substantiate an exceptional approach for emergency medical triage during terror or terror-like attack situations.

Standardizing psycho-medical torture during the War on Terror: Why it happened, how it happened, and why it didn't work.

After 9/11/2001 the United States launched a global War on Terror. As part of this War, terrorism suspects were detained by the U.S. military and by the C.I.A. It is now widely recognized that the United States tortured a number of these detainees in the context of its 'enhanced interrogation' programme. This article examines how and why U.S. organizations developed standards that allowed healthcare professionals to become involved in torture; why the standards developed by U.S. security institutions failed to control the actions of enhanced interrogation personnel on the ground; and what the role of standards were in stopping the enhanced interrogation initiative. The article concludes by discussing the general lessons that the enhanced interrogation programme has for social science research on standards, namely that individuals can experience ambivalence when caught between competing organizational and professional standards and that it might be inherently difficult to successfully enact certain protocols when these relate to deviant or destructive acts.

The Separation Wall and the right to healthcare.

Nowadays, the concepts of soldier and war have changed due to terrorism and the war on terrorism. According to the literature, to prevent terrorism, it is possible to use more violence, but how can we grant the safety of many versus the dignity of a few? In Israel, in order to protect civilians against possible terrorist attacks, Palestinian ambulances that would reach the Israeli hospitals (or the Palestinian hospitals in East Jerusalem) must be quickly controlled. However, many times, at the checkpoint, patients have to wait for an Israeli vehicle that will take them to Israel. This procedure causes many delays in medical emergency. How to avoid that terrorists may receive better care than Palestinian civilians may just because they are already on the Israeli side of the Separation Wall? How is it possible to ensure the life and safety of many, without denying the right to healthcare to somebody? How to decide when the State requirements conflict with traditional medical duties? Is it acceptable to provide health care to a terrorist? What should be done when it is uncertain whether the ambulance transports weapons besides patients? These questions call upon the core role of the doctor and of the medical profession: taking care of all sick persons. The care is the starting point of ethics. If we do not care about other human beings we do not have a real moral comprehension of any human ideal or action. For this reason we can say that the care is the premise of morality. The rights of all citizens, including the claim to public security, grounds on the care for each individual who needs help.

[Reflecting on a religious conversion event in a clinical setting]. / Penser un événement de conversion religieuse en clinique.

What should be the clinical approach to the event represented by a religious conversion, adherence or attraction to extreme groups and ideas? It requires a conceptual analysis, an ethical and epistemological approach at the centre of social situations presenting a high level of ambiguity, tinged even with a certain sense of unreality, as is being experienced in France.

Two Distinct Moral Mechanisms for Ascribing and Denying Intentionality.

Philosophers and legal scholars have long theorized about how intentionality serves as a critical input for morality and culpability, but the emerging field of experimental philosophy has revealed a puzzling asymmetry. People judge actions leading to negative consequences as being more intentional than those leading to positive ones. The implications of this asymmetry remain unclear because there is no consensus regarding the underlying mechanism. Based on converging behavioral and neural evidence, we demonstrate that there is no single underlying mechanism. Instead, two distinct mechanisms together generate the asymmetry. Emotion drives ascriptions of intentionality for negative consequences, while the consideration of statistical norms leads to the denial of intentionality for positive consequences. We employ this novel two-mechanism model to illustrate that morality can paradoxically shape judgments of intentionality. This is consequential for mens rea in legal practice and arguments in moral philosophy pertaining to terror bombing, abortion, and euthanasia among others.

Physician involvement in torture: an ethical perspective.

Evidence proves that physician involvement in torture is widely practiced in society. Despite its status as an illegal act as established by multiple international organizations, mandates are routinely unheeded and feebly enforced. Philosophies condemning and condoning torture are examined as well as physicians' professional responsibilities and the manner in which such varying allegiances can be persuasive. Physician involvement in torture has proven detrimental to the core values of medicine and has tainted the field's commitment to individuals' health and well-being. Only when this complex issue is addressed using a multilevel approach will the moral rehabilitation of medicine begin.

Mind wars. Brain science and the military.

This article is based on a public lecture hosted by the Monash University Centre for Human Bioethics in Melbourne, Australia on 11 April 2013. The lecture recording was transcribed by Vicky Ryan; and, the original transcript has been edited--for clarity and brevity--by Vicky Ryan, Michael Selgelid and Jonathan Moreno.

Psychologists and detainee interrogations: key decisions, opportunities lost, and lessons learned.

After the 9-11 terrorist attacks, U.S. psychologists faced hard choices about what roles, if any, were appropriate for psychologists in the detainee interrogations conducted in settings such as the Bagram Airbase, the Abu Ghraib Prison, and the Guantanamo Bay Detention Camps. The American Psychological Association (APA) sparked intense controversy with its policies and public statements. This article reviews APA decisions, documents, and public statements in this area, in the context of major criticisms and responses to those criticisms. The review focuses on key issues: how the APA created and reported policies in the areas of ethics and national security; transparency; psychologists' professional identities; psychologists' qualifications; ethical-legal conflicts; policies opposing torture; interpretations of avoiding harm; and effective interrogations. It suggests lessons learned, missed opportunities, and questions in need of a fresh approach.