In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

Ten new essays critique the practice of armed humanitarian intervention, whereby one state sends its armed forces into another to protect citizens against major human rights abuses. The contributors examine a range of concerns, for instance about potential adverse effects and about ulterior motives.

Any attempt to justify war in the fashion of just war theories risks underestimating its morally problematic nature. This becomes clear if we ask how the individual soldier or citizen is supposed to use just war theory in his own thinking. Michael Walzer's recent book, Just and Unjust Wars, illustrates the problem nicely. Walzer's view is that whether a state is justified in going to war is not a matter for the citizen to judge, and with regard to the way (...) the war is conducted the individual soldier can have only minimal moral responsibility for what is done. Walzer's position is criticized in detail and the conclusion drawn that such an understanding of just war theory undermines the theory's significance as a moral outlook on war. It is also argued that a more pertinent version of just war theory must have strong implications for social change. (shrink)

Just war theory entails that some wars may be morally unjustifiable, and hence citizens may be right to object morally to their government''s waging of a war and to their being compelled to serve in it. Given the evils attendant upon even justified war, this fact sharply restricts any obligation to die for the state, and raises important questions about the appropriate state response to selective conscientious objectors. This paper argues that such people should be legally accommodated, and discusses objections (...) to doing so, in particular, the possible erosion of the state''s capacity to wage justified war, the unfairness of granting such exemptions from military service, and the impossibility of determining genuinely conscientious objection. (shrink)

C. A. J. Coady; VIII*—Descartes' Other Myth, Proceedings of the Aristotelian Society, Volume 83, Issue 1, 1 June 1983, Pages 121–142, https://doi.org/10.1093/ar.

Coady explores the challenges that morality poses to politics. He confronts the complex intellectual tradition known as realism, which seems to deny any relevance of morality to politics, especially international politics. He argues that, although realism has many serious faults, it has lessons to teach us: in particular, it cautions us against the dangers of moralism in thinking about politics and particularly foreign affairs. Morality must not be confused with moralism: Coady characterizes various forms of moralism and sketches their distorting (...) influence on a realistic political morality. He seeks to restore the concept of ideals to an important place in philosophical discussion, and to give it a particular pertinence in the discussion of politics. He deals with the fashionable idea of "dirty hands," according to which good politics will necessarily involve some degree of moral taint or corruption. Finally, he examines the controversial issue of the role of lying and deception in politics. Along the way Coady offers illuminating discussion of historical and current political controversies. This lucid book will provoke and stimulate anyone interested in the interface of morality and politics. (shrink)

C. A. J. Coady offers to clear up confusion about what terrorism is. His "tactical definition" focuses on terrorist acts as violent attacks upon non-combatants. He discusses what it means to be a non-combatant, considers various philosophical attempts to defend terrorism, and examines the idea of a connection between religion and terrorism.

Our trust in the word of others is often dismissed as unworthy, because the illusory ideal of "autonomous knowledge" has prevailed in the debate about the nature of knowledge. Yet we are profoundly dependent on others for a vast amount of what any of us claim to know. Coady explores the nature of testimony in order to show how it might be justified as a source of knowledge, and uses the insights that he has developed to challenge certain widespread assumptions (...) in the areas of history, law, mathematics, and psychology. (shrink)

To what extent should scientists, doctors and the community be constrained in their decision-making by a duty to posterity? How should we as a community balance our desire to benefit the present generation against the need not to irretrievably harm our successors? These questions are discussed with particular reference to genetic research and treatment that may have great potential for people suffering from genetic disease but may cause inherited changes in future generations, either deliberately or inadvertently. We conclude that the (...) community should take account of the interests of its successors but this should not immobilise us in the decisions we make for the present. (shrink)

When Huck Finn embarks upon his hilarious education of the slave Jim in the moral vagaries of the monarchies of Europe, he takes himself to be propounding the merest common sense. He may have thought large‐scale villainy restricted to autocracies, but his creator was clearly not so naive. More to the present point, Huck ends his discourse on princely rule with remarks that show he was not merely cataloguing the fact of widespread royal vice, but willing to countenance it as (...) necessary. As he puts it, ‘kings is kings, and you got to make allowances. Take them all around, they're a mighty ornery lot’. (shrink)

abstract This paper aims to gain a deeper understanding of the different forms of moralism in order to throw light upon debates about the role of morality in international affairs. In particular, the influential doctrine of political realism is reinterpreted as objecting not to a role for morality in international politics, but to the baneful effects of moralism. This is a more sympathetic reading than that usually given by philosophers to the realist doctrines. I begin by showing the ambiguity and (...) elusiveness of realist claims about morality in politics and then distinguish six forms of moralism, understood as a distortion of genuine morality: moralism of scope, of imposition, of abstraction, of absolutism, of inappropriate explicitness, and of deluded power. I argue that most of these are relevant to typical realist claims and can make their objections more plausible. But, though realists can be interpreted as rightly drawing attention to the dangers of moralism in international and national affairs, their conflation of moralism with morality wrongly leads them to an exaltation of the pursuit of national interest and to the rejection of policies and judgements that are not in fact moralistic. (shrink)

The “asymmetry myth” is that war crimes are committed by one's enemies but never, or hardly ever, by one's own combatants. The myth involves not only a common failure to acknowledge our own actual war crimes but also inadequate reactions when we are forced to recognize them. It contributes to the high likelihood that wars, just or unjust in their causes, will have a high moral cost. This cost, moreover, is a matter needing consideration in the jus ante bellum circumstances (...) of preparedness for war as well as of conduct within it. As part of the symposium on Ned Dobos's book, Ethics, Security, and the War-Machine, I will argue that the strength of the asymmetry myth is sustained by certain forms of romantic nationalism linked to the glamorization of military endeavor. (shrink)

The concept of conscience continues to play a central role in our ethical reasoning as well as in public and philosophical debate over medical ethics, religious freedom, and conscientious objection in many fields, including war. Despite this continued relevance the nature of conscience itself has remained a relatively neglected topic in recent philosophical literature. In this paper I discuss some historical background to the concept and outline the essential features required for any satisfactory account of conscience and its significance for (...) a coherent moral psychology. It will become clear that conscience is a complex concept resisting reduction to any one of its component features. In doing so I critique recent accounts of conscience which have been insufficiently attentive to these complexities and as a consequence have drawn mistaken conclusions about the legitimate role of conscience in moral reasoning. I also discuss the significance of various distortions of conscience such what I call “the fanaticised conscience”. Clarifying our concept of conscience helps us avoid both conceptual confusion in moral psychology and misapplications of the concept in our understanding of conscientious objection both theoretically and in practice. (shrink)

This essay characterises applied philosophy of religion as a certain sort of engagement with what religion means in the private and public lives of its practitioners. After emphasising continuities with the past, such as Hume's critique of miracles and Hobbes and Spinoza's discussions of scriptural meanings, it then discusses John Cottingham's recent work on spirituality and religious sensibility, followed by a section on new explorations of religious epistemology citing Linda Zagzebski's work on individual and communal epistemic authority, and Leonore Stump's (...) elaboration of a form of non‐propositional knowledge gained from narrative. Debates about the role of religion in liberal democratic politics are then addressed, with special attention to the contentious idea of a religion‐free “secular” or “public” reason as advocated respectively by Robert Audi and John Rawls. The significance of interdisciplinary input for dispelling religious stereotypes leads to a discussion of common gaps between proclamations of religious leaders and the sincere religious beliefs of their flocks. A section follows on the complex idea of religious experience, before the essay concludes with an account of relevant issues in religious ethics. (shrink)