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This chapter argues that preventive force is a security strategy defined along a continuum. While the scale of preventive force varies, the strategic aim is the same: to thwart the development of possible future threats from suspected ill-willed actors. At one end of the spectrum are extreme forms of preventive force, including preventive nuclear strikes and preventive wars. Closer to the other end of the spectrum are smaller scale applications of preventive force, including drone strikes outside of legally recognized war zones, which target and kill individuals regarded as potential security threats. Although preventive targeted killings entail a relatively more limited use of force compared to war, the dramatic expansion of the drone program is consistent with the United States’ enduring commitment to preventive action. Within this context, this chapter reviews historical trends in US preventive logic and its use of preventive force at the beginning of the 21^st century. It then provides an overview of the dilemmas that arise. Finally, it provides an overview of each of the chapters in the volume.

Since World War II and before 9/11, the United States never publicly invoked a right to use force against imminent threat. During its first 150 years, however, the country occasionally resorted to armed force as part of a broader strategy to achieve security at a time when its greatest threat was European imperialism. As a young republic, America pursued a very different path to security highlighted by two goals: keeping itself out of Europe's wars and keeping Europe out of the Americas. The gradual demise of colonialism essentially ended the use of preventive force by the mid-twentieth century. This chapter explores the history of America's use of preventive force in the nineteenth century and the early twentieth century against imminent threat. It first looks at Japan's bombing of Pearl Harbor during World War II and then examines the debate during the Cold War era about whether the United States should have launched a preventive war against the Soviet Union.

This chapter investigates when do leaders use preventive military force as a counterproliferation strategy. It argues that leaders and their beliefs are key to understanding state responses to nuclear proliferation and that their role has been previously overlooked. Specifically, leaders enter executive office possessing different views about the dangers of nuclear proliferation generally and about the threats posed by individual states attempting to go nuclear. These divergent prior views encourage leaders to adopt different preventive force policies once in office when, they may use or consider using military force as a counterproliferation strategy. The chapter then offers a leader-centric argument for understanding preventive war decisions. It emphasizes that the counterproliferation policies adopted by subsequent leaders in the same polity differ because of individual disagreements over the requirements of deterrence and the dangers of nuclear proliferation.

Global terrorism calls for a rethinking of the rules governing the decision to strike first, rather than simply a refocusing of energies. Webster's Rule may be necessary to deal with an enemy that lacks a sense of measured risk, seeks maximum destruction, has the means to do so, and is not easily detection. The moral tradition does not demand absolute imminence from states and has less to say about the procedural norms that should govern preventive force. Under Webster's Rule, a state can determine when the threat of attack is so near in space and time that justifies the use of preemptive force. This chapter describes a standard governing the use of preventive force based on criteria that developed within the moral tradition: certainty of intent, sufficient means, active preparation, magnitude of harm, probability of harm, proportionality (of ends), and necessity (or last resort). It also looks at a few cases to illustrate how such a standard might strike a balance between security and restraint.

The terrorist attacks on the United States has forced the country to consider preventive force as a means to achieve security. In the fight against terrorism, however, preventive force should be an option of last resort. Success in this fight will also require measures such as increased intelligence capacity, better international coordination, tough diplomacy, implementation of the traditional tools of law enforcement, and disruption of the terrorists' financial capability. Despite the formidable challenges involved in task of revision, the moral tradition on the just war points a principled way forward and suggests a framework that limits recourse to force without losing sight of the possibility that an absolute commitment to the imminence rule does not guarantee security. The tradition's consistent affirmation that states are not subject to the imminence requirement runs counter to Webster's Rule and its demand for an instant threat.

This chapter poses one central question: When do states decide to use preventive military force to forestall or destroy an adversary's nuclear weapons program? It aims to understand why some leaders use preventive war, others consider it, and still others never contemplate it as a counterproliferation strategy. The chapter argues that leaders have different prior beliefs about nuclear matters, which influence how these leaders, once in executive office, approach proliferation challenges that arise. The chapter also chronicles significant leader disagreement about the magnitude of threats posed by nuclear proliferation generally and by specific states' nuclear programs, which are central to understanding this variation in behavior. It contends that leaders' beliefs formed prior to or early in leaders' tenure in executive office (before the case of interest) are what shape their later preventive war decisions. The chapter contributes to our growing understanding of the domestic sources of nuclear politics writ large.

Over the past several years, the United States has dramatically changed its approach to preventing future enemy attack. In particular, the government has become willing to use preemptive force against emerging threats. This book examines the use of armed force to strike first to prevent an imminent attack by considering anticipatory force or anticipatory self-defense as well as preemptive and preventive force. Drawing upon a body of reflections on the morality of war that have accumulated over hundreds of years, it looks at the American experience with preventive war. It discusses the relationship between preventive force and the nation's moral identity and explores the announced willingness of the United States to strike first in the context of the imminence rule. The book also considers two challenges related to striking first: the challenge of moral legitimacy and the challenge of developing a narrow framework to govern the use of preventive force.

This chapter opens with a discussion on the US response to the nuclear program of North Korea—officially the Democratic People's Republic of Korea (DPRK). It highlights that the response was characterized first by a lack of presidential concern and by rapid escalation to the brink of war. The chapter then argues that these two sets of behaviors can be explained by the nuclear beliefs of presidents George H. W. Bush and William J. Clinton. It shows that Bush was a (weak) nuclear optimist, focused on stability and largely confident in deterrence. By contrast, Clinton, a nuclear pessimist generally and regarding North Korea, seriously considered the use of preventive military force to forestall the North Korean program. The chapter leans on public statements, contemporaneous accounts, and the secondary literature, itself dependent on limited archival material. Despite data limitations, the observed outcomes are consistent with the model's theoretical expectations. The North Korean case offers an important test of the leader-centric model's generalizability beyond the Cold War.

The moral dilemma felt by Americans about striking first against Japan on the eve of the Pearl Harbor bombing, against the Soviet Union following World War II, and against Cuba in 1962 reflected a conviction that war should be a last resort. Americans and their leaders came to believe that a preventive war at any of these moments would have crossed this moral line and would have been inconsistent with what America represented. The belief that war should be a last resort made up the moral tradition on just war, which rejects both pacifism and realism. This chapter examines the origins of the moral tradition, what it says, and its impact on American attitude regarding the role of preventive force against imminent threat. In particular, it looks at Augustine's discussions of war as a moral issue and their relevance to just war as an “expression of the American mind”.

Contemporary U.S. health care is characterized by the under-use of services known to improve patients’ outcomes and the over-use of services beyond what can benefit patients. Large proportions of Americans are not receiving treatment that is in accordance with evidence showing what works best for their conditions. The situation is allowed to continue because of payment policies that reimburse physicians and hospitals for the services they deliver on the basis of volume rather than appropriateness, evidence of effectiveness, or value. Our outlays for health insurance premiums, deductibles, and co-payments are buying us suboptimal medical care. If more and better comparative effectiveness research is to increase the value of the dollars we spend on health care, patients, providers and third party payers must become better students of medical evidence, and payment policies and the organization of health services must be reconfigured to align medical care with evidence.

This chapter, like the entire volume, is dedicated to the memory of Channi Kumar. I first met Channi in August 1984 in Oakland, California, at the biennial meeting of the Marcé Society, hosted by James Hamilton. I had already been impressed by Channi’s research but knew him only through his published work. In person, the man did not disappoint. He was elegant and kind, a man who treated everyone with respect. Over the years, my affection and admiration for Channi grew through many stimulating discussions and delightful social occasions. Even our last series of meetings focused on a new, exciting initiative of Channi’s: the ‘Transcultural Study,’ which he envisioned as a way to harmonize the detection, assessment, and treatment of perinatal mood disorders, across western Europe and even the United States, Asia, and Africa. Through experiences like these, Channi made my life richer, personally and professionally; and I greatly miss him as a mentor and a friend, and feel privileged, along with my colleague Lisa Segre, to contribute a small piece to honor this great psychiatrist and humanitarian. Michael W. O’Hara Perinatal depression is a significant mental health problem that afflicts women around the world at a time when they are highly vulnerable—pregnant or managing a new infant. In one form or another, perinatal depression has been recognized for thousands of years; however, only in the past 50 years has there been a sustained focus on the non-psychotic mental illnesses experienced by some during pregnancy and the postpartum period. The literature of the 1960s contains only a few papers with the words postpartum depression, postnatal depression, or perinatal depression. Not until the 1970s did these terms come into common use. Indeed, a search for at least one of these terms on the PsycNET database (from entries catalogued between 1884 and 9 September 2012) revealed the vast majority (2,743 or 75%) of 3,651 papers, books, and book chapters on perinatal depression were published after 2000. These findings show how work in the field of perinatal mental illness has expanded exponentially.