BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Developments in medical big data analytics may bring societal benefits but are also challenging privacy and other ethical values. At the same time, an overly restrictive data protection regime can form a serious threat to valuable observational studies. Discussions about whether data privacy or data solidarity should be the foundational value of research policies, have remained unresolved. We add to this debate with an empirically informed ethical analysis. First, experiences with the implementation of the General Data Protection Regulation (GDPR) within (...) a European research consortium demonstrate a gap between the aims of the regulation and its effects in practice. Namely, strictly formalised data protection requirements may cause routinisation among researchers instead of substantive ethical reflection, and may crowd out trust between actors in the health data research ecosystem; while harmonisation across Europe and data sharing between countries is hampered by different interpretations of the law, which partly stem from different views about ethical values. Then, building on these observations, we use theory to argue that the concept of trust provides an escape from the privacy-solidarity debate. Lastly, the paper details three aspects of trust that can help to create a responsible research environment and to mitigate the encountered challenges: trust as multi-agent concept; trust as a rational and democratic value; and trust as method for priority setting. Mutual cooperation in research—among researchers and with data subjects—is grounded in trust, which should be more explicitly recognised in the governance of health data research. (shrink)

One of the new ways used by companies to demonstrate their social responsibility is to encourage employee volunteering, whereby employees engage in socially beneficial activities on company time, while being paid by the company. The reasoning is that it is good for employee motivation (internal effects) and good for the company reputation (external effects). This article reports an empirical investigation of the internal effects of employee volunteering conducted amongst employees of the Dutch ABN-AMRO bank. The study showed that (a) socio-demographic (...) characteristics from employee volunteers markedly differ from those of non-volunteers and community volunteers and (b) employee volunteering seems to have positive effects on attitudes and behavior towards the organization. (shrink)

Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

Background In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents. Objective To discuss who can best protect a child9s interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership. Methods We describe the case of a 3-year-old boy with acquired (...) brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians. Conclusions Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team. (shrink)

Emotions play an important part in moral life. Within clinical ethics support (CES), one should take into account the crucial role of emotions in moral cases in clinical practice. In this paper, we present an Aristotelian approach to emotions. We argue that CES can help participants deal with emotions by fostering a joint process of investigation of the role of emotions in a case. This investigation goes beyond empathy with and moral judgment of the emotions of the case presenter. In (...) a moral case deliberation, the participants are invited to place themselves in the position of the case presenter and to investigate their own emotions in the situation. It is about critically assessing the facts in the case that cause the emotion and the related (moral) thoughts that accompany the emotion. It is also about finding the right emotion in a given situation and finding the right balance in dealing with that emotion. These steps in the moral inquiry give rise to group learning. It is a process of becoming open towards the perspectives of others, leading to new insights into what is an appropriate emotion in the specific situation. We show how this approach works in moral case deliberation. A physician presents a situation in which he is faced with a pregnant woman who is about to deliver multiple extremely premature infants at the threshold of viability. The moral deliberation of the case and the emotions therein leads to the participants’ conclusion that “compassion” is a more adequate emotion than “sadness”. The emotion “sadness” is pointed towards the tragedy that is happening to the woman. The emotion “compassion” is pointed towards the woman; it combines consideration and professional responsibility. Through the shift towards compassion, participants experienced more creativity and freedom to deal with the sad situation and to support the woman. The paper ends with an analysis and reflection on the deliberation process. In the conclusion we argue for more attention to emotions in clinical ethics support and offer some directions for doing this in the right way. (shrink)

In this article, we hypothesize that leaders who display group-oriented values (i.e., values that focus on the welfare of the group rather than on the self-interest of the leader) will be evaluated more positively by their followers than leaders who do not display group-oriented values. Importantly, we expected these effects to be more pronounced for leaders who are ingroup members (i.e., stemming from the same social group as their followers) than for leaders who are outgroup members (i.e., leaders stemming from (...) a different social group than their followers). We tested our hypotheses in two studies. Results of a field study (N = 95) showed the expected relationship between leaders’ group-oriented values and followers’ identification with their leaders. A scenario study (N = 137) replicated the results and extended it to followers’ endorsement of their leaders. Overall, these findings suggest that displaying group-oriented values pays off more for ingroup than for outgroup leaders. (shrink)

Persons with profound intellectual and multiple disabilities cannot speak about their Quality of Life, which makes it necessary to involve others. In current approaches, these ‘others’ are seen as assessors trying to describe QoL as objectively as possible, which involves a reduction of their experiences, through which they develop knowledge on the QoL of the person with PIMD. The objective of this paper is to give caregivers’ knowledge on the QoL of a person with PIMD a theoretical basis that values (...) these experiences. We will argue that caregivers should be seen as witnesses, not assessors, and their statements on QoL as testimonies, not assessments. Audiences judge the trustworthiness of these witnesses intersubjectively, which implies a relationship characterized by trust and suspicion. Trust supports the witness to tell in her own words about the QoL of the person with PIMD; it demands receptivity, indicating that both the witness and the audience are willing to reconsider their perspective on QoL. Suspicion is necessary too, which helps the witness to critically approach her own interpretations and supports her to create more trustworthy testimonies. We conclude that the concept of witnessing helps to acknowledge caregivers’ experiential knowledge of QoL of a person with PIMD, which may also apply to other persons who cannot speak about their own QoL. We hope that our study will empower caregivers to give testimonies on QoL of a person with PIMD, which is crucial when complex decisions about the life of this person have to be made. (shrink)

One of the new ways used by companies to demonstrate their social responsibility is to encourage employee volunteering, whereby employees engage in socially beneficial activities on company time, while being paid by the company. The reasoning is that it is good for employee motivation (internal effects) and good for the company reputation (external effects). This article reports an empirical investigation of the internal effects of employee volunteering conducted amongst employees of the Dutch ABN-AMRO bank. The study showed that (a) socio-demographic (...) characteristics from employee volunteers markedly differ from those of non-volunteers and community volunteers and (b) employee volunteering seems to have positive effects on attitudes and behavior towards the organization. (shrink)

In this article, we hypothesize that leaders who display group-oriented values (i.e., values that focus on the welfare of the group rather than on the self-interest of the leader) will be evaluated more positively by their followers than leaders who do not display group-oriented values. Importantly, we expected these effects to be more pronounced for leaders who are ingroup members (i.e., stemming from the same social group as their followers) than for leaders who are outgroup members (i.e., leaders stemming from (...) a different social group than their followers). We tested our hypotheses in two studies. Results of a field study ( N = 95) showed the expected relationship between leaders’ group-oriented values and followers’ identification with their leaders. A scenario study ( N = 137) replicated the results and extended it to followers’ endorsement of their leaders. Overall, these findings suggest that displaying group-oriented values pays off more for ingroup than for outgroup leaders. (shrink)

Traditionally, conceptualizations of human values are based on the assumption that individuals possess a single integrated value system comprising those values that people are attracted by and strive for. Recently, however, van Quaquebeke et al. (in J Bus Ethics 93:293–305, 2010 ) proposed that a value system might consist of two largely independent value orientations—an orientation of ideal values and an orientation of counter-ideal values (values that individuals are repelled by), and that both orientations exhibit antithetic effects on people’s responses (...) to the social world. Following a call for further research on this distinction, we conducted two studies to assess the independent effects of ideal and counter-ideal values in leadership settings. Study 1 ( N = 131) finds both value orientations to explain unique variance in followers’ vertical respect for their leaders. Study 2 ( N = 136) confirms these results and additionally shows an analogous effect for followers’ identification with their leaders. Most importantly, we find that both value orientations exhibit their effects only independently when the content of the two orientations pertain to different value types in Schwartz’s (in J Soc Issues 50:19–46, 1994 ) circumplex model. Implications for theory and practice are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Richard H. Popkin 1923-2005Harry M. Bracken and Richard A. WatsonRichard H. Popkin, founding editor of the journal of the History of Philosophy, died on April 14, 2005. He was 81 years old and had continued his research and writing to the last moment before he entered the hospital on march 21st with extreme respiratory difficulties.Popkin's The History of Scepticism from Erasmus to Descartes (1960) revolutionized the study and understanding (...) of early modern philosophy. Popkin entered the minds and world of thinkers from Erasmus to Descartes in a way few other scholars had done, and he showed how the development of philosophy and science was far from an easy series of steps from success to success. Instead, philosophers and scientists pursued a dozen lines from the scepticism of Sextus Empiricus through religious belief, atheism, numerology, astrology, alchemy, eschatology, magic, and millenarianism—a maelstrom of ideas out of which emerged the major figures and ideas of Modern philosophy and science. Dick once explained that actually he lived in the 17th century, and certainly he knew as many of those thinkers and their thoughts as did many people who actually lived at that time. Of course Popkin did not originate the notion of exploring the history of philosophy in the context of its times, but he made that approach central today. It led him not only through the Early Modern period, but also from medieval jewish philosophy to a critical analysis of the Kennedy assassination.Popkin received his PhD at Columbia University, and in his career he taught at the universities of Connecticut, Iowa, California (San Diego and Los Angeles), Washington University in St. Louis, and Harvey Mudd College. He served as the first editor of the Journal of the History of Philosophy, and as president of JHP, Inc. For many years, and was active in its operation for over four decades, having attended the annual meeting of the Board of Directors a little over a month before he died. After retirement, he lived in close association with the Clark Library in Los Angeles. He was well known to scholars and librarians throughout the world. Whatever library he visited, he was likely to find some obscure or hidden document that would either clear up some mystery, or give rise to a new problem. His memory was extraordinary. During his final years when he was virtually blind, he would sift through his mind, send assistants off to look for something that had to be in this or that library and write papers in his head for later dictation. Besides his memory, indispensable throughout his lifetime he had Julie, his co-worker and wife of 60 years, without whom, the Popkin we knew could not have existed.These few paragraphs are meant to be neither an obituary nor an adequate memorial. We were Dick's first two PhDs, and we were barely five years his junior. He treated us from the beginning as colleagues and he became a lifelong friend. He changed our lives, as he did the lives of many other aspiring scholars. We miss him.Copyright © 2005 Journal of the History of Philosophy, Inc.... (shrink)

The essays in this volume are the result of a project on Values in Tort Law directed by the Westminster Institute for Ethics and Human Values. We are indebted to the Board of Westminster Col lege for its financial support. The project involved two meetings of a mixed group of lawyers and philosophers to discuss drafts of papers and general issues in tort law. Beyond the principal researchers, whose papers appear here, we are grateful to John Bargo, Dick Bronaugh, (...) Craig Brown, Earl Cherniak, Bruce Feldthusen, Barry Hoffmaster and Steve Sharzer for their helpful discussion, and to Nancy Margolis for copy editing. All of these papers except one have appeared before in the journal Law and Philosophy (Vol. 1 No.3, December 1982 and Vol. 2 No.1, Apri11983). Chapman's paper which was previously published in The University of Western Ontario Law Review (Vol. 20 No.1, 1982) appears here with permission. Westminster Institute for Ethics and Human Values, M.D.B. Westminster College, London, Canada B.C. vii INTRODUCTION The law of torts is society's primary mechanism for resolving disputes arising from personal injury and property damage. (shrink)

Machine generated contents note: 1. Astrobiology in societal context Constance Bertka; Part I. Origin of Life: 2. Emergence and the experimental pursuit of the origin of life Robert Hazen; 3. From Aristotle to Darwin, to Freeman Dyson: changing definitions of life viewed in historical context James Strick; 4. Philosophical aspects of the origin-of-life problem: the emergence of life and the nature of science Iris Fry; 5. The origin of terrestrial life: a Christian perspective Ernan McMullin; 6. The alpha and the (...) omega: reflections on the origin and future of life from the perspective of Christian theology and ethics Celia Deane-Drummond; Part II. Extent of Life: 7. A biologist's guide to the Solar System Lynn Rothschild; 8. The quest for habitable worlds and life beyond the Solar System Carl Pilcher; 9. A historical perspective on the extent and search for life Steven J. Dick; 10. The search for extraterrestrial life: epistemology, ethics, and worldviews Mark Lupisella; 11. The implications of discovering extraterrestrial life: different searches, different issues Margaret S. Race; 12. God, evolution, and astrobiology Cynthia S. W. Crysdale; Part III. Future of Life: 13. Planetary ecosynthesis on Mars: restoration ecology and environmental ethics Christopher P. McKay; 14. The trouble with intrinsic value: an ethical primer for astrobiology Kelly C. Smith; 15. God's preferential option for life: a Christian perspective on astrobiology Richard O. Randolph; 16. Comparing stories about the origin, extent, and future of life: an Asian religious perspective Francisca Cho; Index. (shrink)

Background: The magnitude of bullying and harassment among psychiatrists is reportedly high, yet no peer-review published studies addressing this issue could be found. Therefore, it was decided to conduct a pilot study to assess the degree of the problem, the types of bullying/harassment and to provide some insights into the situation.Methods and Principal Findings: Following multiple focus group meetings, a yes/no response type questionnaire was developed to assess the degree and type of bullying and harassment experienced by psychiatrists. Over a (...) 3-month period the questionnaire was administered to a random sample of 60 psychiatrists. 57 out of the 60 psychiatrists reported harassment and bullying. Frequencies of the following response variables are presented in descending order: rumours 40% ; defamation 20% ; passing remarks 20% ; false accusations 15% ; threats 13.3% ; verbal abuse 13.3% ; unjustified complaints 13.3% ; promotion blocked 13.3% ; humiliation 13% ; bad reference given 10% ; credentials questioned 8.3% ; physical attacks 5% ; termination 5% ; derogatory remarks 1.7% and 1.7% were subjected to personal work. As a result of being subjected to harassment, 66.7% of the psychiatrists did not take any action, whereas 33.3% confronted the person they believed responsible. Asked whether the bullying and harassment caused distress, 18.3% of the psychiatrists did not report any effect, 30% reported mild distress, 40% moderate distress and severe distress was reported by 11.7%.Conclusions: It was concluded that the magnitude of bullying and harassment among psychiatrists may be quite high, as evidenced by this pilot study. There is a need for extensive systematic studies on this subject and to establish strategies to prevent and address this issue at a national and regulatory level. (shrink)

Health reform proposals tend to be rich with details and dimensions. The primary goal of health reform is typically to extend health coverage to people who lack it. Yet even the most similar of plans differ in terms of exactly who is targeted for assistance, the means by which assistance is delivered, and the type of health coverage promoted. Moreover, the Byzantine nature of the existing U.S. health system means that any reform plan can appear complex. The plan that aims (...) for a new, simple health system will require radical changes to achieve it, while the plan that strives to be the least disruptive will have extensive rules that target assistance while maintaining the existing sources of coverage. Indeed, some have argued that the complexity inherent in meaningful reform is an impediment to reform itself. Few involved in the 1993-94 health reform debate have forgotten the politically damaging chart created by Dick Armey and Newt Gingrich that described the “59 new federal programs, 79 new federal mandates” of the Clinton health reform plan. A similar chart could be made for almost any health reform plan. Despite this richness, health reform proposals are most often characterized by two numbers: how much they costs and how many people they assist. This article reviews these cost and coverage estimates through the prism of the health reform policy debate which has emerged in the 2004 election. Even at an early stage, when the focus on the major candidates’ policies has not yet sharpened, the importance of the numbers around health proposals is apparent. To gain insight into this phenomenon, the article examines why numbers matter, their meaning and sources, and their potential misuses. It concludes with a discussion of the powerful influence that numbers have in the current, past and probably future health reform debates. (shrink)

L'ouvrage ici presente appartient peut-etre a la derniere periode de la production d'Avicenne. Le Livre des directives et remarques supplee les parties perdues de La philosophie orientale, dernier grand projet avicennien, en ce sens qu'il tend a rearticuler science divine et science universelle, par raport a l'entreprise philosophique du Shifa'. Neanmoins les Directives ne sont aucunement un traite, mais plutot un recueil de notes sur des points controverses. Les liens entre les chapitres sont souvent tenus, parfois meme arbitraires, mais il (...) ressort pourtant de la des modifications importantes par rapport aux philosophes grecs. Les theories d'Avicenne sont ainsi toutes en faveur d'une pensee rationaliste et scientifique. L'avance scientifique des orientaux a, pour lui, ouvert a l'intelligence des voies nouvelles; les methodes grecques de pensee demeurent fondamentales, mais des exigences inconnues de leur temps demandent qu'elles soient depassees. (shrink)

Dicke discusses the metamorphosis of Hegelianism in Feuerbach and Marx through an examination of the concept of identity in the three philosophers. He demonstrates the persistence of this concept as a decisive theme in both Feuerbach and Marx, and shows how Hegel's doctrine of identity is transformed and adulterated in the process of adaptation. A primary consequence of Marx's modification of this doctrine is the philosophical sacrifice of the individual to the collective, which has its practical consequences in contemporary communist (...) states.--J. M. W. (shrink)