If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

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)

Ethics for Enemies comprises three original philosophical essays on torture, terrorism, and war. F. M. Kamm deploys ethical theory in her challenging new treatments of these most controversial practical issues. First she considers the nature of torture and the various occasions on which it could occur, in order to determine why it might be wrong to torture a wrongdoer held captive, even if this were necessary to save his victims. In the second essay she considers what makes terrorism wrong--whether it (...) is the intention to harm civilians, rather than harm to them being 'collateral damage,' or something else--and whether terrorism is always wrong. The third essay discusses whether having a right reason, in the sense of a right intention, is necessary in order for a war to be just. Kamm then examines ways in which the harms of war can be proportional to the achievement of the just cause and other goods that war can bring about, so as to make the declaration of war permissible. (shrink)

Efforts to include women in the canon have long been beset by reactionary gatekeeping, typified by the charge “That's not philosophy.” That charge doesn't apply to early and mid‐analytic female philosophers—Welby, Ladd‐Franklin, Bryant, Jones, de Laguna, Stebbing, Ambrose, MacDonald—with job titles like lecturer in logic and professor of philosophy and publications in Mind, the Journal of Philosophy, and Proceedings of the Aristotelian Society. It's hopeless to dismiss their work as “not philosophy.” But comparable reactionary gatekeeping affects them, this paper argues, (...) typified by the labels “bad philosophy” and “derivative philosophy.” Virtue and vice epistemology help explain why these women have been neglected and why their own approaches are epistemically virtuous. Their contemporaries and historians are deficient in scholarly virtues in labelling these women's work “bad” or derived from male mentors with no or specious justification. Their disparaged qualities—intellectual humility, modesty, critical self‐reflection, disclosing biases—are often epistemic virtues. (shrink)

The problem of simultaneous measurement of incompatible observables in quantum mechanics is studied on the one hand from the viewpoint of an axiomatic treatment of quantum mechanics and on the other hand starting from a theory of measurement. It is argued that it is precisely such a theory of measurement that should provide a meaning to the axiomatically introduced concepts, especially to the concept of observable. Defining an observable as a class of measurement procedures yielding a certain prescribed result for (...) the probability distribution of the set of values of some quantity (to be described by the set of eigenvalues of some Hermitian operator), this notion is extended to joint probability distributions of incompatible observables. It is shown that such an extension is possible on the basis of a theory of measurement, under the proviso that in simultaneously measuring such observables there is a disturbance of the measurement results of the one observable, caused by the presence of the measuring instrument of the other observable. This has as a consequence that the joint probability distribution cannot obey the marginal distribution laws usually imposed. This result is of great importance in exposing quantum mechanics as an axiomatized theory, since overlooking it seems to prohibit an axiomatic description of simultaneous measurement of incompatible observables by quantum mechanics. (shrink)

Broad genome-wide testing is increasingly finding its way to the public through the online direct-to-consumer marketing of so-called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision-making with regard to the testing offer, we argue that current (...) practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)

Broad genome‐wide testing is increasingly finding its way to the public through the online direct‐to‐consumer marketing of so‐called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision‐making with regard to the testing offer, we argue that current (...) practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)

The object of this paper is to show that, in the sixth and fifth centuries B.C., two different and radically opposed systems of thought were elaborated within the Pythagorean school. They may be called respectively the mystical system and the scientific. All current accounts of Pythagoreanism known to me attempt to combine the traits of both systems in one composite picture, which naturally fails to hold together. The confusion goes back to Aristotle, who usually speaks indiscriminately of ‘the Pythagoreans,’ though (...) now and then the phrase ‘some Pythagoreans’ indicates that he was aware of different currents within the school. (shrink)

It is well known that the medieval scholastics did not begin their philosophy systematically with an explicit theory of knowledge. Unfortunately many people have concluded from that fact that the very idea of an epistemology, and especially the idea of a critique of knowledge, was completely foreign to them. Within recent years authors such as Professor Van Steenberghen and Father Copleston have done a great deal to spread a correct understanding of St. Thomas’s views on this matter. Much evidence might (...) be adduced from the principal work of John Duns Scotus to show that he also took steps to justify man’s spontaneous conviction that some natural knowledge of truth with certainty can be attained. In this article we will consider some of these elements of Scotus’s philosophy as they are found in the volumes that have so far appeared in the critical edition of his works. (shrink)

Bioethical Prescriptions collects F.M. Kamm's articles on bioethics -- revised for publication in book form -- which have appeared over the last 25 years and which have made her among the most widely-respected philosophers working in this field.

Anaxagoras’ theory of matter offers a problem which, in bald outline, may be stated as follows. The theory rests on two propositions which seem flatly to contradict one another. One is the principle of Homoeomereity: A natural substance such as a piece of gold, consists solely of parts which are like the whole and like one another—every one of them gold and nothing else. The other is: ‘There is a portion of everything in everything’, understood to mean that a piece (...) of gold , so far from containing nothing but gold, contains portions of every other substance in the world. Unless Anaxagoras was extremely muddleheaded, he cannot have propounded a theory which simply consists of this contradiction. One or the other proposition must be reinterpreted so as to bring them into harmony. Some critics attack one, some the other; some try to modify both. Mr. C. Bailey has recently published a fresh attempt to reconstruct the theory in a form consistent with itself. But the result, as he admits, is arbitrary and uneconomical. These defects, like all the contradictions and obscurities found in other accounts of the system, can be traced to the second proposition: ‘There is a portion of everything in everything’, or rather to the construction put upon it. The language is crude, vague, and ambiguous. What does ‘everything’ mean? Has the first ‘everything’ the same sense as the second ? If taken to mean that there is a portion of every material substance in every material substance, the proposition leads to a result for which ‘uneconomical’ is an indulgent epithet. (shrink)

The object of this paper is to determine the relations between the two parts of Parmenides' poem: the Way of Truth, which deduces the necessary properties of a One Being, and the False Way, which contains a cosmogony based on ‘what seems to mortals, in which there is no true belief.’.

The earlier part of this paper yielded the result that the assertion ‘A portion of everything in everything’ has no place or function in the explanation of any sort of apparent ‘becoming’ or change. This conclusion is important because, ever since Aristotle, it has been assumed that the assertion was made in order to explain away becoming and change. But if , according to the best evidence, becoming and such sorts of change as Anaxagoras considered can be explained away without (...) using the assertion at all, it follows that the motive for it must be sought, not in the processes of apparent becoming and change, but in the permanent constitution of the ungenerated and unchanging things which figure as elements in the system. A visible mass of gold or of flesh is formed by the aggregation of smaller particles of gold or of flesh, and it is infinitely divisible into parts, every one of which is gold or flesh. But what is the constitution of a piece of gold of whatever size, and how does it differ from the constitution of a piece of flesh? The proposition we have so far successfully excluded comes in here as part of the answer to this question. (shrink)

The object of this paper is to determine the relations between the two parts of Parmenides' poem: the Way of Truth, which deduces the necessary properties of a One Being, and the False Way, which contains a cosmogony based on ‘what seems to mortals, in which there is no true belief.’.

I begin by reconsidering the arguments of John Taurek and Elizabeth Anscombe on whether the number of people we can help counts morally. I then consider arguments that numbers should count given by F. M. Kamm and Thomas Scanlon, and criticism of them by Michael Otsuka. I examine how different conceptions of the moral method known as pairwise comparison are at work in these different arguments and what the ideas of balancing and tie-breaking signify for decision-making in various types of (...) cases. I conclude by considering how another moral method that I call virtual divisibility functions and what it helps reveal about an argument by Otsuka against those who do not think numbers count. (shrink)

The October 2016 publication of the 2015 convegno on Peter of John Olivi begins with a fine survey of Provence and Languedoc in Olivi's time. J. Chiffoleau, with C. Lenoble, supplies the reader with much detail and some summary, along with abundant reference, on Olivi's home turf. In the come and go of life religious and lay, Olivi saw to critical support for business while trying to stabilize Franciscan life. He did very well by both. Chiffoleau finishes his pages on (...) Olivi's days by suggesting that Olivi had better to do around Narbonne than in Paris.Tiziana Suarez-Nani offers thoughts and examples of Peter Olivi's "spiritual philosophy". That he offers Aristotle little esteem we know; that Olivi... (shrink)