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)

Whole-genome analysis and whole-exome analysis generate many more clinically actionable findings than traditional targeted genetic analysis. These findings may be relevant to research participants themselves as well as for members of their families. Though researchers performing genomic analyses are likely to find medically significant genetic variations for nearly every research participant, what they will find for any given participant is unpredictable. The ubiquity and diversity of these findings complicate questions about disclosing individual genetic test results. We outline an approach for (...) disclosing a select range of genetic results to the relatives of research participants who have died, developed in response to relatives? requests during a pilot study of large-scale medical genetic sequencing. We also argue that studies that disclose individual research results to participants should, at a minimum, passively disclose individual results to deceased participants? relatives. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses’ power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant (...) discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions. (shrink)

Over the past few years, over a dozen states have proposed, and almost as many have passed, something referred to as the Pain-Capable Unborn Child Protection Act, a piece of legislation that makes abortion impermissible once fetal pain is possible and that further stipulates the fetus can feel pain at or before 20 weeks of gestation. Some very important questions immediately relevant to the abortion debate, perhaps even to the more complex issue of fetal rights, are raised by this legislation, (...) especially because it would impinge on the second-trimester abortion rights guaranteed by Roe. We first inquire whether the claim of fetal pain perception at or before 20 weeks is true and how such a claim should be substantiated. Next, we inquire whether the fetal capacity to experience pain, at whatever stage of development, reflects on the morality of abortion and whether it should be at all relevant to determining its legality. Finally, we would like to explore the implications that a commitment to a pain-related or sentience criterion of rights might have for a pro-life agenda. (shrink)

Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)

Stephen Davies offers a compelling account of adornment as a form of aesthetic enhancement that aims either to intensify or to contribute to beauty and sublimit.

This is a welcome reprint of a book that continues to grow in importance.

Two experiments examine the effects of unreportable hints on anagram solving performance and on solvers' subjective experience of insight. In Experiment 1, after seeing a hint presented too briefly to identify, participants solved anagrams preceded by the solution fastest and solved anagrams preceded by unrelated hints slowest. Participants' “warmth” ratings for solution hints were more insight-like than those for unrelated hints. In Experiment 2 a hint, or no hint, was presented at one of three different exposure durations . Participants benefited (...) from solution-relevant hints that were either unreportable or reportable, but showed a cost only for unrelated hints that were reportable. Participants' ratings of their insight experiences showed that unreportable solution and semantically related hints produced more insight-like experiences than did unrelated hints. The results suggest that unreportable processing of solution-related information is important for the insight experience. (shrink)

Recombinant DNA technology will soon allow physicians an opportunity to carry out both somatic cell- and Germ-Line gene therapy. While somatic cell gene therapy raises no new ethical problems, gene therapy of gametes, fertilized eggs or early embryos does raise several novel concerns. The first issue discussed here relates to making a distinction between negative and positive eugenics; the second issue deals with the evolutionary consequences of lost genetic diversity. In distinguishing between positive and negative eugenics, the concept of malady (...) is applied as a definitional criterion for identifying genetic disorders that could qualify for Germ-Line therapy. Because gene replacement techniques are currently unavailable for humans, and because even if they were possible the number of people involved would be quite small, the loss of diversity concern seems moot. Finally, we dissuss the issue of iatrogenic disorders associated with gene therapy and discuss several ‘real world considerations.’. (shrink)

In this article, I examine the moral dimensions of gender affirmation. I argue that the moral value of gender affirmation is rooted in what Iris Murdoch called loving attention. Loving attention is central to the moral value of gender affirmation because such affirmation is otherwise too fragile or insincere to have such value. Moral reasons to engage in acts that gender affirm derive from the commitment to give and express loving attention to trans people as a way of challenging their (...) marginalization. In the latter part of the paper, I will discuss how my arguments bear on recent arguments by Robin Dembroff and Daniel Wodak (2018) on the use of gender-neutral language. They argue that we have a duty not to use gender-specific pronouns for anyone. Their conclusion turns, in part, on a rejection of gender affirmation as a moral duty. The value of gender affirmation, rooted in our moral perception of trans people, should make us skeptical of this conclusion, in favor of a more nuanced and pluralistic approach to the ethics of gendering. (shrink)

Feldman has recently argued that leibniz never stated leibniz' law. This article seeks to rebut his arguments and makes a number of incidental points about the interpretation of the law.

Comparatively speaking, philosophy has not been especially long-winded in attempting to answer questions about what is funny and why we should think so. There is the standard debate of many centuries’ standing between superiority and incongruity accounts of humor, which for the most part attempt to identify the intentional objects of our amusement.1 There is the more recent debate about humor and morality, about whether jokes themselves may be regarded as immoral or about whether it can in certain circumstances be (...) wrong to laugh.2 There is even apparently some disagreement about whether amusement is an emotion proper or a different kind of psychological attitude altogether. While I have almost despite myself taken .. (shrink)

The starting point of this paper is a recent exchange in the Journal of Aesthetics and Art Criticism1 that pits moderate moralism against robust immoralism and has Humean antecedents. I will proceed by agreeing in part with both, but fully with neither, thereby annoying as many people as possible in one go. I believe, with Anne Eaton, the proponent of robust immoralism, that fictions which valorize what she calls "rough heroes" can arouse both aesthetically compelling and morally troubling reactions. On (...) the other hand, I argue that the troubling moral reaction targeted need not be a sufficient ground for attributing a moral flaw to the... (shrink)