This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants’ lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants’ narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts (...) on self and others. The paper shows: that the impact of incidental findings may be greater than participants at first let on; incidental findings can have significant effects on participants’ social environment; and participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants’ experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings. (shrink)

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed. The (...) questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive. (shrink)

In the law, it is generally acknowledged that there are intuitive differences between reasoning with rules and reasoning with principles. For instance, a rule seems to lead directly to its conclusion if its condition is satisfied, while a principle seems to lead merely to a reason for its conclusion. However, the implications of these intuitive differences for the logical status of rules and principles remain controversial.A radical opinion has been put forward by Dworkin (1978). The intuitive differences led him to (...) argue for a strict logical distinction between rules and principles. Ever since, there has been a controversy whether the intuitive differences between rules and principles require a strict logical distinction between the two. For instance, Soeteman (1991) disagrees with Dworkin's opinion, and argues that rules and principles cannot be strictly distinguished, and do not have a different logical structure. (shrink)

We identify two aspects of the problem of maintaining perceptual stability despite an observer's eye movements. The first, visual direction constancy, is the (egocentric) stability of apparent positions of objects in the visual world relative to the perceiver. The second, visual position constancy, is the (exocentric) stability of positions of objects relative to each other. We analyze the constancy of visual direction despite saccadic eye movements.Three information sources have been proposed to enable the visual system to achieve stability: the structure (...) of the visual field, proprioceptive inflow, and a copy of neural efference or outflow to the extraocular muscles. None of these sources by itself provides adequate information to achieve visual direction constancy; present evidence indicates that all three are used.Our final question concerns how information processing operations result in a stable world. The three traditionally suggested means have been elimination, translation, or evaluation. All are rejected. From a review of the physiological and psychological evidence we conclude that no subtraction, compensation, or evaluation need take place. The problem for which these solutions were developed turns out to be a false one. We propose a “calibration” solution: correct spatiotopic positions are calculated anew for each fixation. Inflow, outflow, and retinal sources are used in this calculation: saccadic suppression of displacement bridges the errors between these sources and the actual extent of movement. (shrink)

Ever since they began to take an interest in lens grinding, the brothers Christiaan and Constantijn Huygens searched for high-quality glass to turn in to lenses. Historical research in combination with optical measurements on preserved lenses has allowed the verificationof the lenses ground by the brothers, and also provided information on who helped them with the necessary knowledge and material.

The phenomena referred to by the term attention were not discovered by scientific psychology. They were discovered and described within philosophy and gently handed over to the emerging academic psychology of the nineteenth century. The main contributors and contributions to the delineation and construction of attention as an empirical phenomenon and a topic for theorizing were Aristotle, who noticed that not all that reaches the senses is clearly perceived; Augustine, who interpreted attention as an effort of the soul; Descartes, who (...) distinguished active attention from passive attention; and Leibniz, who discussed the relation between attention, perception, and consciousness. (For further information on attention's philosophical past the reader is referred to Neumann's (in press) brief history of this philosophical past that is badly in need of an English translation.). (shrink)

The explanatory gap refers to the lack of concepts for understanding “how it is that . . . a state of consciousness comes about as a result of irritating nervous tissue.” By assuming that there are colours in the outside world, Block needlessly widens this gap and Lycan and Kitcher simply fail to see the gap. When such assumptions are abandoned, an unnecessary and incomprehensible constraint disappears. It then becomes clear that the brain can use its own neural language for (...) representing aspects of the outside world. While this may not close the gap, it becomes clearer where we need new concepts. (shrink)

Everybody knows the phenomena summarized with the term attention: concentration, focalization, limitation, selection, and intensification . The explanation of these phenomena is, however, a different matter. Problems easily arise with regard towhathas to be explained and with regard to thestyleof explanation. A problem of the first kind is the “methodology of ‘bad focus’”: the explanation starts with and is fixated on an intuitively striking but nonessential behavioral feature or cognitive achievement. A problem of the second kind is a “virtus dormitiva” (...) explanation: the explanation starts with emphasizing one aspect of the observed phenomena, the emphasized aspect receives an interesting and suggestive name, and that name with its connotations is used as a concept in the explanation. At the start of contemporary, behavior-based, information processing psychology, avirtus dormitivaexplanation infiltrated the functional accounts of the phenomena of attention; the empirical observation that people show performance limitations was translated into the theoretical concept of a communication channel with a limited capacity. That limited capacity notion became the core concept in what can be called the standard theory of attention. This standard theory of attention faced severe difficulties in explaining the guidance of attention by the information processor's goals and intentions. Subsequent modifications, concerned with removing these difficulties, revealed that selection, guided by goals and intentions, is the essential behavioral feature and that the observed performance limitations are a result of this selection. So, the limited capacity theorizing was not only plagued by avirtus dormitivaexplanation, it also suffered from the methodology of bad focus. (shrink)