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)

The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of (...) the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline. (shrink)

There is a need for person-centred approaches and empowerment of staff within the residential care for older people; a movement called ‘culture change’. There is however no single path for achieving culture change. With the aim of increasing understandings about cultural change processes and the promotion of cultural values and norms associated with person-centred practices, this article presents an action research project set on a unit in the Netherlands providing care for older people with dementia. The project is presented as (...) a case study. This study examines what has contributed to the improvement of participation of older people with dementia in daily occupational and leisure activities according to practitioners. Data was collected by participant observation, interviews and focus groups. The results show that simultaneous to the improvement of the older people’s involvement in daily activities a cultural transformation took place and that the care became more person-centred. Spontaneous interactions and responses rather than planned interventions, analysis and reflection contributed to this. Furthermore, it proved to be beneficial that the process of change and the facilitation of that process reflected the same values as those underlying the cultural change. It is concluded that changes arise from dynamic, interactive and non-linear processes which are complex in nature and difficult to predict and to control. Nevertheless, managers and facilitators can facilitate such change by generating movement through the introduction of small focused projects that meet the stakeholders’ needs, by creating conditions for interaction and sense making, and by promoting the new desired cultural values. (shrink)

Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

The use of coercive measures in the care for the addicted has changed over the past 20 years. Laws that have adopted the “dangerousness” criterion in order to secure patients’ rights to non-intervention are increasingly subjected to critique as many authors plead for wider dangerousness criteria. One of the most salient moral issues at stake is whether addicts who are at risk of causing danger to themselves should be involuntarily admitted and/or treated. In this article, it is argued that the (...) dilemma between coercion on the one hand and abandonment on the other cannot be analysed without differentiated perspectives on the key notions that are used in these debates. The ambiguity these notions carry within care practice indicates that the conflict between the prevention of danger and respect for autonomy is not as sharp as the legal systems seem to imply. Some coercive measures need not be interpreted as an infringement of autonomy—rather, they should be interpreted as a way to provide good care. (shrink)

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)

What endogenous factors contribute to minority (Red Queen) or majority (Red King) domination under conditions of coercive bargaining? We build on previous work demonstrating minority disadvantage in non-coercive bargaining games to show that under neutral initial conditions, majorities are advantaged in high conflict situations, and minorities are advantaged in low conflict games. These effects are a function of the relationship between (1) relative proportions of the majority and minority groups and (2) costs of conflict. Although both Red King and Red (...) Queen effects can occur, we further show that agents’ increased initial propensity toward conflict advantages majorities. (shrink)

Dialog is a joint action at different levels. At the highest level, the goal of interlocutors is to align their mental representations. This emerges from joint activity at lower levels, both concerned with linguistic decisions (e.g., choice of words) and nonlinguistic processes (e.g., alignment of posture or speech rate). Because of the high‐level goal, the interlocutors are particularly concerned with close coupling at these lower levels. As we illustrate with examples, this means that imitation and entrainment are particularly pronounced during (...) interactive communication. We then argue that the mechanisms underlying such processes involve covert imitation of interlocutors’ communicative behavior, leading to emulation of their expected behavior. In other words, communication provides a very good example of predictive emulation, in a way that leads to successful joint activity. (shrink)

Various claims have been made, recently, that Darwin's argumentation in the Origin instantiates and so supports some general philosophical proposal about scientific theorizing, for example, the "semantic view". But these claims are grounded in various incorrect analyses of that argumentation. A summary is given here of an analysis defended at greater length in several papers by the present author. The historical and philosophical advantages of this analysis are explained briefly. Darwin's argument comprises three distinct evidential cases on behalf of natural (...) selection, cases, that is, for its existence, its adequacy and its responsibility. Theorizing, today, about evolution by natural selection involves a similar structure of evidential and explanatory concerns. (shrink)

In this paper we examine ethical issues relevant to conducting mental health research with refugees and immigrant communities that have cultural orientations and social organisation that are substantially different to those of the broader Australian community, and we relate these issues to NH&MRC Guidelines. We describe the development and conduct of a mental health research project carried out recently in Melbourne with the Somali community, focusing on ethical principles involved, and relating these to the NH&MRC National Statement on Ethical Conduct (...) in Research Involving Humans, and the NH&MRC document Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research.The experience of conducting mental health research with the Somali community highlights the fact that the principles of inclusion and benefit enunciated in the NH&MRC document Values and Ethics are particularly pertinent when conducting research with refugees and immigrant communities that are culturally distant to those of the broader Australian community. These principles inform issues of research design and consent, as well as guiding respectful engagement with the participating community and communication of the research findings. (shrink)

Studies of callosal sexual differentiation have concentrated on global measures of callosal size, using the rat as a model for studies of potential hormonal mechanisms. It is time to shift the study of callosal sexual differentiation to a more cellular level. Finally, there are potential problems with using the female rat as the primary model for understanding hormonal mechanisms during postnatal life.

The Geological Society of London was the first learned society to be devoted solely to geology, and its members were responsible for much of the spectacular progress of the science in the nineteenth century. Its distinctive character as a centre of geological discussion and research was established within the first five years from its foundation in 1807. During this period its activities were directed, and its policies largely shaped, by its President, George Bellas Greenough, on whose unpublished papers this account (...) is chiefly based.The Society began as a small scientific dining club in London, but it developed rapidly into a learned society with a nation-wide membership. It became so independent in outlook and so active in research that it was felt to threaten the esteem of the Royal Society; and little more than a year after its foundation it clashed with the Royal Society so violently that its continued existence was for a time uncertain.Its development into a large independent society was the outcome of its ‘Baconian’ view of the importance of collecting geological facts as a surer basis for geological theories. For this purpose it initiated an ambitious scheme for co-operative research, which would unite the efforts of ‘philosophers’ with those of ‘practical men’. Only personal reasons seem to have kept the most prominent of the practical men—William Smith—from co-operating with the Society. (shrink)

As a historical figure, Lamarck proves a rather difficult subject. His writings give us few explicit leads to his intellectual debts; nor do they present his theories as the outcome of any sustained course of observations or experimental research; and, what is equally frustrating, it is hard to see how his personal development as a scientific theorist was affected by the dramatic political and social upheavals of the period, in which he took an active and lively interest. And so, with (...) his importance for later writers much clearer than his relationship to those of his own and earlier ages, historians have repeatedly interpreted his works as prophetic of doctrines developed more fully by subsequent generations. No less surprisingly, this facile tactic has provoked a reaction; we have been offered Lamarck as a Stoic, a romantic, harking back to Heraclitus. (shrink)

In this paper we examine the case of Tay, the Microsoft AI chatbot that was launched in March, 2016. After less than 24 hours, Microsoft shut down the experiment because the chatbot was generating tweets that were judged to be inappropriate since they included racist, sexist, and anti-Semitic language. We contend that the case of Tay illustrates a problem with the very nature of learning software that interacts directly with the public, and the developer's role and responsibility associated with it. (...) We make the case that when LS interacts directly with people or indirectly via social media, the developer has additional ethical responsibilities beyond those of standard software. There is an additional burden of care. (shrink)

Bernard Norton's friends in the history of science have had many reasons for commemorating, with admiration and affection, not only his research and teaching but no less his conversation and his company. One of his most estimable traits was his refusal to beat about the bush in raising the questions he thought worthwhile pursuing. I still remember discoursing at Pittsburgh on Darwin's route to his theory of natural selection, and being asked at the end by Bernard what were Darwin's views (...) on heredity. I answered with the conventional waffle to the effect that the theory concerned the populational fate rather than the individual production and transmission of heritable variation, so that whatever views Darwin had on heredity had only a subsidiary place in his theorizing. Bernard was not fooled. ‘I would have thought’, he said, ‘that in order to understand anyone's theorising about evolution it would be necessary to look at his views on heredity’. (shrink)

George Greenough was one of the influential group of early nineteenth-century English geologists who rejected both Hutton's and Werner's attempts to propound all-embracing geological theories, and followed a deliberately empirical approach. He travelled through Scotland in 1805, studying geological phenomena in the light of both the Plutonist and the Neptunist theories, and generally concluded that neither was entirely satisfactory as an explanation of the observable facts. He was also the first to suggest that the ‘Parallel Roads’ of Glen Roy were (...) the successive beach-levels of a former lake: this theory was later attacked by Darwin but ultimately vindicated by Agassiz's glacial theory. The more important geological passages from Greenough's MS. journal of the tour are reproduced and discussed in this paper. They illustrate some of the scientific problems that were involved in accepting either Hutton's or Werner's theory entire. (shrink)