No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Both bioethics and law have governed human genomics by distinguishing research from clinical practice. Yet the rise of translational genomics now makes this traditional dichotomy inadequate. This paper pioneers a new approach to the ethics of translational genomics. It maps the full range of ethical approaches needed, proposes a “layered” approach to determining the ethics framework for projects combining research and clinical care, and clarifies the key role that return of results can play in advancing translation.

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

Background: Genomic analysis may reveal both primary and secondary findings with direct relevance to the health of probands’ biological relatives. Researchers question their obligations to return findings not only to participants but also to family members. Given the social value of privacy protection, should researchers offer a proband’s results to family members, including after the proband’s death? Methods: Preferences were elicited using interviews and a survey. Respondents included probands from two pancreatic cancer research resources, plus biological and nonbiological family members. (...) Hypothetical scenarios based on actual research findings from the two cancer research resources were presented; participants were asked return of results preferences and justifications. Interview transcripts were coded and analyzed; survey data were analyzed descriptively. Results: Fifty-one individuals (17 probands, 21 biological relatives, 13 spouses/partners) were interviewed. Subsequently, a mailed survey was returned by 464 probands, 1,040 biological family members, and 399 spouses/partners. This analysis highlights the interviews, augmented by survey findings. Probands and family members attribute great predictive power and lifesaving potential to genomic information. A majority hold that a proband’s genomic results relevant to family members’ health ought to be offered. While informants endorse each individual’s choice whether to learn results, most express a strong moral responsibility to know and to share, particularly with the younger generation. Most have few concerns about sharing genetic information within the family; rather, their concerns focus on the health consequences of not sharing. Conclusions: Although additional studies in diverse populations are needed, policies governing return of genomic results should consider how families understand genomic data, how they value confidentiality within the family, and whether they endorse an ethics of sharing. A focus on respect for individual privacy—without attention to how the broad social and cultural context shapes preferences within families—cannot be the sole foundation of policy. (shrink)

Incidental fndings of potential medical signifcance are seen in approximately 5-8 percent of asymptomatic subjects and 16 percent of symptomatic subjects participating in large computed tomography colonography studies, with the incidence varying further by CT acquisition technique. While most CTC research programs have a well-defned plan to detect and disclose IFs, such plans are largely communicated only verbally. Written consent documents should also inform subjects of how IFs of potential medical signifcance will be detected and reported in CTC research studies.

During much of the past century, it was widely believed that phonemes--the human speech sounds that constitute words--have no inherent semantic meaning, and that the relationship between a combination of phonemes (a word) and its referent is simply arbitrary. Although recent work has challenged this picture by revealing psychological associations between certain phonemes and particular semantic contents, the precise mechanisms underlying these associations have not been fully elucidated. Here we provide novel evidence that certain phonemes have an inherent, non-arbitrary emotional (...) quality. Moreover, we show that the perceived emotional valence of certain phoneme combinations depends on a specific acoustic feature--namely, the dynamic shift within the phonemes' first two frequency components. These data suggest a phoneme-relevant acoustic property influencing the communication of emotion in humans, and provide further evidence against previously held assumptions regarding the structure of human language. This finding has potential applications for a variety of social, educational, clinical, and marketing contexts. (shrink)

Data are lacking with regard to participants' perspectives on return of genetic research results to relatives, including after the participant's death. This paper reports descriptive results from 3,630 survey respondents: 464 participants in a pancreatic cancer biobank, 1,439 family registry participants, and 1,727 healthy individuals. Our findings indicate that most participants would feel obligated to share their results with blood relatives while alive and would want results to be shared with relatives after their death.

Kant’s formula of universal law (FUL) is standardly understood as a test of the moral permissibility of an agent’s maxim: maxims which pass the test are morally neutral, and so permissible, while those which do not are morally impermissible. In contrast, I argue that the FUL tests whether a maxim is the cause or determining ground of an action at all. According to Kant’s general account of causality, nothing can be a cause of some effect unless there is a law-like (...) relation between the putative cause and effect. Applied to the case of action, no maxim can be the cause of an agent’s action unless there is a law-like relation between maxims of that kind and actions of that kind. The special capacity to act according to maxims as law-like causes is what Kant calls a will; the basic constitutive principle of the will is a non-normative principle I call the categorical declarative. While the actions of a perfectly good will would be described by the categorical declarative alone, human action is determined not only by the causality of the will, but also by competing causes, namely those stemming from inclination. There is thus need for a causal test for putative maxims. The test contained in the FUL is meant to determine whether an action could be grounded solely on the agent’s maxim, or whether it requires a cause external to the will. This account permits one to build eventual distinctions concerning the morality of actions on prior and independent distinctions concerning their causality. (shrink)

This 2005 book is a critical examination of Michel Foucault's relation to ancient Greek thought, in particular his famous analysis of Greek history of sexuality. Wolfgang Detel offers an understanding of Foucault's theories of power and knowledge based on modern analytical theories of science and concepts of power. He offers a complex reading of the texts which Foucault discusses, covering topics such as Aristotle's ethics and theory of sex, Hippocratic dietetics, the earliest treatises on economics, and Plato's theory of love. (...) The result is a philosophically rich and probing critique of Foucault's later writings, and a persuasive account of the relation between ethics, power and knowledge in classical antiquity. His book will have a wide appeal to readers interested in Foucault and in Greek thought and culture. (shrink)

As we look to the future in a world with porous borders and boundaries transgressed by technologies, an inevitable question is:Can there be a single, global bioethics? Intimately intertwined with this question is a second one: How might a global bioethics account for profound - and constantly transforming - sources of cultural difference? Can a uniform, global bioethics be relevant cross-culturally? These are not simple questions, rather, a multi-dimensional answer is required. It is important to distinguish between two meanings of (...) bioethics: the academic discipline of bioethics as opposed to bioethics as a set of practices governing clinical care and scientific research. There is growing evidence to support the notion of a shared global understanding of bioethics as a field of inquiry focused on the moral dimensions of science and biomedicine. (shrink)

As we look to the future in a world with porous borders and boundaries transgressed by technologies, an inevitable question is:Can there be a single, global bioethics? Intimately intertwined with this question is a second one: How might a global bioethics account for profound - and constantly transforming - sources of cultural difference? Can a uniform, global bioethics be relevant cross-culturally? These are not simple questions, rather, a multi-dimensional answer is required. It is important to distinguish between two meanings of (...) bioethics: the academic discipline of bioethics as opposed to bioethics as a set of practices governing clinical care and scientific research. There is growing evidence to support the notion of a shared global understanding of bioethics as a field of inquiry focused on the moral dimensions of science and biomedicine. (shrink)

In Freedom Within Reason, Susan Wolf charts a course between incompatibilism, or the notion that freedom and responsibility require causal and metaphysical independence from the impersonal forces of nature, and compatibilism, or the notion that people are free and responsible as long as their actions are governed by their desires. Wolf argues that some of the forces which are beyond our control are friends to freedom rather than enemies of it, enabling us to see the world for what (...) it is. The freedom we want is not independence from the world, but independence from the forces that prevent us from choosing how to live in the light of a sufficient appreciation of the world. (shrink)

Most people, including philosophers, tend to classify human motives as falling into one of two categories: the egoistic or the altruistic, the self-interested or the moral. According to Susan Wolf, however, much of what motivates us does not comfortably fit into this scheme. Often we act neither for our own sake nor out of duty or an impersonal concern for the world. Rather, we act out of love for objects that we rightly perceive as worthy of love--and it is (...) these actions that give meaning to our lives. Wolf makes a compelling case that, along with happiness and morality, this kind of meaningfulness constitutes a distinctive dimension of a good life. Written in a lively and engaging style, and full of provocative examples, Meaning in Life and Why It Matters is a profound and original reflection on a subject of permanent human concern. (shrink)

For over thirty years Susan Wolf has been writing about moral and nonmoral values and the relation between them. This volume collects Wolf's most important essays on the topics of morality, love, and meaning, ranging from her classic essay "Moral Saints" to her most recent "The Importance of Love.".

Philosophers frequently distinguish between causal responsibility and moral responsibility, but that distinction is either ambiguous or confused. We can distinguish between causal responsibility and a deeper kind of responsibility, that licenses reactive attitudes and judgments that a merely causal connection would not, and we can distinguish between holding people accountable for their moral qualities and holding people accountable for their nonmoral qualities. But, because we sometimes hold people deeply responsible for nonmoral qualities of behavior and character, these distinctions are not (...) the same. A number of recent accounts of responsibility identify deep responsibility with moral responsibility and in consequence miss some key features of the concept of which they are trying to give an account. A view that distinguishes two levels of responsibility, according to which the conditions of attributability are weaker than the conditions of accountability, might seem to account for a kind of non.. (shrink)

In this paper, I contest increasingly common "realist" interpretations of Hegel's theory of "the concept" (der Begriff), offering instead a "isomorphic" conception of the relation of concepts and the world. The isomorphism recommended, however, is metaphysically deflationary, for I show how Hegel's conception of conceptual form creates a conceptually internal standard for the adequacy of concepts. No "sideways-on" theory of the concept-world relationship is envisioned. This standard of conceptual adequacy is also "graduated" in that it allows for a lack of (...) fit between concept and world. The possibility for a "maximally isomorphic" fit between concept and world obtains through the teleological realization of concepts, which marks especially the "artificial" world of human culture (law, art, religion, etc.). Some of the most seemingly exaggerated claims Hegel makes about the concept, I contend, can be understood when we consider the significance Hegel ascribes to human making, which is provided for in his conceptual theory. But my framework provides an interpretive key for the way Hegel sees concepts imperfectly realized in the natural world as well. (shrink)

The current explosion of genetic knowledge and the rapid proliferation of genetic tests has rightly provoked concern that we are approaching a future in which people will be labeled and disadvantaged based on genetic information. Indeed, some have already suffered harm, including denial of health insurance. This concern has prompted an outpouring of analysis. Yet almost all of it approaches the problem of genetic disadvantage under the rubric of “genetic discrimination.”This rubric is woefully inadequate to the task at hand. It (...) ignores years of commentary on race and gender demonstrating the limits of antidiscrimination analysis as an analytic framework and corrective tool. Too much discussion of genetic disadvantage proceeds as if scholars of race and gender had not spent decades critiquing and developing antidiscrimination theory.Indeed, there are multiple links among race, gender, and genetics. Dorothy Roberts has discussed the historical links between racism and genetics, while she and others have begun to map connections between gender and genetics. (shrink)

Participant-driven research is a burgeoning domain of research innovation, often facilitated by mobile technologies. Return of results and data are common hallmarks, grounded in transparency and data democracy. PDR has much to teach traditional research about these practices and successful engagement. Recommendations calling for new state laws governing research with mHealth modalities common in PDR and federal creation of review mechanisms, threaten to stifle valuable participant-driven innovation, including in return of results.

There are well-known problems for formalist accounts of game-play with regards to cheating. Such accounts seem to be committed to cheaters being unable to win–or even play–the game, yet it seems that there are instances of cheaters winning games. In this paper, I expand the discussion of such problems by introducing cases of pre-game cheating, and see how a formalist–specifically a Suitsian–account can accommodate such problems. Specifically, I look at two (fictional) examples where the alleged game-players cheat prior to a (...) game-instance in such as a way as to cast doubt on whether the alleged game-players are truly playing the game. To escape the worries brought about by these examples of pre-game cheating, I will appeal to the concept of nested games. This concept will give us the needed tools to explain how the alleged players are cheating and how the alleged players are players. On the whole, this discussion should help illuminate some important issues with regards to cheating and rules on a Suitsian account of game-play, and help give support for formalist accounts more generally. (shrink)

In his works on argumentation, Aristotle develops three main forms: apodeictical, dialectical, and rhetorical argumentation; dialectic is subdivided into several subspecies. The purpose of this paper is to discuss all of the forms described by Aristotle, to examine their differences and to point out their interrelations. This leads to an examination of the differentiating criteria and their applicability in the case of each argumentation form—and in particular to the question regarding the number of criteria that are necessary to describe each (...) form clearly and unambiguously. It is argued that Aristotle’s works on argumentation contain an implicit system of argumentation forms that is based on no more than three criteria. (shrink)

In recent years, theories of social understanding have moved away from arguing that just one epistemic strategy, such as theory-based inference or simulation constitutes our ability of social understanding. Empirical observations speak against any monistic view and have given rise to pluralistic accounts arguing that humans rely on a large variety of epistemic strategies in social understanding. We agree with this promising pluralist approach, but highlight two open questions: what is the residual role of mindreading, i.e. the indirect attribution of (...) mental states to others within this framework, and how do different strategies of social understanding relate to each other? In a first step, we aim to clarify the arguments that might be considered in evaluating the role that epistemic strategies play in a pluralistic framework. On this basis, we argue that mindreading constitutes a core epiststrategy in human social life that opens new central spheres of social understanding. In a second step, we provide an account of the relation between different epistemic strategies which integrates and demarks the important role of mindreading for social understanding. (shrink)

In recent years, theories of social understanding have moved away from arguing that just one epistemic strategy, such as theory-based inference or simulation constitutes our ability of social understanding. Empirical observations speak against any monistic view and have given rise to pluralistic accounts arguing that humans rely on a large variety of epistemic strategies in social understanding. We agree with this promising pluralist approach, but highlight two open questions: what is the residual role of mindreading, i.e. the indirect attribution of (...) mental states to others within this framework, and how do different strategies of social understanding relate to each other? In a first step, we aim to clarify the arguments that might be considered in evaluating the role that epistemic strategies play in a pluralistic framework. On this basis, we argue that mindreading constitutes a core epiststrategy in human social life that opens new central spheres of social understanding. In a second step, we provide an account of the relation between different epistemic strategies which integrates and demarks the important role of mindreading for social understanding. (shrink)

In “Meeting the Moment: Bioethics in the Time of Black Lives Matter,” Camisha Russell calls for transforming “bioethics-as-usual” with help from “outsiders”. Prior scholars agree...

A standard line in the contemporary philosophical literature has it that physical theories are equivalent only when they agree on their empirical content, where this empirical content is often understood as being encoded in the equations of motion of those theories. In this article, we question whether it is indeed the case that the empirical content of a theory is exhausted by its equations of motion, showing that (for example) considerations of boundary conditions play a key role in the empirical (...) equivalence (or otherwise) of theories. Having argued for this, we show that philosophical claims made by Weatherall (2016) that electromagnetism in the Faraday tensor formalism is equivalent to electromagnetism in the vector potential formalism, and by Knox (2011) that general relativity is equivalent to teleparallel gravity, can both be called into question. We then show that properly considering the role of boundary conditions in theory structure can potentially restore these claims of equivalence and close with some remarks on the pragmatics of adjudications on theory identity. (shrink)

The Covid‐19 pandemic has exposed four myths in bioethics. First, the flood of bioethics publications on how to allocate scarce resources in crisis conditions has assumed authorities would declare the onset of crisis standards of care, yet few have done so. This leaves guidelines in limbo and patients unprotected. Second, the pandemic's realities have exploded traditional boundaries between clinical, research, and public health ethics, requiring bioethics to face the interdigitation of learning, doing, and allocating. Third, without empirical research, the success (...) or failure of ethics guidelines remains unknown, demonstrating that crafting ethics guidance is only the start. And fourth, the pandemic's glaring health inequities require new commitment to learn from communities facing extraordinary challenges. Without that new learning, bioethics methods cannot succeed. The pandemic is a wake‐up call, and bioethics must rise to the challenge. (shrink)

In this first book-length examination of the Cartesian theory of visual perception, Celia Wolf-Devine explores the many philosophical implications of Descartes’ theory, concluding that he ultimately failed to provide a completely mechanistic theory of visual perception. Wolf-Devine traces the development of Descartes’ thought about visual perception against the backdrop of the transition from Aristotelianism to the new mechanistic science—the major scientific paradigm shift taking place in the seventeenth century. She considers the philosopher’s work in terms of its background (...) in Aristotelian and later scholastic thought rather than looking at it "backwards" through the later work of the British empiricists and Kant. Wolf-Devine begins with Descartes’ ideas about perception in the _Rules _and continues through the later scientific writings in which he develops his own mechanistic theory of light, color, and visual spatial perception. Throughout her discussion, she demonstrates both Descartes’ continuity with and break from the Aristotelian tradition. Wolf-Devine critically examines Cartesian theory by focusing on the problems that arise from his use of three different models to explain the behavior of light as well as on the ways in which modern science has not confirmed some of Descartes’ central hypotheses about vision. She shows that the changes Descartes made in the Aristotelian framework created a new set of problems in the philosophy of perception. While such successors to Descartes as Malebranche, Locke, Berkeley, and Hume accepted the core of his theory of vision, they struggled to clarify the ontological status of colors, to separate what is strictly speaking "given" to the sense of sight from what is the result of judgments by the mind, and to confront a "veil of perception" skepticism that would have been unthinkable within the Aristotelian framework. Wolf-Devine concludes that Descartes was not ultimately successful in providing a completely mechanistic theory of visual perception, and because of this, she suggests both that changes in the conceptual framework of Descartes are in order and that a partial return to some features of the Aristotelian tradition may be necessary. (shrink)

Researchers now commonly collect biospecimens for genomic analysis together with information from mobile devices and electronic health records. This rich combination of data creates new opportunities for understanding and addressing important health issues, but also intensifies challenges to privacy and confidentiality. Here, we elucidate the “web” of legal protections for precision medicine research by integrating findings from qualitative interviews with structured legal research and applying them to realistic research scenarios involving various privacy threats.

The revised Common Rule includes a new option for the conduct of secondary research with identifiable data and biospecimens: regulatory broad consent. Motivated by concerns regarding autonomy and trust in the research enterprise, regulators had initially proposed broad consent in a manner that would have rendered it the exclusive approach to secondary research with all biospecimens, regardless of identifiability. Based on public comments from both researchers and patients concerned that this approach would hinder important medical advances, however, regulators decided to (...) largely preserve the status quo approach to secondary research with biospecimens and data. The Final Rule therefore allows such research to proceed without specific informed consent in a number of circumstances, but it also offers regulatory broad consent as a new, optional pathway for secondary research with identifiable data and biospecimens. In this article, we describe the parameters of regulatory broad consent under the new rule, explain why researchers and research institutions are unlikely to utilize it, outline recommendations for regulatory broad consent issued by the Secretary's Advisory Committee on Human Research Protections, and sketch an empirical research agenda for the sorts of questions about regulatory broad consent that remain to be answered as the research community embarks on Final Rule implementation. (shrink)

Few philosophers today doubt the importance of some notion of rigid designation, as suggested by Kripke and Putnam for names and natural kind terms. At the very least, most of us want our theories to be compatible with the most plausible elements of that account. Anaphoric theories of reference have gained some attention lately, but little attention has been given to how they square with rigid designation. Although the differences between anaphoric theories and many interpretations of the New Theory of (...) reference are substantial, I argue that rigid designation and anaphoric theories can be reconciled with one another and in fact complement one another in important ways. (shrink)

With the originality and energy that have marked his earlier works, Eric Wolf now explores the historical relationship of ideas, power, and culture. Responding to anthropology's long reliance on a concept of culture that takes little account of power, Wolf argues that power is crucial in shaping the circumstances of cultural production. Responding to social-science notions of ideology that incorporate power but disregard the ways ideas respond to cultural promptings, he demonstrates how power and ideas connect through the (...) medium of culture. Wolf advances his argument by examining three very different societies, each remarkable for its flamboyant ideological expressions: the Kwakiutl Indians of the Northwest Pacific Coast, the Aztecs of pre-Hispanic Mexico, and National Socialist Germany. Tracing the history of each case, he shows how these societies faced tensions posed by ecological, social, political, or psychological crises, prompting ideological responses that drew on distinctive, historically rooted cultural understandings. In each case study, Wolf analyzes how the regnant ideology intertwines with power around the pivotal relationships that govern social labor. Anyone interested in the history of anthropology or in how the social sciences make comparisons will want to join Wolf in _Envisioning Power_. (shrink)

Many scientists and doctors hope that affordable genome sequencing will lead to more personalized medical care and improve public health in ways that will benefit children, families, and society more broadly. One hope in particular is that all newborns could be sequenced at birth, thereby setting the stage for a lifetime of medical care and self‐directed preventive actions tailored to each child's genome. Indeed, commentators often suggest that universal genome sequencing is inevitable. Such optimism can come with the presumption that (...) discussing the potential limits, cost, and downsides of widespread application of genomic technologies is pointless, excessively pessimistic, or overly cautious. We disagree. Given the pragmatic challenges associated with determining what sequencing data mean for the health of individuals, the economic costs associated with interpreting and acting on such data, and the psychosocial costs of predicting one's own or one's child's future life plans based on uncertain testing results, we think this hope and optimism deserve to be tempered.In the analysis that follows, we distinguish between two reasons for using sequencing: to diagnose individual infants who have been identified as sick and to screen populations of infants who appear to be healthy. We also distinguish among three contexts in which sequencing for either diagnosis or screening could be deployed: in clinical medicine, in public health programs, and as a direct‐to‐consumer service. Each of these contexts comes with different professional norms, policy considerations, and public expectations. Finally, we distinguish between two main types of genome sequencing: targeted sequencing, where only specific genes are sequenced or analyzed, and whole‐exome or whole‐genome sequencing, where all the DNA or all the coding segments of all genes are sequenced and analyzed.In a symptomatic newborn, targeted or genome‐wide sequencing can help guide other tests for diagnosis or for specific treatment that is urgently needed. Clinicians use the infant's symptoms (or phenotype) to interrogate the sequencing data. These same complexities and uncertainties, however, limit the usefulness of genome‐wide sequencing as a population screening tool. While we recognize considerable benefit in using targeted sequencing to screen for or detect specific conditions that meet the criteria for inclusion in newborn screening panels, use of genome‐wide sequencing as a sole screening tool for newborns is at best premature. We conclude that sequencing technology can be beneficially used in newborns when that use is nuanced and attentive to context. (shrink)

Many philosophers have been persuaded that if we don’t create our own characters, we cannot be responsible for acts that flow from our characters; they also raise doubts about whether acts that do not flow from our characters can fairly be attributed to us. Both these concerns, however, reflect a simplistic and implausible conception of character and of its relation to our actions and our selves. I suggest a different relationship between character and responsibility: We can be responsible for acts (...) that are in character and also for acts that are out of character, but to be capable of being responsible at all is closely related to the capacity to have a character. I relate this capacity to the exercise of active intelligence—a capacity that is manifested in actions in or out of character, but not in the display of many psychological conditions or disorders. (shrink)

The purpose of this article is to provide a critical examination of two aspects of culture and biomedicine that have helped to shape the meaning and practice of genetic testing for breast cancer. These are: the cultural construction of fear of breast cancer, which has been fuelled in part by the predominance of a ‘risk’ paradigm in contemporary biomedicine. The increasing elaboration and delineation of risk factors and risk numbers are in part intended to help women to contend with their (...) fear of breast cancer. However, because there is no known cure or foolproof prevention for breast cancer, risk designations bring with them recommendations for vigilant surveillance strategies and screening guidelines. We argue that these in effect exacerbate women’s fears of breast cancer itself. The volatile combination of discourses of fear, risk and surveillance have significant ethical and social consequences for women’s lives and well-being. Genetic testing decisions are made within this context; if nurses understand this context they can play an important role in helping women to cope with the anxiety and fear of breast cancer risk. (shrink)