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)

This unique textbook--the first to offer balanced, comprehensive coverage of all major perspectives on the rational justification of religious belief--includes twenty-four key papers by some of the world's leading philosophers of religion. Arranged in six sections, each representing a major approach to religious epistemology, the book begins with papers by noted atheists, setting the stage for the main theistic responses--Wittgensteinian Fideism, Reformed epistemology, natural theology, prudential accounts of religious beliefs, and rational belief based in religious experience--in each case offering a (...) representative sample of papers by leading exponents, a critical paper, and a substantial bibliography. A comprehensive introductory essay and ample cross-references help students to contrast and evaluate the different approaches, while the overall arrangement encourages them to assess the full range of philosophical positions on the issue. Carefully selected to provide both a comprehensive overview of current work and a series of modern perspectives on many classic sources--Swinburne's detailed discussion of Hume's critique of the design argument, for example, as well as an entire section evaluating and extending Pascal's famous Wager--the essays also provide a uniquely readable survey that will be useful in a wide range of undergraduate and graduate courses in philosophy of religion and epistemology. (shrink)

This book describes the adventures in Russia of Samuel Bentham, the brother of the famous law-reformer, Jeremy Bentham. Shipbuilder, technical expert and inventor, his talents were employed for several years in serving the government of Catherine II, involving him in activities both in peace and war, and in extensive travel through the Russian Empire. The Russian court, war against the Turks, commercial enterprise in Siberia, are a few of the themes illuminated by his correspondence which forms the basis for this (...) book. (shrink)

PurposeIn addition to data transforming the insurance sector from within, insurance consumers and their behaviour has transformed significantly over the past 20 years from traditional retail to, predominantly, online trading. Data are a fundamental part of how the sector operates, and the use of data in insurance is constantly evolving. This paper aims to explore consumer perceptions about digital privacy and their subsequent motivations to disclose personal data for insurance purposes.Design/methodology/approachThe study uses an exploratory research approach based on in-depth interviews (...) to generate metathemes to provide an understanding of consumer perceptions about digital privacy and data sharing in the insurance sector.FindingsConsumers were extrinsically motivated to disclose data by financial reward and convenience; however, subsequent intrinsic motivations may be an influence on the initial motivations. Consumers perceived transactions as “fair” if they received the expected rewards, retained control of the data, and the data was not unilaterally used to their detriment. Concern for privacy was generally low, provided antecedent conditions were met.Research limitations/implicationsAs the study uses an exploration for discovery approach, the main limitation of this study is its small sample. However, this research aimed to identify metathemes and issues that may be the focus of future research in this area and is, therefore, not proposing to suggest strong conclusions and definitive answers.Originality/valueThis paper presents the first empirical research to examine data privacy issues in the UK insurance context. It contributes to knowledge in the areas of motivation, applied ethics and online consumer behaviour in general. (shrink)

Exploiting the resources of phenomenal conservatism, Harold Netland has offered a “critical-trust” approach to assessing the veridicality of religious experience and to ascertaining its evidential force in relation to Christian theistic belief. I suggest that, if we give seemings carried in religious experience their epistemic due, it may turn out that religious experience is practically universal and that the potential defeat of justification for religious belief by disagreement among purported epistemic peers is itself defeated by the private character of seemings (...) in the religious experiences of believers. (shrink)

Koriat & Goldsmith propose that the correspondence metaphor captures the essence of everyday memory research. We suggest that correspondence is often not at issue because objective assessments of everyday events are frequently lacking. In these cases, other questions arise, such as how individuals evaluate the validity of memories and the significance they attach to those evaluations.

De Neys proposed a “switch” model to address what he argued to be lacuna in dual-process theory, in which he theorized about the processes that initiate and terminate analytic thinking. We will argue that the author neglected to acknowledge the abundant literature on metacognitive functions, specifically, the meta-reasoning framework developed by Ackerman and Thompson (2017), that addresses just those questions.

Current research into the molecular biology of blood‐clotting factors suggests that the basis of inherited bleeding disorders may soon be understood. In addition, the expression of cloned genes for the factors in mammalian cell lines provides the hope of pure factors being available for replacement therapy, uncontaminated with the causative agents for Hepatitis and Acquired Immune Deficiency Syndrome (AIDS), identified in the blood products at present available. The recent findings on the molecular biology of several of the key blood clotting (...) genes are described here. (shrink)

It describes and explains the patient-centered model examining and evaluating qualitative and quantitative research. It comprehensively covers the evolution and the six interactive components of the patient-centered clinical method, taking the reader through the relationships between the patient and doctor and the patient and clinician. All the editors are professors in the Department of Family Medicine at the University of Western Ontario, London, Canada.

How to reconcile the existence of evil with the belief in a benevolent God has long posed a philosophical problem to the system of Christian theism. This work redress this difficulty in modern terms.

There is an irony about this that can only be appreciated by considering carefully Greco’s epistemological method. With alacrity and equanimity, Greco denies the efficacy of skeptical arguments as arguments that the conditions required for empirical knowledge are not fulfilled. His confidence in this matter is not the result of an elaborate anti-skeptical argument. Rather, it is born of an awareness that there are clear cases of empirical knowledge. This I find refreshing. The shortest route to denying the generalization embodied (...) in knowledge-skepticism is producing counterexamples to the generalization by identifying bona fide cases of empirical knowledge. This is embarrassingly easy to do. G. E. Moore exhibited a special talent for this when he held up his two hands and laconically remarked, “Here is one hand, and here is another.”. (shrink)

The aim of this paper is to cast light upon the moral vision—the vision of what is good and what is obligatory —that governs many if not most of the motion pictures produced in the United States in recent years. I especially have in mind productions such as Pleasantville, Cider House Rules , and American Beauty , and will give special attention to these three movies in what follows. But the phenomenon in question extends far beyond these cases. The basic (...) idea governing these films is now a wide-spread and deep-lying conviction in the contemporary American soul. It is that moral rules and rigorous moral order in life, as traditionally understood, are meaningless or pointless at best, and really are repressive of the best aspects of human relationships, individuality and creativity . What would have traditionally been thought of as moral propriety and human goodness is now generally thought of as arbitrary and as harmful to life, if not downright vicious (at least in its effects), largely because they eliminate or repress feelings , the true elixir of life. (shrink)

In his critical commentary on my earlier essay, "The Evidential Value of Miracles," Evan Fales explores a series of general methodological issues in sympathy with David Hume and sets forth three arguments against the historicity of the resurrection of Jesus Christ, which it was not the purpose of my essay to defend but which I nevertheless affirmed. In response, I first address each of Fales’s critical asides and interpretive comments, and then respond to his claim that there are three independently (...) decisive arguments against the historicity of the resurrection. Our exchange is part of a larger book symposium on miracles. (shrink)

Spontaneous mutations that perturb myelination occur in a range of species including man, and together with engineered mutations have been used to study disease, normal myelination and axon/glial inter‐relationships. Only a minority of the currently defined mutations have an apparently simple pathogenesis due to lack of a functional protein. Mutations in the myelin basic protein gene lead to a lack of protein, resulting in changes in the structure of myelin, which can be rescued by transgenic complementation. The pathogenesis of autosomal (...) dominant and X‐linked mutations affecting either oligodendrocytes or Schwann cells is more complex. Point mutations may act in a dominant negative manner and gene dosage is clearly linked to phenotypic change. Mutations in regulatory genes, such as those encoding transcription factors, can also disturb myelination by selected cell types. Other less‐well studied and unexpected consequences of myelin mutations, such as seizures in mutations affecting genes expressed in Schwann cells and axonal changes associated with dysmyelination, are also considered. With the major developments in gene mapping and cloning it is now relevant to study mutations in a variety of species with the real prospect of defining their molecular basis. Examples are given of unusual, but potentially useful, uncharacterised mutations in dog and bovine. (shrink)

There is nothing more humbling to one’s inner moral compass than to realize that you do not initially know what is right or wrong! I found myself in just such a situation after reading the above case. Much has been written, both in the professional literature and the popular media, about the “Ashley Treatment” since Gunther and Diekema published their article in 2006. It is unclear if others in the United States or around the world have, to any significant degree, (...) adopted growth attenuation therapy and/or surgical intervention for children with severe neurological compromise, but the case quoted above suggests that hospital ethics committees may also be struggling with these decisions. An informal survey of pediatric endocrinologists, mentioned in a recent article on the topic, claims that many physicians are facing this dilemma as well. (shrink)

I would like to present the details of an actual case from my own experience over which I, along with the family, have agonized. I think this case brings into focus some of the unique issues in perinatal medicine where multiple patients, some real and some potential, can enter into a single decision. I hope that through this presentation others may gain insight into the complexities of applied ethics in perinatal medicine.