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)

An interdisciplanary collection of essays focused on Kant's work on the concept of community.

New Blackfriars, Volume 103, Issue 1107, Page 607-621, September 2022.

Contains contributions from some of the most prominent thinkers and experts in philosophy-driven methods, such as phenomenology, hermeneutics, and semiotics. This international body of scholars discuss the issue of method itself, as well as bring those methods to bear on some of the most prominent issues of our time in the areas of media, culture and criticism.

This article aims to read feminist new materialisms (Barad), together with ‘postulated’ linguistic or cultural primacy of Queer Theory (Butler), to show how both are engaged in similar critical-ethical endeavours. The central argument is that the criticism of Barad and new materialisms misses Butler’s materialistic insights due to a narrow interpretation of Butler's alleged social-constructivist position. There is, therefore, a specific focus on where they both make similar ethical appeals. Moreover, the article relies on Adorno's negative dialectic to highlight an (...) interpretation of Barad and Butler as being part of the same dialectical movement, in which materialism and idealism fluctuate in their mutual criticisms, thus continuing the procession towards 'new knowledge' and emancipation, or freedom, through their motions back and forth. (shrink)

From the way we speak it appears that we think changes do not merely come about but are brought about. Can we really think this? Have we any idea of the bringing or being brought about of a change distinct from our idea of its coming about? In the first part of this paper I shall try to describe some of the forms of causal thinking which are reflected in our ordinary causal judgments. In the second, having criticized two current (...) analyses of the notion of change, I shall argue that to think of a change as something which comes about is to think of it as a causal explanandum, and to think of a change as a coming about of something is to think of it as a causal explanans. (shrink)

The starting in 1960 of the British Journal of Aesthetics was a courageous act. In those days people liked to call aesthetics a ‘dreary’ intellectual region, and high-flying philosophers seldom descended into it. But when in the decade that followed new philosophy departments were created and old ones expanded, aesthetics took up some of the spare capacity. Courses were laid on, and books and articles appeared which could match the quality of work in better established branches of philosophy like ethics (...) and epistemology. The question now is whether the lean years which have begun will eat up the fat years of the sixties and seventies. As courses are cut and vacancies left unfilled, aesthetics is likely to be the first branch of philosophy to suffer. (shrink)

It is often held that movement can be defined in terms of places and times. Thus Russell says: We must entirely reject the notion of a state of motion. Motion consists merely in the occupation of different places at different times, subject to continuity as explained in Part V.

Systems Theory analyses the world in terms of communications and divides the natural world into environment and systems. Systems are characterised by their high density of communications and tend to become more complex and efficient with time, usually by means of increased specialisation and coordination of functions. Management is an organisational sub-system which models all necessary aspects of organisational activity such that this model may be used for monitoring, prediction and planning of the organisation as a whole. The function of (...) a specific management system depends on its history of selection by interactions with the environment (which includes other systems). The main function of a management system will be a consequence of the most powerful and sustained selection pressure it has experienced. Systems Theory implies a management science which is quantitative and comparative. It is quantitative because it is based upon the measurement and mapping of communications as the basis of analysis; it is comparative because evaluations relate to specific variables measured in a specific spatio-temporal context and subjected to analytic processes of constrained complexity. Selection processes are broadly responsible for the dominance of management in contemporary Western societies. The complexity of management systems will probably continue to increase for as long as the efficiency-enhancing potential of complexity outweighs its increased transaction costs. (shrink)

One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we (...) consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a ‘mistake in moral mathematics’. First, it fails to abide by what we term a principle of ‘non-perfectionism’ in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of ‘numerical discrimination’. Various attendant issues around fairness and lotteries are also discussed. (shrink)

The UK’s National Institute for Health and Care Excellence is responsible for conducting health technology assessment on behalf of the National Health Service. In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness —and one substantive—an ‘ethics of opportunity costs’ that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE’s approach and to analyse (...) whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE’s approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE’s recommendations. These changes also weaken NICE’s commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE’s approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE’s practice of HTA and to better understand how and why they have come about. (shrink)

'Stress' is a widely used word in clinical practice, the biological sciences and everyday life; but one which has little real value, serving mainly to confuse and confound rational thought. Whether it is described in terms of stimulus, response, or a combination of the two the definitions of stress are invariably found to be circular. We should stop using the word 'stress' and instead discuss specific stimuli or responses as appropriate. The author suggests that 'pressure' and 'tension' might provide suitable (...) substitutes for everyday clinical practice. (shrink)