BackgroundIn the Canadian Alliance for Healthy Hearts and Minds cohort, participants underwent magnetic resonance imaging of the brain, heart, and abdomen, that generated incidental findings. 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 were recruited with (...) a follow-up questionnaire administered to 909 participants 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% of participants, with the highest proportions found in the brain and abdomen. The majority of participants 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 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)

A review of E.J. Lowe and Ontology, Edited By Mirosław Szatkowski. (New York, Oxford: Routledge, 2022. Pp. 326. Price £130.00.).

J.S. Mill's plural voting proposal in Considerations on Representative Government presents political theorists with a puzzle: the elitist proposal that some individuals deserve a greater voice than others seems at odds with Mill's repeated arguments for the value of full participation in government. This essay looks at Mill's arguments for plural voting, arguing that, far from being motivated solely by elitism, Mill's account is actually driven by a commitment to both competence and participation. It goes on to argue that, for (...) Mill, much of the value of political participation lies in its unique ability to educate the participants. That ability to educate is not, however, a product of participation alone; rather, for Mill, the true educative benefits of participation obtain only when competence and participation work together in the political sphere. Plural voting, then, is a mechanism for allowing Mill to take advantage of the educative benefits that arise from the intersection of competence and participation. (shrink)