Context The attitudes of medical professionals towards physician assisted dying have been widely discussed. Less explored is the level of agreement among physicians on the possibility of ‘rational suicide’—a considered suicide act made by a sound mind and a precondition of assisted dying legislation. Objective To assess attitudes towards rational suicide in a representative sample of senior doctors in England and Wales. Methods A postal survey was conducted of 1000 consultants and general practitioners randomly selected from a commercially available database. (...) The main outcome of interest was level of agreement with a statement about rational suicide. Results The corrected participation rate was 50%; 363 questionnaires were analysed. Overall 72% of doctors agreed with the possibility of rational suicide, 17% disagreed, and 11% were neutral. Doctors who identified themselves as being more religious were more likely to disagree. Some doctors who disagreed with legalisation of physician assisted suicide nevertheless agreed with the concept of rational suicide. Conclusions Most senior doctors in England and Wales feel that rational suicide is possible. There was no association with specialty. Strong religious belief was associated with disagreement, although levels of agreement were still high in people reporting the strongest religious belief. Most doctors who were opposed to physician assisted suicide believed that rational suicide was possible, suggesting that some medical opposition is best explained by other factors such as concerns of assessment and protection of vulnerable patients. (shrink)

Escalation of commitment causes people to continue a failing course of action. We study the role of construal level in such escalation of commitment. Consistent with the widely held view of construal level as a primed effect, we employed a commonly used prime for manipulating this construct in a laboratory experiment. Our findings revealed that the prime failed to produce statistically significant differences in construal level, which was measured using the Behavior Identification Form. Furthermore, there was no effect of the (...) prime on escalation of commitment, or on constructs that have previously been linked to construal level such as the perceived importance of feasibility considerations relative to desirability considerations, and the number of pros and cons that subjects can think of.Interestingly, however, subjects’ actual construal level scores on the BIF were found to significantly affect escalation. Specifically, our findings show that people with a low construal level are less willing to continue a failing project. This relation is mediated by the perceived importance of the feasibility of the project relative to its desirability. For people with a low construal level, the perceived importance of feasibility relative to desirability is higher, which in turn makes escalation of commitment less likely.Our findings are consistent with prior research suggesting that priming construal level may not always be effective. Thus, while construal level has typically been regarded as a state-like variable that can be primed, in this study, we show that construal level may also be considered as a trait. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

In this consensus report by a diverse group of academics who conduct and/or are concerned about social and behavioral genomics (SBG) research, the authors recount the often‐ugly history of scientific attempts to understand the genetic contributions to human behaviors and social outcomes. They then describe what the current science—including genomewide association studies and polygenic indexes—can and cannot tell us, as well as its risks and potential benefits. They conclude with a discussion of responsible behavior in the context of SBG research. (...) SBG research that compares individuals within a group according to a “sensitive” phenotype requires extra attention to responsible conduct and to responsible communication about the research and its findings. SBG research (1) on sensitive phenotypes that (2) compares two or more groups defined by (a) race, (b) ethnicity, or (c) genetic ancestry (where genetic ancestry could easily be misunderstood as race or ethnicity) requires a compelling justification to be conducted, funded, or published. All authors agree that this justification at least requires a convincing argument that a study's design could yield scientifically valid results; some authors would additionally require the study to have a socially favorable risk‐benefit profile. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

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)

PurposeTo use the power of knowledge acquisition and machine learning in the development of a collaborative computer classification system based on the features of age-related macular degeneration (AMD).MethodsA vocabulary was acquired from four AMD experts who examined 100 ophthalmoscopic images. The vocabulary was analyzed, hierarchically structured, and incorporated into a collaborative computer classification system called IDOCS. Using this system, three of the experts examined images from a second set of digital images compiled from more than 1000 patients with AMD. Images (...) were annotated, and features were identified and defined. Decision trees, a machine learning method, were trained on the data collected and used to extract patterns. Interrelationships between the data from the different clinicians were investigated.ResultsSix drusen classes in the structured vocabulary were largely sufficient to describe all the identified features. The decision trees classified the data with 76.86% to 88.5% accuracy and distilled patterns in the form of hierarchical trees composed of 5 to 15 nodes. Experts were largely consistent in their characterization of soft, and to a lesser extent, hard drusen, but diverge in definition of other drusen. Size and crystalline morphology were the main determinants of drusen type across all experts.ConclusionsMachine learning is a powerful tool for the characterization of disease phenotypes. The creation of a defined feature set for AMD will facilitate the development of an IDOCS-based classification system. (shrink)

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the (...) frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing. (shrink)

On September 18, 1995, the U.S. Court of Appeals for the Seventh Circuit handed down a decision in Blue Cross & Blue Shield United of Wisconsin v. Marshfield Clinic ) that sets two important precedents regarding the status of health maintenance organizations under antitrust law. Chief Judge Posner, writing for the court, concluded that HMOs do not constitute a market separate from the general market for medical services and that agreements, between HMOs in a region, to operate in separate areas (...) constitute a prohibited form of market splitting.This case primarily involves two HMOs in north central Wisconsin: one a subsidiary of Blue Cross, the other a subsidiary of the Marshfield Clinic. The Blue Cross HMO claimed that the Marshfield HMO had an illegal monopoly in the region's HMO market and therefore violated the Sherman Act ). (shrink)

Conspiracy theories and conspiracy theorists have been accused of a great many sins, but are the conspiracy theories conspiracy theorists believe epistemically problematic? Well, according to some recent work, yes, they are. Yet a number of other philosophers like Brian L. Keeley, Charles Pigden, Kurtis Hagen, Lee Basham, and the like have argued ‘No!’ I will argue that there are features of certain conspiracy theories which license suspicion of such theories. I will also argue that these features only license a (...) limited suspicion of these conspiracy theories, and thus we need to be careful about generalising from such suspicions to a view of the warrant of conspiracy theories more generally. To understand why, we need to get to the bottom of what exactly makes us suspicious of certain conspiracy theories, and how being suspicious of a conspiracy theory does not always tell us anything about how likely the theory in question is to be false. (shrink)

Pitcher has taken upon himself the task of refining and defending the thesis that sense perception is the acquiring of true beliefs concerning particular facts about one's environment, by means of the senses. The book is divided into four parts, the first part being a critical treatment of the sense-data theories via an examination of several of the major arguments traditionally forwarded in defense of the view. The theory advocated by the author is presented in the second part, where the (...) view is first stated in unpolished form and gradually refined and qualified as problems and objections are dealt with. Any philosophical theory of perception, the author maintains, is related to the empirical sciences in that its task is to render intelligible the facts about perception, as uncovered by the relevant sciences. Thus, in the third part of the book, some recent experiments in the psychology of perception are discussed in relation to the theory of perception held by the author. In the final part of the book, Pitcher discusses color perception, since the perception of colors seems, at first glance, to present a problem for his theory. If a dispositional analysis is given for perceptual belief, what behavior is peculiar to the perception of a color? An interesting discussion of the primary-secondary quality contrast follows Pitcher's solution to this problem. Though the author does not claim originality for the theory of perception he offers, there is still much to be said for his treatment of the materials presented.--R. L. M. (shrink)

A systematic account of explanation and meaning, on an introductory level. The book is designed not only for students who are primarily interested in philosophy, but also for students whose primary interests may lie in the physical or social sciences, literature, or history. There are fifteen relatively brief chapters, the first eight of which are concerned with the concept of explanation while the remaining seven chapters deal with the concept of meaning. The author begins his treatment of explanation by dismissing (...) as fruitless disputes over what a 'real' explanation must be. Instead, he proposes to examine different types of explanation in order to determine their differences and the relative importance of their differences. "Scientific Explanation," "What-explanations," and "Reason-giving Explanation" are then distinguished and discussed in the early chapters, and this is followed with chapters on historical explanation and explanation in literary criticism. In the remaining chapters on meaning, the author maintains the view that meanings are not a sort of thing, mental or physical. He supports this thesis through his criticisms of causal theories of meaning, "Fido"-Fido theories of meaning, and theories which attempt to identify the meaning of a word with a mental event or an essential definition. The author favors identifying the meaning of a work with its use and deals with some of the problems connected with this view. A list of additional references for each chapter is provided at the end of the book. Though the book is primarily a systematic account of explanation and meaning, a variety of issues from different areas of contemporary philosophical concern are touched upon along the way. These issues concern, for example, natural laws, explaining human behavior, the nature of historical explanation, interpretation in literature, definition, synonymy, and metaphor. This is a clearly written introduction to contemporary philosophy.--R. L. M. (shrink)

Von Wright describes his position as "teleological" yet distinguishes it from Aristotle's "notion of the good of man relative to a notion of the nature of man," by likening it to that of the utilitarian tradition. There is painstaking attention to the staggering diversity of functions of "good" and related words, and an examination of instrumental, technical, medical, hedonic and utilitarian goodness. Von Wright regards the moral sense of "good" as derivative and defines it in terms of the beneficial, a (...) sub-class of Utilitarian Goodness. Chapters on Virtue, "Good" and "Must," Duty, Justice are included. There are rather few references to other works, very many distinctions, and an Index which includes, among others, the word "all right."--R. L. M. (shrink)

This volume contains fourteen essays, all of which were written by Ebersole over a period of seven years, on various epistemological problems. A few of the essays have appeared before as journal articles, but the bulk of the essays are here printed for the first time. The essays deal with three principle topics: sense-datum theories of perception, memory and the past, and the possibility of knowledge of existence without experience. In style and approach, the essays can be characterized as belonging (...) to the school of analytic philosophy, dealing with philosophical problems with an emphasis on the use and function of relevant linguistic expressions. Although some of the essays are interesting, readers of Wittgenstein will find the material all too familiar.--R. L. M. (shrink)

Traditional navigation visualization utilizes two-dimensional. maps for road guidance or arrow symbols for turn by turn information. While the advantage of map views is supposed to be the inherent understanding of the surroundings, often these schematic line-drawing bird's eye views are rather confusing than helpful because they cannot provide an overview and an appropriate level of detail in an area of interest at the same time, i.e. the user is forced to change between different resolutions. In this paper we describe (...) a 3D visualization system for vehicle navigation that overcomes these shortcomings by providing a realistic and perspective 3D view of the environment. (shrink)

Basham and Dentith argue that the danger of condemning both conspiracy theorists and their conspiracy theories in a democracy has grave consequences. They argue that we should encourage research into public concerns about influential institutions, especially in cases where a conspiracy has been alleged. Rather than dismiss conspiracy theorising, we should, encourage the politically crucial, historically proven gift of watchfulness in the citizen, and its sometimes necessary, proper and correct expression, conspiracy theory.

Background Central to the involvement of children in health research is the notion of risk. In this paper we present one of the factors, a matter of trust, that shaped Canadian parents' and children's perceptions and assessments of risk in child health research. Participants and methods Part of a larger qualitative research study, 82 parents took part an in-depth qualitative interview, with 51 parents having children who had participated in health research and 31 having children with no research history. 51 (...) children ranging from 6 to 19 years of age were also interviewed, with 28 having a history of participation in child health research and 23 having no history. Children also took part in 3 focus groups interviews. Themes emerged through a grounded theory analysis of coded interview transcripts. Findings The presence or absence of trust was not only perceived by parents and children as a contributing factor to involving children in health research, but also shaped their perceptions and assessments of risk. Three interrelated subthemes identified were: (1) relationships of trust; (2) placing trust in symbols of authority; and (3) the continuum of trust. Conclusions Our study reinforces that trust is an important factor when parents assess risk in child health research and shows that children use the language of trust in relation to risk. More discussion regarding trust in training researchers is warranted given the trust in researchers and institutions evident in this study. We also recommend further study of the continuum of trust in child health research. (shrink)