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)

Several recent papers dealing with Plato's position on the imperfection of the phenomenal world draw heavily on the differences between two kinds of predicates in order to show the following: In the middle dialogues, Plato posits Forms only as referents of what the writers call incomplete predicates. He does not posit Forms as referents for complete predicates. When interpreters ignore the differences between these kinds of predicates, they ascribe too radical a view regarding the imperfection of the phenomenal world to (...) the middle dialogues. The ontology of these dialogues includes sensible particulars which retain their identity over time even though they are continually changing in some respect or other. (shrink)

In this lecture Justice Breyer examines three classical criticisms of constitutional judicial review. Those criticisms say that a grant to unelected judges of the power to set aside legislation as contrary to a written constitution leads to judicial decision-making that is (a) undemocratic, (b) subjective, and impractical. Justice Breyer describes features of the constitutional decision-making that do not dictate results in individual cases, but none the less hold the judges' 'subjective' will in check. He also describes necessary judicial efforts to (...) focus upon considerations of administrative practicality. The description seeks, not to refute the criticisms in their entirety, but to help evaluate the extent to which those criticisms militate against the adoption of a system of constitutional judicial review. (shrink)

This book examines Augustine's description of the actually existing world, especially that aspect most important for the human pursuit of happiness: the human being and God. It begins with an overview of the characteristics of the human individual and the context in which they must live out their lives, a context dominated by two seemingly contradictory realities: the existence of God and the existence of evil.

Søren Kierkegaard præsenterer os for ikke mindre end 18 opbyggelige taler forholdsvist tidligt i forfatterskabet, og det vil sige, at vi er i den del af hans værker, der betegnes som religiøse. Det er samtidig ensbetydende med, at Kierkegaard står ved det skrevne og ikke lader et pseudonym være den ansvarshavende, som ellers er tilfældet med mange af hans udgivelser. Talerne forkynder, formidler og forklarer kristendommen eller Jesu budskaber, og vi præsenteres for fortællinger og historier fra Bibelen, der på eksemplarisk (...) vis perspektiverer begreber som tvivl, godhed, sandhed og naturligvis tro med frelse. Når Kierkegaard bruger betegnelsen opbyggelige taler, så er det, fordi det netop er tanker og beskrivelser, der automatisk fører til refleksion og eftertænksomhed, og dermed er det enkelte menneske allerede i gang med en form for opbyggelse. Guiden giver således et indblik i og overblik over talerne, så man er bedre rustet, når man vil læse Kierkegaard selv. (shrink)