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 book takes a bold new look at ways of exploring the nature, origins, and potentials of consciousness within the context of science and religion.

This essay explains the inescapability of moral demands. I deny that the individual has genuine reason to comply with these demands only if she has desires that would be served by doing so. Rather, the learning of moral reasons helps to shape and channel self- and other-interested motivations so as to facilitate and promote social cooperation. This shaping happens through the “embedding” of reasons in the intentional objects of motivational propensities. The dominance of the instrumental conception of reason, according to (...) which reasons must be based in desires of the individual, has made it harder to recognize that reasons shape desires. I attempt to undermine this dominance by arguing that the concept of a self that extends over time is constructed to meet the demands of social cooperation. Prudential reasons to act on behalf of the persisting self's desires are often taken to constitute the paradigm of reasons based on desires of the individual. But such reasons, along with the very concept of the persisting self, are constructed to promote human cooperation and to shape the individual's desires. (shrink)

Modern science developed in the interflow of culture between west and east. Combing of pratice technology with philosophic thoughts formed experimental method. Holistic views contacting atomism produced system theory. System thoughts are applicated in the science and engineering of biosystems, and the cencepts of system biomedicine (Kamada T.1992), systems biology (Zieglgansberger W, Tolle TR.1993), system bioengineering and system genetics (Zeng BJ. 1994) were established. From positive to synthetic thoughts, philosophy have been developed ontology, cosmology, organism theories. Structurity is structure logic (...) system founded on entity, develop, exist axioms, tolerance, adaptation, fluctuate, interweave, transform theorems and integrate, adaptation, construct laws. Structurity be discussed on the cosmos, life, culture system, creation, hologram theories of structure ontology, construct mutation, simi-structure organism and entity emergence, symbol implication. From the relation of structure, function and development, the structurity put forward the cycle, spiral, triangle structure stability patterns of self-organization in structure complement each other and stratification, functional couple and interflow bounds growth, coordinativetransformation and holographic symmetry. (shrink)

Objectives: To compare attitudes of medical and law students toward informing a cancer patient about diagnosis and prognosis and to examine whether differences are related to different convictions about benefit or harm of information.Setting and design: Anonymous questionnaires were distributed to convenience samples of students at the University of Geneva containing four vignettes describing a cancer patient who wishes, or alternatively, who does not wish to be told the truth.Participants: One hundred and twenty seven medical students and 168 law students.Main (...) outcome measures: Five point Likert scale of responses to the vignettes ranging from “certainly inform” to “certainly not inform” the patient.Results: All medical students and 96% of law students favoured information about the diagnosis of cancer if the patient requests it. Seventy four per cent of medical students and 82% of law students favoured informing a cancer patient about his or her prognosis . Thirty five per cent of law students and 11.7% of medical students favoured telling about the diagnosis and 25.6% of law students and 7% of medical students favoured telling about the prognosis even if the patient had clearly expressed his wish not to be informed. Law students indicated significantly more often than medical students reasons to do with the patient’s good, legal obligations, and the physician’s obligation to tell the truth, and significantly less often than medical students that their attitude had been determined predominantly by respect for the autonomous choice of the patient.Conclusion: Differences in attitudes according to the type of case and the type of studies were related to convictions about the benefit or harm to the patient caused by being given information. The self reported reasons of future physicians and future lawyers are helpful when considering means to achieve a better acceptance of patients’ right to know and not to know. (shrink)

The revolution in semantics in the late 1960s and 1970s overturned an earlier competing paradigm, ‘translational’ semantics. I revive and defend Prior’s translational semantics for modals and tense-modals. I also show how to extend Prior’s propositional modal semantics to quantificational modal logic, and use the resulting semantics to formalize Prior’s own counterexample to the Barcan Formula.

The ageing population and new technology are both increasing the cost of our free health service, and there are sound economic reasons for extending measures which reduce the diseases common to our society. But if education fails to change public attitudes towards habits such as tobacco smoking and poor diet, to what extent is the State justified in compelling us to be healthy? This issue touches on the sensitive areas of personal freedom and responsibility and involves complex cultural, historical and (...) economic considerations. Both governments and individuals can be criticised for the way this issue has been handled in the past, and it is hoped that the examples discussed in this paper will stimulate further debate. (shrink)

Philosophy of history is analyzed here from the point of its epistemological and ontological meaning. The author considers that the ontological point of view makes it possible to conceptualize the history as the unity of its all times - Past, Present and Future. The connection between these three times based on their relation to the concept of Eternity which has been symbolically formed within the mythological, religious and utopian Weltanschauung. The necessity of these relations transforms philosophy of history into a (...) special kind of ontological historical knowledge. The study of history from the prospect of unity is only possible within the historical interpretation of Future as an epoch of bridging the gap between Time and Eternity. Author calls this philosophical concept the Time of Freedom. (shrink)