Euthanasia and physician-assisted suicide (PAS) by request and/or based on an advance directive are legal in The Netherlands under strict conditions, thus providing options for patients with Huntington's disease (HD) and other neurodegenerative diseases to stay in control and choose their end of life. HD is an inherited progressive disease characterised by chorea and hypokinesia, psychiatric symptoms and dementia. From a qualitative study based on interviews with 15 physicians experienced in treating HD, several ethical issues emerged. Consideration of these aspects (...) leads to a discussion about the professional role of a physician in relation to the personal autonomy of a patient. Such a discussion can raise awareness that talking about end-of-life wishes with an HD patient is part of the legal, professional and moral responsibility of the physician, and that a letter of intent on behalf of the physician can improve active participation in the process. Discussion of these issues can help to advance the debate on euthanasia and PAS in HD and other neurodegenerative diseases. (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)

Among the insinuations that Tacitus bequeaths to posterity in the negative segment of his post mortem of Augustus is the emperor's putative role as machinator doli in the death of the consul Hirtius during the fighting at Mutina in the spring of 43. The historian is thinking of a focal moment in the Aeneid when Sinon releases his fellow Greeks from within the wooden horse. I quote Aen. 2.264–7. Among the heroes who descend from the animal's belly are Ulixes, Neoptolemus (...) et Menelaus et ipse doli fabricator Epeos. invadunt urbem somno vinoque sepultam; caeduntur vigiles, portisque patentibus omnis accipiunt socios atque agmina conscia iungunt. (shrink)

In an interesting article on Kierkegaard and the “Existential” Philosophy, contributed to the number of Philosophy for July 1941, Miss Dorothy Emmet counselled her readers to make themselves acquainted with the Journals of the famous Danish thinker, now rendered accessible to Englishmen ignorant of his language by the translation of Mr. Dru. I have taken her advice and am grateful to her for it. I am not indeed convinced that this self-revelation of a remarkable personality can be ranked among the (...) great autobiographies of the world. It seems to me to fall, if only on account of its lack of unity as a work of literary art, below the standard which such an estimate of it would imply. But it is undoubtedly both impressive in itself and important in view of the influence which its author, little known in his lifetime beyond a circle of the parochial narrowness of which he was painfully conscious, has come, long after his death, to exert upon the spiritual and intellectual life of Europe to-day. The present article, however, will not be concerned with the exposition or criticism of this or other writings of Kierkegaard, but with thoughts, more or less suggested by my reading of him, respecting the notion of God and its significance for philosophy. (shrink)

In this article, Badiou analyzes and rejects a classical model of politics based on state representation. He envisions a new model of politics without representation and claims that this new model is more closely tied to the ethical.

One of the most extensive yet least conclusive methodological debates within religious studies revolves around the question of what, precisely, the phenomenology of religion is and what contribution it can make to the study of religion. I do not intend to answer this important question here. To do so satisfactorily would require a range of historical, philosophical and methodological inquiry which would go quite beyond the bounds of a single article. My intention in this paper is, by comparison, unambitious. It (...) is to take one view of what phenomenology of religion is and to consider an area outside that usually explored by students of religion which can, nonetheless, shed some light on how religions might be studied in a way which is in accordance with the phenomenology of religion so understood. What follows will offer an answer to the question of what contribution one particular understanding of phenomenology might make to the study of religion, but no attempt will be made to establish whether or not this particular understanding ought to be regarded as normative. (shrink)

In the bracket mushroom, Schizophyllum commune, a recessive genetic alteration, mnd, causes abnormally hyperplastic three‐dimensional mounds of hyphae to rise from the surface of both haploid and dikaryotic mycelia. mnd, although not a genetic block in the fruiting body developmental pathway, is at least partially epistatic to fruiting. Within dikaryons containing both mutant and wild‐type nuclei, [mnd + mnd+], a nonreciprocal somatic recombination event can lead to stable conversion of the mnd+ region of the wild‐type nucleus to mnd. This transformation (...) to the homoallelic [mnd + mnd] condition involves no genomic areas other than the mnd region and permanently prevents any further fruiting. Studies relating to the recombination mechanism have ruled out a diploid intermediate state and other concomitants of orthodox somatic recombination, as well as whole chromosome transfer. Instead, a novel form of internuclear genetic transfer is postulated whereby a nearby locus, mob+, controls the mobilization of the mnd chromosomal region alone from one nucleus to the other within the binucleate cells of dikaryotic mycelia. (shrink)

In a discussion-note in Mind, Father P. M. Farrell, O.P., gave an account, in what he admitted to be an embarrassingly brief compass, of the Thomist doctrine concerning evil. There is one sentence in this discussion which at first glance appears paradoxical. Father Farrell has been arguing that a universe containing ‘corruptible good’ as well as incorruptible is better than one containing ‘incorruptible good’ only. He continues: ‘If, however, they are to manifest this corruptible good, they must be corruptible and (...) they must sometimes corrupt.’ The final words, despite Father Farrell's italics, strike one as expressing, not a self-evident truth, but a non sequitur. The fact that I am capable of committing murder does not entail that I will at some time commit it. It is not immediately obvious that a similar entailment holds in the case of corruption and corruptibility. (shrink)

The texts before us are relatively early works. They predate the famous Manifesto of the Communist Party of 1848. Their importance lies in this: that here historical materialism is outlined and defended for the first time. This new philosophy is elaborated in the course of Marx and Engels' effort to settle accounts with previous German philosophy—and, perhaps, with philosophy as such. The new outlook is developed, therefore, in the context of polemic against Hegel and Feuerbach, precisely the thinkers that they (...) most admired earlier in fact. (shrink)

PLATO: PROTAGORAS, trans, with Notes by C. C. W. Taylor. Clarendon Press: O.U.P., 1976. vii+230 pp. £7.50 cloth, £3.75 paper.