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)

In this paper I respond to Robert Taylor's argument that a Rawlsian framework does not support strong affirmative action programs. The paper makes three main arguments. The first disputes Taylor's claim that strong AA would not be needed in ideal conditions. Private racial discrimination, I suggest, might still exist in such conditions, so strong AA might be needed there. The second challenges Taylor's claims that pure procedural justice constrains Rawlsian nonideal theory. I argue that this rests on a fetishizing of (...) pure procedural justice that is absent from Rawls's work. I also show that a revised formulation of Taylor's concern here also fails. My third argument makes a positive Rawlsian case for strong AA in nonideal conditions that builds on a Taylor concession. Taylor suggests that the goal of nonideal theory is to create a world in which ideal theory can be applied. My argument begins by showing that another permissible goal of Rawlsian nonideal theory is to ameliorate injustice. I then argue that Rawls's contractualist framework supports the strongest forms of AA when category 3 interventions are blocked. (shrink)

I argue that an ambiguity exists between Philip Pettit's largely normative and Quentin Skinner's largely historical accounts of republican liberty. Historical republican liberty, as seen in Livy's narrative of the period following the expulsion of the Roman kings to the passage of the Licinian-Sextian laws, was largely defensive, in the form of the tribunate. Though republican liberty protected the plebeians from wanton patrician abuse, removing them from a formal dependence analogous to that of slave or child in Roman law, it (...) left them under the tutelage and guidance of a paternalistic order. Thus, while historical republican liberty was anti-patriarchal, it was normatively compatible with paternalism. Yet paternalism is probably undesirable for both normatively- and historically-minded advocates of republicanism. (shrink)

Guidelines for a model bride in Islam based on Islamic teachings; includes stories of six exemplary Muslim wives during Prophet Muhammad's time.

I welcome Mr Kennedy's general approach, but query whether the concept of consumerism is so closely applicable to medical care as he maintains. However, in particular aspects, especially the handling of complaints, his criticisms echo those made by the Patients Association. Finally, I detect some ground for hope in the more enlightened attitude creeping in to the eduction of the medical student.

Arab countries; intellectual life; 20th century.

La doctrine du ‘contrat social’ a fait récemment une réapparition dans l'ouvrage A Theory of Justice de John Rawls. D'un avis unanime, chacun reconnaît l'importance de ce livre. Et cependant son contenu est objet de critiques divergentes. Le présent article est conçu comme une modeste contribution aux débats en cours. Après une rapide esquisse des idées maîtresses de Rawls, l'auteur dresse un bilan synoptique des conceptions du contrat social de Hobbes, Locke, Rousseau et Kant. Sont mis en évidence : 1° (...) le fait que ces quatre philosophes parlent d'un droit naturel immuable 2° le fait que, tout en étant révolutionnaires sur le plan des idées politiques, ils ne sont pas parvenus à déceler les problèmes sociaux. Rawls a intégré l'inspiration socialiste -la préoccupation de la justice sociale -dans la théorie du contrat social. Il insiste sur le dialogue impartial, base de la recherche des principes de justice politique et sociale. Son ouvrage souffre néanmoins d'une profonde incohérence. Rawls s'est tourné vers la tradition du contrat social pour sortir de l'utilitarisme, sa pensée est en effet dirigée par une inspiration toute différente. Pourtant, dans sa déduction des principes de justice, il retombe dans l'utilitarisme qu'il voulait éviter. L'ambiguïté qui en résulte le place dans l'impossibilité de répondre valablement à une critique venue de divers côtés. (shrink)

The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does (...) not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right. (shrink)

In BioEssays, vol. I. no. 5, p. 227, P. A. Lawrence discussed the selector gene hypothesis and its implications for development. In the following article, D. Gubb presents an alternative view of the genetic control of development.

We present the true stages machinery and illustrate its applications to descriptive set theory. We use this machinery to provide new proofs of the Hausdorff–Kuratowski and Wadge theorems on the structure of $\mathbf {\Delta }^0_\xi $, Louveau and Saint Raymond’s separation theorem, and Louveau’s separation theorem.

The German philosopher Robert Spaemann is one of the most important living thinkers in Europe today. This volume presents a selection of essays that span his career, from his first published academic essay on the origin of sociology to his more recent work in anthropology and the philosophy of religion. Spaemann is best known for his work on topical questions in ethics, politics, and education, but the light he casts on these questions derives from his more fundamental studies in metaphysics, (...) the philosophy of nature, anthropology, and the philosophy of religion. At the core of the essays contained in this book is the concept of nature and the notion of the human person. Both are best understood, according to Spaemann, in light of the metaphysics and anthropology found in the classical and Christian tradition, which provides an account of the intelligibility and integrity of things and beings in the world that safeguards their value against the modern threat of reductionism and fragmentation. A Robert Spaemann Reader shows that Spaemann's profound intellectual formation in this tradition yields penetrating insights into a wide range of subjects, including God, education, art, human action, freedom, evolution, politics, and human dignity. (shrink)