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)

L'A. soutient, contre Germain Grisez, Joseph Boyle, John Finnis et William May, que le contrôle naturel des naissances pratiqué avec une intention mauvaise n'est pas contraception. Il montre que les auteurs identifient de façon incorrecte la fin prochaine de la contraception comme choix qu'il n'y ait pas d'enfant, alors que la fin prochaine véritable est d'empêcher un enfant de venir au monde . Ainsi donc, puisque en NFP un couple ne cherche pas à empêcher la venue au monde d'un (...) enfant, NFP n'implique pas d'action contraceptive. L'A. soutient aussi qu'identifier la fin prochaine comme choix qu'il n'y ait pas d'enfant ne spécifie pas de façon adéquate une classe homogène d'actes objectifs, bien que cela spécifie une classe homogène d'actes moraux. (shrink)

This is a collection of essays on themes of legal philosophy which have all been generated or affected by Hart's work. The topics covered include legal theory, responsibility, and enforcement of morals, with contributions from Ronald Dworkin, Rolf Sartorius, Neil MacCormach, David Lyons, Kent Greenawalt, Michael Moore, Joseph Raz, and C.L. Ten, among others.

This classic collection of essays, first published in 1968, represents H.L.A. Hart's landmark contribution to the philosophy of criminal responsibility and punishment. Unavailable for ten years, this new edition reproduces the original text, adding a new critical introduction by John Gardner, a leading contemporary criminal law theorist.

H. L. A. Hart; The Presidential Address: I—Prolegomenon to the Principles of Punishment, Proceedings of the Aristotelian Society, Volume 60, Issue 1, 1 June 196.

This incisive book deals with the use of the criminal law to enforce morality, in particular sexual morality, a subject of particular interest and importance since the publication of the Wolfenden Report in 1957. Professor Hart first considers John Stuart Mill's famous declaration: "The only purpose for which power can be rightfully exercised over any member of a civilized community is to prevent harm to others." During the last hundred years this doctrine has twice been sharply challenged by two great (...) lawyers: Sir James Fitzjames Stephen, the great Victorian judge and historian of the common law, and Lord Devlin, who both argue that the use of the criminal law to enforce morality is justified. The author examines their arguments in some detail, and sets out to demonstrate that they fail to recognize distinction of vital importance for legal and political theory, and that they espouse a conception of the function of legal punishment that few would now share. (shrink)

A representation is a remnant of previous experience that allows that experience to affect later behavior. This paper develops a metatheoretical view of representation and applies it to issues concerning representation in animals. To describe a representational system one must specify the following: thedomainor range of situations in the represented world to which the system applies; thecontentor set of features encoded and preserved by the system; thecodeor transformational rules relating features of the representation to the corresponding features of the represented (...) world; themedium, or the representation's physical instantiation; and thedynamics, or how the system changes with time. In part because of the behaviorist assumption that the hypothetical, covert changes occurring in an organism during learning correspond to the overt physical changes that are observed, issues of representation in animal behavior have been largely ignored as irrelevant or misleading. However, it can be inferred that representations, acting as models of environmental regularities, operate at many levels of behavioral functioning, both cognitive and noncognitive. Objections to the use of this concept in explanations of animal behavior, based on the claim that it is indeterminate and on behaviorist considerations of parsimony, can be answered. Animal representations may be specialized in terms of tasks and species. Data from tasks involving spatial memory, delayed matching-to-sample, and sequence learning suggest some foundations for a general theory of animal representations. (shrink)

Love's memories, love recalling itself in letters lost and found over an interval of forty years: Cixous's writer-narrator advances here far into a labyrinth of passions long ago delivered and yet still arriving through the mail, through letters and literature, in other words, the poetry of the post. As for the lovers' returning scenes, they have their addresses in Paris and in New York, but also in a lost oasis of the Egyptian desert during the Napoleonic wars, in Athens and (...) along the shores of a great lake centuries ago in the country of myth. The lovers are poets or soldiers, philosophers or students madly in love with poetry and poets. They are as well mermaids or panthers. Panthers? Yes, for it is the passion of the animal that drives all these lovers to bare themselves, and sometimes their claws, before the beloved. Misunderstandings are often, even inevitably the result. Seconded and witnessed by her passionate, truth-telling cats, Cixous's narrator-writer returns unerringly to moments of errancy inflicted on address and language, those errors and faults when love, perhaps, is listening only to itself, without subject or object, lover or beloved, just love itself, l'amour meme, l'amour m'aime, love loving me, in the letter box of memory. (shrink)

H. Tristram Engelhardt, Jr., Joseph Boyle, John Peppin, David Solomon; Christian Bioethics, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Vol.