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)

After a discussion of Bacon's views on the subject, Van Leeuwen examines a different theory of certainty. This is the theory that was elaborated by Chillingworth and Tillotson, two English Protestant clergymen, in the course of a controversy centering upon the problem of deciding with certainty which beliefs constituted a Rule of Faith, i.e., the basic requirements of belief for Salvation. Chillingworth and Tillotson attempted to avoid both dogmatism and total skepticism by insisting on the existence of levels of certainty (...) and maintaining that the criteria of common sense are appropriate for the solution of theoretical religious questions. According to Van Leeuwen, the application of this theory is extended to scientific contexts in the work of Wilkins and Glanvill and is inherent in the scientific work of such members of the Royal Society as Boyle and Newton. The exposition is good; but the author's claim to a rigorous evolutionary line in the development of the doctrine of certainty among the figures he has treated is sometimes overstated.—T. J. C. (shrink)

The natural name theory, recently discussed by Johnson (2018), is proposed as an explanation of pure quotation where the quoted term(s) refers to a linguistic object such as in the sentence ‘In the above, ‘bank’ is ambiguous’. After outlining the theory, I raise a problem for the natural name theory. I argue that positing a resemblance relation between the name and the linguistic object it names does not allow us to rule out cases where the natural name fails to resemble (...) the linguistic object it names. I argue that to avoid this problem, we can combine the natural name theory with a type-realist metaphysics of language, and hold that the name is natural because the name is an instance of the kind that it names. I conclude by reflecting on the importance of the metaphysics of language for questions in the philosophy of language. (shrink)

v. 1. Nicomachean ethics. Politics. The Athenian Constitution. Rhetoric. On Poetics.--v. 2. Logic.--v. 3. Physics. Metaphysics. On the soul. Short physical treaties.--v. 4. On the heavens. On generation and corruption. Meteorology. Biological treatises.

An ancient doctor who advocated the therapeutic benefits of wine and passive exercise was bound to be successful. However, Asclepiades of Bithynia did far more than reform much of traditional Hippocratic therapeutic practice; he devised an extraordinary physical theory which he used to explain all biological phenomena in uniformly simple terms. His work laid the theoretical basis for the anti-theoretical medical sect called Methodism. For his trouble he was despised by his intellectual progeny and, more importantly perhaps, by Galen. None (...) of his work survives intact, but copious ancient testimonia relating to him allow us to reconstruct many details of the theory. His ideas offer us a fascinating glimpse of how Hellenistic philosophy and medicine interacted, and provide an introduction to one of the most intriguing doctrinal disputes in Greek science. (shrink)

It has been hypothesized that psychedelic experiences elicit lasting psychological benefits by altering narrative selfhood, which has yet to be explicitly studied. The present study investigates retrospective reports (n = 418) of changes to narrative self that participants believe resulted from, or were catalysed by, their psychedelic experience(s). Responses to open-ended questions were analysed using inductive and deductive thematic coding and interpreted within agent-centred approaches to development and well-being. Themes include decentred introspection, greater access to self-knowledge, positive shifts in self-evaluation (...) processes, greater psychological and behavioural autonomy, and enhanced connectedness with others and the world. While this explorative qualitative study offers some initial support for the explanation that changes to narrative self are a cornerstone of psychedelics' therapeutic and transformative potential, methodological and recruiting limitations preclude the ability to make objective claims and generalizations. Future scientific research is necessary to further elucidate this hypothesized mechanism. (shrink)

Dennett’s story “Where am I?” is used to set up the difficulty of locating the self in the natural world. The story is told from a first-person point of view in which the narrator maintains his identity across exchanges of brain and body, but there is no physical thing in the story that can act as bearer of his identity. The story seems to present a dilemma between Cartesian dualism and Dennett’s a “no-self” view. This chapter argues for a third (...) option. Prepersonal processes in the brain stabilize separable conceptions of self and world out of patterns in sensory information. The conception of self starts out as a mere sensorimotor point of view but gradually develops into something richer. Seeing how the first-person point of view arises is seeing how the self arises, because the self is nothing but the proper subject of a first-person point of view. (shrink)

Gilles de la Tourette syndrome (TS) is a childhood neuropsychiatric disorder characterised by the presence of motor and vocal tics. Patients with malignant TS experience severe disease sequelae; risking morbidity and mortality due to tics, self-harm, psychiatric comorbidities and suicide. By definition, those cases termed ‘malignant’ are refractory to all conventional psychiatric and pharmacological regimens. In these instances, deep brain stimulation (DBS) may be efficacious. Current 2015 guidelines recommend a 6-month period absent of suicidal ideation before DBS is offered to (...) patients with TS. We therefore wondered whether it may be ethically justifiable to offer DBS to a minor with malignant TS. We begin with a discussion of non-maleficence and beneficence. New evidence suggests that suicide risk in young patients with TS has been underestimated. In turn, DBS may represent an invaluable opportunity for children with malignant TS to secure future safety, independence and fulfilment. Postponing treatment is associated with additional risks. Ultimately, we assert this unique risk-benefit calculus justifies offering DBS to paediatric patients with malignant TS. A multidisciplinary team of clinicians must determine whether DBS is in the best interest of their individual patients. We conclude with a suggestion for future TS-DBS guidelines regarding suicidal ideation. The importance of informed consent and assent is underscored. (shrink)

The observations which are compatible with temporal origins of the earth, the solar system and the universe are briefly mentioned, prior to examining the assumptions implicit in the hypothesis of temporal origin which the observations were designed to test. No decisive observation enables us to distinguish between theories of a temporal origin of the universe and the theories of infinite time (continuous creation); the aspects of the galaxies offer no test of either theory without invoking additional assumptions. Curvature of time (...) is rejected as being a complication at present scientifically unnecessary, as is also the hypothesis of continuous creation. The view maintained is that the temporal theory based on linear extrapolation is acceptable until it be disproved. Various new techniques which may be useful in attempting to refute this theory are discussed. (shrink)

The intuitive difference between a system that choreographs the motion of its parts in the service of goals of its own formulation and a system composed of a collection of parts doing their own thing without coordination has been shaken by now familiar examples of self-organization. There is a broad and growing presumption in parts of philosophy and across the sciences that the appearance of centralized information-processing and control in the service of system-wide goals is mere appearance, i.e., an explanatory (...) heuristic we have evolved to predict behavior, but one that will eventually get swept away in the advancing tide of self-organization. I argue that there is a distinction of central importance here, and that no adequate science of complex systems can dispense with it. (shrink)