As thousands of healthy research participants are being included in small and large imaging studies, it is essential that dilemmas raised by the detection of incidental findings are adequately handled. Current ethical guidance indicates that pathways for dealing with incidental findings should be in place, but does not specify what such pathways should look like. Building on an interview study of researchers’ practices and perspectives, we identified key considerations for the set-up of pathways for the detection, management and communication of (...) incidental findings in imaging research. We conducted an interview study with a purposive sample of researchers at research facilities across the Netherlands. Based on a qualitative analysis of these interviews and on existing guidelines found in the literature, we developed a prototype ethical framework, which was critically assessed and fine-tuned during a two-day international expert meeting with bioethicists and representatives from large population-based imaging studies from the United Kingdom, Germany, Sweden and Belgium. Practices and policies for the handling of incidental findings vary strongly across the Netherlands, ranging from no review of research scans and limited feedback to research participants, to routine review of scans and the arrangement of clinical follow-up. Respondents felt that researchers do not have a duty to actively look for incidental findings, but they do have a duty to act on findings, when detected. The principle of reciprocity featured prominently in our interviews and expert meeting. We present an ethical framework that may guide researchers and research ethics committees in the design and/or evaluation of appropriate pathways for the handling of incidental findings in imaging studies. The framework consists of seven steps: anticipation of findings, information provision and informed consent, scan acquisition, review of scans, consultation on detected abnormalities, communication of the finding, and further clinical management and follow-up of the research participant. Each of these steps represents a key decision to be made by researchers, which should be justified not only with reference to costs and/or logistical considerations, but also with reference to researchers’ moral obligations and the principle of reciprocity. (shrink)

This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants’ lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants’ narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts (...) on self and others. The paper shows: that the impact of incidental findings may be greater than participants at first let on; incidental findings can have significant effects on participants’ social environment; and participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants’ experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

Background: Although genetic research into Alzheimer disease (AD) is increasing, the ethical aspects of this kind of research and the differences between ethical issues related to genetic and non-genetic research into AD have not yet received much attention. Objectives: (1) To identify and compare the five ethical issues considered most important by surveyed expert panellists in non-genetic and genetic AD research and (2) to compare our empirical findings with ethical issues in genetic research in general as described in the literature. (...) Method: A modified Delphi study in two rounds Results: Genetic and non-genetic research into AD generated an approximately equal number of topics with a considerable overlap. Different priorities in the ethics of both types of research were found. Genetic research raised new topics such as “confidentiality of genetic information” and “implications of research for relatives” which changes the impact and application of existing ethical topics such as “informed consent” and is judged to have more impact on both individuals and society. A difference with the results of more theoretical approaches on ethical aspects related to AD research was also found. Conclusions: Different priorities are given to ethical issues in genetic and non-genetic research. These arise partly because genetic research causes unique and new questions, mostly related to the position of family members and the status of and access to genetic information. Differences found between the results of our empirical study and the more theoretical literature, suggest an additional value for empirical research in medical ethics. (shrink)

Introduction, W G Runciman Social Evolution in Primates: The Role of Ecological Factors and Male Behaviour, Carel P van Schaik Determinants of Group Size in Primates: A General Model, R I M Dunbar Function and Intention in the Calls of Non-Human Primates, Dorothy L Cheney & Robert M Seyfarth Why Culture is Common, but Cultural Evolution is Rare, Robert Boyd & Peter J Richerson An Evolutionary and Chronological Framework for Human Social Behaviour, Robert A Foley Friendship and the Banker?s Paradox: (...) Other Pathways to the Evolution of Adaptations for Altruism, John Tooby & Leda Cosmides The Early Prehistory of Human Social Behaviour: Issues of Archaeological Inference and Cognitive Evolution, Steven Mithen The Emergence of Biologically Modern Populations in Europe: A Social and Cognitive ?Revolution??, Paul Mellars Responses to Environmental Novelty: Changes in Men?s Marriage Strategies in a Rural Kenyan Community, Monique Borgerhoff Mulder Genetic Language Impairment: Unruly Grammars, M Gopnik, J Dalalakis, S E Fukuda, S Fukuda & E Kehayia The Emergence of Cultures among Wild Chimpanzees, Christophe Boesch Terrestriality, Bipedalism and the Origin of Language, Leslie C Aiello Conclusions, John Maynard Smith. (shrink)

When Moschion orders Daos up to him for punishment, Daos points to the spot by Moschion's had indicated , but then darts fearfully away. I wish I could name the originator of this attractive part-division, which makes the use of more precise; but in seminars the correct assignment of ideas is often very difficult.

"I'll furnish the war": the making of a media myth -- Fright beyond measure? the myth of the war of the worlds -- Murrow vs. McCarthy: timing makes the myth -- The Bay of Pigs/New York Times suppression myth -- Debunking the "Cronkite moment" -- The nuanced myth: bra burning at Atlantic City -- It's all about the media: Watergate's heroic-journalist myth -- The "fantasy panic": the news media and the crack-baby myth -- "She was fighting to the death": mythmaking (...) in Iraq -- Hurricane Katrina and the myth of superlative reporting -- Conclusion. (shrink)

In a note on Aesch. Ag. 1243 f. in C.R. lxxv 187-8, I had occasion to cite a number of examples of adverbial transference. Whether they were or were not adequate to establish the point I was seeking to make I leave to the judgement of others, but the idiom possesses interest of its own, and it seems worth while to quote some further instances of it that I have noted since my article appeared. I will divide them according as (...) they occur with verbs of hearing or with other verbs. (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)

Modern knowledge of servo systems and computing machines makes it possible to specify a circuit that can and will induce the rules and winning moves in a game like chess when they are given only ostensibly, that is, by playing against opponents who quit when illegal or losing moves are made. Such circuits enjoy a value social in the sense that it is shared by the players.La connaissance moderne des servomécanismes et des machines à calculer permet de concevoir un circuit (...) qui pourra suivre des règles et décider les coups décisifs dans un jeu comme le jeu d'échecs tout au moins quand les coups sont joués de faÇon apparente, c'est-à-dire contre des adversaires qui abandonneront dans le cas de coups irréguliers ou de coups absurdes.De tels circuits possèdent une „valeur” sociale dans la mesure où elle est partagée par les autres joueurs.Moderne Kenntnissen im Gebiete von Folgegeraeten und Rechenmaschinen ermoeglichen es einen elektrischen Kreis aufzuwerfen, der die Regeln und gewinnbringende Zuege eines Spieles wie Schach induktiv erfassen kann und wird, wenn diese Regeln und Zuege nur ostensiv gegeben sind; d.h. indem mit Gegnern gespielt wird, die das Spiel einstellen sobald regelwidrige oder verlustbringende Zuege gemacht werden. Solche Kreise schaffen demnach einen Wert, der gesellschaftlich in dem Sinn ist, dass er auch von den Mitspielern geteilt wird. (shrink)