If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)

To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the (...) guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process. (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)

Les décisions politiques sur les risques environnementaux complexes font fréquemment intervenir des éléments scientifiques contestés. Il n’y a généralement pas de « faits » qui conduisent à une politique correcte unique. Les éléments de preuve qui sont intégrés dans les avis scientifiques destinés à une décision politique nécessitent une évaluation de leur qualité. En 2003, l’Agence néerlandaise d’évaluation environnementale a adopté une méthode standardisée, désignée sous le nom de « guide », dans le cadre de laquelle les principaux aspects de (...) la production et de l’utilisation des connaissances sont présentés grâce à une liste de contrôle visant à l’évaluation et à la communication des incertitudes. Dans cet article, nous présentons des résultats de l’application de ce guide à la controverse sur les risques des particules en suspension. La délibération active sur l’incertitude dans un contexte d’expertise entraîne un processus d’apprentissage commun entre les experts et les décideurs politiques, ce qui conduit à une meilleure prise de conscience du phénomène d’incertitude et de ses implications politiques.Policy decisions on complex environmental risks often involve disputed science. Typically, there are no “ facts” to support a single unequivocally correct policy. The evidence provided in scientific studies for policy-making decisions requires high-quality assessment. In 2003, the Netherlands Environmental Assessment Agency adopted a standardized method, referred to as “guidelines”, whereby key quality aspects of knowledge production and use are presented in the form of a checklist for uncertainty assessments and communication. In this article, we present the outcomes of applying the guidelines in controversies on the risks of ambient particulate matter. In the policy–advisory context, active deliberation on uncertainty produces a common learning process for advisors and policy makers, which leads to a deeper understanding and increased awareness of the phenomenon of uncertainty and its policy implications. (shrink)

The philosophical papers comprising this volume range from process metaphysics and theology, through the phenomenological study of intentionality, to the foundations of geometry and of the system of real numbers. New light, it is thought, is shed on all these topics, some of them being of the highest interest and under intensive investigation in contemporary philosophical discussion. Metaphysi cians, process theologians, semanticists, theorists of knowledge, phenomenologists, and philosophers of mathematics will thus find in this book, it is hoped, helpful materials (...) and methods. The categoreal scheme of Whitehead's Process and Reality is discussed rather fully from a logical point of view in the first paper [I] in the light of the author's previous work on the logico-metaphysical theory of events. The clarification that results is thought to provide a new depth and precision to the problem of interpreting one of the most difficult books in the recent history of metaphysics and cosmol ogy. A detailed examination of some aspects of Hartshorne's recent Creative Synthesis and Philosophic Method is given in II. This book is perhaps the most significant work on process philosophy since Process and Reality itself, and its logical underpinnings thus merit a full critical discussion. (shrink)

Efforts to include women in the canon have long been beset by reactionary gatekeeping, typified by the charge “That's not philosophy.” That charge doesn't apply to early and mid‐analytic female philosophers—Welby, Ladd‐Franklin, Bryant, Jones, de Laguna, Stebbing, Ambrose, MacDonald—with job titles like lecturer in logic and professor of philosophy and publications in Mind, the Journal of Philosophy, and Proceedings of the Aristotelian Society. It's hopeless to dismiss their work as “not philosophy.” But comparable reactionary gatekeeping affects them, this paper argues, (...) typified by the labels “bad philosophy” and “derivative philosophy.” Virtue and vice epistemology help explain why these women have been neglected and why their own approaches are epistemically virtuous. Their contemporaries and historians are deficient in scholarly virtues in labelling these women's work “bad” or derived from male mentors with no or specious justification. Their disparaged qualities—intellectual humility, modesty, critical self‐reflection, disclosing biases—are often epistemic virtues. (shrink)

We argue that thoughts are structures of concepts, and that concepts should be individuated by their origins, rather than in terms of their semantic or epistemic properties. Many features of cognition turn on the vehicles of content, thoughts, rather than on the nature of the contents they express. Originalism makes concepts available to explain, with no threat of circularity, puzzling cases concerning thought. In this paper, we mention Hesperus/Phosphorus puzzles, the Evans-Perry example of the ship seen through different windows, and (...) Mates cases, and we believe that there are many additional applications. (shrink)

Are fictional characters such as Sherlock Holmes real? What can fiction tell us about the nature of truth and reality? In this excellent introduction to the problem of fictionalism R. M. Sainsbury covers the following key topics: what is fiction? realism about fictional objects, including the arguments that fictional objects are real but non-existent; real but non-factual; real but non-concrete the relationship between fictional characters and non-actual worlds fictional entities as abstract artefacts fiction and intentionality and the problem of irrealism (...) fictionalism about possible worlds moral fictionalism. R. M. Sainsbury makes extensive use of examples from fiction, such as Sherlock Holmes, Anna Karenina and Madame Bovary and examines the work of philosophers who have made significant contributions to the topic, including Meinong, David Lewis, and Bas Van Fraassen. Additional features include chapter summaries, annotated further reading and a glossary of technical terms, making _Fiction and Fictionalism_ ideal for those coming to the issue for the first time. (shrink)

Broad genome-wide testing is increasingly finding its way to the public through the online direct-to-consumer marketing of so-called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision-making with regard to the testing offer, we argue that current (...) practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)

Broad genome‐wide testing is increasingly finding its way to the public through the online direct‐to‐consumer marketing of so‐called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision‐making with regard to the testing offer, we argue that current (...) practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)

Scholars of Plato are divided between those who emphasize the literature of the dialogues and those who emphasize the argument of the dialogues, and between those who see a development in the thought of the dialogues and those who do not. In this important book Russell Dancy focuses on the arguments and defends a developmental picture. He explains the Theory of Forms of the Phaedo and Symposium as an outgrowth of the quest for definitions canvassed in the Socratic dialogues, by (...) constructing a Theory of Definition for the Socratic dialogues based on the refutations of definitions in those dialogues, and showing how that theory is mirrored in the Theory of Forms. His discussion, notable for both its clarity and its meticulous scholarship, ranges in detail over a number of Plato's early and middle dialogues, and will be of interest to readers in Plato studies and in ancient philosophy more generally. (shrink)

The problem of simultaneous measurement of incompatible observables in quantum mechanics is studied on the one hand from the viewpoint of an axiomatic treatment of quantum mechanics and on the other hand starting from a theory of measurement. It is argued that it is precisely such a theory of measurement that should provide a meaning to the axiomatically introduced concepts, especially to the concept of observable. Defining an observable as a class of measurement procedures yielding a certain prescribed result for (...) the probability distribution of the set of values of some quantity (to be described by the set of eigenvalues of some Hermitian operator), this notion is extended to joint probability distributions of incompatible observables. It is shown that such an extension is possible on the basis of a theory of measurement, under the proviso that in simultaneously measuring such observables there is a disturbance of the measurement results of the one observable, caused by the presence of the measuring instrument of the other observable. This has as a consequence that the joint probability distribution cannot obey the marginal distribution laws usually imposed. This result is of great importance in exposing quantum mechanics as an axiomatized theory, since overlooking it seems to prohibit an axiomatic description of simultaneous measurement of incompatible observables by quantum mechanics. (shrink)

This book is divided into three parts: in Part I, R. M. Hare offers a justification for the use of philosophy of language in the treatment of moral questions, together with an overview of his moral philosophy of ‘universal prescriptivism’. The second part, and the core of the book, consists of five chapters originally presented as a lecture series under the title ‘A Taxonomy of Ethical Theories’. Hare identifies descriptivism and non‐descriptivism as the two main positions in modern moral philosophy. (...) The former he divides into Naturalism and Intuitionism, and the latter into Emotivism and Rationalism. Hare argues that all forms of descriptivism tend to lead to Relativism because the truth conditions of moral statements are culturally variant. Of the positions discussed, only Hare's own position, a form of Rationalism, which he calls Universal Prescriptivism, meets all of the requirements that an adequate ethical theory should meet. Part III consists of Hare's previously published essay ‘Could Kant have been a Utilitarian?’ (Utilitas 5, 1993). Here, Hare puts forward the controversial thesis that Kant's moral philosophy is, in its basic principles, compatible with utilitarianism. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

I had a strange dream, or half-waking vision, not long ago. I found myself at the top of a mountain in the mist, feeling very pleased with myself, not just for having climbed the mountain, but for having achieved my life's ambition, to find a way of answering moral questions rationally. But as I was preening myself on this achievement, the mist began to clear, and I saw that I was surrounded on the mountain top by the graves of all (...) those other philosophers, great and small, who had had the same ambition, and thought they had achieved it. And I have come to see, reflecting on my dream, that, ever since, the hard-working philosophical worms have been nibbling away at their systems and showing that the achievement was an illusion. True, their skeletons, indigestible to worms, remained, and were surprisingly similar to one another. But I was led to think again about what one can, and what one cannot, achieve in this direction. (shrink)