Addressing Incidental Findings in Neuroimaging Studies: Never Easy, Rarely Rescue

Population-wide neuroimaging studies reveal brain lesions in approximately 3% of putatively healthy research participants. It is unclear how researchers ought to address this problem and whether they should seek out incidental findings. Koplin and colleagues argue that researchers have a duty of easy rescue and therefore a duty to look for and disclose potentially serious incidental findings to research participants in neuroimaging studies. In this article, I argue that the duty of easy rescue is an inappropriate approach to this ethical problem. The duty of easy rescue paradigmatically applies to cases in which the intervention is (1) minimally burdensome to the rescuer, (2) virtually certain to minimally burden the individual in danger, and (3) virtually certain to confer benefit to the individual in danger. By contrast, looking for and disclosing potentially serious incidental findings is (1) often burdensome to researchers, (2) poses the risk of burdening research participants with false positive findings, and (3) even when a potentially serious incidental finding is found, disclosed, and medically managed, doing so may not confer benefit to the research participant. The duty of easy rescue is not a useful tool for navigating the ethical problems raised by incidental findings in population-wide neuroimaging research.