The Max Charlesworth prize in bioethics
Isn’t it a woman’s prerogative to change her mind? The ethical issues of requesting medical intervention in labour for which consent had previously been declined.
The management of pain in labour consists of a spectrum from non invasive, non pharmacological treatments (aromatherapy, warm water immersion, massage), through to pharmacological treatments (opioids, inhaled nitrous oxide) and finally to invasive pharmacological methods (epidural analgesia with the administration of local anaesthetic agents into the epidural space near the spinal nerve roots). While largely safe, epidural analgesia is not without risks, in some cases significant risks, albeit with very infrequent incidence. Insertion of an epidural for the relief of labour pain is therefore subject to the same clinical guidelines regarding informed consent as other medical interventions. This essay will look at the ethical issues and difficulties that clinicians face when patients change their mind having previously declined an intervention. I will start with a case description (based on a number of clinical experiences throughout my career as an anaesthetist) and then explore the ethical concepts of autonomy and the ability to give informed consent which are highlighted. I will argue that the patient was able to give informed consent to a decision regarding a medical procedure while in pain using a syllogism analysis. In terms of the question regarding respect for autonomy, I will argue that the patient made two autonomous decisions at different points in time and that, while contradictory, both autonomous decisions were respected at the times they were made. I will also briefly suggest how such a situation could be avoided to the benefit of both patient and clinician in the future.
In pursuit of our parenting ideals: A Kantian argument against genetic selection
No conference was held this year
Disclosure is inadequate as a solution to conflicts of interest in research
Disclosure is a common response to conflicts of interest; it is intended to expose the conflict to scrutiny and enable it to be appropriately managed. For disclosure to be effective the receiver of the disclosure needs to be able to use the information to assess how the conflict may impact on their interests, and then implement a suitable response. The act of disclosure is also intended to trigger some self-regulation, as the person with the conflicting interests will be mindful of their own potential biases and aware that their decisions may be monitored. In this presentation I will discuss some of the problems of relying on disclosure as a solution to address conflicts of interest in research. I will focus particularly on issues around the ability of research participants to manage the conflict of interest. I explore these issues in the context of the Dan Markingson case–a research participant who committed suicide during a clinical trial. I will conclude that disclosure is not sufficient to address the issue of conflicts of interest in research because: 1) participants are not well placed to accurately assess the potential impact the conflict may have on them; 2) self-management is unreliable; and 3) effective management is further compromised when individual conflicts are complementary to the associated institution’s conflicts.
No information available
The emergence and popularisation of autologous adult stem cell therapies in Australia: Therapeutic innovation or regulatory failure?
Ethical and practical issues in (un)veiling the diagnosis of dementia
Teaching medical ethics to meet the realities of a changing health care system
Personalised medicine in the age of neo-liberal health care
In recent years we have seen a shift in health care aims and goals along with a new approach to health care, an idea of personalised medicine. Personalised medicine flourishes in the current neo-liberal health care landscape, were the commercialization of the body, genetic knowledge and health has encouraged individual citizens to be active and autonomous agents in the pursuit of and maintenance of their state of good health. The argument is that these interacting social ideas about how one can best access, organize and receive health care have created both a commercial and social need for personalised medicine. In this paper I critique the emergence of personal medicine by examining the ways in which personalised medicine is already impacting upon health and health care delivery.
No information available
Health, law and ethics: when is consent bad practice?
The power of linked population data to deliver significant benefits for the community will be illustrated using the findings from a number of Western Australian research studies on children’s health outcomes. De-identified data, provided to researchers without an individual’s consent but in accordance with National Health and Medical Research Council (NHMRC) Guidelines approved under Section 95A of the Privacy Act 1988, enable the conduct of high quality research in the public interest, with negligible risk to the individual’s right to privacy.
Australia’s only large-scale linked data system for health research, the Western Australian Data Linkage System (WADLS), will be described. The WADLS uses innovative linkage procedures to ensure the de-identification and anonymous analysis of population data. The capacity of new technology and methods to conduct linkage as well as privacy legislation reduces the risk of identifying individuals or the misuse of information.
So why is this such an issue? There are areas of ignorance and misperception amongst the general public about why researchers and planners want to link and use data. Even in ethics committees there appears a lack of awareness about how important this activity is and why it can override privacy concerns. I will discuss the conundrum between the moral obligation to use record linked data on individuals for social good, compared with what people perceive as an invasion of their privacy.
The John McPhee prize in health, law and ethics
Patient Autonomy and Informed Consent in Birth Trauma Litigation
This paper will explore the contested doctrine of informed consent in the context of childbirth. It will be argued that despite there being risks associated with vaginal delivery, Australian negligence law and policy creates barriers for pregnant women to make informed choices about the mode of delivery and interventions such as forceps or vacuum, that may be used during delivery. Firstly, this paper will explore the history of the denial of reproductive choice across various jurisdictions including Australia. This will be followed by a discussion of the ordinary principles of informed consent and causation with the reference to the doctor-patient relationship more generally. Thirdly, this paper will address why childbirth is considered unique with regard to informed consent and choice. Part II of this paper will address a number of birth trauma cases across various Australian jurisdictions and the approaches taken by the courts in assessing informed consent in childbirth. This will be followed by a discussion of the United Kingdom (UK) decision in Montgomery v Lanarkshire Health Board,and whether Australia is likely to follow the court’s decision to impose a duty upon obstetricians to offer alternative methods of delivery to women.
 1 AC 1430 (‘Montgomery’).
The boundaries of embryo research: Extending the 14 day rule
The disciplines of ethics, science and the law often conflict when it comes to determining the limits and boundaries of embryo research. Under current Australian law and regulations, and in various other jurisdictions, research conducted on the embryo in vitro is permitted up until day 14, after which, the embryo must be destroyed. Reproductive technology and associated research is rapidly advancing at a rate that contests current societal and ethical limits surrounding the treatment of the embryo. This has brought about the question of the adequacy of the 14 day rule and whether it is necessary for it be reconsidered and reformed. This paper will highlight some of the tensions that exist in ethics, science and the law in relation to the extension of the rule. It will be concluded that any move to extend the rule must be accompanied by close consultation with the public as the ultimate stakeholders in how the future of reproductive technology is created, constructed and contested.
No conference was held this year
Decision-making capacity and unusual beliefs: Two contentious cases
Decision-making capacity is a vital concept in law, ethics, and clinical practice. Two legal cases where capacity literally had life and death significance are NHS Trust v Ms T  EWHC 1279 and Kings College Hospital v C  EWCOP 80. These cases share another feature: unusual beliefs.
This paper will critically assess the concept of capacity, particularly in relation to the unusual beliefs in these cases. Firstly, the interface between capacity and unusual beliefs will be examined. This will show that the ‘using and weighing of information’ is the pivotal element in assessment. Next, this paper will explore the relationship between capacity assessment and a decision’s ‘rationality’. Then, in light of these findings, the paper will appraise the judgments in NHS v T and Kings v C, and consider these judgments’ implications.
More broadly, this paper asks: Does capacity assessment examine only the decision-making process (as the law states), or is it also influenced by a decision’s rationality? If influenced by rationality, capacity assessment has the potential to become “a search and disable policy aimed at those who are differently orientated in the human life-world.” (Gillett, 2012, p. 233). In contentious cases like these, this potential deserves attention.
Reference: GILLETT, G. 2012. How do I learn to be me again? Autonomy, life skills, and identity. In: RADOILSKA, L. (ed.) Autonomy and Mental Disorder. New York: Oxford University Press.