A fine balance: disability, discrimination and public safety

The Conversation, online 17 April 2014
Author: Malcolm Parker
“A recent discrimination case has highlighted the difficulty of balancing the rights of disabled medical students with the rights of the community to safe medical and health care. In the BKY v The University of Newcastle, a New South Wales tribunal found the university had discriminated against a medical student by refusing her an extension to complete the five-year medical course beyond the usual maximum of eight years.”
Find article here.

Leave prescribing to doctors and nurse practitioners

The Conversation, online 16 April 2014
Author: Rhian Parker
“We started the week with a new proposal by the Grattan Institute to shake up the hospital workforce and allow nurses to take on more roles traditionally performed by doctors. But should registered nurses’ roles extend even further, to prescribing medication? …Australia already has a category of nurse specialists who can prescribe some medicines – nurse practitioners.”
Find article here.

Forced to be free? Increasing patient autonomy by constraining it

J Med Ethics 2014;40:293-300
Author: Neil Levy
“It is universally accepted in bioethics that doctors and other medical professionals have an obligation to procure the informed consent of their patients. Informed consent is required because patients have the moral right to autonomy in furthering the pursuit of their most important goals. In the present work, it is argued that evidence from psychology shows that human beings are subject to a number of biases and limitations as reasoners, which can be expected to lower the quality of their decisions and which therefore make it more difficult for them to pursue their most important goals by giving informed consent. It is further argued that patient autonomy is best promoted by constraining the informed consent procedure.”
Find article and related commentary here.

Physicians’ practices when frustrating patients’ needs: a comparative study of restrictiveness in offering abortion and sedation therapy

J Med Ethics 2014;40:306-309 doi:10.1136/medethics-2012-101194
Author: Niels Lynøe
“In this paper it is argued that physicians’ restrictive attitudes in offering abortions during 1946–1965 in Sweden were due to their private values. The values, however, were rarely presented openly. Instead physicians’ values influenced their assessment of the facts presented—that is, the women’s’ trustworthiness. In this manner the physicians were able to conceal their private values and impede the women from getting what they wanted and needed. The practice was concealed from both patients and physicians and never publicly discussed. It is also argued that a similar tacit practice could currently be applied by palliative care physicians.”
Find abstract here.

‘Doctor, what would you do in my position?’ Health professionals and the decision-making process in pregnancy monitoring

J Med Ethics 2014;40:310-314 doi:10.1136/medethics-2012-100887
Author: Solène Gouilhers Hertig, Samuele Cavalli, Claudine Burton-Jeangros, Bernice S Elger
Objective Routine prenatal screening for Down syndrome challenges professional non-directiveness and patient autonomy in daily clinical practices. This paper aims to describe how professionals negotiate their role when a pregnant woman asks them to become involved in the decision-making process implied by screening.”
Find abstract here.

Family presence during cardiopulmonary resuscitation: who should decide?

J Med Ethics 2014;40:315-319 doi:10.1136/medethics-2012-100715
Author: Zohar Lederman, Mirko Garasic, Michelle Piperberg
“Whether to allow the presence of family members during cardiopulmonary resuscitation (CPR) has been a highly contentious topic in recent years. Even though a great deal of evidence and professional guidelines support the option of family presence during resuscitation (FPDR), many healthcare professionals still oppose it. One of the main arguments espoused by the latter is that family members should not be allowed for the sake of the patient’s best interests, whether it is to increase his chances of survival, respect his privacy or leave his family with a last positive impression of him. In this paper, we examine the issue of FPDR from the patient’s point of view.”
Find abstract here.

Against autonomy: justifying coercive paternalism

J Med Ethics 2014;40:349 doi:10.1136/medethics-2013-101444
Author: Sarah Conly
“Too often, we as individuals do things that harm us, that seriously interfere with our being able to live in the way that we want. We eat food that makes us obese, that promotes diabetes, heart failure and other serious illness, while at the same time, we want to live long and healthy lives. Too many of us smoke cigarettes, even while acknowledging we wish we had never begun. We behave in ways that undercut our ability to reach some of our most valued goals, despite education and despite incentives to choose the right thing. What should be done?”
Find precis and related commentaries here.

The NDIS must bring disruptive change without doing harm: mental health leader

Croakey, the Crikey Health Blog, 15 April 2014
Authors: Melissa Sweet/Frank Quinlan
“Those responsible for implementing the NDIS should keep in mind the advice of a certain Roman emperor – “to make haste slowly”, says Frank Quinlan, the CEO of the Mental Health Council of Australia.”
Find article here.

How do we decide the value of death (and life)?

The Conversation, online 3 April 2014
Author: Peter Saul
“Allowing people with incurable and unsupportable illness to die is ethically acceptable to most people, even though it’s unlikely there will ever be unanimity about when and how we allow such deaths. But as we move into an era of treating chronically ill people with technology that tempts us to try achieve the hopeless, it’s more important than ever that we talk about what kind of death (and life) is acceptable to us – and why.”
Find article here.

Médecins Sans Frontières releases case studies that reveal the organisation’s internal struggle to position itself in the face of the Rwandan genocide

MSF, online 02.04.14
“Twenty years after the Rwandan Genocide, Médecins Sans Frontières is publishing for the first time its Speaking Out Case Studies via the website speakingout.msf.org. The first case study: Genocide of Rwandan Tutsis 1994 depicts the Médecins Sans Frontières reaction when confronted with systematic extermination of Rwandan Tutsis between April and July 1994. It is estimated that 800,000 people lost their lives in 100 days. The slow reaction from the UN Security Council to categorise the massacre “genocide” resulted in a 10 week delay of intervention as hundreds of thousands of Rwandans lost their lives.  “The case study reveals publicly what were the constraints, dilemmas and internal questioning for Médecins Sans Frontières’ field and headquarter teams during one of the most agonizing moments in Médecins Sans Frontières history of medical-humanitarian work,” said Dr Joanne Liu, Médecins Sans Frontières International President, “it describes the attempts to respond by reacting to the situation publicly.””
Find release and case studies here.