Embracing the new professionalism: self-regulation, mandatory reporting and their discontents

In response to perceived failures in medical self-regulation in Australia, first in two States (for doctors) and now under the National Registration and Accreditation Scheme (for all health practitioners), mandatory reporting of peer status or practice that poses risks to patients has been introduced. Yet now, in response to the lobbying of State and federal health ministers by the medical profession, mainly in relation to the impairment provisions, this is to be reviewed. This column argues that claims concerning the negative consequences for practitioners of mandatory reporting are illogical and lack supporting evidence. There is, however, evidence that the medical profession does not consistently act in accordance with its professed positions in the area of physician impairment and departure from accepted clinical standards. The call for a review of mandatory reporting reflects an outdated model of regulation that does not align with increasing calls for a "new professionalism". In its own interests, but primarily in the interests of patients, the medical profession should embrace new attitudes and practices that will at first appear to threaten the privilege of self-regulation, but on proper scrutiny will be seen as necessary to retain it.     

Cosmetic surgery in Australia: a risky business?

Cosmetic surgery is increasing in popularity in Australia and New Zealand, as it is across other Western countries. However, there is no systematic mechanism for gathering data about cosmetic surgery, nor about the outcomes of that surgery. This column argues that the business of cosmetic surgery in Australia has questionable marketing standards, is conducted with little scrutiny or accountability and offers patients imperfect knowledge about cosmetic procedures. It also argues that while medical practitioners debate among themselves over who should carry out cosmetic procedures, little attention has been paid to questionable advertising in the industry and even less to highlighting the real risks of undergoing cosmetic surgery. While consumers are led to believe that cosmetic surgery is accessible, affordable and safe, they are sheltered from the reality of invasive and risky surgery and from the ability to clearly discern that all cosmetic procedures carry risk. While doctors continue to undertake advertising and engage in a territorial war, they fail to address the really important issues in cosmetic surgery. These are: providing real evidence about what happens in the industry, developing stringent regulations under which the industry should operate and ensuring that all patients considering cosmetic surgery are fully informed as to the risks of that surgery.     

Financial Intelligence: A Price Worth Paying?

The harvesting of financial intelligence by law enforcement and intelligence services through various forms of surveillance is now so prevalent that it has become a core feature of contemporary security practice. Not surprisingly, concerns have been raised regarding the intrusive nature of financial intelligence collection and the emerging challenges posed to liberty. This article, whilst written primarily from a UK perspective, considers the trade-offs that inevitably emerge when liberty and security collide. Above all it argues that such measures are a necessary consequence of a changing security environment and that effective counter measures inevitably come at a price. The value added from data surveillance by the state, when lawfully sanctioned, audited and regulated are in the interests of public safety and national security, deemed a price worth paying.     

Sovereignty and Human Rights: Re-examining Carter’s Foreign Policy Towards the Third World

This analysis examines the evolution of Jimmy Carter’s human rights policy towards the Third World during the course of his Administration. By exploring the impact of the Soviet invasion of Afghanistan and the Soviet-backed Vietnamese invasion of Cambodia, it analyses how Carter responded to international outcry by pairing sovereignty as a human right, which specifically appealed to the concerns of newly independent nations in the late 1970s. Carter’s shift is explained first by a brief outline of his initial human rights policy and stumbling blocks; second, by examining Third World responses to the dual invasions; and, finally, exploring how this affected Carter’s human rights policy. It moves beyond claims that Carter abandoned his human rights agenda as he encountered an increasingly volatile international environment, instead examining the very real ways that he re-imagined this policy in the face of a changing global landscape.     

Effects of advanced age and dementia on restoration of competence to stand trial

Elderly defendants (age 65+) and defendants with dementia adjudicated incompetent to stand trial and hospitalized for restoration to competence (RTC) often present unique challenges to clinicians charged with their restoration. In this study, we attempted to better identify predictors of successful RTC by building upon previous research correlating increased age with decreased likelihood of RTC. We identified elderly non-demented defendants (n = 31) and defendants diagnosed with dementia (n = 47) from a state database of 1380 individuals hospitalized for competence restoration from 1988–2004. Using regression analysis and correcting for demographic variables and common admission psychiatric diagnoses, we studied the relationship of age at hospital admission and dementia diagnosis on the likelihood of successful RTC. Both advanced age and dementia diagnosis were associated with decreased RTC. After correcting for dementia diagnosis, increased age retained its negative correlation with restoration success. Both elderly non-demented defendants and defendants diagnosed with dementia were significantly less likely to be restored to competence than all other RTC admissions (n = 1302). However, a substantial percentage of both demented and elderly non-demented defendants were successfully restored to competence, potentially justifying restoration attempts for both of these groups of defendants.     

Patient competence and professional incompetence: disagreements in capacity assessments in one Australian jurisdiction, and their educational implications

The determination of capacity to make medical, personal and financial decisions has significant individual and social implications. Medical and other health professionals are traditionally relied on by courts and tribunals to provide clinical and psychometric evidence of the presence or absence of capacity, or competence. Concern has long been expressed over the variability of these assessments. A survey of 285 decisions of the Queensland Guardianship and Assessment Tribunal (GAAT) between 2005 and 2008 was conducted to estimate the incidence of disagreement between health professionals in capacity assessments; to provide examples of conflicting assessments and models of assessment used; and to consider the educational implications of disagreements. While the final capacity determinations by the GAAT appear sound, this case series, and other studies in the capacity literature, strongly suggest the need to improve the education of health professionals, especially doctors, at undergraduate and postgraduate levels, in the practical assessment of capacity as a fundamental clinical skill.     

‘We who strive for the foundation of a principle’: feminism and suffrage in the biography of Bessie Parkes Belloc

ABSTRACT

Bessie Rayner Parkes (later Belloc, 1829–1925) was a central figure in British women’s rights activism during the 1850s and 1860s. She was founding editor of the feminist English Woman’s Journal and one of the organisers of the pioneering 1866 petition for women’s suffrage. She lived long enough to witness some women gaining the vote in 1918, by which time her children, Marie Belloc Lowndes and Hilaire Belloc, were themselves public figures who had taken up opposing positions on women’s suffrage. This article takes as its starting point 1866, a pivotal moment in nineteenth-century agitation for women’s suffrage and in Parkes Belloc’s individual biography, before moving to a longer view of her feminist life before and after this date. It demonstrates the value of a biographical approach to exploring the diversity of perspectives and experiences of women within first-wave feminism and the suffrage movement.     

The Mutual Obligation Policy in Australia: The rhetoric and reasoning of recent social security policy

Since 1997, the Australian Federal Liberal Government has introduced policies which have sought to reduce rates of unemployment, particularly long-term unemployment. The policy, known as Mutual Obligation, increased the expectations on unemployed people in return for their social security payment. At the same time, previous labour market programmes and government assistance schemes were scrapped or privatised. This article explores the justification of the term 'Mutual Obligation' by examining both the language and the underlying principles of the policy. By defining the problem of unemployment in terms of flaws in the previous social security system, the stage is set for the government to introduce policies which remedy those flaws by emphasising self- reliance in favour of government assistance. Further, by invoking notions of fairness and mutuality, the article argues that the term 'Mutual Obligation' masks both the extent and the strength of the obligations imposed on unemployed people.