Irrationality, evidence-based medicine and the standard of care

The determination of the legal standard of care in Australia for medical diagnosis and treatment has gone through three apparent phases in modern times: the Bolam era, the post-Rogers v Whitaker era, and the current Civil Liability Acts era. It is conventionally accepted that the two shifts linking these phases were a jettisoning of the Bolam principle in Rogers and a return to a modified Bolam principle in the Civil Liability legislation, with the post-Rogers interregnum being a time of a court-imposed standard. This story is somewhat inaccurate. The Bolam test relied more on practice accepted at the time as proper by a responsible body of medical opinion rather than the practice of a "responsible body of medical men". The ability of post-Rogers courts to override medical evidence was more a rhetorical power than an actual one. And the irrationality condition, which reserves the right to override medical opinion under the Civil Liability Acts, is more dependent on sound evidence than the terminology might suggest. It is not so much that the legal standard of care has changed in dramatic ways as that the content of competent professional opinion has evolved as medical research and practice have developed. There is greater continuity than is usually granted, throughout the three phases, of the standard's reliance on current best evidence and opinion. This is more easily seen with the advent of evidence-based medicine.     

Governing Genetic Databases: Challenges Facing Research Regulation and Practice

This paper reports on the initial findings of an interdisciplinary research project on the governance of human genetic databases in England and Wales. The number of biosample and information collections has expanded, yet considerable legal uncertainty surrounds their definition, collection, storage, management, and use which could inhibit research and clinical practice, while failing to protect the rights and interests of all stakeholders. We report some initial findings from the legal research and identify major challenges associated with defining 'genetic databases'. We identify a wide range of relevant instruments and regulatory actors, and suggest that none adequately addresses the challenges posed by contemporary research techniques or the'corporeal'and'informational'materials used in the genetic databases context. This preliminary analysis seriously questions the efficacy of the current regulatory framework and concludes that developing an appropriate governance framework for the creation, maintenance, and use of genetic databases requires the bringing together of legal analysis with good quality empirical evidence.     

Restorative Justice in Business Regulation? The Australian Competition and Consumer Commission's Use of Enforceable Undertakings

Enforceable undertakings are now used extensively by both the Australian Competition and Consumer Commission (ACCC) and other Australian regulators to formalise decisions to forego enforcement litigation on the basis that offenders will correct their misconduct and comply in the future. A 'fairness' critique warns that regulators might exert undue pressure in negotiating enforceable undertakings and that the terms agreed might be inappropriately broad and not legally authorised. A 'bias' critique argues that enforceable undertakings favour business above the public interest in taking tough court action against business offences. The article draws on empirical research into the ACCC's use of enforceable undertakings to show how they are used in practice, and argues that, if appropriately implemented, enforceable undertakings can be a valuable 'restorative justice' alternative to traditional regulatory enforcement action, simultaneously addressing both fairness and bias concerns.     

Geophysics and the search of freshwater bodies: A review

Geophysics may assist scent dogs and divers in the search of water bodies for human and animal remains, contraband, weapons and explosives by surveying large areas rapidly and identifying targets or environmental hazards. The most commonly applied methods are described and evaluated for forensic searches. Seismic reflection or refraction and CHIRPS are useful for deep, open water bodies and identifying large targets, yet limited in streams and ponds. The use of ground penetrating radar (GPR) on water (WPR) is of limited use in deep waters (over 20 m) but is advantageous in the search for non-metallic targets in small ditches and ponds. Large metal or metal-bearing targets can be successfully imaged in deep waters by using towfish magnetometers: in shallow waters such a towfish cannot be used, so a non-metalliferous boat can carry a terrestrial magnetometer. Each device has its uses, depending on the target and location: unknown target make-up (e.g. a homicide victim with or without a metal object) may be best located using a range of methods (the multi-proxy approach), depending on water depth. Geophysics may not definitively find the target, but can provide areas for elimination and detailed search by dogs and divers, saving time and effort.