Teaching medical ethics and law

The teaching of medical ethics is not yet characterised by recognised, standard requirements for formal qualifications, training and experience; this is not surprising as the field is still relatively young and maturing. Under the broad issue of the requirements for teaching medical ethics are numerous more specific questions, one of which concerns whether medical ethics can be taught in isolation from considerations of the law, and vice versa. Ethics and law are cognate, though distinguishable, disciplines. In a practical, professional enterprise such as medicine, they cannot and should not be taught as separate subjects. One way of introducing students to the links and tensions between medical ethics and law is to consider the history of law via its natural and positive traditions. This encourages understanding of how medical practice is placed within the contexts of ethics and law in the pluralist societies in which most students will practise. Four examples of topics from medical ethics teaching are described to support this claim. Australasian medical ethics teachers have paid less attention to the role of law in their curricula than their United Kingdom counterparts. Questions like the one addressed here will help inform future deliberations concerning minimal requirements for teaching medical ethics.     

Explanations of a Violent Relationship: The Male Perpetrator’s Perspective

The purpose of this study was to understand the way male perpetrators’ perceive and explain intimate partner violence (IPV) in their relationship. Specifically, men were invited to reflect upon their role in their relationship when violence exists, their contributions to the violence, and how they felt about it. Using coding procedures from grounded theory methodology, researchers analyzed data from 13 men who had been in violent relationships. Seven key themes were identified from 104 significant statements. These themes included justification, relapse, control, anger, emotional threshold, triggers, and remorse. Clinical implications as well as suggestions for future research are presented.     

Front‐of‐Pack Food Labeling and the Politics of Nutritional Nudges

This article examines the potential for new front‐of‐pack (FOP) nutrition labeling initiatives to nudge consumers toward healthier food choices. The libertarian‐paternalist approach to policy known as nudge initially developed by Thaler and Sunstein is discussed, with its emphasis on designing spaces (including the space of the food label) to shape the behavior of individuals while not restricting consumer choice or imposing restrictions or penalties on producers. In the context of concerns over diet‐related chronic diseases and obesity, new FOP interpretive nutrition labels have been proposed or implemented in an attempt to shift consumer dietary choices, including the Multiple Traffic Light labeling system in the United Kingdom and the Health Star Rating system in Australia. We identify some of the characteristics, the underlying nutritional philosophies, and the limitations of these FOP labeling schemes. We suggest that the potential of these schemes is compromised by the coexistence on the food label of many other forms of nutrition information and food marketing. Some alternative ways of labeling and communicating the nutritional quality of foods are also discussed.     

Lessons from the New York Waterfront: Addressing the Risks of Drinking Water Contamination from Unregulated Contaminants

Perflourinated compounds, or PFCs, have been widely used in our industrialized society. Notably, they are used in the manufacture of non-stick coated bakeware and in firefighting foams designed to fight high heat fires. These unregulated chemicals have gotten into surface and groundwater sources of drinking water in locations around the United States and likely the world. Data shows widespread release, particularly near airports and air bases and near industrial production sites.

PFCs cause many health related impacts. Human exposure pathways include perinatal transfer, consuming contaminated water, and consuming contaminated fish. Clean Water Act permitting programs can address their release into waterways. Contaminated site clean-up laws can also be used to remove the source contamination. Granular activated carbon technology can remove most forms of the chemicals from drinking water. The case study of drinking water contamination in Newburgh, New York illustrates the PFC challenge, public reaction, and government response.     

The "other diseases" of the Millennium Development Goals: rhetoric and reality of free drug distribution to cure the poor's parasites

The sixth MDG aims 'to combat HIV/AIDS, TB, malaria and other diseases'. The residual category of 'other diseases' has become the focus of intense interest, partly because it has provided an opportunity to increase resources for the control of the mostly parasitic 'neglected tropical diseases' (NTDs). Intense lobbying has secured large amounts of funding from donors, as well as generous donations of medicines from the major drug companies. A massive programme is now underway to treat the parasites of the poor in Africa via integrated vertical interventions of mass drug administration in endemic areas. The approach has been hailed as remarkably effective, with claims that there is now a real prospect of complete control and, for some NTDs, even elimination. However, a closer look at evaluation and research data reveals that much less is known about what is being achieved than is suggested. Competition between implementing organisations is leading to potentially counterproductive exaggerations about treatment coverage. Detailed local-level research in Uganda and Tanzania shows that actual rates of drug take-up among target populations are often lower than is necessary to effectively control the diseases, and that methods of drug distribution may even lead to active resistance to treatment. If current trends are not corrected, declining rates of NTD infection will not be sustained. Much more rigorous and effective monitoring is essential.     

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.     

EARLY INTERVENTION IN NEW ZEALAND FAMILY COURT CASES

In April 2010 the New Zealand Family Court introduced the National Early Intervention Process (NEIP) to diversify its previous unitary dispute resolution pathway into two tracks (standard and urgent). A “triage” model is now in use to assess and assign cases appropriately. This article outlines the key milestones in the Family Court's 30‐year history which have led to this new initiative to reduce delays and help avoid the escalation of family conflicts over the care of children into bitter and intractable disputes. NEIP represents the most overarching reform of the Family Court since the Court's inception in 1981.     

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.     

Public administration reform and the “new managerialism”: a comparative assessment of a fundamental challenge confronting canadian public administration

The “new managerialism” is becoming the new ortodoxy in public administration. It has challenged the classic assumptions about the nature of bureaucracy in democratic countries. However, it has not implied a great deal of serious debate. In Canada, it is challenging the model of constitutional bureaucracy around which public administration has been organized. Such a model involves two main principles: the ministerial Department and a neutral career public service. The former has meant that power flow in downward and responsibility and accountability upward (to the elected state authorities). The latter that, among other things, officials enjoy security of tenure in exchange for their willingness to serve governments of all partisan affiliations with equal loyalty and effectiveness. The new managerialism challenges both principles since it proposes to diffuse authority both horizontally and vertically, make accountabi1;ty run downward to “clients” and be more capable to substitute personell according to the needs of the moment. Since the new managerialism involves serious risks, the author ends up asking whether these two contending paradigms can or should be reconcilied, and warning not to overlook the past histories of Canadian and Western administrative and political institutions.