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MEDICINE AND MEDICAL LAW
FOR DEBATERS
Richard [email protected]
You may contact me by email anytime if you want
to talk about medicine or medical law
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Your license to use this work
This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 Australia License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/au/ or send a letter to Creative Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.
Portions of this lecture are taken from Wikipedia.
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Frequent medical/medicolegal debating topics
Abortion Blood transfusion to Jehovah’s
Witnesses Child abuse Child sexuality Circumcision Cloning Confidentiality of medical records Consent to medical therapy Consent to sexual intercourse Euthanasia Forced sterilisation of intellectually
disabled people Genetic engineering Heroin injecting rooms Indigenous health Infectious disease control among
immigrants
Mandatory reporting of child abuse/pregnancy
Medical marijuana Medical negligence litigation Mental illness Paedophilia Partial-birth abortion Pharmaceutical patents Pregnant children Sadomasochism Surrogacy Taking patients off life support Unconscious patients who cannot give
consent Vaccination
etc.
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There are 3 topics in this presentation
Abortion Child abuse Consent to medical therapy
I don’t have time to cover the other topicsduring this presentation
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For each topic, we have 3 tasks
Let’s learn the terminology Let’s learn the status quo Let’s learn about proposals to change
the status quo
Some of the information in this presentation has been simplified for easy debating usage, and none of it is intended to be a definitive treatment of the topic.
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Abortion
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Abortion terminology
A substance that induces miscarriage
Abortifacient
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Abortion terminology
The age of the embryo or fetus Time since the last normal menstrual period
Normal human gestation = 40 weeks
First trimester = 0 to 12 weeks
Second trimester = 13 to 28 weeks
Third trimester = 29 weeks+
Gestational age
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Abortion terminology
Conceptus = Embryo or fetus Embryo = up to 8 weeks gestation Fetus = beyond 8 weeks gestation Late-term abortion = definition varies Viability = approximately 24 weeks
Gestational age
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Abortion terminologyGestational age at termination
United Kingdom
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Abortion terminology
An abortion that is intended to: Save the life of the mother Preserve the mother’s physical or
mental health Prevent a child being born with a fatal or
serious congenital disorder Selectively reduce multiple pregnancy
Therapeutic abortion
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Abortion terminology
An abortion that is intended to: Delay or prevent childbearing Prevent disruption of education or work Prevent financial or relationship
pressure Account for the mother’s immaturity or
disability
Elective abortion
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Abortion terminology
Surgical/suction termination of pregnancy
(Suction curette/vacuum aspiration)
STOP
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Abortion terminology
Intact dilatation and extraction/partial-birth abortion
IDE or IDX
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Abortion status quo
About 40 million abortions are performed annually worldwide (one every second)
Half of these are unsafe
40% of women worldwide live in an area where abortion is legal
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Abortion status quo
Abortion law can be very difficult to interpret
Abortion is (mostly) legal on demand in the United States, Canada, China, South Africa
Abortion is (mostly) illegal in Ireland, Afghanistan, Iraq, Iran, Vatican City
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Abortion status quo
A registered medical practitioner may perform an abortion on a woman who is not more than 24 weeks pregnant.
After 24 weeks, two doctors must agree that the abortion is ‘appropriate’ given ‘the woman's current and future physical, psychological and social circumstances’
Victoria
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Abortion status quo
Abortion is legal if a doctor can find ‘any economic, social or medical ground or reason' that an abortion is required to avoid a 'serious danger to the pregnant woman's life or to her physical or mental health' at any point during pregnancy or for the rest of the woman’s life.
A doctor was convicted in 2006 of failing to ask for a reason.
New South Wales
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Abortion status quo
In Western Australia (only), if a girl under 16 years old who lives with at least one parent wants an abortion, that parent must be notified.
Parental consent is not required by law anywhere in Australia
Parental notification
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Abortion proposals
Gestational age limits
Parental notification and/or consent
Partial-birth abortion
Protecting the health of the mother
Rape or incest
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Child abuse
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Child abuse terminology
Physical (22% of cases)
Psychological
Verbal
Sexual (8% of cases)
Medical
Neglect (54% of cases)
Child abuse types
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Child abuse status quo
Doctors
Nurses
Teachers
Principals
Police officers
Mandatory reporting in Victoria applies to:
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Child abuse status quo
…they must report if they form a “Belief on reasonable grounds that a child is in need of protection”
Mandatory reporting in Victoria
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Child abuse status quo
Tasmanian criterion:
“Suspicion” of child abuse taking place
or
Victorian criterion:
“Belief” of child abuse taking place
The degree of suspicion for mandatory reporting
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Child abuse proposals
In South Australia, mandatory reporting applies also to dentists, pharmacists, psychologists, clergy, all government employees, any employees or agents of any sporting, religious or recreational activity
In the Northern Territory, mandatory reporting applies to any person
Modifying the list of professionals who must report child abuse
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Child abuse proposals
Provide for privileged communication for certain types of professional, or for certain types of communication
For example, in South Australia, a clergyman does not have to report a disclosure of child abuse that occurs in a confessional box
Providing exemptions for mandatory reporting
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Consent to medical therapy
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Consent terminology
Autonomy is the idea of giving a rational individual capacity to make an informed, un-coerced decision
Autonomy requires competence, voluntariness, disclosure and understanding.
Autonomy
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Consent terminology
Beneficence is the idea of providing to others actions that promote their well-being
Non-maleficence is the idea that a doctor should do no harm to a patient
Beneficence and non-maleficence
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Consent terminology
Competence is a measure of a person’s ability to exercise autonomy
In general, competent patients exercise autonomy
In general, doctors exercise beneficence toward incompetent patients
Competence
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Consent terminology
An advance directive is an expression of the patient’s wishes, made while the patient was still competent
It is also known in the UK as a ‘living will’
Advance directive
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Consent terminology
Informed consent is the idea that a patient should know about the significant risks of a medical therapy before he or she is given the chance to give or refuse consent
Informed consent
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Consent status quo
In general, in Australia a patient has the right to refuse any type of medical therapy…
… Even if that would result in avoidable harm
… Even if it would result in the patient’s death
Right to refuse therapy
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Consent status quo
Children
Mentally ill people
Anorexic patients
Asylum seekers
Exceptions to the right to refuse therapy
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Consent proposals
Do what is medically orthodox?
(UK approach: Beneficence)
Give the decision to a relative of the patient?
(Australian approach: Substituted judgment)
Try to work out what the patient would want?
(US approach: Autonomy)
When a patient is incompetent (unconscious, irrational or intellectually subnormal) should we:
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Consent proposals
Are they binding or persuasive or irrelevant?
Do they bind only in respect of the present situation or all future situations?
Do they override substituted judgment?
Advance directives
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Let’s debate!
That this house would require parental consent for an abortion performed on a girl under 18 years old
That this house would force-feed anorexia nervosa patients
That this house would require clergy to report all suspected child abuse
That this house would treat unconscious patients in accordance with the principle of autonomy rather than beneficence
Suggested topics