An Ethical Analysis Of The Disclosure Of Surgeons' Performance Data To Patients Within The Informed Consent Process
Funder
National Health and Medical Research Council
Funding Amount
$148,937.00
Summary
For over a decade, hospitals in the American state of New York have been collecting information about the mortality rates of surgeons conducting Coronary Artery Bypass Grafts, and making this information available to patients. The United Kingdom is set to make these and other performance indicators on the ability of surgeons ('report cards') available from 2004. There are good reasons to think a similar system may be introduced in Australia in the near future. Patients can use the information co ....For over a decade, hospitals in the American state of New York have been collecting information about the mortality rates of surgeons conducting Coronary Artery Bypass Grafts, and making this information available to patients. The United Kingdom is set to make these and other performance indicators on the ability of surgeons ('report cards') available from 2004. There are good reasons to think a similar system may be introduced in Australia in the near future. Patients can use the information contained in report cards when deciding whether or not to consent to have a particular surgeon conduct an operation on them. Contemporary bioethicists stress the importance of a proper informed consent process in medicine. This is a process in which a doctor advises a patient of relevant information and ensures that the patient comprehends that information, before the patient consents to an operation. Currently report cards in America are publicly disseminated on the internet, however there is no systematic attempt to incorporate the information contained in report cards into the informed consent process. We do not know if patients understand the information they are given, or if they incorporate it into their decision making procedures appropriately. In our study we will consider how information that is contained in report cards could best be used in the informed consent process. We will keep in mind the importance of helping patients to make their own informed decisions to consent to operations, the importance of respecting the professional integrity of surgeons and the importance of providing the best possible standard of care for patients. The result of our study will be a revised model of the informed consent process that incorporates report cards in an ethically acceptable way.Read moreRead less
Difficult Decisions: A Critical Analysis Of Consent To High-risk Medical Procedures
Funder
National Health and Medical Research Council
Funding Amount
$320,918.00
Summary
Consent is the cornerstone of ethics as applied to healthcare and is central to the relationship between healthcare and the law. Whilst no-one would deny the importance of seeking consent to high-risk medical procedures, much depends on the practical manner in which this is done. By studying consent for high-risk procedures with the participation of patients and their health care providers, we will both test the limits of consent and find practical ways to address those limits. In doing so, the ....Consent is the cornerstone of ethics as applied to healthcare and is central to the relationship between healthcare and the law. Whilst no-one would deny the importance of seeking consent to high-risk medical procedures, much depends on the practical manner in which this is done. By studying consent for high-risk procedures with the participation of patients and their health care providers, we will both test the limits of consent and find practical ways to address those limits. In doing so, the project will re-cast consent processes in a way that better accommodates the contingencies of clinical practice in high-risk settings in which patient autonomy is often compromised. Because this reformulation of consent will be grounded in the realities of high-risk clinical practice, our findings will reflect the needs and values of relevant stakeholders (patient and health professionals) and more likely to make a significant contribution to patient care and health policy. This project also addresses what the High Court of Australia has acknowledged as widespread weaknesses in the common formulation of consent in medicine. Finally this project, which operates in an important area of overlap between the law and medicine, will show how these disciplines can work jointly to serve the interests of all Australians, and Australian society.Read moreRead less
Ethical And Legal Issues Surrounding The Decision-making Process For Donating And Banking Umbilical Cord Blood
Funder
National Health and Medical Research Council
Funding Amount
$417,550.00
Summary
Altruistic donation of umbilical cord blood (UCB) is essential to provide a source of stem cells to treat various cancers and blood-immune disorders. However, parents can instead, bank UCB for personal use. This project will determine if parents are aware and understand differences between UCB donation and banking, as well as analysing the legal issues surrounding both processes. We aim to make recommendations to improve the decision-making process with the hope of increasing UCB donation rates.
Competence To Give Informed Consent For Research Participation In Schizophrenia And Related Psychoses.
Funder
National Health and Medical Research Council
Funding Amount
$300,000.00
Summary
There is current controversy surrounding the ethics of allowing people with mental illness to participate in research. By trying to safe guard what is considered a vulnerable group, we may also be denying these people their rights to make decisions for themselves. The potential benefits of clinical research in an area where treatments are often ineffective and cause serious side effects may also be denied to these people. This study aims to measure the capacities of patients with psychoses to gi ....There is current controversy surrounding the ethics of allowing people with mental illness to participate in research. By trying to safe guard what is considered a vulnerable group, we may also be denying these people their rights to make decisions for themselves. The potential benefits of clinical research in an area where treatments are often ineffective and cause serious side effects may also be denied to these people. This study aims to measure the capacities of patients with psychoses to give informed consent to participate in clinical research. The uniqueness of this project is that subjects will be rated as either competent or incompetent according to legal definitions applicable in Australia by utilising predetermined thresholds. We will also determine whether performance of patients in tests of competence can be improved through an established educational program. Additionally we plan to re-evaluate patients after a period of 6 months in order to test the reliability of competence performance.Read moreRead less
How Do Lay People Understand The Risk Of Developing Cancer? A Qualitative Study Using Grounded Theory Procedures.
Funder
National Health and Medical Research Council
Funding Amount
$282,118.00
Summary
This project is about cancer risk. New discoveries are regularly made about the contribution of genes, environmental exposures, and lifestyles to cancer risk. These findings are often reported in the mass media, or used in television advertising to encourage us to attend cancer screening or change our habits. Some cancers are said to be almost entirely preventable. In fact some experts argue that whether or not we get cancer is largely our own responsibility. This study doesn't ask what causes c ....This project is about cancer risk. New discoveries are regularly made about the contribution of genes, environmental exposures, and lifestyles to cancer risk. These findings are often reported in the mass media, or used in television advertising to encourage us to attend cancer screening or change our habits. Some cancers are said to be almost entirely preventable. In fact some experts argue that whether or not we get cancer is largely our own responsibility. This study doesn't ask what causes cancer. Instead it asks what the risk of developing cancer means to Australians and in Australian society. This question will be answered by conducting a rigorous analysis of healthy lay people's descriptions of their own and others' risk of developing cancer. The researchers will talk with a wide range of people about cancer risk. They will ask: how do we think about cancer risk for ourselves? how do we engage with information about cancer risk? Do we listen to it? Do we trust it? Does it make sense to us? What do we think should be done about it? The resulting findings will be compared with the assumptions that underlie cancer prevention activities. Finally, the discoveries made about similarities and differences will be actively translated for expert and lay audiences. There have been many studies of what it is like to be a cancer patient or to be screened for cancer. But there has been very little systematic study of the way in which healthy Australians make sense of cancer risk. This study will develop a detailed model of what cancer risk means to Australians. It will provide new knowledge to researchers and practitioners in public health, health psychology and sociology, and risk communication, guiding communication about cancer risk and research about cancer risk well into the future. It will help lay people and professionals to communicate more effectively about cancer risk, and thus support continuing improvement in cancer prevention in Australia.Read moreRead less
An Investigation Of The Relationship Between The Pharmaceutical Industry, Medical Profession And Medical Practitioners
Funder
National Health and Medical Research Council
Funding Amount
$186,449.00
Summary
In recent years there has been a rapid expansion in the number and range of interactions between the pharmaceutical industry and the medical profession. While this has the potential to advance research, education and health care, there are risks that such interactions may inappropriately serve commercial objectives and ultimately compromise the best interests of patients and society in general. Most major medical and pharmaceutical organisations have released guidelines of policy statements on t ....In recent years there has been a rapid expansion in the number and range of interactions between the pharmaceutical industry and the medical profession. While this has the potential to advance research, education and health care, there are risks that such interactions may inappropriately serve commercial objectives and ultimately compromise the best interests of patients and society in general. Most major medical and pharmaceutical organisations have released guidelines of policy statements on the relationship between the medical profession and the pharmaceutical industry. To date most debate has taken the form of personal observations or professional opinion , and there has been little objective research into medical industry interactions. This project aims to examine the relationship between the pharmaceutical industry, the medical profession and the medical practitioners. Specifically, the aim of this project is to establish whether this relationship as it currently exists, and as stated in guidelines from professional bodies, is appropriate in terms of justifiable ethical standards, empirical research and social perspectives. The results of this research will enable assessment of current guidelines and the development of further guidelines and regular process where appropriate.Read moreRead less
Australia has limited systems in place to identify, then reduce or withdraw (disinvest) ineffective or inappropriate health care practices. Such practices result in sub-optimal care and inefficient use of scarce resources. Disinvestment models are few and have not been tested in Australia. We will develop a novel, systematic policy framework by linking policy, clinical, patient and community members as partners in the decision process for disinvesting (or not) selected health care practices.