1. Richard Cavell richardcavell@mail.com You may contact me by email anytime if you want to talk about medicine or medical law

2. 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.

3. 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.

4. There are 3 topics in this presentation  Abortion  Child abuse  Consent to medical therapy I don’t have time to cover the other topics during this presentation

5. 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.

6. Abortion

7. Abortion terminology A substance that induces miscarriage Abortifacient

8. 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

9. 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

10. Abortion terminology Gestational age at termination United Kingdom

11. 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

12. 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

13. Abortion terminology Surgical/suction termination of pregnancy (Suction curette/vacuum aspiration) STOP

14. Abortion terminology Intact dilatation and extraction/partial-birth abortion IDE or IDX

15. 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

16. 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

17. 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

18. 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

19. 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

20. Abortion proposals  Gestational age limits  Parental notification and/or consent  Partial-birth abortion  Protecting the health of the mother  Rape or incest

21. Child abuse

22. Child abuse terminology  Physical (22% of cases)  Psychological  Verbal  Sexual (8% of cases)  Medical  Neglect (54% of cases) Child abuse types

23. Child abuse status quo Doctors Nurses Teachers Principals Police officers Mandatory reporting in Victoria applies to:

24. 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

25. 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

26. 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

27. 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

28. Consent to medical therapy

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. Consent status quo  Children  Mentally ill people  Anorexic patients  Asylum seekers Exceptions to the right to refuse therapy

36. 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:

37. 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

38. 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