Medicine and Medical Law for debaters

MEDICINE AND MEDICAL LAW

FOR DEBATERS

Richard Cavellrichardcavell@mail.com

You may contact me by email anytime if you want

to talk about medicine or medical law

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.

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.

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

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.

Abortion

Abortion terminology

A substance that induces miscarriage

Abortifacient

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

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

Abortion terminologyGestational age at termination

United Kingdom

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

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

Abortion terminology

Surgical/suction termination of pregnancy

(Suction curette/vacuum aspiration)

STOP

Abortion terminology

Intact dilatation and extraction/partial-birth abortion

IDE or IDX

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

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

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

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

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

Abortion proposals

Gestational age limits

Parental notification and/or consent

Partial-birth abortion

Protecting the health of the mother

Rape or incest

Child abuse

Child abuse terminology

Physical (22% of cases)

Psychological

Verbal

Sexual (8% of cases)

Medical

Neglect (54% of cases)

Child abuse types

Child abuse status quo

Doctors

Nurses

Teachers

Principals

Police officers

Mandatory reporting in Victoria applies to:

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

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

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

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

Consent to medical therapy

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

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

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

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

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

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

Consent status quo

Children

Mentally ill people

Anorexic patients

Asylum seekers

Exceptions to the right to refuse therapy

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:

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

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