Ethics

To the Editor: Weisbrot and Breen’s proposal1 for a no-fault compensation system for medical injuries should extend to all injuries in Australia, including those from motor vehicle accidents and in the workplace. It should also apply to recreational injuries that may lead to common law compensation cases. After 40 years of clinical experience in the rehabilitation of patients with severe neurological injury, I argue that such ...

David C Burke

To the Editor: We read with great interest the article by Burns and Belton regarding the deficiencies in knowledge and attitudes of health professionals towards understanding legal considerations of photographic ownership, storage and disposal.1 This article is timely, given the escalation of smartphone use among clinicians in daily practice. However, we feel that no practical advice was offered to clinicians. The advent of smartphones capable of ...

Rahul Chakrabarti · Chandrashan M Perera

To the Editor: Burns and Belton1 are to be commended for their reminder that informed consent is required before taking patient photographs. They warn that many clinicians are unaware of copyright issues, fail to meet required hospital standards for clinical photographs and/or store images in unacceptable ways. These are important messages. Interestingly, their article did not mention the core reason for medical photography. They state that ...

Rod Phillips

In reply: We are grateful for the interest in our article on medical photography. We plan to publish a more comprehensive article on our research results shortly, to provide a better understanding of the issue in one Australian tertiary hospital. Medical photographs aid diagnosis by becoming part of the patient file, providing a highly useful visual record for case management. Among 167 clinicians surveyed in our research, ...

Kara Burns · Suzanne Belton

At a time when increasing use of electronic health records and communication methods has led to increasing use of clinical photography — particularly in visually oriented specialties — this is timely guidance on proper procedure and permissible uses of photographs.

Patrick D Mahar MB BS(Hons), LLB(Hons), MACLM · Peter A Foley MB BS, MD, FACD · Alexander Sheed-Finck BA, LLB(Hons) · Christopher S Baker MB BS, FACD

The risks to the future child of morbidity associated with birth outside a hospital setting — largely ignored to date — need to be better quantified and communicated.

Lachlan J de Crespigny · Susan P Walker · Julian Savulescu

Australian cancer care is among the best provided in the world. Yet, many cancer patients choose to either forgo aspects of conventional treatment or seek unproven complementary therapies. My own recent cancer treatment prompted me to wonder whether these choices may, at least in part, be due to the failure of Western medicine to address the psychological ...

Tanya L Hall BMed, FRANZCP

In the past, most deaths took place at home. There has recently been a lot of interest in providing patients and their families with a “good death”, and research has shown that if a choice was given to terminally ill patients in the intensive care unit (ICU), they would prefer to die at home. Much ...

Vineet Sarode MB BS, MD, FCICM · John Reeves MB BS, FANZCA, FCICM · Jonathan Barrett MB BS, FRACP, FCICM · Jennifer McCambley CCRN, BEdSt, PGDipPsych

The implication by Wilson and colleagues that selection processes might at any stage be designed “to identify students ... who are likely to develop physical or mental illness ... that will impair their ability to practise in an empathic and professional manner” raises significant ethical and legal issues. The solution suggested by Wilson et al with reference to “fitness to practise” processes in place in medical schools suggests a link ...

Patrick D Mahar

To the Editor: In deference to Grattan-Smith,1 defendant doctors are clearly advantaged and plaintiff patients disadvantaged by the High Court’s decision in Tabet v Gett,2 because a patient must now prove on the balance of probability (> 50%), not possibility (< 50%) as before, that negligence by the doctor caused harm. Nonetheless, like us, Grattan-Smith empathises with the harmed plaintiff who receives no compensation and bears all litigation ...

Neera Bhatia · James Tibballs

Objective: To determine whether international medical graduates (IMGs) have more complaints made against them to medical boards and experience more adverse disciplinary findings than Australian-trained doctors.Design and setting: Data on all complaints made against doctors to medical boards in Victoria and Western Australia over 7.5 years and 5.25 years, respectively, were extracted and linked with information on all doctors registered in those states over the ...

Katie Elkin LLB, BSc · Matthew J Spittal PhD, MBio · David M Studdert LLB, ScD, MPH

To the Editor: Kowal’s article resonates with our experience.1 However, the National Health and Medical Research Council has supported genetic testing in Indigenous Australians for longer than she cites. Through a 1995–1997 project grant, a 1998 PhD scholarship,2,3 a 2006 program grant and an Australia Research Fellowship (2008–), the NHMRC has supported work on kidney and related chronic diseases, in protocols endorsed by two remote communities and approved ...

Wendy E Hoy

To the Editor: We read with interest the article by Kowal about genetic research in Indigenous health.1 As stated, this topic is extremely sensitive, but it is one that we must now tackle. The article raises a related issue that has not received any attention: the provision of genetic health services to Aboriginal and Torres Strait Islander people. We should not presume that Aboriginal and Torres ...

Gail Garvey · Christina M Bernardes

In reply: I thank Hoy, and Garvey and Bernardes, for their responses. Hoy highlights the difficulties her group has experienced in conducting genetic research in an Aboriginal community over two decades. Indeed, this was the project I referred to as losing its ethics approval as a direct result of the Human Genome Diversity Project. She attributes the difficulties she has faced to conflicting views between ...

Emma E Kowal

Policies to prevent medical photography being performed unethically and unlawfully are critical in the digital ageIn the era of easily obtainable, easy-to-use digital cameras, any owner of a camera can be a “medical photographer”. Yet professionalism in obtaining medical photographs is much more than the sum of one’s equipment. Digital cameras, especially the ones in smartphones, give clinicians a high degree of autonomy in taking ...

Kara Burns BSci(AppSci)(Hons) · Suzanne Belton PhD

The 2011 report of the Productivity Commission (PC) recommended the establishment of a no-fault national injury insurance scheme limited to “catastrophic” injury, including medical injury. The report is welcome, but represents a missed opportunity to establish simultaneously a much-needed no-fault scheme for all medical injuries. The existing indemnity scheme based on negligence remains a slow, costly, inefficient, ill targeted and stress-creating system. A fault-based ...

David Weisbrot BA(Hons), JD · Kerry J Breen MB BS, MD, FRACP

A new medical injury scheme will require realistic costing, careful planning and gradual implementationIn his recently published book, The righteous mind, American psychologist Jonathan Haidt makes the observation that “morality is an emotional issue, not a rational one; and in a contest between what we think is reasonable and what we feel in our hearts, emotion always wins”.1 Therefore, recent proposals for national disability and injury ...

Julian L Rait FRACS, FRANZCO, FAICD

Are current standards of evidence always appropriate when making the decision to subsidise treatment?

Wendy L Lipworth MB BS, MSc, PhD · Ken Ho MD, FRACP, FRCP · Ian H Kerridge BMed(Hons), MPhil, FRACP · Richard O Day AM, MD, FRACP

Friends of Science in Medicine should avoid threatening their own valuesScience has always been — and should be — a battleground for contending views on what is true. Because of the close connection between knowledge and power, however, the risk is always present that those who command the dominant theories or ideologies will rely on their positions of influence to overcome those who oppose them. ...

Paul A Komesaroff MB BS, PhD, FRACP · Amber Moore BChineseMed(Hons), BA(Hons) · Ian H Kerridge MPhil, FRACP, FRCPA

The moral panic surrounding human embryo research has fuelled unrealistic public expectations for the imminent success of induced pluripotent stem cell therapyTraditionally, treatment for chronic degenerative conditions revolved around reducing symptoms and improving physiological functioning in the hope of gaining some (often limited) increase in life expectancy. However, in the past decade, the advent of ...

Ronald K F Fung BSc(Adv) · Ian H Kerridge MPhil, FRACP, FRCPA · Loane L C Skene LLB(Hons), LLM, LLD · Megan J Munsie BAppSc, MRepSc, PhD