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Biomedical subjects

I Kerridge

Publications and source records attributed to I Kerridge.

At least 19 recordsLinked to original sources
PubMed2007

Mental health and other clinical correlates of euthanasia attitudes in an Australian outpatient cancer population.

A majority of patients with cancer have been reported to endorse euthanasia and physician assisted suicide (PAS) in general and a substantial proportion endorse these for themselves. However, the potential influence of mental health and other clinical variables on these decisions is not well understood. This study of 228 outpatients attending an oncology clinic in Newcastle, Australia used a cross-sectional design and logistic regression modelling to examine the relationship of demographic, disease status, mental health and quality of life variables to attitudes toward euthanasia and PAS. The majority reported support for euthanasia (79%, n=179), for PAS (69%, n=158) and personal support for euthanasia/PAS (68%, n=156). However, few reported having asked their doctor for euthanasia (2%, n=5) or PAS (2%, n=5). Three outcomes were modelled: support for euthanasia was associated with active religious belief (adjusted odds ratio (AOR) 0.21, 95% CI: 0.10-0.46); support for PAS was associated with active religious belief (AOR 0.35, 95% CI: 18-0.70) and recent pain (AOR 0.87, 95% CI: 0.0.76-0.99); and personal support for euthanasia/PAS was associated with active religious belief (AOR 0.26, 95% CI: 0.14-0.48). Depression, anxiety, recent suicidal ideation, and lifetime suicide attempt were not independently associated with any of the three outcomes modelled.

Adolescent↗
PubMed2006

Consent in crisis: the need to reconceptualize consent to tissue banking research.

The issues surrounding consent to tissue banking research in Australia are complex and have created a forum of intense debate, thus providing a window of opportunity to critically appraise and challenge standard models of consent for research in general and for tissue banking research in particular. The usual practical difficulties associated with meeting the criteria for valid consent to research (including adequate information provision and voluntariness) are amplified in the case of tissue banking research. A number of models, based on widely accepted ethical principles, have been proposed to improve the process of obtaining consent to tissue banking research, all of which assume that the consent of individual tissue donors is needed to meet the criteria for valid consent. Feminist and communitarian theories use many of the same criteria for valid consent but interpret these criteria differently and de-emphasize the importance of individual autonomy as the central criterion for valid consent. An enriched model of consent incorporating feminist and communitarian ideas could satisfy the currently accepted criteria for valid consent while also furthering a broader range of community values.

Biomedical Research↗
PubMed2005

Empirical uncertainty and moral contest: a qualitative analysis of the relationship between medical specialists and the pharmaceutical industry in Australia.

Alliances between the medical profession and the pharmaceutical industry have become increasingly widespread in recent years. While there are clearly benefits for doctors and their patients derived from the medical profession working with industry, concern has arisen that the commercial imperative of industry may conflict with physicians' independence and professional integrity. This paper reports the findings of an in-depth interview study with 50 Australian medical specialists undertaken to explore how and why they interact with the pharmaceutical industry and to gain insight into specialists' moral evaluation of the relationship and its consequences. Analysis of the qualitative data led to the categorizing medical specialists into three types--Confident Engagers, Ambivalent Engagers and Avoiders--based on their descriptions and evaluations of their relationship. The majority of interviewees believed that some relationship with the pharmaceutical industry was inevitable, that there were both risks and benefits associated with the relationship and that as individuals they were competent in minimizing the risks and maximizing the benefits. However, their views diverged on the extent and magnitude of the risks and benefits. The data suggested that there is considerable variance in specialists' judgments of what constituted appropriate industry largesse. Specialists' relationship with the pharmaceutical industry has inherent tensions that are managed by different doctors in different ways. Moral evaluation of the relationship and its consequences varies and the ethical concerns surrounding the relationship appeared as an area of contest. The findings suggest that in developing normative guidelines for academic and professional practice, policy makers should recognise and account for the complexity of the relationship and for the variation in medical specialists' views and feelings.

Australia↗
PubMed2005

Cooperative partnerships or conflict-of-interest? A national survey of interaction between the pharmaceutical industry and medical organizations.

BACKGROUND: There is extensive and varied interaction between the pharmaceutical industry and the medical profession. Most empirical research concerns contact between individual physicians and industry, and reflects North American experience. We sought to clarify the extent and nature of relationships between the pharmaceutical industry and Australian medical organizations. METHODS: We administered questionnaires to 63 medical organizations concerned with clinical practice, continuing medical education or professional accreditation, or the political representation of medical professionals. RESULTS: Survey instruments were received from 29 organizations, giving a response rate of 46%. Seventeen of these organizations (59%) had received support from one or more pharmaceutical company in the past financial year. Support was predominantly for annual conferences, with some support for continuing medical education, research, travel and library purchases. The majority of organizations had an academic journal or newsletter, and 10 (34%) accepted revenue from pharmaceutical advertising. Twenty organizations (72%) had policies or guidelines covering their relationship with industry. Few organizations indicated that they would be unable to continue their activities without pharmaceutical industry support. CONCLUSION: These data indicate a high level of inter-action between the pharmaceutical industry and medical organizations in Australia. While most organizations have policies for guiding their relationship with industry, it is unclear whether these are effective in preventing conflicts of interest and maintaining public trust.

Australia↗
PubMed2005

From advance directives to advance care planning: current legal status, ethical rationales and a new research agenda.

This paper uses a case example to review the current legal status of advance directives, as well as their ethical rationale. We draw attention to ongoing efforts to institutionalize advance directives, and to some of the tractable and intractable reasons why advance directives are ineffective. We then introduce the concept of advance care planning, and argue that we should not assume that advance care directives have a place in this process. We conclude by offering three reasons why this assumption may operate, and by suggesting that contingency and uncertainty may sometimes overwhelm all rational approaches to medical care.

Advance Care Planning↗
PubMed2005

Risk, rationality, and regret: responding to the uncertainty of childhood food anaphylaxis.

Risk and uncertainty are unavoidable in clinical medicine. In the case of childhood food allergy, the dysphoric experience of uncertainty is heightened by the perception of unpredictable danger to young children. Medicine has tended to respond to uncertainty with forms of rational decision making. Rationality cannot, however, resolve uncertainty and provides an insufficient account of risk. This paper compares the medical and parental accounts of two peanut allergic toddlers to highlight the value of emotions in decision making. One emotion in particular, regret, assists in explaining the actions taken to prevent allergic reactions, given the diffuse nature of responsibility for children. In this light, the assumption that doctors make rational judgments while patients have emotion led preferences is a false dichotomy. Reconciling medical and lay accounts requires acknowledgement of the interrelationship between the rational and the emotional, and may lead to more appropriate clinical decision making under conditions of uncertainty.

Anaphylaxis↗
PubMed2001

Is it possible to assess the "ethics" of medical school applicants?

Questions surrounding the assessment of medical school applicants' morality are difficult but they are nevertheless important for medical schools to consider. It is probably inappropriate to attempt to assess medical school applicants' ethical knowledge, moral reasoning, or beliefs about ethical issues as these all may be developed during the process of education. Attitudes towards ethical issues and ethical sensitivity, however, might be tested in the context of testing for personality attributes. Before any "ethics" testing is introduced as part of screening for admission to medical school it would require validation. We suggest a number of ways in which this might be achieved.

Attitude to Health↗
PubMed2000

Advance care planning in residential care.

BACKGROUND: To provide optimal care for our ageing population, some form of advance care planning (ACP) is essential. Overseas data suggest that the process of ACP and the use of advance care directives (ACD) is suboptimal in residential care institutions. By comparison there are few Australian data. AIM: To study the process of ACP and the prevalence of ACD in residential care. METHODS: Cross-sectional study using a questionnaire in the Hunter area, NSW, Australia. RESULTS: Very low levels of formal advance directives were found (available for only 0.2%). Only 1.1% of residents had 'no-CPR' orders documented in the medical record, while 5.6% had a formal guardian and 2.8% had an enduring guardian. Informal processes of advance planning were much more prevalent. Sixty-five per cent had a 'person responsible' recorded to make decisions for them while in 13% of cases, there was 'staff consensus' as to the optimal care for the patient. However, in 10.6% there was no clear process for medical decision making identified. CONCLUSIONS: Advanced directives are infrequently used in residential care. Further qualitative and quantitative studies are warranted to explore current processes of decision making.

Advance Directives↗
PubMed1997

Implementation of guidelines for No-CPR orders by a general medicine unit in a teaching hospital.

BACKGROUND: No-cardiopulmonary resuscitation (CPR) orders are frequently used to limit the use of cardiopulmonary resuscitation in patients who die in hospital. International research has consistently highlighted major deficiencies in the formulation, documentation and communication of such orders. There has been little Australian research into No-CPR orders and the impact of clinical guidelines. AIMS: This audit aimed to examine compliance with published guidelines for No-CPR orders previously developed by the hospital Clinical Ethics Committee. METHODS: The notes of all patients who died while under the care of the General Medicine Unit during June-December 1994 were reviewed to evaluate the use of No-CPR orders. Adherence to hospital No-CPR guidelines was evaluated as well as the principal diagnosis, age, level of care and competence of patients to state their wishes. RESULTS: A No-CPR order was documented in 61% (n = 40) of the 66 patients who died during this period. Of these patients 80% were judged to be incompetent and were unable to be involved in decisions not to resuscitate. There was substantial compliance with the guidelines, with the exception of documenting involvement of nursing staff. CONCLUSIONS: No-CPR orders are frequently implemented as a result of failure to respond to curative therapy and do not represent abandonment of the patient. Although this study demonstrates the value of No-CPR guidelines and the audit process, the findings raise fundamental issues regarding the involvement of nursing staff, and of patients, that need to be further addressed.

Adult↗