HIV/AIDS: the twenty injunctions of London summary of the conference.
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Biomedical subjects
Publications and source records attributed to M D Kirby.
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This paper is not about the medical condition of AIDS. Nor is it about the history of the condition since it was first reported in Atlanta, Georgia in 1981. It looks rather, at the catalogue of legislative and other legal responses to the spread of AIDS. The paper analyses the AIDS condition in its historical context. The hysteria accompanying the outbreak of AIDS is contrasted with the similar hysteria associated with other previous epidemics experienced in Australia over the past two centuries. The paper categorises the responses of lawmakers to the condition, according to the approach taken; from 'full blast', through 'moderate heat' to 'low key' or an attempt to avoid or minimise legal intervention. It is suggested that the appropriate response should depend upon such factors as the present magnitude of the condition, its likely future course, the availability of cures and protections against its spread and objectives being sought by intervention. Unless these factors are taken into account gross over-reaction can occur, causing social disruption and much personal injustice.
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The editorial in the September 1982 issue of this journal and many articles before and since have addressed the problem of informed consent. Is it possible? Is it a useful concept? Is there anything new to be said about it? In this article the basic rationale of the rule (patient autonomy) is explained and the extent of the rule explored. Various exceptions have been offered by the law and an attempt is made to catalogue the chief of these. A number of specially vulnerable groups are then identified, the most important, and vexed, being children. How can informed consent be secured in the case of young patients? Finally, a few problems are mentioned in an attempt to get this subject back to reality. The appeal to the principle primum non nocere may be medical paternalism in disguise. Informed consent is the competing principle that reminds us of the primacy of human autonomy. A pointer is given to the future: even the use of sound recordings to explain medical procedures and to activate informed consent so that it may become a reality and not just a lawyer's myth, should be considered.
A major problem of democratic government is to get lawmakers to address controversial and sensitive subjects such as mental health law reform. By reference to current and past projects in the Australian Law Reform Commission, its Chairman outlines the way in which permanent law reform agencies can mobilise expert and community opinion to help the lawmaking process address sufficiently the needs of law reform. After outlining briefly the history of mental health law reform in English-speaking countries, the author suggests that moves for reform tend to come in 'cycles' or 'waves'. This is especially so in federations such as Australia. Reforms introduced in South Australia in 1976 are now working their way into the laws of other jurisdictions of Australia, where mental health law is basically a state concern. The reforms deal with such matters as legal representation for persons involuntarily committed and stricter definitions of circumstances for and objectives of hospitalisation of the mentally ill. Some comments are offered on new approaches to the defence of insanity in criminal trials following the jury verdict in the Hinkley case arising out of an attempt on the life of a President of the United States. The implications of this and other cases for the 'anti-psychiatry' movement are referred to and discussed. The author concludes with comments on the implications of mental health law reform for democracies. He suggests a law for law reform agencies in reconciling needs for law reform and community tolerance of change.
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