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. (shrink)

In an earlier paper, Mark Spencer synthesized three understandings of divine simplicity, arguing that the Thomist account can be enriched by Scotist and Palamite distinctions. After summarizing that earlier work, this paper builds upon it in four main ways. Firstly, it relates Scotus’ logical (diminished) univocity to Aquinas’ metaphysical analogy in language about God. Secondly, it explores the limits of univocity and the formal distinction as applied to the divine essence (in the Palamite sense), utilising the scientific metaphor of tomography. (...) Thirdly, it defends Palamite energies from the charge of being Thomistic accidents by introducing the concept of “intrinsic ramification” and applying that concept to the Thomistic divine ideas. Fourthly, it tabulates some significant pre-existing parallels between the three systems’ nomenclature in referring to similar aspects of the divine. (shrink)

The Chairman of the Australian Law Reform Commission summarizes the discussion of in vitro fertilization (IVF) at the 1983 Mogul International Management Consultants Ltd. Conference on "Bioethics and Law of Human Conception in Vitro." Participants included IVF pioneers Patrick Steptoe and Robert Edwards, as well as other British physicians, scientists, sociologists, and moral philosophers. They raised questions about multiple embryo implantations, the risks and benefits of IVF, the ethical responsibilities of investigators, public policy and social control of IVF, threats to (...) the family and to genetic integrity, and the implications of IVF for determining criteria of personhood and the beginning of life. (shrink)

This point of view compares the issue of informed patient consent primarily as it operates in Australia and the United Kingdom. It affords an overview, also, of the applicable law in the United States and Canada. It particularly focuses on the legal test to be applied to patient consent as established in the Bolam case in the United Kingdom. The case, following its approval by the House of Lords, holds that the negligent standard in patient consent situations is to be (...) determined, in cases of dispute, in accordance with standards as viewed by a proper body of competent medical practitioners. By contrast, the law in the United States is premised on the notion of the fundamental right of patients to determine what should or should not be done with their own bodies. In Australia the Bolam test has been rejected by the High Court of Australia following earlier decisions in the State Supreme Courts. The Australian courts did not accept that the setting of standards by the medical profession was an acceptable way of determining the entitlements of a patient who has suffered harm. The author places this discussion in the context of greater community awareness of medical procedures, the heightened accountability of professionals and the increasing practice of having a substantial patient input into medical decisions. He also suggests that the differing social and professional attitudes to authority and fundamental rights to be found between Australia and the United Kingdom have influenced the outcome of the cases in the higher courts of both countries. He suggests that the Bolam test is an illustration of the tendency of authority in the United Kingdom to believe that 'Nanny know best'. (shrink)

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. (shrink)