The rights of donor inseminated children to know their genetic origins in Australia

Twenty years after it was recognised that adopted children have rights to understand their origins, the dawn has finally broken with respect to children conceived as a result of the Assisted Reproductive Technologies (ART), specifically donor insemination (DI). Recipients and practitioners of conception technologies focus their energies and ethical deliberation on the achievement of pregnancy and the successful birth of the child. Law, in contrast, must focus beyond birth to enshrine respect for the rights of the child, who is 'not legally capable of defending [his or her] own future interests.' This article undertakes an assessment of what is in the best interests of a child using empirical studies to ground a position that should be adopted by law in Australia. This article also critically evaluates the current legal position of the various States and Territories with regards to a DI conceived child's rights to know of their form of conception; access to identifying information of their donor; at what age they may access information; the position of DI children born before existing legislation; record-keeping; and finally whether international law grants such children rights. Australian children must enjoy the right in theory and practice to know they were donor conceived and the identity of their donor. It is disappointing that New South Wales, as the most recent State to propose legislation on ART, has not utilised international empirical research on the best interests of DI children or even followed the Infertility Treatment Act 1995 (Vic) which seems to be far more progressive in recognising how best to protect the rights of DI children. The current legal position is chaotic. States and Territories should confer power on the Federal Government to legislate uniform and explicit regulation of ART for the benefit of DI children.

Advising patients with medication-related dysphagia: caution required

District Nurse Sister Mary Evans is caring for a patient John, who is very overweight and has angina and type two diabetes. John takes medication to assist in managing these conditions, namely verapamil for the angina and metformin for the type two diabetes. Sister Evans has recently noticed a deterioration in John’s health and when pressed he admitted that he had stopped taking his medication as he was having great difficulty swallowing the tablets especially metformin which he described as a ‘big horse tablet’. Sister Evans emphasises how important it is for John to take his medication regularly and advises his wife to crush the tablets and mix it with his food to assist with swallowing and ensure that he takes the prescribed medication.

[Domestic elder abuse and neglect--conclusions from the evaluation of a model project]

The main task of a federally funded model project in the German city of Hannover was to develop approaches for prevention and intervention in the field of domestic elder abuse. Over a three year period (1998-2001), different approaches--like a telephone helpline for senior citizens, and social workers operating as counsellors for elderly people and their relatives--were tested at a local level. The paper presents results from the evaluation of the project and draws conclusions for future prevention and intervention in the field. The authors argue that the explicit use of the conceptual framework of "violence"/"abuse" creates potentials for scandalizing the issue and is therefore supportive for media appearance, whereas it can impede the approach to the main target groups (elderly people and their relatives) and reduce accessibility of counselling services for potential clients. In the light of evaluation results the focus of the project ("domestic elder abuse" or "violence against elderly people in close relationships") was too narrow for a local project. Counselling services were used in a relatively small number of cases; analyses of cases show that incidents of domestic elder abuse are often embedded in complex problem constellations. Cases brought to the attention of the model project were multifaceted and not limited to incidents of neglect and abuse of elderly care recipients caused by caregiver overload. Cases of intimate violence in partnerships and of intergenerational violence without any of the participants being dependent on care show the need to develop a broader concept of domestic elder abuse. Integration of the concepts of domestic violence, violence against women, elder abuse/neglect and abuse/neglect in caregiving relationships is necessary on a conceptual level as well as on the level of interagency cooperation of institutions dealing with cases of "elder abuse".

Ethical issues in expert opinions and testimony

As the private sector rehabilitation industry matures, certain ethical and malpractice issues have emerged. This article provides an overview of ethical issues in private for-profit practice, with particular focus on expert testimony, using examples from a sample of claims filed with the National Association of Rehabilitation Professionals in the Private Sector (NARPS), malpractice insurance companies, selected court cases, and complaints submitted to NARPPS Standards Compliance Review Board Committee and the Commission on Rehabilitation Counselor Certification. It is evident that complaints have a direct relationship to at least half of the ethical canons of the Code of Professional Ethics for Rehabilitation Counselors because they most frequently involve issues related to competence, the client-counselor relationship, professional relationships, confidentiality, and use of the certified rehabilitation counselor (CRC) designation.

Duty to warn of genetic harm in breach of patient confidentiality

Harm caused by the failure of health professionals to warn an at-risk genetic relative of her or his risk is genetic harm. Genetic harm should be approached using the usual principles of negligence. When these principles are applied, it is shown that (a) genetic harm is foreseeable; (b) the salient features of vulnerability, the health professional's knowledge of the risk to the genetic relative and the determinancy of the affected class and individual result in a duty of care being owed to the genetic relative; (c) the standard of care required to fulfil the duty to warn should be the expectations of a reasonable person in the position of the relative; and (d) causation is satisfied as the harm is caused by the failure of intervention of the health professional. Legislation enacted subsequent to the Report of the Commonwealth of Australia, Panel of Eminent Persons (Chair D Ipp), Review of the Law of Negligence Report (2002) and relevant to a duty to warn of genetic harm is considered. The modes of regulation and penalties for breach of any future duty to warn of genetic harm are considered.

Psychosoziale Betreuung von Patienten mit Hauttumoren in Zeiten der Diagnosis Related Groups (DRG)

Patients with skin cancer suffer from very specific distress. Highly distressed patients need an unburdening support, enabling them to develop an active- cognitive coping style. In the past, an approach to psycho-oncological intervention which proved beneficial offered basic support to all patients and additional help to overburdened patients and their relatives. The introduction of the diagnosis related groups (DRG)-a system of all inclusive compensation-has endangered this approach because psychosocial care is not sufficient recognized and reimbursed for by DRG. Within the framework of already implemented structural alterations and focal shifts of content, different approaches to future psycho-oncological care for patients with skin cancer will be presented.

Rapid diagnostic testing for HIV. Clinical implications

There have been many advances in HIV counseling, testing, and referral over the past ten years. One of the most recent advances is the United States Food and Drug Administration's (FDA) approval of a rapid test. As a result of the availability of rapid diagnostic testing for HIV, practices regarding testing and counseling need to be updated, particularly in time-sensitive situations in which rapid results are crucial.

Counselling--its role in the infertility team

Counselling was made a statutory requirement for clinics providing assisted reproduction services as a result of the concern raised that these treatments would raise uniquely challenging emotional and ethical problems for patients. Before the Human Fertilisation and Embryology Act 1990, few counsellors specialized in this field and there were no standards for their training or experience. In the intervening years considerable progress has been made in these areas. The research evidence, which informs their practice concerning the impact of infertility and its treatment, has also grown very substantially. There is now a reasonable consensus about the broad nature of the emotional and psychological sequelae, although many unexplored questions remain. In addition, the literature providing evidence for the efficacy and effectiveness of counselling in other areas has developed in both quantity and sophistication. Counsellors are often well-placed to work with patient groups and also with the multidisciplinary assisted conception team itself on the very difficult psychosocial and ethical issues faced in practice. The sophisticated research in these fields has not yet been done in the context of infertility; it is therefore necessary to extrapolate from other fields, especially in mental health practice. This article will argue that there is now ample evidence to support the decisions made by legislators in requiring counselling to be available to patients in assisted conception units. The infertility counselling profession is in a position to begin contributing to the generation of research relevant to this field.

Fetal anomalies: ethical and legal considerations in screening, detection, and management

A number of ethical considerations arise with regard to screening for, detecting, and managing fetal anomalies. Some of these considerations involve the need to give attention to emotional distress the pregnant woman might be experiencing. The ethical principle of beneficence gives rise to a duty of the obstetrician to provide emotional support when needed in relation to screening, confirmatory testing, giving bad news, making abortion decisions, making management decisions after viability, and dealing with the grieving process. Other issues involve ethical decision-making, such as deciding what recommendations to make concerning management of fetal anomalies after viability. The ethical principle of autonomy creates a duty of the obstetrician to help the pregnant woman make informed management decisions based on her values and goals. A recommendation for a particular approach to management is sometimes ethically justifiable on the basis of an analysis of the risks and benefits to the mother and fetus. Legal considerations are relevant because they create requirements or prohibitions that must be taken into account in ethical decision-making. The discussion in this article does not exhaust the range of issues that arise. For example, sometimes a delivery procedure is considered that is traumatic to the fetus, such as cephalocentesis for vaginal delivery of a fetus with hydrocephaly. The reader is referred to other sources for a discussion of the ethics of delivery procedures that might injure or kill the fetus. Other issues involve deciding when there is a duty to offer new prenatal genetic tests, routinely or for high-risk couples, and whether to carry out maternal requests for prenatal tests for late-onset diseases and susceptibilities to diseases. These issues have been discussed elsewhere.

Does a doctor have a duty to provide information and advice about complementary and alternative medicine?

It is argued that a doctor has a duty to provide information about reasonably available complementary and alternative medicine treatments where that information would be material to the particular patient or the hypothetical prudent patient. Given the vast array of such treatments available, doctors will want to rely on evidence-based medicine problem-solving skills to ascertain those treatments that are safe and efficacious. While the risk of litigation for failure to provide such information is probably low at this time, given the high rate of patient self-prescribing, it is necessary for a doctor to open a dialogue with a patient about complementary and alternative medicine to address safety concerns. In addition, it is important to facilitate access to the best of conventional and complementary treatments to ensure better health outcomes for the patient.

Obligation to advise of options for treatment--medical doctors and complementary and alternative medicine practitioners

An important aspect of health professional's duty of care is to advise patients of the available options of treatment so that the patient can choose the form of treatment that suits her or his requirements. As CAM becomes more evidence-based and accepted, medical doctors need to consider the extent to which they should provide patients with information about those types of treatments. If a CAM treatment option is evidence-based, there is a strong argument that medical doctors should advise of this option for treatment to satisfy their duty. CAM practitioners should also provide details of options for treatment within their own modality but are not obliged to advise of medical options.

Legal and ethical issues involved when counseling minors in nonschool settings

Many counselors in non-school settings will work with children at some time during their practice; therefore, it is essential that they understand the legal and ethical issues relevant to working with minors. Major court cases and legislation are presented, and 4 critical ethical issues--counselor competence, the client's rights to confidentiality and informed consent, and duties related to child abuse--are addressed. Suggestions for working ethically with minors in order to limit legal liability are presented.