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Kendal E. Whose (germ) line is it anyway? Reproductive technologies and kinship. Bioethics 2023. [PMID: 38105607 DOI: 10.1111/bioe.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
Reproductive biotechnologies can separate concepts of parenthood into genetic, gestational and social dimensions, often leading to a fragmentation of heteronormative kinship models and posing a challenge to historical methods of establishing legal and/or moral parenthood. Using fictional cases, this article will demonstrate that the issues surrounding the intersection of current and emerging reproductive biotechnologies with definitions of parenthood are already leading to confusion regarding social and legal family ties for offspring, which is only expected to increase as new technologies develop. Rather than opposing these new technologies to reassert traditional concepts of the family, however, this article will explore the opportunities that these technologies represent for re-imagining various culturally cherished values of family-making in a way that is inclusive of diverse genders, sexualities and cultures. It will consider IVF, gametogenesis, mitochondrial donation, surrogacy, artificial gestation, CRISPR-Cas9 gene editing, foster care and adoption as some of many possible pathways to parenthood, including for members of the LGBTIAUQ+ community.
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Affiliation(s)
- Evie Kendal
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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2
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Sudenkaarne T, Browne TK, Kendal E. Toxic masculinity: A neglected public health problem. Bioethics 2023; 37:725-727. [PMID: 37209689 DOI: 10.1111/bioe.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 05/22/2023]
Affiliation(s)
- Tiia Sudenkaarne
- University of Helsinki, Faculty of Social Sciences, Helsinki, Finland
- Tampere University, Faculty of Social Sciences, Tampere, Finland
| | | | - Evie Kendal
- Swinburne University of Technology, School of health sciences, Hawthorn, Australia
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Browne TK, Kendal E, Sudenkaarne T. Feminist Concerns About Artificial Womb Technology. Am J Bioeth 2023; 23:97-99. [PMID: 37130394 DOI: 10.1080/15265161.2023.2191036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Kendal E, Bhatt R. Financial toxicity and dialysis: Autonomy and truth-telling in resource-limited settings. Indian J Med Ethics 2023; VIII:46-52. [PMID: 36420603 DOI: 10.20529/ijme.2022.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
From an ethical perspective, resource limitations provide a challenge for healthcare providers. Handling disclosure of the financial details of treatment options in a way that empowers patients, even in the face of extreme poverty, requires careful consideration of the personal preferences and motivations of each patient. This article will consider the high costs of dialysis for patients experiencing extreme poverty in light of various ethical principles, including informed consent and truth-telling. It will conclude that a graduated method of disclosing the physical and financial burdens of each treatment option is the best way forward, particularly for healthcare workers engaged in resource-limited settings.
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Affiliation(s)
- Evie Kendal
- Swinburne University of Technology, SPW Level 2, John St Hawthorn VIC, 3122, AUSTRALIA
| | - Rohin Bhatt
- Master of Bioethics candidate, Harvard Medical School, Boston MA, USA
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5
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Kendal E. Ethical issues for uterine transplant donation. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-0949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Evie Kendal
- Department of Preventive Medicine, Swinburne University of Technology, Melbourne, Australia
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Kendal E. Science fiction in bioethics: a role for feminist narratology. Med Humanit 2022; 48:e12. [PMID: 35074927 DOI: 10.1136/medhum-2021-012283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
This article explores the various reasons science-fictional references feature so prominently in bioethical debate, particularly regarding emerging reproductive biotechnologies. It will reflect on how science-fictional references are often co-opted in bioethics scholarship to promote technoconservatism, before considering how bioethicists can engage more appropriately with this genre in practice. This will include a discussion of which kinds of texts might be best suited to stimulate meaningful debate, and how using tools of literary analysis, such as narratology, can maximise the potential benefits of uniting these fields.
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Affiliation(s)
- Evie Kendal
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Kendal E. Ethical, Legal and Social Implications of Emerging Technology (ELSIET) Symposium. J Bioeth Inq 2022; 19:363-370. [PMID: 35749026 PMCID: PMC9243845 DOI: 10.1007/s11673-022-10197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Evie Kendal
- School of Health Sciences and Biostatistics, Swinburne University of Technology, John St, Hawthorn, Victoria, Australia.
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Kendal E. Commentary on Romanis' Assisted Gestative Technologies. J Med Ethics 2022; 48:medethics-2022-108467. [PMID: 35725303 DOI: 10.1136/medethics-2022-108467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Evie Kendal
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Kendal E. Public health crises in popular media: how viral outbreak films affect the public's health literacy. Med Humanit 2021; 47:11-19. [PMID: 30661040 DOI: 10.1136/medhum-2018-011446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
Infectious disease epidemics are widely recognised as a serious global threat. The need to educate the public regarding health and safety during an epidemic is particularly apparent when considering that behavioural changes can have a profound impact on disease spread. While there is a large body of literature focused on the opportunities and pitfalls of engaging mass news media during an epidemic, given the pervasiveness of popular film in modern society there is a relative lack of research regarding the potential role of fictional media in educating the public about epidemics. There is a growing collection of viral outbreak films that might serve as a source of information about epidemics for popular culture consumers that warrants critical examination. As such, this paper considers the motivating factors behind engaging preventive behaviours during a disease outbreak, and the role news and popular media may have in influencing these behaviours.
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Kendal E. Pregnant people, inseminators and tissues of human origin: how ectogenesis challenges the concept of abortion. Monash Bioeth Rev 2020; 38:197-204. [PMID: 33175992 DOI: 10.1007/s40592-020-00122-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
The potential benefits of an alternative to physical gestation are numerous. These include providing reproductive options for prospective parents who are unable to establish or maintain a physiological pregnancy, and saving the lives of some infants born prematurely. Ectogenesis could also promote sexual equality in reproduction, and represents a necessary option for women experiencing an unwanted pregnancy who are morally opposed to abortion. Despite these broad, and in some cases unique benefits, one major ethical concern is the potential impact of this emerging technology on abortion rights. This article will argue that ectogenesis poses a challenge to many common arguments in favour of a pregnant woman's right to choose, but only insomuch as it highlights that their underlying justifications for abortion are based on flawed conceptions of what the foetus and pregnancy actually are. By interrogating the various interests and relationships involved in a pregnancy, this article will demonstrate that the emergence of artificial gestation need not impact existing abortion rights or legislation, nor definitions of independent viability or moral status.
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Affiliation(s)
- Evie Kendal
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
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Koplin JJ, Kendal E. Ethical issues in uterine transplantation. Korean Journal of Transplantation 2020; 34:78-83. [PMID: 35769346 PMCID: PMC9188934 DOI: 10.4285/kjt.2020.34.2.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
Despite a recent surge of bioethical attention, ethical analysis of uterine transplantation is still in its early stages, and many of the key ethical issues remain underexamined and unresolved. In this paper, we briefly review some key ethical issues associated with uterine transplantation (beyond those associated with organ transplantation more generally). We structure our discussion in terms of Beauchamp and Childress’ four principles of biomedical ethics: beneficence, non-maleficence, autonomy, and justice. Our review highlights some ethical questions that require further bioethical attention before uterine transplantation can be fully embraced as a potential treatment for absolute uterine factor infertility. We close by arguing that the costs and benefits of uterine transplantation need to be considered in the context of other possible treatments for absolute uterine factor infertility and alternative methods of family creation.
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Affiliation(s)
- Julian J. Koplin
- Melbourne Law School, University of Melbourne, Parkville, Australia
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, Australia
| | - Evie Kendal
- Deakin School of Medicine and Alfred Deakin Institute, Deakin University, Melbourne, Australia
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Luyckx VA, Martin DE, Moosa MR, Bello AK, Bellorin-Font E, Chan TM, Claure-Del Granado R, Douthat W, Eiam-Ong S, Eke FU, Goh BL, Jha V, Kendal E, Liew A, Mengistu YT, Muller E, Okpechi IG, Rondeau E, Sahay M, Trask M, Vachharajani T. Developing the ethical framework of end-stage kidney disease care: from practice to policy. Kidney Int Suppl (2011) 2020; 10:e72-e77. [PMID: 32149011 DOI: 10.1016/j.kisu.2019.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022] Open
Abstract
Ethical issues relating to end-stage kidney disease (ESKD) care are increasingly being discussed by clinicians and ethicists but are still infrequently considered at a policy level or in the education and training of health care professionals. In most lower-income countries, access to kidney replacement therapies such as dialysis is not universal, leading to overt or implicit rationing of resources and potential exclusion from care of those who are unable to sustain out-of-pocket payments. These circumstances create significant inequities in access to ESKD care within and between countries and impose emotional and moral burdens on patients, families, and health care workers involved in decision-making and provision of care. End-of-life decision-making in the context of ESKD care in all countries may also create ethical dilemmas for policy makers, professionals, patients, and their families. This review outlines several ethical implications of the complex challenges that arise in the management of ESKD care around the world. We argue that more work is required to develop the ethics of ESKD care, so as to provide ethical guidance in decision-making and education and training for professionals that will support ethical practice in delivery of ESKD care. We briefly review steps that may be required to accomplish this goal, discussing potential barriers and strategies for success.
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Affiliation(s)
- Valerie A Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland.,Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mohammed Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Aminu K Bello
- Division of Nephrology and Immunity, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ezequiel Bellorin-Font
- Division of Nephrology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Tak Mao Chan
- Division of Nephrology, Department of Medicine, University of Hong Kong, Hong Kong
| | - Rolando Claure-Del Granado
- Division of Nephrology, Department of Medicine, Hospital Obrero 2-Caja Nacional de Salud, Universidad Mayor de San Simon School of Medicine, Cochabamba, Bolivia
| | - Walter Douthat
- Hospital Privado-Universitario de Cordoba and Instituto Universitario de Ciencias Biomédicas, Cordoba, Argentina
| | - Somchai Eiam-Ong
- Department of Medicine, Chulalongkorn Hospital, Bangkok, Thailand
| | - Felicia U Eke
- Department of Pediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Bak Leong Goh
- Department of Nephrology and Clinical Research Centre, Hospital Serdang, Jalan Puchong, Kajang, Selangor, Malaysia
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Evie Kendal
- School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Adrian Liew
- Department of Renal Medicine, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Imperial College London-Nanyang Technological University, Singapore
| | | | - Elmi Muller
- Transplant Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
| | - Michele Trask
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.,Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Tushar Vachharajani
- Nephrology Section, Salisbury Veterans Affairs Health Care System, Salisbury, North Carolina, USA.,Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Affiliation(s)
- Bryanna Moore
- Center for Medical Ethics and Health PolicyBaylor College of Medicine Houston TX USA
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Abstract
This essay explores how feminist utopian literature can inform bioethical debates regarding the fundamental differences between female and male experiences of human reproduction, focusing on the use of biological and technological methods to redress natural inequalities arising from biological difference. Inherently speculative, utopian fiction serves as a useful tool for interrogating social and political attitudes toward procreation and childrearing, adopting a similar degree of abstraction as a philosophical thought experiment. Thus, there is the potential for bioethicists to engage more thoroughly with this form of literature in order to communicate key ethical issues related to reproductive rights and sexual equality.
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Diug B, Kendal E, Ilic D. Evaluating the use of twitter as a tool to increase engagement in medical education. Educ Health (Abingdon) 2017; 29:223-230. [PMID: 28406107 DOI: 10.4103/1357-6283.204216] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Social media is regularly used by undergraduate students. Twitter has a constant feed to the most current research, news and opinions of experts as well as organisations. Limited evidence exists that examines how to use social media platforms, such as Twitter, effectively in medical education. Furthermore, there is limited evidence to inform educators regarding social media's potential to increase student interaction and engagement. AIM To evaluate whether social media, in particular Twitter, can be successfully used as a pedagogical tool in an assessment to increase student engagement with staff, peers and course content. METHODS First year biomedical science students at Monash University completing a core public health unit were recruited into the study. Twitter-related activities were incorporated into the semester long unit and aligned with both formative and summative assessments. Students completed a structured questionnaire detailing previous use of social media and attitudes towards its use in education post engagement in the Twitter-specific activities. Likert scale responses compared those who participated in the Twitter activities with those who did not using student's t-test. RESULTS A total of 236 (79.4%) of invited students participated in the study. Among 90% of students who reported previous use of social media, 87.2% reported using Facebook, while only 13.1% reported previous use of Twitter. Social media was accessed most commonly through a mobile device (49.1%). Students actively engaging in Twitter activities had significantly higher end-of-semester grades compared with those who did not [Mean Difference (MD) = 3.98, 95% CI 0.40, 7.55]. Students perceived that the use of Twitter enabled greater accessibility to staff, was a unique method of promoting public health, and facilitated collaboration with peers. DISCUSSION Use of social media as an additional, or alternate, teaching intervention is positively supported by students. Specific use of micro-blogs such as Twitter can promote greater student-staff engagement by developing an ongoing academic conversation.
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Affiliation(s)
- Basia Diug
- Department of Epidemiology and Preventive Medicine, Medical Education Research and Quality Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Evie Kendal
- Department of Epidemiology and Preventive Medicine, Medical Education Research and Quality Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dragan Ilic
- Department of Epidemiology and Preventive Medicine, Medical Education Research and Quality Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Abstract
This paper aims to address how artificial gestation might affect equality of opportunity for the unborn and any resultant generation of "ectogenetic" babies. It will first explore the current legal obstacles preventing the development of ectogenesis, before looking at the benefits of allowing this technology to control fetal growth and development. This will open up a discussion of the treatment/enhancement divide regarding the use of reproductive technologies, a topic featured in various bioethical debates on the subject. Using current maternity practices in Western society as a comparator, this paper will conclude that neither naturally nor artificially gestated fetuses have interests that can conflict with those of potential parents who might want to use this technology to control fetal development. Such control may include selective implantation of embryos of a desired gender, deliberate choice of genetic traits, or maintenance of an ideal incubation environment to avoid fetal damage. Objections on the basis of disability as well as concerns regarding eugenics will be addressed. The paper will conclude that none of these objections are compelling grounds to prevent the development and use of ectogenesis technologies for the purpose of achieving specific reproductive goals, particularly when compared to current practices in pre-implantation genetic diagnosis and selective abortion on the grounds of undesired traits. As such, when deciding whether to support ectogenesis research, the enduring interests of parents must be the primary consideration, with societal concerns regarding potential misuse the only valid secondary consideration.
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Affiliation(s)
- Evie Kendal
- School of Public Health and Preventive Medicine, Monash University, Alfred Centre Level 5, 99 Commercial Rd, Melbourne, 3000, Australia.
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Kendal E, Maher LJ. Should patients in a persistent vegetative state be allowed to die? Guidelines for a new standard of care in Australian hospitals. Monash Bioeth Rev 2015; 33:148-166. [PMID: 26507136 DOI: 10.1007/s40592-015-0039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this article we will be arguing in favour of legislating to protect doctors who bring about the deaths of PVS patients, regardless of whether the death is through passive means (e.g. the discontinuation of artificial feeding and respiration) or active means (e.g. through the administration of pharmaceuticals known to hasten death in end-of-life care). We will first discuss the ethical dilemmas doctors and lawmakers faced in the more famous PVS cases arising in the US and UK, before exploring what the law should be regarding such patients, particularly in Australia. We will continue by arguing in favour of allowing euthanasia in the interests of PVS patients, their families, and finally the wider community, before concluding with some suggestions for how these ethical arguments could be transformed into a set of guidelines for medical practice in this area.
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