Ashley Leong 42648332

!"#$%& ()*$)+
!"#$%&'(#)%"* ,#-)(. /"& 0$%12..)%"/3 0$/(#)(2
1. CommlLmenL Lo professlonallsm (PonesLy, responslblllLy, self-appralsal, docLor-paLlenL
relaLlonshlp, dlscrlmlnaLlon, relaLlng Lo oLhers, parLlclpaLlon)
2. LecLures (rofesslonallsm, professlonal behavlour, medlcal regulaLlon, accounLablllLy)
3. SLudenL lnLegrlLy and MlsconducL ollcy (assessmenL of professlonal behavlour ln
con[uncLlon wlLh 9 speclflc expecLaLlons of SCM)
!"#$%&'(#)%"* ,#-)(.4 5)%2#-)(. /"& 0-)3%.%6-7 %1 82&)()"2
8ra|n M|nd
8ody (obey physlcal laws,
blologlcal laws)
erson
Causes 8easons
ueLermlnlsm lreedom
LxplanaLlon !usLlflcaLlon
lacLs values
Sclence LLhlcs/law
ulsease lllness
Curlng Peallng
1here ls a duallsLlc naLure of us: very lnLulLlve
WesLern emplrlclsL Lrend
o no supernaLural causes
o Lmplrlcal generallsaLlons for sclenLlflc Lheorles
o 8aLlonal sclence
o Lvldence based medlclne LesLs Lhese
Puman behavlour
o naLural sclence: purposeless, predlcLable, excludes human behavlour, ls Lhe
body/person a machlne?
o sychopaLhologlcal classlflcaLlons (uSM lv) - sclenLlflc sLudy of menLal dlsorders
! uescrlpLlve/sclenLlflc?
! Lg. soclopaLhy, personallLy dlsorders, gross narclsslsLlc personallLy dlsorders
! Maklng dlagnoses llke Lhls ls sLarLlng Lo geL lnLo human freedom lssues...
o lreedom 8esponslblllLy ralse/8lame CughL/oughL noL Lo " L1PlCS
Crlgln of morallLy:
o Cod
o naLure/sense (soclal and blologlcal learnlng over evoluLlon) " soclal regulaLlon,
endorsemenL of cooperaLlve arrangemenLs, norms and rules
o 8eason " naLurallsLlc human lnsLlLuLlon
o lnLulLlon
o ALLlLudes/feellngs (we can'L be ob[ecLlve abouL lL), raLlonal, cooperaLlve organlsaLlon
of unlversal emoLlonal responses concernlng whaL we care abouL
uoes eLhlcs= law/rellglon/professlonal code/publlc oplnlon ?
, -./0) ")1"2

1he eLhlcs cenLre ls ln Lhe lronLal Lobe - noL an eLhlcs cenLre" per se, buL a hlghly complex
group of funcLlonal sysLems ln Lhe braln LhaL medlaLe our eLhlcs
refronLal corLex: emoLlonal processlng, general, soclal and moral declslon-maklng (hlneas
Cage, 1848)
LLhlcs: Lhe mosL baslc crlLlcal sLudy of good and bad, rlghL and wrong
Medlcal LLhlcs
1. lormal dlscourse: Medlcal 8oard of AusLralla (empowered by sLaLuLe)
2. Seml-formal dlscourse: Colleges from professlonal groups (AMA, 8oyal colleges)
3. unofflclal dlscourse: !ournals, commenLarles (academlc bloeLhlcs commenLarlaL,
debaLes)
SocraLes: Pow should we llve? Pow should we dle?
kanL (kanLlan): 8ellglous duLy, reason, naLurallsLlc fallacy
Pume: naLurallsLlc (secular) passlons, consequenLlallsm, uLlllLarlanlsm
8esearch eLhlcs evoluLlon
o WWll (unconsenLed research, Lerrlble pracLlses) " PolocausL sLarLed research eLhlcs
and lnformed consenL
o nuremberg
o 8eecher
o P8LC sysLems
Cllnlcal eLhlcs
o 30s and 60s rapld Lechnologlcal developmenL
o ulalysls: braln deaLh crlLerla
o rolongaLlon of llfe: quallLy of llfe
o ManlpulaLlon of early llfe forms
o Lnd of llfe lssues
o Clvll 8lghLs movemenLs and challenges Lo auLhorlLy
o uocLor-paLlenL relaLlonshlp
8loeLhlcs
o rlnclpllsm
o 8esponses Lo prlnclpllsm
! CommunlLarlanllsm
! Clobal bloeLhlcs
! 8eneflL sharlng"
! AlLernaLlve concepLlons of eLhlcs
- Anglo-Amerlcan analyLlc (ragmaLlsm)
- Luropean (CommunlLarlan)
- ArlsLoLellan (narraLlve eLhlcs, femlnlsL eLhlcs)
- osLmodern
o AuLonomy
o 8loeLhlcs and blolaw
8ole of docLors
o Managlng uncerLalnLy of lnducLlve knowledge ln relaLlon Lo medlcal Lheory and
pracLlce (applylng evldence-based medlclne) Induct|ve reason|ng, a|so known as
|nduct|on or |nforma||y "bottom-up" |og|c,[1] |s a k|nd of reason|ng that constructs
Ashley Leong 42648332
or eva|uates genera| propos|t|ons that are der|ved from spec|f|c examp|es.
Induct|ve reason|ng contrasts w|th deduct|ve reason|ng, |n wh|ch spec|f|c examp|es
are der|ved from genera| propos|t|ons.
o CfLen pracLlse wlLhln Lhe consLralnLs of uncerLalnLy ln relaLlon Lo medlcal
knowledge, eLhlcs and law
o 1radlLlonal eLhlcal values (LradlLlon, auLhorlLy, professlon, soclal conLracL, role-
modelllng) ls belng challenged by new bloeLhlcs
!"#$%&'(#)%"* 9/: /"& ;'</" =)>-#.
ConvenLlons: eLlqueLLe, norms, cusLoms
MorallLy... and Lhen Law: source?, naLure of auLhorlLy? sancLlons?, ob[ecLlvlLy?, unwrlLLen,
welfare/harm/relaLlonshlps, connecLlon wlLh consclousness, raLlonallLy, freedom,
general/unlversal
PlppocraLlc CaLh: flrsL do no harm
uLlllLarlanlsm: flne Lo do harm as long as Lhe ma[orlLy beneflL
Law ls changlng, source ls AcLs of arllamenL

1wo broad legal LradlLlons
o naLural Law (Aqulnas) !"#$%#&'(
! arLlclpaLlon ln dlvlne law by raLlonal creaLures who parLlclpaLe ln Lhe
world
! Crlglnal, lndependenL of human belngs
! naLural world and supernaLural world lnLerconnecLed
! lacLs = values (permanenL)
! ulvlne law: lmmoral law ls &#$ law
! Puman law: lmperfecL verslon of naLural law
! 1radlLlons, cusLoms, rellglon, morals, bellefs, rlLuals, pracLlces
! SLolc phllosophy: law and morallLy are Lhe same - perpeLual LhroughouL
Lhe ages
! Clcero) +,-! ('. %/ ,%01$ ,!'/#& %& '0,!!"!&$ .%$1 &'$-,!2 %$ %/ #3
-&%4!,/'( '55(%6'$%#&7 -&61'&0%&0 '&8 !4!,('/$%&0 999 :'(%8 3#, '(( &'$%#&/
'&8 3#, '(( $%"!/7 '&8 $1!,! .%(( ;! #&! "'/$!, '&8 #&! ,-(!,7 $1'$ %/7
<#87 #4!, -/ '((7 3#, =! %/ $1! '-$1#, #3 $1%/ ('.7 %$/ 5,#"-(0'$#,7 '&8 %$/
!&3#,6%&0 >-80!9
3 -./0) ")1"2

! Medleval perlod: Puman reason sLlll dlscovers naLural law buL Lhls ls
revelaLlon, canon law was prlnclple vehlcle of naLural law
! Larly modern perlod: CroLlus - self-evldenL prlnclples, $1!& lndependenL
even of x Cod, more secular verslon " beglnnlngs of lndlvlduallsm and
soclal conLracL relaLed Lo lndlvldual rlghLs
! LaLer modern perlod: naLural rlghLs assoclaLed wlLh fundamenLal laws,
18
Lh
C ueclaraLlon of Puman 8lghLs, Locke: need for regulaLlon and
proLecLlon from governmenL power
! norm ls parL of Lhe fabrlc of Lhe world
o Legal poslLlvlsm (Penry ll) &#&?!"#$%#&'(
! We lmpose law on Lhe world " normaLlve ls nC1 parL of Lhe fabrlc of
Lhe world, we creaLed lL
! uoes noL promoLe vlrLue, buL faclllLaLes peaceful, harmonlous socleLy
! uoesn'L deal wlLh eLhlcs ln a very emoLlonal way
! Secular: law has no necessary facLual or loglcal connecLlon wlLh
morallLy, derlves from human experlence and pracLlsed morallLy, noL
any ldeal or unlversally valld source
! ueflned formally or procedurally (democraLlc process), sub[ecL Lo
challenge, change and reslsLance eg. AborLlon law
! Pobbes: rovlde proLecLlon from naLural sLaLe of war beLween one
anoLher. 8e[ecLs exlsLence of naLurally occurrlng soclablllLy. We adapLed
naLural rlghLs of man.
! 8enLhan & AusLln: Law amounLs Lo commands of Lhe soverelgn and ls
backed by sancLlons
! uLlllLarlan slanL
AppllcaLlon 1: nazl Law
o naLural law: lmmoral law ls noL law and need Lo be obeyed
o Legal poslLlvlsm: lmmoral law ls sLlll law buL can be repealed and replaced
AppllcaLlon 2: Law and morallLy (boLh are good)
o naLural law: obeylng law ls noL moLlvaLed only by fear or auLhorlLy, lL has a moral
elemenL/foundaLlon
o Legal poslLlvlsm: law ls noL prlmarlly almed aL promoLlng lndlvldual vlrLue, moral
experlence ls noL narrowly conflned Lo legal caLegorles
AppllcaLlon 3: Laws, morallLy and governmenLs
o naLural law: SLaLes can encroach on rellglous and moral freedom, more conslsLenL
wlLh reslsLance Lo un[usL laws
o Legal poslLlvlsm: sLaLes developed Lo reduce lmpacLs of rellglon and morallLy,
poslLlvlsL model of law helps harmony occur
Puman 8lghLs
o un ueclaraLlons: clalmed as unlversal and self-evldenL (closer Lo naLural law model)

?/3'2. @3/$)1)(/#)%"
Ashley Leong 42648332
Medlcal eLhlcs: a form of applled eLhlcs (noL meLa-eLhlcs or normaLlve eLhlcs), dlfferenL
varleLles uLlllse dlfferenL normaLlve frames (eg. uLlllLarlanlsm)

Pow we geL our values
o rlmary soclallzaLlon: famlly and school
o Secondary soclallzaLlon: co-currlcular, M88S program, church group
o 8ole-modelllng: peers, Leachers, cllnlclans
o Clarlfylng Lhrough experlence: whaL do l flnd Lolerable? WhaL are Lhe
consequences?
values: LmoLlonal, cognlLlve, behavloural
Clarlfylng my values:
o Sense of self and self-worLh
o 8aLlonal Lhlnklng (prlnclples)
o LmoLlonal awareness (moral senslLlvlLy, reacLlve aLLlLudes)
o CrlLlcally examlne personal behavlours (acLlon)
loundaLlonal Lheorles: Lhere are cerLaln prlmary values we cannoL [usLlfy raLlonally (Lhey are
lrreduclble, [usL are")
o SeL 1: CommunlLy, elder auLhorlLy, ancesLral reverence
o SeL 2: ersonal sLrengLh, human perfecLlon, lnequallLy
o SeL 3: leasure / aln
o SeL 4: Survlval, securlLy, flourlshlng (common Lo all socleLles, buL reallsed dlfferenLly,
common emoLlons, common needs)
o SylloglsLlc (deducLlve) model of applled eLhlcs
! (1) Moral prlnclple (eplsLemlc prlorlLy) + (2) facL " (3) moral concluslon
! (1) kllllng lnnocenL bables ls always wrong + (2) !ack ls an lnnocenL baby "
(3) kllllng [ack ls morally wrong
o lnducLlve/analogy model of casulsLlc eLhlcs (llke sclence and precedenLs)
! (1) parLlcular moral [udgemenL (eplsLemlc prlorlLy) + (2) analogous cases "
(3) rlnclple for all cases
! (1) AborLlng !ane's baby ls wrong + (2) !lll and 8eLh and ... are pregnanL "
(3) AborLlon ls wrong ln clrcumsLances
Coherence Lheorles: Lhere are no foundaLlonal values. 1he besL we can do ls Lry Lo make our
values as coherenL as posslble.
o nelLher prlnclples or parLlcular cases have prlorlLy
o @!3(!6$%4! !A-%(%;,%-") 6#1!,!&6! '61%!4!8 $1,#-01 '61%!4%&0 "#,! #, (!//
6#&3%8!&6! %& ;!(%!4! $1,#-01 ;'6B '&8 3#,$1 ,!'/#&%&0
o Allows prlnclples Lo be challenged as a resulL of novel cases
o loundaLlonal prlnclple/moral lnsLlLuLlon (1) All kllllng ls wrong doesn'L equal wlLh
new case (2) LuLhanasla
4 -./0) ")1"2

o CpLlon A: Subsume new case under orlglnal prlnclple = All kllllng ls wrong so we
should noL euLhanase
o CbLlon 8: Modlfy orlglnal prlnclple = All kllllng ls wrong excepL ln cases of euLhanasla

o Lower level values are revlsed more readlly
o Plgher level values are close Lo lnLulLlons
o Wlde reflecLlve equlllbrlum lncludes conslderaLlon of facLs, soclal maLLers,
compeLlng normaLlve Lheorles
o roblems: hard Lo argue when baslc values are so dlfferenL, CoherenL SysLem x and
? muLually excluslve
82&)(/3 0$/(#)(2 A #-2 9/:
1hlnk flrsL 1. Crlmlnal/clvll law 2. rofesslonal conducL (suspenslon/de-reglsLraLlon)
o uereglsLraLlon: gross professlonal mlsconducL eg. murder, rape
o Suspenslon: serlous cllnlcal lncompeLence/gross negllgence eg. serlous harm or
deaLh wlLhouL lnLenLlon
kerrldge, Lowe and SLewarL: CD'. %/ ' /E/$!" #3 ,-(!/ '&8 5,%&6%5(!/7 3#,"'((E 6,!'$!87 .1%61
0#4!,&/ /5!6%3%!8 ',!' #3 1-"'& '6$%4%$E9F
Law may be lnfluenced by moral conslderaLlons, buL ls of llmlLed asslsLance ln dlscusslon of
moral lssues and lags behlnd Lhese " sub[ecLs Lo consLanL change
Woods v Lowns (1966)
o Moral obllgaLlons ! legal obllgaLlons
o Law as an lnsLrumenL of soclal conLrol ls a blunL lnsLrumenL
18
Lh
cenLury lrench pollLlcal phllosopher Charles MonLesquleu: separaLlon of powers
o LeglslaLlve: parllamenLs - debaLe bllls and pass laws
o LxecuLlve: mlnlsLers and deparLmenLs - lmplemenL leglslaLlon
o !udlclal: declde legallLy and lnLerpreL leglslaLlon/apply prlnclples and precedenLs
naLural Law modern exemplar: Puman rlghLs
oslLlvlsm: pragmaLlc rules LhaL reflecL socleLy's broad consensus
rlnclples Lheory: comblnaLlon of boLh, lnLerlocklng rules and broad morally based prlnclples
(uworkln)
CrlLlcal legal sLudles: law ls pollLlcs - exerclse of Lhe domlnanL power
Ashley Leong 42648332
lemlnlsL [urlsprudence: Lhe legal person ls male
Sources of Law:
o LeglslaLlon
o Common (case) law: prlnclples and precedenLs developed by [udges ln cases LhaL
come before Lhem
! AusLralla AcL (1986) reduced Lngllsh law lnfluence
! rlnclple of /$',! 8!6%/%/: degree of predlcLablllLy, falrness and cerLalnLy
! @'$%# 8!6%8!&8%: legal prlnclple formlng precedenL of case
! G;%$!, 8%6$': oLher parLs of [udge's declslon (can be lmporLanL lf made ln
superlor courLs)
Plgh courL of AusLralla > Lhe Plgh CourL > lederal CourLs > SLaLe Supreme CourLs of Appeal >
SLaLe Supreme CourL > ulsLrlcL/CounLy CourLs > MaglsLraLes CourL
AdmlnlsLraLlve 1rlbunals: CCA1 (Cld Clvll and Admln 1rlbunal) - for medlcal and healLh
maLLers, ulsLrlcL CourL [udge asslsLed by 2 healLh pracLlLloners and a communlLy/lay
represenLaLlve
Coroner's courLs: vlolenL, susplclous, unnaLural deaLhs (eg. hosplLal deaLhs). lnqulry
conduced ln an lnqulslLorlal raLher Lhan adversarlal manner wlLh an alm of facL flndlng
Law 8eform Commlsslons: Cueensland Law 8eform Commlsslon - glve revlews and
proposlLlons, Lhese can be acLed on lnLo law
Clvll law: everyLhlng else oLher Lhan crlmlnal law v SLaLuLe Law v LqulLy (slmllar Lo common
law)
Legal duLles of docLors
o needs Lo be enforceable (Lhls depends on level of conLroversy and may depend on
proceedlngs belng broughL eg. euLhanasla)
o Crlmlnal Law
! lnLenLlon: "!&/ ,!'
! Murder (Shlpman uk): Cross professlonal mlsconducL, permanenL
dereglsLraLlon, llfe [all senLence
! 8ape (8 v Mlchaux 1984): ermanenL dereglsLraLlon, long [all Lerm
! ManslaughLer (earce CLu): Suspended reglsLraLlon, [all senLence 3 years
down Lo 6 monLhs
! ManslaughLer (aLel 2010): s288 and s301 Crlmlnal Code: exerclse
reasonable sklll and care ln dolng an acL whlch ls dangerous Lo human llfe or
deaLh. Surglcal Lx may exLend Lo dlagnosls and advlce Lo paLlenL concernlng
lL. (Should we perform Lhe surgery aL all?)
! x asslsL sulclde, perform unlawful aborLlon, negllgence, C8P, defraud (eg.
Medlcare fraud)
! AcLlon broughL by sLaLe, noL vlcLlm
! SLandard of proof: beyond reasonable doubL
o 8egulaLory/ulsclpllnary Law
! PealLh racLlLloner 8egulaLlon naLlonal Law AcL 2010 (CLu)
! uuLy Lo behave professlonally, malnLaln cllnlcal compeLence, remaln
unlmpalred
! M8A can lmpose range of underLaklngs, dlsclpllnary acLlons
! Cnly CCA1 (~ulsLrlcL CourL) can suspend or de-reglsLer
5 -./0) ")1"2

! uuLy Lo reporL oLher healLh professlonals who have performed noLlflable
conducL (drugs, sex, menLal healLh, slgnlflcanL deparLure from
professlonallsm)
o ubllc Law
! MalnLaln healLh of communlLy (noLlflcaLlons, reporLlng Lo courLs)
! rovlde accuraLe cerLlflcaLlon
o Puman 8lghLs/AdmlnlsLraLlve Law
! rovlde servlces and records
! noL deLaln a paLlenL agalnsL Lhelr wlll
o CLher Clvll Law: ConLracL, LqulLy and 1orL
! Concerned wlLh relaLlons bw lndlvlduals
! urpose Lo seek compensaLlon/remedy
! AcLlon broughL by plalnLlff, noL sLaLe
! SLandard of proof: balance of probablllLles
1. ConLracL: usually provlslon of servlce for fee (exerclse reasonable sklll and
care ln order Lo beneflL paLlenL)
2. llduclary uuLy: obllgaLlon lmposed by law of equlLy and acLs Lo proLecL
beneflclary as Lhere ls a greaL u- power lmbalance due Lo vulnerablllLy.
MusL noL explolL eg. duLy noL Lo have sexual relaLlons, accepL glfLs,
confldenLlallLy
3. 1orL: clvll wrongs are negllgence/Lrespass/defamaLlon/nulsance
a. CbLaln consenL (fallure = Lrespass)
b. ulsclose lnformaLlon (fallure = negllgence)
c. Lxerclse reasonable care Lo avold damage (fallure = negllgence)
B'#7 %1 @/$2
uuLy: lormallsaLlon of moral consensus
lalllng Lo dlscharge a requlred duLy of care = negllgence
PlsLory - for lndusLrlal revoluLlon wanLed Lo llmlL llablllLy whllsL maxlmlslng requlremenL for
compensaLlon Lo encourage enLerprlse = now musL 8!"#&/$,'$! faulL (fallure Lo Lake
reasonable care)
Same deal wlLh medlclne - medlcal lndemnlLy crlsls" (lncreaslng compensaLlons, medlcal
servlces were decreaslng) " Clvll LlablllLy AcL 2003 (CLu) CurrenL deflnlLlon of duLy of care
(abouL whaL a reasonable person would do ln Lhe slLuaLlon)
LsLabllshlng a duLy of care
1. lorseeablllLy and roxlmlLy
o hyslcal proxlmlLy
o Causal proxlmlLy (bw acL and ln[ury)
o ClrcumsLanLlal proxlmlLy (u- relaLlonshlp!)
o H#&#01-! 4/ I$!4!&/#& 1932 (snall): ?ou musL Lake reasonable care Lo
avold acLs or omlsslons whlch you can reasonably foresee would be
llkely Lo ln[ure your nelghbour.
2. (1) + whaL ls falr, [usL and reasonable
Ashley Leong 42648332
3. 8e[ecLlon of (2) and (3)-sLage LesLs for a LesL of reasonableness ln Lhe
clrcumsLances accordlng Lo communlLy sLandards"
Medlcal negllgence requlremenLs (musL saLlsfy all 3):
1. uuLy of care owed (foreseeable rlsk quallfled by facLors ln J%4%( D%';%(%$E K6$ LMMNO
2. 8reach of Lhe sLandard of care (compeLenL professlonal pracLlce)
3. 8reach caused damage
o lacLual causaLlon (breach ls a necessary condlLlon of harm)
o normaLlve causaLlon (approprlaLe for scope of llablllLy Lo exLend Lo
harm)
1orLs: negllgence, Lrespass on person/land, prlvaLe nulsance, defamaLlon
no general duLy Lo rescue
LxcepL n1: Crlmlnal Code s133
D#.&/ 4 P##8/ QRSSTO: speclal clrcumsLances creaLed relaLlonshlp of proxlmlLy, desplLe no
prevlous u- relaLlonshlp
oslLlve 5,#3!//%#&'( obllgaLlon by M8A: Cood Medlcal racLlce: A Code of ConducL for
uocLors ln AusLralla (and Lo dlsclose medlcal error)
Cood SamarlLan LeglslaLlon
o D'. ,!3#," '6$ RSSU QVDHO: no llablllLy for healLh pracLlLloner lf acLlon done ln good
falLh
o Legal proLecLlon #&6! healLh professlonal LreaLs
+,'&/5#,$ G5!,'$%#&/ Q@#'8 W/! X'&'0!"!&$O K6$ RSSU QVDHO: lf a person ls ln[ured, musL
make reasonable endeavours for medlcal ald
8ouLlne duLles Lo paLlenL:
o ulagnosls and Lx
o ALLendance/arrangemenL of aLLendance
o ulsclosure - provlslon of lnformaLlon for declslon-maklng
o lollow-up
o ConfldenLlallLy
o ulsclose medlcal error
o ...uuLy Lo revlew LesL resulLs senL by random nurse racLlLloner?
C#'&2"# D231/$2
AMA Code of LLhlcs (1966): conslder flrsL Lhe well-belng of your paLlenL
Lth|cs of Duty
Self CLhers
Lgolsm AlLrulsm
ueslres MorallLy
lnLeresLs uuLy
Plgh sLaLus and lncome, auLonomy, self regulaLlon ln reLurn for " eLhlc of duLy, hlgh
sLandards of care and declslon-maklng burdens (no recognlLlon of self")
ArlsLoLellan eLhlcs and racLlce: happlness=vlrLue, morallLy=deslres, lnLeresLs, values,
personal llfe
67 -./0) ")1"2


aLlenL care = beneflcence (feellng good abouL yourself)
o 8equlres conLlnulng crlLlcal appralsal
o Crounded ln deslres and values
o 8eplaces alLrulsm wlLh beneflcence
o 8eplaces self-sacrlflce wlLh work-llfe balance and boundarles
CmnlpoLenL rofesslonal ulsorder
o CorrupLlng effecLs of power, domlnance, sLaLus
o lnd: lnflexlble lnflaLed and obsesslve bellefs, poor lmpulse conLrol, fallure ln effecLlve
communlcaLlon
o Soclal: rank-closlng and proLecLlon, avoldance of genulne responslblllLy and
accounLablllLy
o Masquerades: excepLlonless alLrulsm, marLyrdom, unearned auLhorlLy
o LffecLs: harm Lo everyone
Welfare, lmpalrmenL aL SCM

Ashley Leong 42648332
PealLh racLlLloner 8egulaLlon naLlonal Law AcL 2009 (CLu) uL lL flrsL ln CLu b/c CLu has no
upper house, now all sLaLes have lL
naLlonal 8eglsLraLlon and AccredlLaLlon Scheme (from 2010)
lnvolves reglsLraLlon of sLudenLs
o naLlonal 8oard may ask educaLlon provlder for llsL of persons underLaklng approved
program of sLudy
o Lach naLlonal 8oard musL keep a sLudenL reglsLer
o 8eglsLered healLh pracLlLloner or sLudenL Lo glve naLlonal 8oard noLlce of cerLaln
evenLs (offence punlshable by 12 monLhs lmprlsonmenL or more, flndlng of gullL for
an offence punlshable by lmprlsonmenL, forelgn reglsLraLlon suspended) wlLhln 7
days
AP8A (AusLrallan PealLh racLlLloner 8egulaLlon Agency) supporLs Medlcal 8oard
lmpalrmenL (physlcal or menLal) musL deLrlmenLally affecL sLudenL's capaclLy Lo underLake
cllnlcal Lralnlng
LducaLlon provlder musL noLlfy naLlonal Agency lf
o SLudenL enrolled has an lmpalrmenL > may place Lhe publlc aL subsLanLlal rlsk of
harm
o Lven lf noL dlre, school can #5$%#&'((E noLlfy Lhe board
Crounds for volunLary noLlflcaLlon (can be healLh assessed)
o SLudenL has been charged wlLh an offence LhaL ls punlshable by 12 monLhs
lmprlsonmenL or
o SLudenL has, or may have, an lmpalrmenL
o SLudenL has conLravened (vlolaLed) a condlLlon of sLudenL's reglsLraLlon
C#'&2"# 52-/E)%'$ /"& FG !"#2>$)#7 /"& 8).(%"&'(#
9 caLegorles for expecLaLlons of Lhe school
1. PonesLy/lnLegrlLy
2. 8esponslblllLy/rellablllLy
3. Compasslon
4. Self-appralsal
3. u- relaLlonshlp
6. ulscrlmlnaLlon
7. 8especL
8. 8elaLlng Lo oLhers
9. arLlclpaLlon

6, -./0) ")1"2

AdvanLages: beLLer ln llne wlLh uC pollcy, lnvolve wlder group of School sLaff as declslon-
makers, lnvolve uC's educaLlonal role ln professlonal regulaLlon


0$%12..)%"/3).<4 H((%'"#/I)3)#7 /"& C231J=2>'3/#)%"
rofesslon: speclallsed knowledge and skllls, requlres exLended educaLlon, sLandards of
compeLence (professlonally and legally regulaLed), profess values, codes of eLhlcs, self-
regulaLlon, geL auLhorlLy and presLlge, professlonal auLonomy/proLecLlon
knowledge - sclence " compeLence " eLhlcal sLandards - codes
LLhlcal codes
o Cood Medlcal racLlce: A Code of ConducL for uocLors ln AusLralla (M8A)
o AMA Code of LLhlcs
o Medlcal rofesslonallsm 2010 (AMA)
Self-regulaLlon processes: educaLlon (M88S Lhen speclallsL Lralnlng), Aus. Medlcal Councll
accredlLaLlon of Med Schools, CuallLy assurance commlLLees, L8M, Legal sLandard of care,
Medlcal 8oard
Self-regulaLlon aLLenuaLlon:
o PealLh CuallLy and ComplalnLs Commlsslon (separaLe body)
o naLlonal compeLlLlon pollcy
o lncreased communlLy represenLaLlon (M8A)
o ShlfLs ln negllgence law - @#0!,/ 4 P1%$'B!, (surgeon musL dlsclose all rlsks whlch
may evenLuaLe)
o naLlonal 8eglsLraLlon and AccredlLaLlon: =!'($1 Y,'6$%$%#&!, @!0-('$%#& Z'$%#&'( D'.
K6$ LMMS QVDHO
Areas of self-regulaLlon:
o Cllnlcal compeLence/performance
o hyslclan lmpalrmenL
o unprofesslonal conducL
Ashley Leong 42648332
;2/3#- 0$/(#)#)%"2$ =2>'3/#)%" K>'7 1$%< H'.L ;2/3#- 0$/(#)#)%"2$ =2>'3/#)%"
H>2"(7M
Councll of AusLrallan CovernmenLs (CCAC) commlssloned roducLlvlLy Commlsslon reporL
(2006), complex mulLl-reglsLraLlon sysLem, no unlformlLy " naLlonal scheme for reglsLraLlon
2010
Slnce !uly 2010: naLlonally conslsLenL leglslaLlon, 1 naLlonal scheme (+WA)
AdvanLages: moblllLy, unlformlLy, efflclency, collaboraLlon, Lransparency

naLlonal 8oards: proLecL publlc, powers governed by naLlonal Law, seL pollcles, reglsLraLlon
o uevelop sLandards, codes and guldellnes for professlon
o lnvesLlgaLe complalnLs (work wlLh AP8A and PealLh ComplalnLs LnLlLles ln each
sLaLe Lo declde who wlll lnvesLlgaLe) $1!/! ',! &#$ 5-;(%6 -&(!// ,!3!,,!8 $#
[&8!5!&8!&$ +,%;-&'( (very serlous ones)
o ConducL panel hearlngs and refer serlous maLLers Lo 1rlbunal hearlngs
o Approve accredlLaLlon sLandards
o Crlmlnal hlsLory checks
o 8enewals (provlde annual sLaLemenL, make cerLaln declaraLlons)
SLaLe and 1errlLory 8oards: declde abouL lndlvldual pracLlLloners, reglsLraLlon, geL
delegaLlons from naLlonal 8oard
AP8A: supporLs 8oards, advlses MlnlsLerlal Councll abouL admlnlsLraLlon of Lhe naLlonal
scheme
8eglsLraLlon sLandards
o Crlmlnal hlsLory
o rofesslonal lndemnlLy lnsurance (musL be ln force)
o ConLlnulng rofesslonal uevelopmenL
o 8ecency of racLlce
o Lngllsh
naLlonal 8eglsLers (provlde publlc record of):
o 8eglsLered healLh pracLlLloners
63 -./0) ")1"2

o CondlLlons and underLaklngs
o uereglsLered pracLlLloners
F"&2$.#/"&)"> B2/#-
ueaLh ln AusLralla - A8S daLa
o Llfe expecLancy has lmproved over Lhe pasL 20 years - 3.6 years for males, 3.9 years
for females
o 8oy: 79.3 years
o Clrl: 84 years
o SLandardlsed deaLh raLes (Su8) were hlghesL ln n1, lowesL ln AC1
o ueaLh raLes have been decreaslng for 1-4 years old (?)
ueflnlng deaLh
o 8ernaL, Culver and CerL (1981) - permanenL cessaLlon of funcLlonlng of Lhe
organlsm as a whole"
o CerL, Culber and Clouser (2006) - permanenL cessaLlon of all observable naLural
funcLlonlng of Lhe organlsm as a whole and Lhe permanenL absence of
consclousness ln Lhe organlsm as a whole and ln any parL of LhaL organlsm."
o CLu: 1radlLlonal cardloresplraLory deflnlLlon: asysLole, apnoea (leadlng Lo deaLh of
all organs wlLhln a shorL Llme) $1%/ 61'&0!8 .%$1 4!&$%('$#,/\
o nLW: 8raln deaLh: a person ls braln dead when all elecLrlcal acLlvlLy of Lhe braln has
ceased for a speclfled perlod of Llme (lncludes hlgher corLlcal funcLlons and lower
braln sLem funcLlons)
o uonaLlon afLer cardlac deaLh (uCu) " lncrease LransplanL raLes ('";%0-%$E #3 .1!&
Y!,/#& CKF %/ 5,#&#-&6!8 8!'8O
8lologlcal (braln/body) and blographlcal (mlnd/person) deaLh
o !ohn kerr, rofessor of aLhology aL uC dlscovered apopLosls (now modern heal
move people closer Lo Lhelr apopLoLlc poLenLlal)
o ueaLh Lhrough Lrauma: blologlcal and blographlcal deaLh slmulLaneous
o ueaLh Lhrough demenLla: blographlcal deaLh precedes blologlcal deaLh
o erslsLenL vegeLaLlve SLaLe (vS): sLlll some acLlvlLy ln braln
ManlpulaLlng deaLh
o ManlpulaLe up: prolong dylng by Lemporarlly supporLlng some of Lhe dylng organs
o ManlpulaLe down: wlLhdrawal and wlLhholdlng when no progress ls belng made
Medlcallslng deaLh
o PomosexuallLy: crlmlnal > sln > medlcal caLegory > non-caLegory now (resulL of
soclal acLlon)
o AnclenL: rlesL used Lo sLand aL end of bed
o osL LnllghLenmenL: deaLh ls now a 8%'0&#/%/
1he meanlng of deaLh
o Cood: paln-free, open acknowledgemenL of lmmlnence of deaLh, surrounded by
famlly and frlends, unflnlshed buslness resolved, manner of lnd personallLy,
palllaLlve care as a medlcallsed good" deaLh, 8!'$1 '/ 5!,/#&'( 0,#.$1
C/"(#)#7NG'/3)#7 %1 9)12
Ashley Leong 42648332
Llvlng person?
o Puman embryos
o ArLlflclally susLalned whole braln dead bodles
o lndlvlduals ln vS
o lndlvlduals wlLh advanced demenLla
o Anencephallc bables
Cb[ecLlve quallLy of llfe: baslc needs are meL and Lhe maLerlal resources necessary Lo llve llfe
o Slnger: lnfanLlclde up Lo a very young age ls relaLlvely permlsslble and Lhere ls no
morally slgnlflcanL dlfference bw a foeLus and an embryo
o 8uL lL really ls sub[ecLlve!
Slnger
o CuallLy of llfe poslLlon
o uangerous - challenges convenLlonal wlsdom, even Lhough he looks llke a mlld-
mannered reporLer
o Says SmlLh comblnes Lwo morally dlfferenL Lhlngs
o valuable: consclousness and llves of Lhose who wlsh Lo llve
o Specles membershlp noL morally slgnlflcanL
o noL all bables should llve - b/c quallLy of llfe may noL be sufflclenLly good, preferable
Lo brlng baby Lo dle by leLhal ln[ecLlon raLher Lhen succumb (buL Lx can make baby
comforLable) no dlsLlncLlon bw wlLhdrawal and leLhal ln[ecLlon
o recedenL > docLors wlLhdraw llfe susLalnlng Lx
o PearL ls lmporLanL buL reason musL play lmporLanL parL. values can'L be drlven by
emoLlons alone (PlLler)
o 8eLLer Lo save money on llves noL worLh llvlng ln 1
sL
world counLrles and Lransfer Lo
Lhose worLh llvlng ln 3
rd
world counLrles
neonaLologlsL: l wlll never be an assassln
Wesley SmlLh
o SancLlLy of llfe poslLlon
o Lveryone's llfe ls of equal value
o uoesn'L belleve any lndlvlduals are expendable (non-uLlllLarlanlsm)
o Self-evldenL we musL never klll a baby
@%"(26#. %1 B).2/.24 ;2/3#- /"& !33"2..
An lndlvldual may have dlabeLes melllLus accordlng Lo one LesL, buL noL accordlng Lo Lhe
oLher: accuracy vs convenlence/cosLs " musL maxlmlse paLlenL welfare, even lf false
negaLlves
ueflnlLlon of PealLh
o negaLlve deflnlLlon: healLh ls Lhe absence of dlsease
o oslLlve deflnlLlon: healLh ls a sLaLe of compleLe physlcal, menLal and soclal well-
belng, and noL merely Lhe absence of dlsease or lnflrmlLy
o CannoL healLh=global well-belng
o PealLh can deLerloraLe ln absence of some dlscreLe dlseases
AbnormallLy: sLaLlsLlcally, cllnlcally, prognosLlcally (lncreased rlsk of morbldlLy or morLallLy)
64 -./0) ")1"2

ueafness: sLaLlsLlcally and cllnlcally abnormal, yeL some don'L regard deafness as a problem
" sub[ecLlve maLLers of preference and cholce
LssenLlallsL/blomedlcal vlew: dlsease descrlpLlons LhoughL of as enLlLles lndependenL of Lhelr
occurrence ln Lhe 5!,/#&, knowlng Lhe cause and sclenLlflc explanaLlon prlvlleges Lhe
condlLlon and LherapeuLlc efforLs are dlrecLed aL flxlng blomechanlcal cause, separaLe from
lnLeracLlons wlLh body mechanlsms
nomlnallsL vlew: noL excludlng essenLlallsm, buL accommodaLlng lL wlLhln a wlder fram LhaL
allows for redescrlpLlon/reclasslflcaLlon, name of dlseases are noL separaLe enLlLles, buL Lhe
common properLles shared by lndlvlduals sharlng Lhe same slckness, beLLer allows for values
ln deflnlng dlseases
ulsease or lllness
o lndlvldual evaluaLlon noL sufflclenL - we don'L care abouL Lhlngs some lndlvlduals
value (cosmeLlc dlfferences) buL we do abouL Lhlngs lndlvlduals don'L care abouL
(llke advanced demenLla)
o We wanL 1. 8oLh descrlpLlve and evaluaLlve elemenLs 2. Some boundarles around
whaL healLhcare ls responslble for
o ledoryka: healLh ls naLural 3(#-,%/1%&0 (physlologlcal requlremenLs wlLh evaluaLlon -
flourlshlng ls Lhe good of Lhe organlsm). luncLlons LhaL deflne healLh - Lhose
occurrlng naLurally," noL from our cholces (buL some appear Lo be chosen")
Pard Lo be ob[ecLlve" wlLh psychlaLry

ulsease-mongerlng: creaLlng new dlagnosLlc caLegorles Lo develop new drugs " $$
sychlaLry
o Are sclence and freedom compaLlble?
o naLure and sLaLus of lnLenLlonallLy
o Causal deLermlnlsm: we make necessary and sufflclenL condlLlons for occurrence Lo
happen and use Lhese Lo make predlcLlons. lf we are wrong, we quesLlon Lhe
explanaLlon whlch grounds Lhe predlcLlon ln Lhe flrsL place.
o Pard Lo dlsLlngulsh naLural" dysfuncLlon vs. chosen" dysfuncLlon b/c we are
looklng aL behavlour and menLal whlch ls arguably sub[ecL Lo cholce and conLrol
o AlLernaLlve soluLlons:
1. sychlaLry ls noL sclenLlflc/essenLlallsL/blomedlcal, so ls noL a proper parL
of medlclne
Ashley Leong 42648332
2. nomlnallsL model accommodaLe aspecLs LhaL are baslc (prlor Lo any
cholces), and apply approprlaLe measures (eg. drugs) buL also accounL for
lnLerpersonal, lnLenLlonal aspecLs wlLh oLher LherapeuLlc meLhods (eg.
psychologlsL)
Scope of healLh care
1. uLlllse ldeas of naLural funcLlon, flourlshlng and dysfuncLlon, comblnlng Lhe descrlpLlve
and Lhe evaluaLlve
2. lnclude maladles oLher Lhan whaL an essenLlallsL, mechanlcal concepLlon of dlsease
accepLs
3. Avold over-medlcallsaLlon of caLegorles LhaL are noL problems of naLural dysfuncLlon,
buL also over-medlcallsaLlon of lndlvldually dlsvalued problems
4. Alm for provlslonal agreemenL amongsL soclal values ln relaLlon Lo healLhcare
!"#2$/(#)%". :)#- @%332/>'2.
8eferrlng Lo speclallsL: raLlonale and requlremenLs for dolng so and whaL are reclprocal
obllgaLlons
o AdequaLe deLall ln communlcaLlon
o knowledge and acknowledgemenL of roles and responslblllLles of roles and
responslblllLles of consulLanL and C
LLhlcs vs eLlqueLLe
o LLhlcs: Moral lmperaLlves have a characLerlsLlc lmporLance and urgency ln vlrLue of
belng grounded ln prlnclples LhaL are very general, non-arblLrary, and aL Lhe hearL of
whaL makes lL posslble for human belngs Lo flourlsh ln communlLles.
o LLlqueLLe: CaLegorlcal, buL noL necessarlly lmporLanL. Slmllar Lo morals buL Lhey do
noL have Lhe klnd of cenLral and lnellmlnably pervaslve lmporLance ln human affalrs
LhaL moral norms have.
o 8lurred bw bad manners
1homas erclval: wroLe flrsL medlcal eLhlcs book: Medlcal LLhlcs 1803 (dealL wlLh belng a
genLleman and Lhe professlonal code of eLhlcs for physlclans and surgeons)
o uuLles
o Common sLandards
o CooperaLlon bw docLors
o lndependence of docLors from employers
uldacLlc Leachlng: lnLended Lo Leach, parLlcularly ln havlng moral lnsLrucLlon as an ulLerlor
moLlve (v. Pelrarchlcal v. Compllance wlLh unquesLloned auLhorlLy) " llke dldacLlc medlclne
(paLernallsLlc)
SLudenL-docLor problems:
o negaLlve role-modelllng
o uneLhlcal Lx
o CsLraclsm of complalnanLs
uylng role of Cs (no longer equal parLners)
o CommunlLy demand for super-speclallsaLlon
o llnanclal blas of Medlcare sysLem for procedural work
65 -./0) ")1"2

o lragmenLaLlon of care " C no longer has a managemenL role, [usL a
referral/gaLekeeper role
! 8eferrals are necessary buL fragmenL care, buL should be llmlLed
! lnLer-speclallsL referrals can occur wlLhouL conference wlLh Lhe C furLher
fragmenLs occur and reduces overall conLlnulLy/conLlnuaLlon
! C loses Lrack of whaL ls golng on " sllos of medlcal pracLlce" consLanL
referral buL doesn'L know whaL's golng on ln oLher sllos
! PosplLal care ofLen mulLl-speclallsL wlLh no coordlnaLlon
! C noL presenL ln mosL hosplLals
! aLlenLs someLlmes requesL referrals LhaL are noL requlred (demand seelng
a speclallsL only) C8 referrals wlLhouL even seelng C (C ls LoLally
bypassed)
o 1ask subsLlLuLlon: nurse pracLlLloners
roblems wlLh colleagues:
1. CLher docLor's LreaLmenLs
o CommenL on colleague's compeLence
o 8alance obllgaLlon Lo Lx paLlenL adequaLely vs. confuslng paLlenL
o ln a sense, sLarL from square 1: 1ell me abouL Lhe problem, don'L blame oLher
ur, say whaL you Lhlnk Lx should be
o Legal duLy of dlsclosure and mandaLory reporLlng laws Lo M8A
2. CLher docLor's problems
o roblems wlLh LreaLlng docLor as (denles rlghL Lo be a paLlenL, assumes docLor
knows everyLhlng abouL Lhelr problem as well, can collude
o lmpalred pracLlLloners (fear of belng prevenLed from worklng, reslsLance Lo
obLalnlng Lx)
82&)(/3 @'3#'$2 /"& 82&)(/3 C#'&2"#.
Crganlsed medlclne ln Lhe 19
Lh
and 20
Lh
cenLurles: rlse of professlons, soclal conLracL, eLhlcs
of ArlsLoLellan pracLlce
4am loglc
o learnlng moral prlnclples and crlLlcal Lhlnklng skllls wlll be lnsufflclenL Lo enable
[unlor docLors Lo acL eLhlcally. AddlLlonal knowledge and skllls for deallng wlLh Lhe
pressures of hosplLal work LhaL wlll acL agalnsL Lhem behavlng ln accordance wlLh
Lhelr eLhlcal convlcLlons are necessary Lo complemenL Lhe declslon-maklng skllls LhaL
currenLly form Lhe focus of eLhlcs Leachlng"
o LLhlcs educaLlons alms Lo produce eLhlcal pracLlLloners
o So much more needed
o !unlor docLors need Lo be eLhlcally-senslLlve and have Lhe courage and ablllLy Lo
volce concerns
o aLlenL harm vs. belng a [unlor docLor (culLure ls changlng slowly)
negaLlve aspecLs of medlcal culLure:
1. negaLlve role-modelllng
o lallure Lo be honesL wlLh paLlenLs (noL Lelllng Lhem Lhe full sLory)
o aLernallsLlc aLLlLudes
Ashley Leong 42648332
o lallure Lo dlsclose errors Lo paLlenLs
o ulsdaln for evldence-based pracLlses (llke handwashlng)
o AccepLlng unreasonable largesse (eg. pharmaceuLlcal companles beneflLs)
o lallure Lo acknowledge lmpalrmenL or lack of knowledge: perfecLlonlsm and
narclsslsm
2. Abuse
o Sexual harassmenL or verbal abuse/humlllaLlon
o uelegaLlng Lasks lnapproprlaLe Lo Lralnlng sLage (eg. breaklng bad news, obLalnlng
consenL)
o nepoLlsm, favourlLlsm
o 8aclal dlscrlmlnaLlon
3. Pelrarchles and llLLlng ln
o Abuse and negaLlve role-modelllng engender flLLlng ln, complylng, noL saylng
anyLhlng " cynlclsm
o erpeLuaLes Lhe culLure " provldes comforL, relnforcemenL, sLaLus, power
o values and behavlours resulL from medlcal soclallsaLlon and 1%88!& 6-,,%6-(-"
Challenglng Lo Lhe Medlcal CulLure:
1. SLrucLural Changes
o Changes Lo self-regulaLlon: mandaLory reporLlng of cllnlcal sLandards, lmpalrmenL,
boundary lssues
o aLlenL safeLy movL lncludlng error dlsclosure
o PCCC (PealLh CuallLy and ComplalnLs Commlsslon) SLandards: handwashlng
o LlmlLs on pharmaceuLlcal supporL beneflLs
o Safe worklng hours developmenLs
o Lxposure of lnapproprlaLe responslblllLles (eg. obLalnlng consenL)
o More medlcal educaLlon abouL law
2. More 8eslsLanL
o ersonallLy-relaLed lssues (problems wlLh consulLanLs and senlors who have
problemaLlc personallLles (narclsslsLs)
! aLernallsm: resLrlcLlng Lhe freedom and responslblllLles of Lhose
underneaLh you
! uerogaLory commenLs
! uemeanlng behavlour
! 8oundary lssues
,7 -./0) ")1"2