In whose interests? The best interests principle under ethical scrutiny

This paper critically examines the best interests principle and its role in making decisions about intensive care treatment. In current practice the best interests principle is sometimes relied upon to guide decision making in circumstances when the patient is incompetent, although it is intrinsically linked to inconsistent assumptions about what is meant by quality of life. This situation means that there is potential that moral errors will be made that may result in an unwanted extension of life for some individuals or the premature death of others.

It is difficult to justify such decision making on ethical grounds. A greater understanding of the best interests principle, and consequently the concept of quality of life, is needed in order to ensure that decision making about intensive care is ethically defensible. It is argued that an ideal theory of quality of life provides an appropriate framework for best interests decisions, and that the decision making process ought to, whenever possible, involve the patient's close family.

Decision making in health care: limitations of the substituted judgement principle

The substituted judgement principle is often recommended as a means of promoting the self-determination of an incompetent individual when proxy decision makers are faced with having to make decisions about health care. This article represents a critical ethical analysis of this decision-making principle and describes practical impediments that serve to undermine its fundamental purpose. These impediments predominantly stem from the informality associated with the application of the substituted judgement principle. It is recommended that the principles upon which decisions are made about health care for another person should be transparent to all those involved in the process. Furthermore, the substituted judgement principle requires greater rigour in its practical application than currently tends to be the case. It may be that this principle should be subsumed as a component of advance directives in order that it fulfils its aim of serving to respect the self-determination of incompetent individuals.

Provocation: the ongoing subservience of principle to tradition

The defence of provocation has been highly criticised. Most
commentators argue that the defence i" misguided. There does not appear
to be any community pressure to preserve the defence. Despite this,
legislatures are reluctant to abolish provocation as a partial defence to,
murder. This article examines the underlying rationale for tile defence. I1
concludes that the defence is founded on a flaw~ed assumption about
human nature-that people are captive to some of their emotional states.
It is also argued that the convoluted and confusing (if not confused) test
for provocation is evidence of the unsound nature of the defence-it is
simply a case of not being able to develop a feasible (and candid) principle
for a doctrine that is devoid of a sound justification.

Macleod and the offence of defrauding the company in one-person businesses: the divergence between legal principle and logic widens

The recent High Court decision in Macleod v R establishes that a director and sole shareholder may be convicted of fraudulently applying a company's property even though the person has consented to the personal use of the company's property. It is contended that while this decision is consistent with the weight of precedent, it is wrong in principle. The decision implies that corporations are not only separate legal entities, but that they are highly virtuous legal entities -- incapable of being imbued with the dishonest intentions and activities of the individuals controlling the company.

The problem of voluntariness: parents and the anti-discrimination principle

Examines the theoretical justifications for the anti-discrimination protection for working parents in Australia. Implication of discrimination, voluntaries and employment; Analysis of the tort principles; Factors affecting the justification for protecting working parents.

Giving content to the principle of proportionality: happiness and pain as the universal currency for matching offence seriousness and penalty severity

The principle of proportionality prescribes that the punishment should equal the crime. It is one of the most important principles of sentencing. Yet, despite its widespread acceptance it offers no meaningful guide to sentencing. Hence penalty levels fluctuate greatly between jurisdictions and within jurisdictions. This is because there is no universally agreed criterion for measuring offence seriousness or penalty severity. This article suggests that the appropriate criteria for matching offence seriousness and penalty severity is the level of unhappiness or pain stemming from each of these impositions. Thus, for example, the level of pain meted out to a rape offender should equal the level of pain caused to a rape victim. Emerging scientific studies on human well-being and happiness show that human beings are similarly built in terms of the experiences that are either conducive or inimical to well-being. This commonality provides a strong foundation to be confident to make reasonably accurate predictions concerning the extent to which adverse events, such as being the victim of a criminal offence or subjected to a form of criminal sanction will stifle human flourishing. This will then allow us to match accurately offence seriousness and penalty level.

Balancing continuity and change through forms of organising

Faced with increasing environmental complexity and uncertainty, organisations have been urged to replace traditional bureaucratic structures with more flexible, responsive forms of organising. However, the emerging paradox is that exploration and experimentation, features of new forms of organising, benefit from the planning, coordinating and direction-setting mechanisms that underpin traditional forms of organising. It is therefore important to recognise the distinctive and complementary features of traditional and new forms of organising. This demands a dualities-sensitive perspective which encourages, rather than tries to resolve, a constructive tension between seemingly contradictory organising forms such as flexibility and efficiency, autonomy and control, hierarchy and networks, focus and diversification. Managing continuity and change through forms of organising becomes central to building healthy organisations.

Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement

Aim. The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.
Background. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.
Method. A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.
Findings. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.
Conclusion. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.

The role of dualities in arbitrating continuity and change in forms of organizing

A substantial body of literature on new forms of organizing has forecast the end of bureaucracy. More recent empirical studies, however, indicate that high-performing organizations are adopting dual forms of organizing in which the controllability advantages associated with traditional forms work to complement and support the responsiveness attributes of new forms of organizing. The paradox is that, if organizations discard the key planning, co-ordinating and direction-setting mechanisms of traditional forms of organizing, they also remove the stabilizing dimensions of organizational form that are essential in periods of uncertainty and change. The challenge for organizations lies in learning how to manage the tensions or dualities between traditional and new forms of organizing, a process demanding the arbitration of continuity and change. This paper explores the concept of dualities and its salience in the management of organizing forms. First, the nature of dualities is explained; secondly, a set of characteristics is developed to describe the behaviour of dualities; and thirdly, suggestions are presented for arbitrating the tensions that exist in organizing form dualities. These three contributions are relevant because they signal the route to the effective creation and management of organizing form dualities, the benefit of which is the constructive combination of dynamic capabilities (underpinning innovation and responsiveness, the hallmarks of new forms of organizing) and operational capabilities (underpinning stability and efficiency, the hallmarks of traditional forms of organizing).

Conceptual framework of the precautionary principle approach in the decision-making process

This article reviews the precautionary principle as an approach in addressing decisions with far reaching environmental consequences under scientific uncertainty. The precautionary principle is intended to assist with structuring environmentally risky decisions toward sustainable development. It responds to the lack of scientific evidence of a potential environmental problem. There is currently no framework to assist with the process indicating the areas of importance and stages of decisionmaking. This paper suggests a framework to assist with the process of decision-making for complex environmental problems. The main areas of concern are the issues relating to the costs, risks, and benefits assessments. The main stages of the framework includes; definition of the problem, analysis of the potential environmental risks, assessments of specific anticipated legal, social, economic, political, and technological impacts, review of the key players (social, organisation and government) obligations, comparison of alternatives available, determination of accountability, implementation, decision making, monitoring and control processes.

China's defence industries : change and continuity

Asia looks and feels very different now compared to the days of the Cold War. The sense that Asia now works differently can be traced to a single source – the re-emergence of China. China was the dominant power in greater Asia for most of recorded history. This historical norm was interrupted from the early 19th century, too far into the past to be recognisable and readily accommodated by the actors in today’s international arena. A powerful China feels new and unfamiliar.

Arriving peacefully at mutually acceptable relationships of power and influence that are very different from those that have prevailed for the past half century will be a demanding process. The world’s track record on challenges of this kind is not terrific. It will call for statesmanship of a consistently high order from all the major players, and building the strongest possible confidence among these players that there are no hidden agendas.