'Ultrasound is an invaluable third eye, but it can't see everything' : a qualitative study with obstetricians in Australia

Background: Obstetric ultrasound has come to play a significant role in obstetrics since its introduction in clinical care. Today, most pregnant women in the developed world are exposed to obstetric ultrasound examinations, and there is no doubt that the advantages of obstetric ultrasound technique have led to improvements in pregnancy outcomes. However, at the same time, the increasing use has also raised many ethical challenges. This study aimed to explore obstetricians' experiences of the significance of obstetric ultrasound for clinical management of complicated pregnancy and their perceptions of expectant parents' experiences. Methods: A qualitative study was undertaken in November 2012 as part of the CROss-Country Ultrasound Study (CROCUS). Semi-structured individual interviews were held with 14 obstetricians working at two large hospitals in Victoria, Australia. Transcribed data underwent qualitative content analysis. Results: An overall theme emerged during the analyses, 'Obstetric ultrasound - a third eye', reflecting the significance and meaning of ultrasound in pregnancy, and the importance of the additional information that ultrasound offers clinicians managing the surveillance of a pregnant woman and her fetus. This theme was built on four categories: I:'Everyday-tool' for pregnancy surveillance, II: Significance for managing complicated pregnancy, III: Differing perspectives on obstetric ultrasound, and IV: Counselling as a balancing act. In summary, the obstetricians viewed obstetric ultrasound as an invaluable tool in their everyday practice. More importantly however, the findings emphasise some of the clinical dilemmas that occur due to its use: the obstetricians' and expectant parents' differing perspectives and expectations of obstetric ultrasound examinations, the challenges of uncertain ultrasound findings, and how this information was conveyed and balanced by obstetricians in counselling expectant parents. Conclusions: This study highlights a range of previously rarely acknowledged clinical dilemmas that obstetricians face in relation to the use of obstetric ultrasound. Despite being a tool of considerable significance in the surveillance of pregnancy, there are limitations and uncertainties that arise with its use that make counselling expectant parents challenging. Research is needed which further investigates the effects and experiences of the continuing worldwide rapid technical advances in surveillance of pregnancies.

How to live : being happy and dealing with moral dilemmas

"This work provides clear answers to difficult moral and social issues that we face in our personal lives - that governments need to address when balancing the interests of the community. By demystifying moral discourse, How to Live provides a clear moral pathway for students of philosophy, medicine, and law, as well as the general reader. The moral framework of How to Live is developed from an interdisciplinary perspective. The culmination presents a forward-thinking theory that will maximize the success and happiness of the individual and the community within a society."--BOOK JACKET

Dasyurid dilemmas: problems and solutions for conserving Australia's small carnivorous marsupials

Dasyurid marsupials are distributed throughout the major terrestrial environments of Australia but since European settlement have suffered local and regional extinctions, range reductions and population declines. In this paper we examine the conservation status of small dasyurids (<500 g) and the threats they face. We also evaluate recovery procedures for threatened taxa and assess their success. Twenty-four percent of smaller dasyurids are classified as vulnerable, endangered or data deficient. Large body size and occupancy of one or two habitat types are correlated strongly with  endangerment species currently considered as 'low risk, near threatened' group closely with vulnerable and endangered species, indicating a risk of further declines. The processes contributing most to declines include habitat loss and fragmentation, altered fire regimes and predation. As of April 200 I, no Recovery Plans had been adopted by the Commonwealth Govemment for any small dasyund species. There is much information on the reproduction and development of smaller dasyurids, making them suitable for captive breeding. However, captive breeding programs have been limited. the  dibbler Paranrechinus apicalis being the only species bred systematically for reintroductions. There is a need for integration between captive breeding programs and recovery planning. as well as for more information on the population viability and metapopulation structures of small dasyurids genetic diversity of populations and inbreeding depression. We suggest a program of survey. research. management and education to Improve conservation outcomes for all small dasyurids.

Theoretical issues and political dilemmas in working with men

The aim of this chapter is to highlight some of the theoretical issues and political dilemmas involved in working with men in the human services. To develop a framework for practice with men, we have to adequately conceptualise the issues £1cing men. These are confusing and unsettling times for many men. To make sense of this confusion it is important to understand men's experiences within the context of the patriarchal structures in society and their relationship to class, race and gender regimes. Men and women who work with men in the human services should have an analysis of the social construction of masculinities and they need to understand how the forces that construct dominant masculinities embed men and women in relations of dominance and subordination that limit the potential for them to be in partnership with each other. To the extent that we ignore the social construction of masculinity,
it blocks insight into the real trouble in men's lives. Furthermore, if men do not grasp the basic notion of gender as a social construction, then feminist critiques of patriarchy, dominant masculinity and abusive male behaviours are going to be felt by men at a deeply personal level (Schwalbe 1996, pp. 187, 231).

Ethical ramifications of corporatised legal practice

Ethical constraints applying to lawyers are largely found in formal restrictions in legislation - ethical duties arise as a result of a lawyer's service to the public - business ethics - corporatisation and the push for Multi-Disciplinary Practices (MDPs) - duty of confidentiality - avoiding conflicts of interest - the advent of MDP will add further pressures to lawyers juggling competing interests.

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.

Tensions and dilemmas in community development: new discourses, new Trojans?

This paper begins by noting the range of contradictions and dilemmas facing those involved in community development today. It then draws on research into the operating frameworks that set the stage for much current community development activity. It discusses four key operating frameworks and how each framework can affect community development practice. The final section deals with the ways in which the frameworks, and the discourses associated with them, come together.

Legal ethics is (just) normal ethics: towards a coherent system of legal ethics

The standards governing how lawyers ought to conduct themselves consist of a number disparate principles and rules, which are devoid of an overarching rationale. We argue that legal ethics is not a stand-alone social construct. Rather, it is the application of normal ethical principles so far as they relate to the law. Approached in this manner, legal ethics becomes a far more coherent and justifiable institution. In this paper we apply general moral theory to several key dilemmas facing lawyers. This results in outcomes which some may find counter-intuitive. We conclude that lawyers should not do pro bono work; that the first cab rank off the rank principle is unsound and that there is no relevant difference between expressly misleading the court and putting the other side to the proof of its case.

Embryonic stem cell research: the principal ethical issue-when does life begin?

Embryonic stem cell research is perhaps the most controversial ethical issue of the new century. This is not surprising. It promises unprecedented potential benefits to human health but arguably comes at the expense of violating the most fundamental moral virtue - the right to life. The debate has become increasingly emotive. The Catholic Church has labelled stem cell research as cannibalism.1 This has led perhaps the world's most famous moral philosopher, Peter Singer, to label the Church, which has over a billion followers, as irrelevant.2 The principal purpose of this paper is not to  discuss all of the relevant moral issues in the embryonic stem cell debate. Considerations of space do not permit this and in any event there are  numerous reports which catalogue the relevant issues.3 Rather we attempt  to identify the crux of the issues in the debate. In our view, the main issue is the point at which life commences. We offer some preliminary observations on this matter. This discussion appears in section four. In the next section, we provide a brief  overview of nature and potential benefits of stem cell  research. This is followed by a discussion of the current legal position. In the final section, we offer some concluding remarks including some  suggestions for law reform.

General practitioners' perspectives regarding competence and confidentiality in an adolescent with suspected anorexia nervosa: legal and ethical considerations

In Victoria, Australia, the legal position regarding young people's competence to make medical treatment decisions has not been clarified in legislation, and a number of often vague common law decisions must be relied on for guidance. This situation produces a degree of uncertainty about appropriate professional practice, while also potentially impeding young people's rights claims in health care settings. With this in mind, the present research explored general practitioners' competence and confidentiality decisions regarding a 17-year-old female who presented with symptoms of an eating disorder. Questionnaires were sent to a random sample of 500 Victorian general practitioners, of whom 190 responded. After reading a case vignette, general practitioners indicated whether they would find the hypothetical patient competent and if they would maintain her confidentiality. Seventy-three per cent of respondents found the patient competent and most would have maintained confidentiality, at least initially. However, subsequent analysis of the rationales supplied for these decisions revealed a wide diversity in general practitioners' understandings and implementations of extant legal authority. This research highlights the need for general practitioners to be exposed to up-to-date and clinically relevant explanations of contemporary legal positions.

Ethical behaviour: the means for creating and maintaining better reputations in arts organisations

Arts organisations, unsure of the level of continued government funding available and confronted with the need ever to improve, are seeking new ideas upon which they can focus. At a time when leadership and governance in arts organisations have changed in line with cultural expectations, how is their ethical stance assessed? How does their ethical stance impact on reputation? The challenge to build a good reputation starts at the top of the organisation; however, traditionally, one type of arts organisation, art museums, has focused on the activities level. In an age of globalisation, economic restructuring and technological change, museums therefore may be seen as a contradiction. Traditionally seen as temples for the muses, today’s museums are being challenged to be ethical for society and to build their reputation. As a solution, proposes a cooperative model of cultural organisational ethics that attempts to provide a framework by which arts organisations can put in place ethical artefacts that enhance organisational reputation, rather than detract from it.

The transition from pediatric to adult health care services for young adults with a disability : an ethical perspective

Young children with disabilities and their carers or parents tend to form a long-term dependent relationship with a paediatrician throughout childhood At some stage when the young person with a disability reaches early adulthood, the relationship is severed This paper draws upon recent research undertaken by the authors that describes the difficulties experienced by young people with disabilities as they go through the transition from paediatric care to adult mainstream health care services. The purpose of this article is to present the argument that the dependent, paternalistic relationship that tends to exist between young people with disabilities (and/or their carers) and paediatricians throughout childhood does not facilitate the successful negotiation of adult mainstream health care services, nor optimally promote the well-being of these young people with disabilities. It is proposed that the promotion of autonomy (or self-determination) via a well planned transition program will increase the likelihood that young adults with disabilities and/or their carers will be empowered to successfully negotiate the current mainstream health care system in Australia, and will enhance the well-being of young adults with disabilities.

The ethical, social and environmental reporting-performance portrayal gap

The purpose of this article is twofold. First, it assesses in detail the extent to which corporate reporting on ethical, social and environmental issues reflects corporate performance in case study company Alpha. This “reporting-performance” portrayal gap is a key measure of the extent to which an organisation is accountable to its stakeholders. Alpha's disclosures concerning its ethical, social and environmental performance for the years 1993 and 1999 were compared with information obtained on Alpha's performance from other sources. Two different pictures of performance emerged leading to the conclusion that, in the case of Alpha, reports do not demonstrate a high level of accountability to key stakeholder groups on ethical, social and environmental issues. Of particular concern is the lack of “completeness” of reporting. Second, the article assesses the potential of recent standards or guidelines developed by the Global Reporting Initiative (GRI) and the Institute of Social and Ethical AccountAbility (AccountAbility) as well as the industry's own “responsible care” initiative to reduce this “reporting-performance” portrayal gap and improve corporate accountability. The conclusions point to the need for other measures to improve accountability including mandatory reporting guidelines, better developed audit guidelines, a mandatory audit requirement for MNCs and a radical overhaul of corporate governance systems.

Environmental education research in southern Africa: dilemmas of interpretation

These multiple framings of our reflections on environmental education research in southern Africa are written as dilemmas of interpretation that aim to disrupt any temptation to generalise or essentialise its qualities and characteristics. Recognising that research is a textual practice, we use J. M. Coetzee's portrayal of the dilemmas faced by African novelists as a point of departure in reflecting on the changing landscape of environmental education research in southern Africa as we have experienced it over six years. We provide readings framed by reference to post-colonialism, changing epistemologies and methodologies, contexts of transformation and tension, the influence of international organisations such as the United Nations and its instrumentalities, and concerns about human rights and accountability. We conclude by affirming the post-colonialist trajectories of environmental education research in southern Africa and speculating on the distinctive possibilities that recovering ubuntu (an ethic of sharing and hospitality) might offer to researchers in this region.