Advance directives, autonomy and the refusal of life-sustaining medical treatment

As Australian society 1s agemg, individuals are increasingly concerned about managing their future, including making decisions about the medical treatment they may wish to receive or refuse if they lose decision-making capacity. To date, there has been relatively little research into the extent to which legal regulation allows competent adults to make advance refusals of life-sustaining medical treatment that will bind health professionals and others when a decision needs to be made at a future time. This thesis aims to fill this gap in the research by presenting the results of research into the legal regulation of advance directives that refuse life-sustaining medical treatment. In the five papers that comprise this thesis, the law that governs this area is examined, and the ethical principle of autonomy is used to critically evaluate that law. The principal finding of this research is that the current scheme of regulation is ineffective to adequately promote the right of a competent adult to make binding advance directives about refusal of medical treatment. The research concludes that legislation should be enacted to enable individuals to complete an advance directive, only imposing restrictions to the extent that this is necessary to promote individual autonomy. The thesis first examines the principle of autonomy upon which the common law (and some statutory law) is expressed to be based, to determine whether that principle is an appropriate one to underpin regulation. 1 The finding of the research is that autonomy can be justified as an organising principle on a number of grounds: it is consistent with the values of a liberal democracy; over recent decades, it is a principle that has been even more prominent within the discipline of medical ethics; and it is the principle which underpins the legal regulation of a related topic, namely the contemporaneous refusal of medical treatment. Next, the thesis reviews the common law to determine whether it effectively achieves the goal of promoting autonomy by allowing a competent adult to make an advance directive refusing treatment that will operate if he or she later loses decision-making capacity. 2 This research finds that conunon law doctrine, as espoused by the judiciary, prioritises individual choice by recognising valid advance directives that refuse treatment as binding. However, the research also concludes that the common law, as applied by the judiciary in some cases, may not be effective to promote individual autonomy, as there have been a number of circumstances where advance directives that refuse treatment have not been followed. The thesis then examines the statutory regimes in Australia that regulate advance directives, with a focus on the regulation of advance refusals of life-sustaining medical treatment.3 This review commences with an examination ofparliamentary debates to establish why legislation was thought to be necessary. It then provides a detailed review of all of the statutory regimes, the extent to which the legislation regulates the form of advance directives, and the circumstances in which they can be completed, will operate and can be ignored by medical professionals. The research finds that legislation was enacted mainly to clarify the common law and bring a level of certainty to the field. Legislative regimes were thought to provide medical professionals with the assurance that compliance with an advance directive that refuses life-sustaining medical treatment will not expose them to legal sanction. However, the research also finds that the legislation places so many restrictions on when an advance directive refusing treatment can be made, or will operate, that they have not been successful in promoting individual autonomy.

“More tick-the-box”: the challenge of promoting interdisciplinary learning in the middle years through the Australian history curriculum

The Australian Curriculum marks national reforms in social science education, first with the return to the disciplines of history and geography and second, through a new approach to interdisciplinary learning. This paper raises the question of whether the promise of interdisciplinary learning can be realised in the middle years of schooling if teachers have to teach history as a discipline rather than within an over-arching integrated curriculum framework. The paper explores the national blueprints and considers the national history curriculum in light of theories of teachers’ knowledge and middle school education. Evidence from teacher interviews indicates that historical understanding can be achieved through integrated frameworks to meet the goals of middle schooling.

Converting theory to practice : university-school collaboration on devising strategies for mentoring pedagogical knowledge

There appears no shortage of theorists for preservice teacher education; however many ideas are abandoned without practical applications. Indeed, it can take years for theories to materialise into practice, if they materialise at all. The quality of preservice teacher education is central for enhancing an education system, and mentors’ roles can assist to shape preservice teachers’ development within the school context. Yet mentoring can be haphazard without being underpinned by a theoretical framework. A mentoring model (personal attributes, system requirements, pedagogical knowledge, modelling, and feedback) has emerged from research and the literature to guide mentors’ practices. This qualitative study investigates mentors’ pedagogical knowledge as one factor crucial to the mentoring process. More specifically, this study involves a questionnaire and audio-recorded focus group meetings with experienced mentors (n=14) who deliberated on devising practical applications for mentoring pedagogical knowledge. Findings revealed that these experienced mentors pinpointed practical applications around a mentor’s role for providing pedagogical knowledge to the mentee. These strategies were varied and demonstrated that any one mentoring practice may be approached from a number of different angles. Nevertheless, there were core mentoring practices in pedagogical knowledge such as showing the mentee how to plan for teaching, articulating classroom management approaches, and talking about how to connect learning to assessment. Mentors may require education on current mentoring practices with practical strategies that are linked to theoretical underpinnings.

Educational change and youth voice: Informing school action on cyberbullying

Change is a regular part of school life. Educational innovations are constantly being implements in order to benefit students, improve outcomes and meet the obligations and accountability demands of governments. Rapid social and technological change has occurred within and around schools during the past 15 or more years, impacting upon curricula and pedagogies. Simultaneously, there has been a trend towards incorporating youth voice, where young people share in the decisions that will impact on their school experiences (Mitra, 2008a, 2004). Most recently, with the advent of the first National Australian Curriculum (McGaw, 2010), there is an imposed curriculum change, which reflects the growing global trend towards centralised control over what students learn in school (Zhao, 2011) and highlights that schools have to respond to change from all levels. Spears (in press) also notes that parents are raising children in an increasingly wireless world which is far removed from the one in which they were raised. Educators are teaching in schools that are vastly different technologically from those they knew as children and adolescents, or even those in which they were teaching a decade ago. Children born in 1995, the year when the Internet was first commercialised, are 16 years old in 2011 and, whilst parents may have embraced technological advances in their own adult working or social lives, they are yet to fathom fully what it means for their children and their relationships: to be educated and to socialise in the midst of mobile social media. Young people have greater access to more information than at any time past and move seamlessly between online and offline environments, often referring to them as ‘the same life’ (Spears, Kofoed, Bartolo, Palermiti and Castabile, in press). Along with these changes has come the transformation of traditional forms of bullying to cyberbullying, amid the public perception that bullying generally is becoming worse in schools.

Data modeling in elementary and middle school classes : a shared experience

This paper argues for a renewed focus on statistical reasoning in the elementary school years, with opportunities for children to engage in data modeling. Data modeling involves investigations of meaningful phenomena, deciding what is worthy of attention, and then progressing to organizing, structuring, visualizing, and representing data. Reported here are some findings from a two-part activity (Baxter Brown’s Picnic and Planning a Picnic) implemented at the end of the second year of a current three-year longitudinal study (grade levels 1-3). Planning a Picnic was also implemented in a grade 7 class to provide an opportunity for the different age groups to share their products. Addressed here are the grade 2 children’s predictions for missing data in Baxter Brown’s Picnic, the questions posed and representations created by both grade levels in Planning a Picnic, and the metarepresentational competence displayed in the grade levels’ sharing of their products for Planning a Picnic.

Training clinical psychologists : The current situation and a way forward [Guest Editorial]

In the past, training in clinical psychology in Australia and overseas has been dominated by definitions of input— hours of classes or supervision and of specific components. While prospective practitioners have been required to demonstrate the acquisition of generic competencies, satisfaction of these input driven criteria has been required for both accreditation and registration. Ironically, for a discipline that prides itself on requiring empirical bases for practice and communicating those to students (Calhoun, Moras, Pilkonis, & Rehm, 1998), training criteria have been primarily derived from accepted wisdom, rather than from a sound body of data. The situation has been remarkably like that of a treatment establishing standards of fidelity before its effective components are known—an action our profession has correctly criticised in the past (Herbert & Mueser, 1992).

An evaluation of the pattern and structure mathematics awareness program in the early school years

This paper reports a 2-year longitudinal study on the effectiveness of the Pattern and Structure Mathematical Awareness Program (PASMAP) on students’ mathematical development. The study involved 316 Kindergarten students in 17 classes from four schools in Sydney and Brisbane. The development of the PASA assessment interview and scale are presented. The intervention program provided explicit instruction in mathematical pattern and structure that enhanced the development of students’ spatial structuring, multiplicative reasoning, and emergent generalisations. This paper presents the initial findings of the impact of the PASMAP and illustrates students’ structural development.

Perceived gender differences in STEM learning in the middle school

Women are underrepresented in science, technology, engineering and mathematics (STEM) university coursework, reflecting long-standing gender issues that have existed in core middle-school STEM subject areas. Using data from a survey and written responses, we report on findings following the introduction of engineering education in middle school classes across three schools (grade level 7, n=122). The engineering experiences fused science, technology and mathematics concepts. The survey revealed higher percentages for girls than boys in 13 of the 24 items; however there were six items with a 20% difference in their perceptions about learning in STEM. For instance, despite girls recording that they have been provided equal or more opportunities than boys in STEM, they believed they do not do as well as boys (80% boys, 48% girls) or want to seek a career in STEM (39% boys, 17% girls). The written responses revealed gender differences across a number of themes in the students’ responses, including resources, group work, the nature and type of learning experiences, content knowledge, and teachers’ instructional style. Exposing students to STEM education facilitates an awareness of their learning and may assist girls to consider studying STEM subjects or STEM careers.

Complex modelling in the primary/middle school years

The world’s increasing complexity, competitiveness, interconnectivity, and dependence on technology generate new challenges for nations and individuals that cannot be met by continuing education as usual (Katehi, Pearson, & Feder, 2009). With the proliferation of complex systems have come new technologies for communication, collaboration, and conceptualisation. These technologies have led to significant changes in the forms of mathematical and scientific thinking that are required beyond the classroom. Modelling, in its various forms, can develop and broaden children’s mathematical and scientific thinking beyond the standard curriculum. This paper first considers future competencies in the mathematical sciences within an increasingly complex world. Next, consideration is given to interdisciplinary problem solving and models and modelling. Examples of complex, interdisciplinary modelling activities across grades are presented, with data modelling in 1st grade, model-eliciting in 4th grade, and engineering-based modelling in 7th-9th grades.

Tracking employees' twists and turns : describing a mixed methods approach to assessing change in the psychological contract

The psychological contract is a key analytical device utilised by both academics and practitioners to conceptualise and explore the dynamics of the employment relationship. However, despite the recognised import of the construct, some authors suggest that its empirical investigation has fallen into a 'methodological rut' [Conway & Briner, 2005, p. 89] and is neglecting to assess key tenets of the concept, such as its temporal and dynamic nature. This paper describes the research design of a longitudinal, mixed methods study which draws upon the strengths of both qualitative and quantitative modes of inquiry in order to explore the development of, and changes in, the psychological contract. Underpinned by a critical realist philosophy, the paper seeks to offer a research design suitable for exploring the process of change not only within the psychological contract domain, but also for similar constructs in the human resource management and broader organisational behaviour fields.

Creating better learning environments by cross-disciplinary collaboration : a civil engineering and surveying linkage

Many of the teaching elements in Civil and Environmental Engineering and Spatial Science/Surveying are strongly related to multidisciplinary real-world situations. Professionals in each discipline commonly work collaboratively, knowing each other’s professional and technical limitations and requirements. Replication of such real-world situations allows students to gain an insight and acquire knowledge of professional practice for both civil engineering and spatial science disciplines. However, replication of an authentic design project is not always possible in a single unit basis where empirical project situations are often created with controlled sets of constraints, inputs and outputs. A cross-disciplinary design-based project that is designed to promote active student learning, engagement and professional integration would be the preferred option. The central aim of this collaborative project was to create positive and inclusive environments to promote engaging learning opportunities that cater for a range of learning styles with a two-way linkage involving third-year civil engineering and spatial science (surveying) students. This paper describes the cross-disciplinary project developed and delivered in 2010 and 2011. A survey was conducted at completion of the project to assess the degree of improvement in student engagement and their learning experiences. Improvements were assessed in a range of dimensions including student motivation, learning by cross-disciplinary collaboration and learning by authentic design project experiences. In this specific cross-disciplinary linkage project, the study findings showed that teaching approaches utilised have been effective in promoting active student learning and increasing engagement.

Learning by design workshop

The Learning by Design Workshop Program 2010, a part of the Queensland Government Unlimited: Designing for the Asia Pacific Event Program, was a one-day professional development design thinking workshop run on October 9, 2011 at The Edge, State Library of Queensland for self-selected public and private secondary school teachers from the subject areas of Visual Art, Graphics and Industrial Technology and Design. Participants were drawn from a database of Brisbane and regional Queensland schools from the goDesign and Living City Workshop Programs. It aimed to generate leadership within schools for design-led education and creative thinking and give teachers a rare opportunity to work with professional designers to generate future strategies for design-based learning. Teachers were introduced to the concept of design thinking in education by international keynote speakers CJ Lim (Studio 8 Architects) and Jeb Brugmann (The Next Practice), national speaker Oliver Freeman (NevilleFreeman Agency) and three Queensland speakers, Alexander Loterztain, David Williams and Keith Holledge. Inspired by the Unlimited showcase exhibition Make Change: Design Thinking in Action and ‘Idea Starters’/teaching resources provided, teachers worked with a professional designer (from a discipline of architecture, interior design, industrial design, urban design, graphic design or landscape architecture) in ten random teams, to generate optimistic ideas for the Ideal City of tomorrow, each considering a theme – Food, Water, Transport, Ageing, Growth, Employment, Shelter, Health, Education and Energy. They then discussed how this process could be best activated and expanded on to build interest and knowledge in design thinking in the classroom. Assisted by illustrators, the teams prepared a visual presentation of their ideas and process from art materials provided. The workshop culminated in a video-taped interactive design charette to the larger group, which is intended to be utilised as a toolkit and praxis for teachers as part of the State Library of Queensland Design Minds Website Project.

Generation workshop 2010

The Generation Workshop Program 2010, a part of the Queensland Government Unlimited: Designing for the Asia Pacific Event Program, consisted of two one-day intensive design thinking workshops run on October 7-8, 2011 at The Edge, State Library of Queensland, for 100 senior secondary students and 20 secondary teachers self-selected from the subject areas of Visual Art, Graphics and Industrial Technology and Design. Participants were drawn from a database of Brisbane and regional Queensland private and public schools from the goDesign and Living City Workshop Programs. The workshop aimed to facilitate awareness in young people of the role of design in society and the value of design thinking skills in solving complex problems facing the Asia Pacific Region, and to inspire the generation of strategies for our future cities. It also aimed to encourage the collaboration of professional designers with secondary schools to inspire post-secondary pathways and idea generation for education. Inspired by international and national speakers Bunker Roy (Barefoot College) and Hael Kobayashi (Associate Producer on "Happy Feet" film for Australia's Animal Logic), the Unlimited showcase exhibition Make Change: Design Thinking in Action and ‘Idea Starters’/teaching resources provided, students worked with a teacher in ten random teams, to generate optimistic strategies for the Ideal City of tomorrow, each considering a theme – Food, Water, Transport, Ageing, Growth, Employment, Shelter, Health, Education and Energy. Each team of 6 was led by a professional designer (from the discipline of architecture, interior design, industrial design, urban design, graphic design or landscape architecture) who was a catalyst for driving the student creative thinking process. Assisted by illustrators, the teams prepared a visual presentation of their idea from art materials provided. The workshop culminated in a video-taped interactive design chatter to the larger group, which will be utilised as a toolkit and praxis for teachers as part of the State Library of Queensland Design Minds Project. Photos of student design work were published on the Unlimited website.

Modern construction economics [Book Review]

The editor, Gerard de Valence, points out in the preface, this book is neither a textbook nor a guide to what is done by construction managers and construction economists – read quantity surveyors and the like. Rather, de Valence notes it comprises a collection of chapters each of which focus on matters at the industry level and, in doing so, illustrates that a substantially improved understanding of the building and construction industry can be gained beyond the economics of delivering projects. Before giving some thought to how far each of the chapters achieve this, it’s worth reflecting on the virtues of developing construction economics as its own discipline or sub-discipline in general economics and the bold manner by which de Valence is proposing we do this. That is, de Valence proposes partitioning industry and project economics - as explained in the preface and in Chapter 1. de Valence’s view that “the time seems right” for these developments is also worthy of some consideration.