The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : part 3 (Victoria)

This is the final article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Victoria. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training that medical professionals receive on issues such as refusal of treatment certificates and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Victoria. The article also draws together themes from the series as a whole, including conclusions about the need for more and better medical education and about law reform generally.

Investigating and theorizing discourse during analogy writing in chemistry

Explanations of the role of analogies in learning science at a cognitive level are made in terms of creating bridges between new information and students’ prior knowledge. In this empirical study of learning with analogies in an 11th grade chemistry class, we explore an alternative explanation at the "social" level where analogy shapes classroom discourse. Students in the study developed analogies within small groups and with their teacher. These classroom interactions were monitored to identify changes in discourse that took place through these activities. Beginning from socio-cultural perspectives and hybridity, we investigated classroom discourse during analogical activities. From our analyses, we theorized a merged discourse that explains how the analog discourse becomes intertwined with the target discourse generating a transitional state where meanings, signs, symbols, and practices are in flux. Three categories were developed that capture how students intertwined the analog and target discourses—merged words, merged utterances/sentences, and merged practices.

The bondage of an imposed visual discourse : understanding the built environment's influence on the 'oldest-old' aged care residents' sense of peace

This study investigates the influence of the built environment upon residents' sense of familiarity, concept of self and thus, their facilitation of place through the theory of "The Bondage of Imposed Visual Discourse". Simone de Beauvoir's theory "The Bondage of Feminine Elegance" provides the conceptual understanding of the visual discourse between the physicality of clothing and the wearer's personal identity. This fashion theory is transposed to explore the influence of the built environment's physicality upon aged care residents' personal identity. This paper presents findings from a study of professionals' opinions in reference to the built environment of permanent residential aged care for the 'oldest-old' of Australia. The researcher conducted qualitative interviews with four participants: an architect, occupational therapist, nursing home facility manager and an aged care lobbyist in the South-East Queensland. This study is structured towards proposing "place-focused" qualitative design principles to encourage residents' sense of place through the built environment. These proposed principles are addressed with reference to existing Standards and Principles outlined by the Australian Government.

Evaluating medical information retrieval

This paper presents a framework for evaluating information retrieval of medical records. We use the BLULab corpus, a large collection of real-world de-identified medical records. The collection has been hand coded by clinical terminol- ogists using the ICD-9 medical classification system. The ICD codes are used to devise queries and relevance judge- ments for this collection. Results of initial test runs using a baseline IR system are provided. Queries and relevance judgements are online to aid further research in medical IR. Please visit: http://koopman.id.au/med_eval.

The teacher as reflexive professional : making visible the excluded discourse in teacher standards

In the current climate of accountability, political manoeuvring, changing curriculum, increasingly diverse student cohorts and community expectations, teachers, more than ever, need to develop the skills and abilities to be reflective and reflexive practitioners. This study examines national teacher professional standards from Australia and the UK to identify the extent to which reflexivity is embedded in key policy documents that are intended to guide the work of teachers in those countries. Using Margaret Archer's theories of reflexivity and morphogenesis, and methods of critical discourse analysis, we argue that these blueprints for teachers’ work exclude reflexivity as an essential and overarching discourse of teacher professionalism.

Defences in medical negligence : to what extent has tort law reform in Australia limited the liability of health professionals?

Tort law reform has resulted in legislation being passed by all Australian jurisdictions in the past decade implementing the recommendations contained in the Ipp Report. The report was in response to a perceived crisis in medical indemnity insurance. The objective was to restrict and limit liability in negligence actions. This paper will consider to what extent the reforms have impacted on the liability of health professionals in medical negligence actions. The reversal of the onus of proof through the obvious risk sections has attempted to extend the scope of the defence of voluntary assumption of risk. There is no liability for the materialisation of an inherent risk. Presumptions and mandatory reductions for contributory negligence have attempted to reduce the liability of defendants. It is now possible for reductions of 100% for contributory negligence. Apologies can be made with no admission of legal liability to encourage them being made and thereby reduce the number of actions being commenced. The peer acceptance defence has been introduced and enacted by legislation. There is protection for good samaritans even though the Ipp Report recommended against such protection. Limitation periods have been amended. Provisions relating to mental harm have been introduced re-instating the requirement of normal fortitude and direct perception. After an analysis of the legislation, it will be argued in this paper that while there has been some limitation and restriction, courts have generally interpreted the civil liability reforms in compliance with the common law. It has been the impact of statutory limits on the assessment of damages which has limited the liability of health professionals in medical negligence actions.

Loss of chance in medical negligence claims now a lost cause?

The question whether the loss of chance of a better medical outcome in cases of medical negligence should be recognised as actionable damage is ‘a question which has divided courts and commentators throughout the common law world.’ In April 2010, the High Court handed down its anticipated decision in the case of Tabet (by her Tutor Sheiban) v Gett (2010) 240 CLR 537. The issue considered by the court was whether the appellant could claim in negligence for the loss of a chance of a better medical outcome. This issue had not been considered by the High Court previously, the most relevant cases being Rufo v Hosking (2004) 61 NSWLR 678 and Gavalas v Singh (2001) 3 VLR 404. Claiming for a loss of chance in a personal injury action raises questions as to recognised damage and causation, and the members of the High Court considered both of these.