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The salience of genomic information to reproductive autonomy: Australian healthcare professionals’ views on a changing prenatal testing landscapeNew Genetics and Society 43 (1). 2024.Genomic testing in prenatal care is rapidly advancing and it is now possible to obtain an entire fetal genome via a blood test administered in early pregnancy. In the pursuit of reproductive autonomy, more tests are being offered to more people, for an ever-increasing range of indications. Health professionals who provide pregnancy care are at the vanguard of prenatal testing, yet their views on the impact of technology advancements remain under-explored. Qualitative interviews with Australian h…Read more
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7Reconsidering reinterpretation: response to commentariesJournal of Medical Ethics 49 (12): 824-825. 2023.The results of tests carried out using next-generation genomic sequencing (NGS) possess a peculiar and perhaps unique ‘diagnostic durability’. Unlike most other forms of testing, if genomic results or data are stored over time, then it remains possible to interrogate that information indefinitely, without having to retest the patient. Another peculiar property of genomic results is that their interpretations are subject to change within relatively short time frames. For instance, a genomic varia…Read more
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3Hope and Exploitation in Commercial Provision of Assisted Reproductive TechnologiesHastings Center Report 53 (5): 30-41. 2023.Innovation is a key driver of care provision in assisted reproductive technologies (ART). ART providers offer a range of add‐on interventions, aiming to augment standard in vitro fertilization protocols and improve the chances of a live birth. Particularly in the context of commercial provision, an ever‐increasing array of add‐ons are marketed to ART patients, even when evidence to support them is equivocal. A defining feature of ART is hope—hope that a cycle will lead to a baby or that another …Read more
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16What moral weight should patient‐led demand have in clinical decisions about assisted reproductive technologies?Bioethics 38 (1): 69-77. 2023.Evidence suggests that one reason doctors provide certain interventions in assisted reproductive technologies (ART) is because of patient demand. This is particularly the case when it comes to unproven interventions such as ‘add‐ons’ to in vitro fertilisation (IVF) cycles, or providing IVF cycles that are highly unlikely to succeed. Doctors tend to accede to demands for such interventions because patients are willing to do and pay ‘whatever it takes’ to have a baby. However, there is uncertainty…Read more
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79Is Mitochondrial Donation Germ‐Line Gene Therapy? Classifications and Ethical ImplicationsBioethics 31 (1): 55-67. 2016.The classification of techniques used in mitochondrial donation, including their role as purported germ-line gene therapies, is far from clear. These techniques exhibit characteristics typical of a variety of classifications that have been used in both scientific and bioethics scholarship. This raises two connected questions, which we address in this paper: how should we classify mitochondrial donation techniques?; and what ethical implications surround such a classification? First, we outline h…Read more
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21Whole genome sequencing in children: ethics, choice and deliberationJournal of Medical Ethics 43 (8): 540-542. 2017.
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13Do We Need Ethical Theory to Achieve Quality Critical Engagement in Clinical Ethics?American Journal of Bioethics 16 (9): 43-45. 2016.
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9Clinical Ethics Committee Case 10: For the record: Should our patient's relatives be able to record her treatment?Clinical Ethics 5 (2): 57-62. 2010.
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23Intertwined Interests in Expanded Prenatal Genetic Testing: The State’s Role in Facilitating Equitable AccessAmerican Journal of Bioethics 22 (2): 45-47. 2022.In their analysis of how much fetal genetic information prospective parents should be able to access, Bayefsky and Berkman determine that parents should only be able to access information th...
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30Reproductive carrier screening: responding to the eugenics critiqueJournal of Medical Ethics 48 (12): 1060-1067. 2022.Reproductive genetic carrier screening (RCS), when offered to anyone regardless of their family history or ancestry, has been subject to the critique that it is a form of eugenics. Eugenics describes a range of practices that seek to use the science of heredity to improve the genetic composition of a population group. The term is associated with a range of unethical programmes that were taken up in various countries during the 20th century. Contemporary practice in medical genetics has, understa…Read more
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22Obligations and preferences in knowing and not knowing: the importance of contextJournal of Medical Ethics 46 (5): 306-307. 2020.In healthcare broadly, and especially in genetic medicine, there is an ongoing debate about whether patients have a right not to know information about their own health. The extensive literature on this topic is characterised by a range of different understandings of what it means to have a RNTK,1–9 and how this purported right relates to patient autonomy. Ben Davies considers whether obligations not to place avoidable burdens on a publicly funded healthcare system might form the basis for an ob…Read more
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63Reconceptualizing Autonomy for BioethicsKennedy Institute of Ethics Journal 28 (2): 171-203. 2018.The concept of autonomy plays a central role in bioethics,1 but there is no consensus as to how we should understand it beyond a general notion of self-determination. The conception of autonomy deployed in applied ethics2 can have crucial ramifications when it is applied in real-world scenarios, so it is important to be clear. However, this clarity is often lacking when autonomy is discussed in the bioethics literature. In this paper we outline three different conceptions of autonomy, and argue …Read more
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17Ethics of Reproductive Genetic Carrier Screening: From the Clinic to the PopulationPublic Health Ethics 14 (2): 202-217. 2021.Reproductive genetic carrier screening is increasingly being offered more widely, including to people with no family history or otherwise elevated chance of having a baby with a genetic condition. There are valid reasons to reject a prevention-focused public health ethics approach to such screening programs. Rejecting the prevention paradigm in this context has led to an emphasis on more individually-focused values of freedom of choice and fostering reproductive autonomy in RCS. We argue, howeve…Read more
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70For Your Interest? The Ethical Acceptability of Using Non‐Invasive Prenatal Testing to Test ‘Purely for Information’Bioethics 29 (1): 19-25. 2014.Non-invasive prenatal testing is an emerging form of prenatal genetic testing that provides information about the genetic constitution of a foetus without the risk of pregnancy loss as a direct result of the test procedure. As with other prenatal tests, information from NIPT can help to make a decision about termination of pregnancy, plan contingencies for birth or prepare parents to raise a child with a genetic condition. NIPT can also be used by women and couples to test purely ‘for informatio…Read more
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65Should Non-Invasiveness Change Informed Consent Procedures for Prenatal Diagnosis?Health Care Analysis 19 (2): 122-132. 2011.Empirical evidence suggests that some health professionals believe consent procedures for the emerging technology of non-invasive prenatal diagnosis (NIPD) should become less rigorous than those currently used for invasive prenatal testing. In this paper, we consider the importance of informed consent and informed choice procedures for protecting autonomy in those prenatal tests which will give rise to a definitive result. We consider whether there is anything special about NIPD that could sanct…Read more
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94From Chance to Choice: Genetics and Justice: A Buchanan, D W Brock, N Daniels, et al. Cambridge University Press, 2000, pound17.95, $US29.95, pp 398. ISBN 0521660017 (review)Journal of Medical Ethics 28 (1): 60-60. 2002.
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19Is It Just for a Screening Program to Give People All the Information They Want?American Journal of Bioethics 23 (7): 34-42. 2023.Genomic screening at population scale generates many ethical considerations. One is the normative role that people’s preferences should play in determining access to genomic information in screening contexts, particularly information that falls beyond the scope of screening. We expect both that people will express a preference to receive such results and that there will be interest from the professional community in providing them. In this paper, we consider this issue in relation to the just an…Read more
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9Is there a duty to routinely reinterpret genomic variant classifications?Journal of Medical Ethics 49 (12): 808-814. 2023.Multiple studies show that periodic reanalysis of genomic test results held by clinical laboratories delivers significant increases in overall diagnostic yield. However, while there is a widespread consensus that implementing routine reanalysis procedures is highly desirable, there is an equally widespread understanding that routine reanalysis of individual patient results is not presently feasible to perform for all patients. Instead, researchers, geneticists and ethicists are beginning to turn…Read more
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35Scanning the body, sequencing the genome: Dealing with unsolicited findingsBioethics 31 (9): 648-656. 2017.The introduction of novel diagnostic techniques in clinical domains such as genomics and radiology has led to a rich ethical debate on how to handle unsolicited findings that result from these innovations. Yet while unsolicited findings arise in both genomics and radiology, most of the relevant literature to date has tended to focus on only one of these domains. In this article, we synthesize and critically assess similarities and differences between “scanning the body” and “sequencing the genom…Read more
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23Regulating Risk and the Boundaries of State Conduct: A Relational Perspective on Home Birth in AustraliaAmerican Journal of Bioethics 16 (2): 19-21. 2016.
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11Consistency of What? Appropriately Contextualizing Ethical Analysis of Non-Invasive Prenatal TestingAmerican Journal of Bioethics 23 (3): 56-58. 2023.It is unarguable that the implementation and use of noninvasive prenatal testing (NIPT) should be critical and appropriate. After all, decisions that influence when and how to have children have ut...
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22How should severity be understood in the context of reproductive genetic carrier screening?Bioethics 37 (4): 359-366. 2023.Reproductive genetic carrier screening provides information about people's chance of having children with certain genetic conditions. Severity of genetic conditions is an important criterion for their inclusion in carrier screening programmes. However, the concept of severity is conceptually complex and underspecified. We analyse why severity is an important concept in carrier screening and for reproductive decision-making and show that assessments of severity can also have normative societal im…Read more
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12Clinical Ethics Committee Case 8: Should we carry out a predictive genetic test in our young patient?Clinical Ethics 4 (4): 169-172. 2009.
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13Sharing precision medicine data with private industry: Outcomes of a citizens’ jury in SingaporeBig Data and Society 9 (1). 2022.Precision medicine is an emerging approach to treatment and disease prevention that relies on linkages between very large datasets of health information that is shared amongst researchers and health professionals. While studies suggest broad support for sharing precision medicine data with researchers at publicly funded institutions, there is reluctance to share health information with private industry for research and development. As the private sector is likely to play an important role in gen…Read more
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41To offer or request? Disclosing variants of uncertain significance in prenatal testingBioethics (9): 900-909. 2021.The use of genomic testing in pregnancy is increasing, giving rise to questions over how the information that is generated should be offered and returned in clinical practice. While these tests provide important information for prenatal decision-making, they can also generate information of uncertain significance. This paper critically examines three models for approaching the disclosure of variants of uncertain significance (VUS), which can arise from forms of genomic testing such as prenatal c…Read more
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17Clinical Ethics Committee Case 9: Should we inform our patient about animal products in his medicine?Clinical Ethics 5 (1): 7-12. 2010.
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71Clinical Ethics Committee case 6: Our patient wishes to take an unlisted drug even though we're not sure of his diagnosisClinical Ethics 4 (2): 59-63. 2009.
Areas of Specialization
Genetic Ethics |
Public Health |
Medical Ethics |
Reproductive Ethics |
Biotechnology Ethics |
Areas of Interest
Genetic Ethics |
Public Health |
Medical Ethics |
Reproductive Ethics |
Biotechnology Ethics |