Sydney, New South Wales, Australia
Areas of Specialization
Applied Ethics
Areas of Interest
Applied Ethics
  •  107
    Why bioethics needs a concept of vulnerability
    International Journal of Feminist Approaches to Bioethics 5 (2): 11-38. 2012.
  •  106
    Is sex-selective abortion morally justified and should it be prohibited?
    with Angela Ballantyne and Heather Draper
    Bioethics 21 (9). 2007.
  •  90
    Vulnerability in Research Ethics: a Way Forward
    with Margaret Meek Lange and Susan Dodds
    Bioethics 27 (6): 333-340. 2013.
    Several foundational documents of bioethics mention the special obligation researchers have to vulnerable research participants. However, the treatment of vulnerability offered by these documents often relies on enumeration of vulnerable groups rather than an analysis of the features that make such groups vulnerable. Recent attempts in the scholarly literature to lend philosophical weight to the concept of vulnerability are offered by Luna and Hurst. Luna suggests that vulnerability is irreducib…Read more
  •  51
    The interaction between evidence-based medicineand doctors' duty of care to patients iscomplex. One the one hand, there is surely anobligation to take account of the bestavailable evidence when offering health care topatients. On the other hand, it is equallyimportant to be aware of important shortcomingsin the processes and practices ofevidence-based medicine. There are tensionsbetween the population focus of evidence-basedmedicine and the duties that doctors have toindividual patients. Impleme…Read more
  •  46
    The ethics of uterus transplantation
    Bioethics 27 (2): 65-73. 2013.
    Human uterus transplantation is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies and organ transplantation. In relation…Read more
  •  41
    Innovative surgery: the ethical challenges
    with Jane Johnson
    Journal of Medical Ethics 38 (1): 9-12. 2012.
    Innovative surgery raises four kinds of ethical challenges: potential harms to patients; compromised informed consent; unfair allocation of healthcare resources; and conflicts of interest. Lack of adequate data on innovations and lack of regulatory oversight contribute to these ethical challenges. In this paper these issues and the extent to which problems may be resolved by better evidence-gathering and more comprehensive regulation are explored. It is suggested that some ethical issues will be…Read more
  •  40
    Is there a moral duty for doctors to trust patients?
    Journal of Medical Ethics 28 (2): 77-80. 2002.
    In this paper I argue that it is morally important for doctors to trust patients. Doctors' trust of patients lays the foundation for medical relationships which support the exercise of patient autonomy, and which lead to an enriched understanding of patients' interests. Despite the moral and practical desirability of trust, distrust may occur for reasons relating to the nature of medicine, and the social and cultural context within which medical care is provided. Whilst it may not be possible to…Read more
  •  37
    The Line-drawing Problem in Disease Definition
    Journal of Medicine and Philosophy 42 (4): 405-423. 2017.
    Biological dysfunction is regarded, in many accounts, as necessary and perhaps sufficient for disease. But although disease is conceptualized as all-or-nothing, biological functions often differ by degree. A tension is created by attempting to use a continuous variable as the basis for a categorical definition, raising questions about how we are to pinpoint the boundary between health and disease. This is the line-drawing problem. In this paper, we show how the line-drawing problem arises within…Read more
  •  35
    Addressing Within-Role Conflicts of Interest in Surgery
    Journal of Bioethical Inquiry 10 (2): 219-225. 2013.
    In this paper we argue that surgeons face a particular kind of within-role conflict of interests, related to innovation. Within-role conflicts occur when the conflicting interests are both legitimate goals of professional activity. Innovation is an integral part of surgical practice but can create within-role conflicts of interest when innovation compromises patient care in various ways, such as by extending indications for innovative procedures or by failures of informed consent. The standard r…Read more
  •  35
    This paper raises questions about the epistemological foundations of evidence-based medicine . We argue that EBM is based upon reliabilist epistemological assumptions, and that this is appropriate - we should focus on identifying the most reliable processes for generating and collecting medical knowledge. However, we note that this should not be reduced to narrow questions about which research methodologies are the best for gathering evidence. Reliable processes for generating medical evidence m…Read more
  •  33
    Fragility, uncertainty, and healthcare
    Theoretical Medicine and Bioethics 37 (1): 71-83. 2016.
    Medicine seeks to overcome one of the most fundamental fragilities of being human, the fragility of good health. No matter how robust our current state of health, we are inevitably susceptible to future illness and disease, while current disease serves to remind us of various frailties inherent in the human condition. This article examines the relationship between fragility and uncertainty with regard to health, and argues that there are reasons to accept rather than deny at least some forms of …Read more
  •  32
    Feminism and public health ethics
    Journal of Medical Ethics 32 (6): 351-354. 2006.
    This paper sketches an account of public health ethics drawing upon established scholarship in feminist ethics. Health inequities are one of the central problems in public health ethics; a feminist approach leads us to examine not only the connections between gender, disadvantage, and health, but also the distribution of power in the processes of public health, from policy making through to programme delivery. The complexity of public health demands investigation using multiple perspectives and …Read more
  •  32
    Social justice and pandemic influenza planning: The role of communication strategies
    with Connal Lee and Annette Braunack-Mayer
    Public Health Ethics 1 (3): 223-234. 2008.
    Department of Medical Education, Flinders University of South Australia, GPO Box 2100, Adelaide SA 5001. Tel. : +61-8-7225-1111; Fax: +61-8-8204-5675; Email: lee0359{at} ' + u + '@ ' + d + ' '/ /- ->.This paper analyses the role of communication strategies in pandemic influenza planning. Our central concern is with the extent to which nations are using communication to address issues of social justice. Issues associated with disadvantage and vulnerability to infection in the event…Read more
  •  31
    Clinicians and policy makers the world over are embracing evidence-based medicine. The promise of EBM is to use summaries of research evidence to determine which healthcare interventions are effective and which are not, so that patients may benefit from effective interventions and be protected from useless or harmful ones. EBM provides an ostensibly rational and objective means of deciding whether or not an intervention should be provided on the basis of its effectiveness, in theory leading to f…Read more
  •  26
    Justice in Health Research: What is the Role of Evidence-Based Medicine?
    with Angela Ballantyne
    Perspectives in Biology and Medicine 52 (2): 188-202. 2009.
  •  25
    Beneficence in general practice: an empirical investigation
    Journal of Medical Ethics 25 (5): 388-393. 1999.
    OBJECTIVES: To study and report the attitudes of patients and general practitioners (GPs) concerning the obligation of doctors to act for the good of their patients, and to provide a practical account of beneficence in general practice. DESIGN: Semi-structured interviews administered to GPs and patients. SETTING AND SAMPLE: Participants randomly recruited from an age and gender stratified list of GPs in a geographically defined region of South Australia. The sample comprised twenty-one general p…Read more
  •  24
    Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery
  •  24
    Current Dilemmas in Defining the Boundaries of Disease
    with Jenny Doust and Mary Jean Walker
    Journal of Medicine and Philosophy 42 (4): 350-366. 2017.
    Boorse’s biostatistical theory states that diseases should be defined in ways that reflect disturbances of biological function and that are objective and value free. We use three examples from contemporary medicine that demonstrate the complex issues that arise when defining the boundaries of disease: polycystic ovary syndrome, chronic kidney disease, and myocardial infarction. We argue that the biostatistical theory fails to provide sufficient guidance on where the boundaries of disease should …Read more
  •  23
    Defining disease in the context of overdiagnosis
    Medicine, Health Care and Philosophy 20 (2): 269-280. 2017.
    Recently, concerns have been raised about the phenomenon of ‘overdiagnosis’, the diagnosis of a condition that is not causing harm, and will not come to cause harm. Along with practical, ethical, and scientific questions, overdiagnosis raises questions about our concept of disease. In this paper, we analyse overdiagnosis as an epistemic problem and show how it challenges many existing accounts of disease. In particular, it raises ques- tions about conceptual links drawn between disease and dysfu…Read more
  •  21
    Gender and trust in medicine: Vulnerabilities, abuses, and remedies
    with Angela Ballantyne
    International Journal of Feminist Approaches to Bioethics 1 (1): 48-66. 2008.
    Trust is taken to be one of the foundational values in the doctor-patient relationship, facilitating access to the benefits of health care and providing a guarantee against possible harms. Despite this foundational role, some doctors betray the trust of their patients. Trusting involves granting discretionary powers and makes the truster vulnerable to the trustee. Patients trust medical practitioners to act with goodwill and to act competently. Some patients carry pre-existing vulnerabilities, f…Read more
  •  21
    International Journal of Feminist Approaches to Bioethics 5 (2): 1-10. 2012.
    Our motivation for proposing a special issue of IJFAB on vulnerability is twofold. First, there is growing interest in the concept of vulnerability within both bioethics and feminist theory. Reflecting this interest, this special issue provides a forum for exploring the relevance for bioethics of feminist perspectives on vulnerability. Second, despite growing recognition within bioethics of the moral significance of vulnerability, the concept remains under-theorized in bioethical (and wider phil…Read more
  •  20
    This article examines the implicit promises of fairness in evidence based medicine , namely to avoid discrimination through objective processes, and to distribute effective treatments fairly. The relationship between EBM and vulnerable groups is examined. Several aspects of EBM are explored: the way evidence is created , and the way evidence is applied in clinical care and health policy. This analysis suggests that EBM turns our attention away from social and cultural factors that influence heal…Read more
  •  20
    Introduction: The Boundaries of Disease
    Journal of Medicine and Philosophy 42 (4): 343-349. 2017.
    Although health and disease occupy opposite ends of a spectrum, distinguishing between them can be difficult. This is the “line-drawing” problem. The papers in this special issue engage with this challenge of delineating the boundaries of disease. The authors explore different views as to where the boundary between disease and nondisease lies, and related questions, such as how we can identify, or decide, what counts as a disease and what does not; the nature of the boundary between the two cate…Read more
  •  18
    Getting clearer on overdiagnosis
    with Yishai Mintzker
    Journal of Evaluation in Clinical Practice 22 (4): 580-587. 2016.
    Overdiagnosis refers to diagnosis that does not benefit patients because the diagnosed condition is not a harmful disease in those individuals. Overdiagnosis has been identified as a problem in cancer screening, diseases such as chronic kidney disease and diabetes, and a range of mental illnesses including depression and attention deficit hyperactivity disorder. In this paper, we describe overdiagnosis, investigate reasons why it occurs, and propose two different types. Misclassification overdia…Read more
  •  17
    Confidentiality and the ethics of medical ethics
    Journal of Medical Ethics 29 (4): 220-224. 2003.
    In this paper we consider the use of cases in medical ethics research and teaching. To date, there has been little discussion about the consent or confidentiality requirements that ought to govern the use of cases in these areas. This is in marked contrast to the requirements for consent to publish cases in clinical journals, or to use personal information in research. There are a number of reasons why it might be difficult to obtain consent to use cases in ethics. Many cases concern people who …Read more
  •  16
    Précising definitions as a way to combat overdiagnosis
    Journal of Evaluation in Clinical Practice 24 (5): 1019-1025. 2018.
  •  15
    Analysing the ethics of breast cancer overdiagnosis: a pathogenic vulnerability
    Medicine, Health Care and Philosophy 22 (1): 129-140. 2019.
    Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying non-harmful ca…Read more
  •  14
    Patient visits are an important opportunity for general practitioners to discuss the risks of smoking and cessation strategies. In Australia, the guidelines on cessation published by the Royal Australian College of General Practitioners represent a key resource for GPs in this regard. The predominant message of the Guidelines is that pharmacotherapy should be recommended as first-line therapy for smokers expressing an interest in quitting. This, however, ignores established evidence about the su…Read more
  •  14
    Practical Ethics for General Practice
    Oxford University Press. 2004.
    The aim of this book is to provide an accessible account of ethics in general practice, addressing concerns identified by practitioners. It contains many examples and allows the reader to gain practical insights into how to identify and analyze the ethical issues they encounter in everyday general practice.
  •  14
    Bioethics and activism: A natural fit?
    Bioethics 33 (8): 881-889. 2019.
    Bioethics, EarlyView.