Correctional health care and Australian prisoners as recipients of kidney transplants: Legal and ethical issues

AIM

This research aims to examine the legal and ethical issues surrounding Australia prisoners as potential kidney transplant recipients.

METHODS

Examination of relevant statutory and common law including human rights law, state and territory corrections legislation and negligence law. Ethical principles considered, particularly in regards to practical and logistical considerations including adequate delivery of transplantation medical care and implications on the broader organ donation program. Approaches in the United States of America and United Kingdom are compared with the Australian approach.

RESULTS

Prisoners are more likely than non-incarcerated individuals to have chronic medical conditions. For most people with kidney failure, kidney transplantation improves both quality of life and life expectancy compared with dialysis therapy. Prisoners have a right to access reasonable medical care under state-based corrections legislation, which is underpinned by human rights law and ethical principles, primarily beneficence, transparency and justice. The right of prisoners to receive reasonable medical care likely extends to ensuring prisoners with kidney failure are considered for kidney transplantation and waitlisted if medically appropriate. Social factors and logistical factors can be relevant when considering eligibility for transplantation as they can relate to a person's ability to comply with medical therapy. Additionally, organ allocation decisions can be emotive, and a decision to offer a kidney transplant to a prisoner may generate significant negative publicity.

CONCLUSION

Prisoners with kidney failure should be considered for kidney transplantation. Logistical barriers, such as guard availability, should be addressed by state departments responsible for prisoner health.

Obligations of Australian health services as employers during COVID-19

The COVID-19 pandemic has brought into focus obligations for health services to protect the health and safety of their staff, arising from Occupational, Health and Safety legislation and the duty of care owed by a health service as an employer. Health workers, by nature of their work, are a particularly at-risk population in the context of COVID-19. This article examines the legal standard of care that healthcare employers owe their staff in terms of reduction of risk exposure, both physically and psychologically, to COVID-19, the obligation to provide staff with personal protective equipment, adequate hygiene, cleaning and the consequences for breaching these standards. This article also explores the right to dismiss employees who are non-compliant with their obligations. What is known about the topic? It is well known that health workers are an at-risk population for COVID-19, particularly those with direct exposure to affected patients. Since early 2020, healthcare services have faced substantial challenges in managing employee risk while complying with Occupational, Health and Safety law in Australia. What does this paper add? This paper explores the standard of care that healthcare services owe their staff in terms of reduction of risk exposure within the current Australian legal framework, as well as the rights and obligations of healthcare service employees. What are the implications for practitioners? Health services should be aware of the range of legal obligations to protect healthcare workers from the consequences of COVID-19 in order to minimise risk as much as reasonably practicable for employees. This includes ensuring access to adequate personal protective equipment, psychological support, adequate hygiene and cleaning of the physical workspace as well as the appropriate reporting of incidents and exposures.