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Lewis S, La Brooy C, Kerridge I, Holmes A, Olver I, Hudson P, Dooley M, Komesaroff P. Choreographing a good death: Carers' experiences and practices of enacting assisted dying. Sociol Health Illn 2024. [PMID: 38386331 DOI: 10.1111/1467-9566.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
The proliferation of assisted dying legislative reforms globally is a significant change in the social and medico-legal landscape of end-of-life care. Understanding the impacts of these legislative reforms on family members who care for a dying person is vital, yet under-theorised in research. In this article, drawing on semi-structured interviews with 42 carers for a person who has sought assisted dying in Australia, and extending ideas of ontological choreography we explore the new and complex choreographies enacted by carers in their endeavour to arrange a 'good death' for the dying person. We find that desires to fulfil the dying person's wishes are often accompanied by normative pressures, affective tensions and complexities in bereavement. Enacting assisted dying requires carers to perform a repertoire of highly-staged practices. Yet, institutional obstacles and normative cultural scripts of dying can constrain carer assisted dying practices. Understanding the nuances of carers' experiences and how they navigate this new end-of-life landscape, we argue, provides critical insights about how assisted dying legislation is producing new cultural touchpoints for caring at the end of life. Moreover, we show how emerging cultural scripts of assisted dying are impacting in the lives of these carers.
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Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Alex Holmes
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Dooley
- Alfred Health, Prahran, Victoria, Australia
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
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Treleaven L, Komesaroff P, La Brooy C, Olver I, Kerridge I, Philip J. A review of the utility of prognostic tools in predicting 6-month mortality in cancer patients, conducted in the context of voluntary assisted dying. Intern Med J 2023; 53:2180-2197. [PMID: 37029711 DOI: 10.1111/imj.16081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/07/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Eligibility to access the Victorian voluntary assisted dying (VAD) legislation requires that people have a prognosis of 6 months or less (or 12 months or less in the setting of a neurodegenerative diagnosis). Yet prognostic determination is frequently inaccurate and prompts clinician discomfort. Based on functional capacity and clinical and biochemical markers, prognostic tools have been developed to increase the accuracy of life expectancy predictions. AIMS This review of prognostic tools explores their accuracy to determine 6-month mortality in adults when treated under palliative care with a primary diagnosis of cancer (the diagnosis of a large proportion of people who are requesting VAD). METHODS A systematic search of the literature was performed on electronic databases Medline, Embase and Cinahl. RESULTS Limitations of prognostication identified include the following: (i) prognostic tools still provide uncertain prognoses; (ii) prognostic tools have greater accuracy predicting shorter prognoses, such as weeks to months, rather than 6 months; and (iii) functionality was often weighted significantly when calculating prognoses. Challenges of prognostication identified include the following: (i) the area under the curve (a value that represents how well a model can distinguish between two outcomes) cannot be directly interpreted clinically and (ii) difficulties exist related to determining appropriate thresholds of accuracy in this context. CONCLUSIONS Prognostication is a significant aspect of VAD, and the utility of the currently available prognostic tools appears limited but may prompt discussions about prognosis and alternative means (other than prognostic estimates) to identify those eligible for VAD.
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Affiliation(s)
- Lydia Treleaven
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Komesaroff
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ian Kerridge
- Department of Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Health Ethics, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jennifer Philip
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia
- Palliative Care Service, Peter MacCallum Cancer Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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3
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Komesaroff P, Upshur R, Light E, Kerridge I, Chapman M. Lead Essay-Viral Trajectories. J Bioeth Inq 2023; 20:571-574. [PMID: 38165557 DOI: 10.1007/s11673-023-10321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/04/2024]
Affiliation(s)
- Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3800, Australia.
| | - Ross Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, 678-155 College Avenue, Toronto, Ontario, M5T 3M5, Canada
- Lunenfeld Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Edwina Light
- Sydney Health Ethics, University of Sydney, Camperdown, NSW, Australia
| | - Ian Kerridge
- Department of Philosophy, Macquarie University, Sydney, NSW, Australia
- Royal North Shore Hospital and Sydney Health Ethics, University of Sydney, Camperdown, NSW, Australia
| | - Michael Chapman
- Department of Palliative Care, Canberra Health Services, Garran, ACT, Australia
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
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Chapman M, Komesaroff P. Radicalizing Hope. J Bioeth Inq 2023; 20:651-656. [PMID: 37676562 PMCID: PMC10942879 DOI: 10.1007/s11673-023-10291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/20/2023] [Indexed: 09/08/2023]
Abstract
The race against COVID-19 has been intense and painful and many of us are now looking for a way to move on. We may try to seize a degree of comfort and security by convincing ourselves that we are among the "fittest"-that is, among those who have managed to survive-who can now hope for a "new-normal" time, relatively unscathed. But this isn't what we should be hoping for. Our world, and ourselves, will never be free of COVID-19 or its insidious effects. COVID-19, like climate change, is a threat multiplier and the challenges it has raised are now indelibly engraved in our vulnerable, interconnected lives. Rather than vainly hoping for a return to an imaginary, erstwhile "normal" what we need is something more fundamental: a new version of hope that embraces a courage to learn what we need to do, to enable us to live a future to which we aspire. Perhaps counter-intuitively, we need to accept that the COVID-19 experience has already changed us deeply and hope that we can learn from this and from the future changes that the pandemic will give rise to. We need to radicalize our responses to the challenges, enabling ourselves to learn new lessons about old but increasingly pertinent topics, such as the realities of human fragility, and inter-connection.
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Affiliation(s)
- Michael Chapman
- Department of Palliative Care, Canberra Health Services, Garran ACT, Canberra, Australia.
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia.
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Komesaroff P, Philip J. Voluntary assisted dying in Victoria: the report card is mixed but we now know what we have to do. Intern Med J 2023; 53:2159-2161. [PMID: 38130051 DOI: 10.1111/imj.16278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Paul Komesaroff
- Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Palliative Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Philip J, Le B, La Brooy C, Olver I, Kerridge I, Komesaroff P. Correction to: Voluntary Assisted Dying/Euthanasia: Will This Have an Impact on Cancer Care in Future Years? Curr Treat Options Oncol 2023; 24:1365-1366. [PMID: 37721705 PMCID: PMC10547607 DOI: 10.1007/s11864-023-01133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy, Melbourne, Victoria, 3065, Australia.
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia.
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Brian Le
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy, Melbourne, Victoria, 3065, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- Public Health & Preventive Medicine, Monash University, Monash, Victoria, Australia
| | - Ian Olver
- University of Notre Dame of Australia, Sydney, NSW, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
- Department of Philosophy, Macquarie University, Macquarie, NSW, Australia
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Philip J, Le B, La Brooy C, Olver I, Kerridge I, Komesaroff P. Voluntary Assisted Dying/Euthanasia: Will This Have an Impact on Cancer Care in Future Years? Curr Treat Options Oncol 2023; 24:1351-1364. [PMID: 37535255 PMCID: PMC10547610 DOI: 10.1007/s11864-023-01126-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/04/2023]
Abstract
OPINION STATEMENT In considering the impact of medically hastened death (MHD) on cancer care, a wide range of variables needs to be considered including demographic factors, diagnoses, local cultural factors, and the legislative frameworks in place. Here, we present a synthesis of recently available published literature and empirical data collected following legislative change to enable MHD in Victoria, Australia to explore in detail the potential impact of MHD on cancer care with a focus on patients/families and professional groups. Our findings reveal that for patients and families, both physical and existential distress frequently underlie MHD requests, with the latter less readily recognised by health professionals. The responses of those around the patient making the request may have a very significant impact on relationships within families and upon the nature of the subsequent bereavement. For palliative care, while differing views may remain, it appears that there has been some accommodation of MHD into or alongside practice over time. The recognition of a shared commitment to relief of suffering of palliative care and MHD appears a helpful means of establishing how these practices may co-exist. In cancer practice more broadly, as individual professionals reflect upon their own roles, new relationships and pathways of patient movement (or referral) must be established in response to patients' requests. Our findings also highlight many unanswered questions in understanding the impact of MHD, including that upon those dying who choose not to access MHD, First Nations peoples, the participating health professionals' longer term, and the relief of suffering itself. A systematic approach to the evaluation of MHD legislation must be adopted in order to understand its full impact. Only then could it be determined if the aspirations for such legislative change were being met.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy 3065, Melbourne, Victoria, Australia.
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia.
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Brian Le
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy 3065, Melbourne, Victoria, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- Public Health & Preventive Medicine, Monash University, Monash, Victoria, Australia
| | - Ian Olver
- University of Notre Dame of Australia, Sydney, NSW, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
- Department of Philosophy, Macquarie University, Macquarie, NSW, Australia
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Lewis S, Willmott L, White BP, La Brooy C, Komesaroff P. First Nations Perspectives in Law-Making About Voluntary Assisted Dying. J Law Med 2022; 29:1168-1181. [PMID: 36763024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Voluntary assisted dying laws have now been enacted in all six Australian States with reform being considered in the remaining two. While there is an emerging body of literature examining various aspects of regulation, there has been scant consideration of what these reforms mean for First Nations peoples, and to what extent their experiences have been considered in the process of developing legislation. This article provides a critical analysis of how Indigenous perspectives both contributed to, and were engaged with, during the law reform processes in Victoria and Western Australia, the first two States to grapple with this topic. Findings reveal the sophistication in how Indigenous organisations and individuals engaged with this issue and highlight the critical importance of not universalising Indigenous perspectives. Significantly, there was much greater engagement with Indigenous views in Western Australia than in Victoria. We conclude by considering how Indigenous voices can meaningfully influence Australian law reform processes.
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Affiliation(s)
- Sophie Lewis
- Senior Lecturer, Sydney School of Health Sciences, University of Sydney, Camperdown, New South Wales
| | - Lindy Willmott
- Professor of Law, Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland
| | - Ben P White
- Professor of End-of-Life Law and Regulation, Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland
| | - Camille La Brooy
- Research Fellow and Senior Study Coordinator, VAD Research Project, School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria
| | - Paul Komesaroff
- Professor of Medicine and Director, international NGO Global Reconciliation, School of Public Health and Preventative Medicine, Monash University, Alfred Hospital, Prahran, Victoria
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9
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Sibbritt D, Peng W, Wardle J, Stewart C, Komesaroff P, Adams J. The Regulation of the Complementary Health Sector: General Public's Knowledge of Complementary Medicine-Related Quality Assurance and Consumer Protection. Int J Health Policy Manag 2022; 11:1482-1488. [PMID: 34273921 PMCID: PMC9808326 DOI: 10.34172/ijhpm.2021.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Complementary medicine (CM) use is a ubiquitous aspect of an increasingly consumer-driven model of healthcare delivery and plays an increasingly prominent role in the Australian health sector. Yet there is limited empirical research investigating the quality and integrity of protections for consumers in Australia. The aim of this study is to help address this gap in knowledge by exploring how members of the public engage with protection mechanisms related to CM use. METHODS This study utilised a cross-sectional online survey to recruit a sample of 1132 Australian adults aged 18 and over. Purposive convenience sampling was used to recruit participants from an existing database of Australian adults who had expressed interest in participating in research. RESULTS The majority of the participants (64.0%) had visited a CM practitioner in their lifetime. However, a minority of participants (36.9%) indicated they would feel confident in knowing where to complain if something went wrong with the treatment they received from a CM practitioner. Most participants (74.7%) had used a CM product in their lifetime. Specifically, 32.3% had 'ever' used an herbal product and 69.9% had 'ever' used a nutritional supplement. However, a minority of participants (32.7%) indicated they would feel confident knowing where to complain if something went wrong with a herbal or nutritional supplement they used. Most participants indicated a lack of knowledge about how CM practitioners and CM products are regulated in Australia. CONCLUSION The findings of this study clearly highlight a concerning lack of knowledge by CM patients and consumers regarding the regulation of CM in Australia. From a policy perspective, it is necessary to seek proactive approaches that target complaint-related knowledge of the CM patients and consumers through education and advocacy efforts.
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Affiliation(s)
- David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Wenbo Peng
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jon Wardle
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Cameron Stewart
- Sydney Law School, University of Sydney, Sydney, NSW, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jon Adams
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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10
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Kerridge I, Komesaroff P. Thinking Honestly About Climate Change: Intergenerational Ethics and the Limits of Rationality. J Paediatr Child Health 2022; 58:739-740. [PMID: 35247212 DOI: 10.1111/jpc.15922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ian Kerridge
- Haematology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Komesaroff
- The Alfred Hospital, Melbourne, Victoria, Australia.,Centre for Ethics in Medicine and Society, Monash University, Melbourne, Victoria, Australia
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11
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Holmes A, Lange P, Stewart C, White B, Willmott L, Dooley M, Philip J, La Brooy C, Komesaroff P. Can depressed patients make a decision to request voluntary assisted dying? Intern Med J 2021; 51:1713-1716. [PMID: 34664368 DOI: 10.1111/imj.15512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Abstract
Depressive symptoms, including those as part of a major depressive disorder, are common at the end of life. A number of psychiatrists consider that a diagnosis of major depression precludes the capacity to make a decision to request voluntary assisted dying (VAD), although this is not a unanimous view. This paper uses a case of a patient in which two different psychiatric opinions were formed regarding her capacity to make the decision to request VAD. The difference of view can be related to whether major depression was diagnosed and the association made between depression and the capacity to request VAD. The view that an absence of major depression is required in order to establish the capacity to request VAD is potentially at odds with the legal definition and not necessarily in keeping with the patient's experience at the end of life.
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Affiliation(s)
- Alex Holmes
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Lange
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Cameron Stewart
- Sydney Health Law, Sydney Law School, University of Sydney, Sydney, New South Wales, Australia
| | - Ben White
- Australian Centre for Health Law Research, School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lindy Willmott
- Australian Centre for Health Law Research, School of Law, Faculty of Business and Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael Dooley
- Faculty of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University Health, Melbourne, Victoria, Australia
| | - Jennifer Philip
- Department of Medicine, University of Melbourne Palliative Care Service, St Vincent's Hospital, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- Centre for Ethics in Medicine and Society, Monash University, Melbourne, Victoria, Australia
| | - Paul Komesaroff
- Centre for Ethics in Medicine and Society, Monash University, Melbourne, Victoria, Australia
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Iyngkaran P, Thomas M, Horowitz JD, Komesaroff P, Jelinek M, Hare DL. Common Comorbidities that Alter Heart Failure Prognosis - shaping new thinking for practice. Curr Cardiol Rev 2020; 17:e160721187934. [PMID: 33185169 PMCID: PMC8950452 DOI: 10.2174/1573403x16666201113093548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/22/2022] Open
Abstract
At least half of all heart failure (CHF) patients will have a comorbidity that could be undertreated, requires additional speciality input and/or polypharmacy. These patients are then at risk from iatrogenic and disease related complications and readmissions if not closely supervised. Common comorbidities of relevance are cardiorenal and cardiometabolic syndromes (DM, obesity, OSA), chronic airways disease, elderly age and accompanying therapeutic optimisation. The structure of community practice often leaves primary, speciality and allied health care in silos. For example, cardiology speciality training in Australia creates excellent sub-specialists to deliver on the diagnostics and therapeutic advances. A casualty of this process has been gradual alienation of general cardiology towards general internal medical specialists and GP's. The consequences are largely noticed in community practice. The issue are compounded by suboptimal communication of information. This review explores these issues from a cardiology sub-speciality lens, firstly cross speciality areas important for cardiologist to maintain their skill and finally a brief overview of disease management and identifying game changing common denominators such as endothelial dysfunction and self-management.
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Affiliation(s)
- Pupalan Iyngkaran
- Department of Cardiology, Cardiologist (Heart Failure & Cardiac Imaging) Heart West, Adjunct Senior Lecturer, Werribee Mercy Sub School, School of Medicine, Notre Dame University, Notre Dame, Sydney. Australia
| | - Merlin Thomas
- Department of Biochemistry, Biochemistry of Diabetes Complications, Monash University, Melbourne. Australia
| | - John D Horowitz
- Department of Cardiology, University of Adelaide, Adelaide. Australia
| | - Paul Komesaroff
- Department of Endocrinology, Professor of Medicine, Monash University, Melbourne. Australia
| | - Michael Jelinek
- University of Melbourne, St. Vincent's Hospital, Melbourne. Australia
| | - David L Hare
- Department of Cardiology, Cardiovascular Research, University of Melbourne, Austin Health, Melbourne, Victoria. Australia
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Stewart C, Lipworth W, Komesaroff P, Kerridge I. Conflicts of interest, end-of-life care and organ donation. J Crit Care 2020; 63:272. [PMID: 33097318 DOI: 10.1016/j.jcrc.2020.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cameron Stewart
- Sydney Health Law, Sydney Law School, University of Sydney, NSW 2006, Australia.
| | - Wendy Lipworth
- Sydney Health Ethics, Faculty of Medicine and Health, University of Sydney, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences at Monash University, Australia
| | - Ian Kerridge
- Royal North Shore Hospital, Sydney and Sydney Health Ethics, University of Sydney, Australia
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Arnold MH, Komesaroff P, Kerridge I. Understanding the ethical implications of the rituals of medicine. Intern Med J 2020; 50:1123-1131. [PMID: 32929818 DOI: 10.1111/imj.14990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/27/2022]
Abstract
Rituals may be understood broadly as stereotyped behaviours carrying symbolic meanings, which play a crucial role in defining relationships, legitimating authority, giving meaning to certain life events and stabilising social structures. Despite intense interest in the subject, and an extensive literature, relatively little attention has been given to the nature, role and function of ritual in contemporary medicine. Medicine is replete with ritualistic behaviours and imperatives, which play a crucial role in all aspects of clinical practice. Rituals play multiple, complex functions in clinical interactions and have an important role in shaping interactions, experiences and outcomes. Longstanding medical rituals have been disrupted in the wake of coronavirus disease 2019 (COVID-19). Medical rituals may be evident or invisible, often overlap with or operate alongside instrumentalised practices, and play crucial roles in establishing, maintaining and guaranteeing the efficacy of clinical practices. Rituals can also inhibit progress and change, by enforcing arbitrary authority. Physicians should consider when they are undertaking a ritual practice and recognise when the exigencies of contemporary practice are affecting that ritual with or without meaning or intention. Physicians should reflect on whether aspects of their ritual interactions are undertaken on the basis of sentiment, custom or evidence-based outcomes, and whether rituals should be defended, continued in a modified fashion or even abandoned in favour of new behaviours suitable for and salient with contemporary practice in the interests of patient care.
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Affiliation(s)
- Mark H Arnold
- Sydney Medical Program, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ian Kerridge
- Sydney Health Ethics, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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15
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Stewart C, Kerridge I, La Brooy C, Komesaroff P. Suicide-related Materials and Voluntary Assisted Dying. J Law Med 2020; 27:839-845. [PMID: 32880402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This column discusses the potential for conflict between the Federal laws forbidding the use of telecommunications to spread "suicide-related materials" and the laws in Victoria and Western Australia which have legalised forms of voluntary assisted dying. The column argues that the effect of the State laws is to differentiate the legal forms of voluntary assisted dying from suicide and assisted suicide, with the effect that Federal prohibitions do not apply to telecommunications between health practitioners and their patients regarding voluntary assisted dying.
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Affiliation(s)
- Miriam Wiersma
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia.
| | - Wendy Lipworth
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia
| | - Paul Komesaroff
- Centre for Ethics in Medicine and Society, Alfred Hospital, Monash University, Commercial Road, Prahran, Victoria, Australia
| | - Ian Kerridge
- The University of Sydney, Sydney Health Ethics, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia
- Haematology Department, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
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Komesaroff P, Kerridge I. A Continent Aflame: Ethical Lessons From the Australian Bushfire Disaster. J Bioeth Inq 2020; 17:11-14. [PMID: 32152898 DOI: 10.1007/s11673-020-09968-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Paul Komesaroff
- Centre for Ethics in Medicine and Society, Monash University, Alfred Hospital, Commercial Road, Prahran, Victoria, Australia.
| | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia
- Haematology Department, Royal North Shore Hospital, Sydney, Australia
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Abstract
Dementia is more than a disease. What dementia is, how it is understood, and how it is experienced is influenced by multiple factors including our societal preoccupation with individual identity. This essay introduces empirical and theoretical evidence of alternative ways of understanding dementia that act as a challenge to common assumptions. It proposes that dementia be understood as an experience of systems, particularly networks of people affected by the diagnosis. Taking this step reveals much about the dementia experience, and about what can be learned from persons with dementia and their networks of family, friends, and carers. It also suggests that dementia may be best thought of as an ecology that arises from the interaction between neuropathological change, people, language, and meaning. While challenging, this perspective may provide new ways of responding to dementia and caring for those affected by it.
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Affiliation(s)
- Michael Chapman
- Medical School, College of Health and Medicine, Australian National University, Building 4, Canberra Hospital, Garran, ACT, 2602, Australia.
- Department of Palliative Care, Canberra Regional Cancer Centre, Canberra Hospital, Garran, ACT, 2602, Australia.
| | - Jennifer Philip
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
- St Vincent's Hospital Department of Palliative Care, Fitzroy, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Abstract
Recognizing the potential hidden artistic contributions of persons with dementia opens new opportunities for interpretation and potential communication. This visual essay explores the authors' responses to the fragile objects of art produced by a person with severe dementia and examines what may be learned from them.
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Affiliation(s)
- Michael Chapman
- Medical School, College of Health and Medicine, Australian National University, Building 4, Canberra Hospital, Garran, ACT, 2602, Australia.
- Department of Palliative Care, The Canberra Hospital, Garran, ACT, 2602, Australia.
| | - Jennifer Philip
- Melbourne University Department of Medicine, Parkville, Victoria, Australia
- St Vincent's Hospital Department of Palliative Care, Fitzroy, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Sally Gardner
- Deakin University Faculty of Arts and Education, Melbourne, Victoria, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Chapman M, Philip J, Komesaroff P. Learning From the Cultural Challenge of Dementia. J Bioeth Inq 2019; 16:159-162. [PMID: 31165414 DOI: 10.1007/s11673-019-09916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
Learning from the profound challenge of dementia is an urgent priority. Success will require a critical deconstruction of current cultural and linguistic representations of this condition, and a kindling of novel and courageous approaches to re-conceptualise dementia's meaning and experience. This symposium collects provocative ideas arising from various discourses, theoretical perspectives, and methodolgical approaches to explore new ways to understand dementia.
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Affiliation(s)
- Michael Chapman
- Medical School, College of Health and Medicine, Australian National University, Building 4, Canberra Hospital, Garran, ACT, 2602, Australia.
- Department of Palliative Care, Canberra Hospital, ACT, Australia.
| | - Jennifer Philip
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- St Vincent's Hospital Department of Palliative Care, Fitzroy, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Haire B, Komesaroff P, Leontini R, Raina MacIntyre C. Raising Rates of Childhood Vaccination: The Trade-off Between Coercion and Trust. J Bioeth Inq 2018; 15:199-209. [PMID: 29497995 DOI: 10.1007/s11673-018-9841-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/02/2017] [Indexed: 05/09/2023]
Abstract
Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through "herd immunity," which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination ("No Jab No Pay"). In addition, it has raised the possibility of banning unvaccinated children from childcare centres ("No Jab No Play"). This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices.
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Affiliation(s)
- Bridget Haire
- Kirby Institute, Level 6, Wallace Wurth Building, UNSW Sydney, Kensington, NSW, 2052, Australia.
| | - Paul Komesaroff
- Monash Centre for the Study of Ethics in Medicine, Monash University, Clayton, Australia
| | - Rose Leontini
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, NSW, 2052, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Sydney, Kensington, NSW, 2052, Australia
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Singla AA, Komesaroff P. Self-collected Pap smears may provide an acceptable and effective method of cervical cancer screening. Health Sci Rep 2018; 1:e33. [PMID: 30623069 PMCID: PMC6266357 DOI: 10.1002/hsr2.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/11/2017] [Accepted: 02/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND AIMS The role of the Papanicolou (Pap) smear in the early detection and prevention of cervical cancer is well established. However, many women fail to undertake the test because of embarrassment or other reasons. To address this problem, we evaluated the feasibility of implementing self-sampling of cervical cytology as an alternative to clinician-collected Pap smears and compared it with the gold standard of colposcopy in terms of specificity. MATERIALS AND METHODS A prospective preliminary study of 40 women recruited from the colposcopy clinic of a tertiary referral hospital was undertaken. Participants were instructed in the technique of self-sampling and asked to collect their own Pap smears. Colposcopic examinations were performed and biopsies taken, if indicated. Clinician-collected Pap smears were performed 4 weeks later. Pairwise agreement was calculated between the outcomes of self-collected, colposcopic, and clinician-collected samples using the weighted κ statistic. RESULTS Self-collected Pap smear had a high level of acceptability among the women, all of whom were able to collect adequate tissue. The agreement of self-collected Pap smears with colposcopic assessment was no worse than that of clinician-collected Pap smears (Cohen's κ statistic 0.54 [95% CI, 0.27-0.82]; cf 0.49 [0.2-0.78], respectively). The specificity of self-collected Pap smears was almost identical to that of clinician-collected samples (specificity: 86% vs 81%, respectively). Direct comparison between patient and clinician collected Pap smears showed fair agreement (κ statistic 0.38 [0.07-0.68]). There were no adverse events in either group. CONCLUSIONS Self-collection of Pap smears is an effective and acceptable alternative to clinician-collected samples and may provide a strategy for improving compliance with cervical testing programs.
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Affiliation(s)
- Amita A. Singla
- Department of GynaecologyThe Queen Elizabeth HospitalAdelaideAustralia
- Department of Obstetrics and GynaecologyUniversity of AdelaideAdelaideAustralia
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Couch D, Han GS, Robinson P, Komesaroff P. Men's weight loss stories: How personal confession, responsibility and transformation work as social control. Health (London) 2017; 23:76-96. [PMID: 28803501 DOI: 10.1177/1363459317724855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is considered a public health concern. In Australia, there are a greater number of overweight or obese men compared with women. The media is an important source of information about body weight and weight management. We undertook a qualitative study to analyse men's weight loss stories in a popular men's magazine. Between January 2009 and December 2012, we collected 47 men's weight loss stories from the Australian edition of Men's Health magazine. We undertook thematic analysis to examine the stories. Confession, personal responsibility, appearance and transformation were key themes. The stories describe the men's self-discipline and their monitoring and tracking of their behaviours as activities which supported their weight loss. In this way, the stories promote the importance of such panoptic self-surveillance and self-discipline to the readers. We consider how such stories contribute to the wider synoptic system of media messages about body weight.
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Williams J, Mayes C, Komesaroff P, Kerridge I, Lipworth W. Conflicts of interest in medicine: taking diversity seriously. Intern Med J 2017; 47:739-746. [DOI: 10.1111/imj.13471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Williams
- Centre for Values, Ethics and the Law in Medicine (VELiM); University of Sydney; Sydney New South Wales Australia
| | - Christopher Mayes
- Centre for Values, Ethics and the Law in Medicine (VELiM); University of Sydney; Sydney New South Wales Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine (VELiM); University of Sydney; Sydney New South Wales Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine (VELiM); University of Sydney; Sydney New South Wales Australia
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Robins-Browne K, Hegarty K, Guillemen M, Komesaroff P, Palmer V. The Role of Relational Knowing in Advance Care Planning. The Journal of Clinical Ethics 2017. [DOI: 10.1086/jce2017282122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Robins-Browne K, Hegarty K, Guillmen M, Komesaroff P, Palmer V. The Role of Relational Knowing in Advance Care Planning. J Clin Ethics 2017; 28:122-134. [PMID: 28614075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that "autonomy" is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because it is unable to facilitate a relational approach to decision making in cases when the patient's competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants' understanding was the emergent concept of "relational knowing," a concept that is poorly articulated in the advance care planning literature. Our findings suggest that the dominant understanding of decision making in conditions of impaired competence is incomplete and obscures much of what matters to people. We conclude that, having recognized a broader set of ethical concerns, it is necessary to develop a relational and narrative based approach that applies in appropriate settings.
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Affiliation(s)
- Kate Robins-Browne
- University of Melbourne, Department of General Practice, 200 Berkeley St., Carlton, Victoria 3093 Australia.
| | - Kelsey Hegarty
- University of Melbourne and Royal Women's Hospital, Victoria, Australia
| | - Marilys Guillmen
- University of Melbourne, 200 Berkeley St., Carlton, Victoria 3093 Australia
| | | | - Victoria Palmer
- University of Melbourne, Department of General Practice, 200 Berkeley St., Carlton, Victoria 3093 Australia
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Arnold M, Kerridge I, Komesaroff P. Watching the Responsibility Clock: Medical Care, Ethics, and Medical Shift Work. Am J Bioeth 2016; 16:22-24. [PMID: 27471933 DOI: 10.1080/15265161.2016.1197345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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29
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Mayes C, Blakely B, Kerridge I, Komesaroff P, Olver I, Lipworth W. On the fragility of medical virtue in a neoliberal context: the case of commercial conflicts of interest in reproductive medicine. Theor Med Bioeth 2016; 37:97-111. [PMID: 26935437 DOI: 10.1007/s11017-016-9353-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians' willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. 'Conflicts of interest' policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine (using the example of fertility services in Australia). We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue.
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Affiliation(s)
- Christopher Mayes
- Centre for Values, Ethics and the Law in Medicine, Sydney School of Public Health, University of Sydney, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia.
| | - Brette Blakely
- Centre for Healthcare Resilience and Implementation Science (CHRIS), Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talevera Rd, Sydney, NSW, 2109, Australia
| | - Ian Kerridge
- Centre for Values, Ethics and the Law in Medicine, Sydney School of Public Health, University of Sydney, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia
| | - Paul Komesaroff
- Centre for Ethics in Medicine and Society, The Alfred Hospital, Monash University, Commercial Road, Prahran, VIC, 3181, Australia
| | - Ian Olver
- Division of Health Sciences, Sansom Institute for Health Research, University of South Australia, P5-06e Playford Building I City East Campus I, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, Sydney School of Public Health, University of Sydney, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia
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Couch D, Thomas SL, Lewis S, Blood RW, Holland K, Komesaroff P. Obese people's perceptions of the thin ideal. Soc Sci Med 2015; 148:60-70. [PMID: 26685706 DOI: 10.1016/j.socscimed.2015.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022]
Abstract
The media play a key role in promoting the thin ideal. A qualitative study, in which we used in depth interviews and thematic analysis, was undertaken to explore the attitudes of 142 obese individuals toward media portrayals of the thin ideal. Participants discussed the thin ideal as a social norm that is also supported through the exclusion of positive media portrayals of obese people. They perceived the thin ideal as an 'unhealthy' mode of social control, reflecting on their personal experiences and their concerns for others. Participants' perceptions highlighted the intersections between the thin ideal and gender, grooming and consumerism. Participants' personal responses to the thin ideal were nuanced--some were in support of the thin ideal and some were able to critically reflect and reject the thin ideal. We consider how the thin ideal may act as a form of synoptical social control, working in tandem with wider public health panoptical surveillance of body weight.
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Affiliation(s)
- Danielle Couch
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia.
| | - Samantha L Thomas
- School of Health and Social Development, Burwood, Deakin University, Australia
| | - Sophie Lewis
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - R Warwick Blood
- News and Media Research Centre, Faculty of Arts and Design, University of Canberra, Canberra, Australia
| | - Kate Holland
- News and Media Research Centre, Faculty of Arts and Design, University of Canberra, Canberra, Australia
| | - Paul Komesaroff
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Parker M, Kerridge I, Komesaroff P. "NEVER REGARD YOURSELF AS ALREADY SO THOROUGHLY INFORMED": THE WITHDRAWAL OF ITS INVITATION TO RODNEY SYME TO ADDRESS ITS 2015 CONGRESS BY THE ROYAL AUSTRALASIAN COLLEGE OF PHYSICIANS. J Law Med 2015; 23:50-54. [PMID: 26554197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In 1628, William Harvey presented his revolutionary theory of the circulation to ears at the Royal College of Physicians that had been deafened by the unquestionable authority of Galen's teachings, from one and a half millennia in the past. Harvey's theory was initially rejected, despite his faith in his colleagues being eager for truth and knowledge, and never regarding themselves as so well informed that they would not welcome "further information". Recently Rodney Syme, the retired Melbourne urologist who for a long time has agitated for the legalisation of assisted dying, and also challenged the authorities to apply the current law in response to his admitted assistance to a number of individuals, was invited to address the 2015 Congress of the Royal Australasian College of Physicians. At the eleventh hour, the invitation to speak was withdrawn. In this column, we trace the course of events leading to this withdrawal of the invitation, and describe some of the correspondence to and from the College in response to the withdrawal. We draw parallels between the experiences of Harvey and Syme, and point to lessons to be learnt from the recent episode of apparent unwillingness, on the part of an institution that seeks to present itself as outward-looking, progressive and socially aware, to fulfil this promise in the increasingly important area of the end-of-life.
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Fiddes P, Brooks P, Komesaroff P. Author reply. Intern Med J 2015. [DOI: 10.1111/imj.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- P. Fiddes
- Peninsula Clinical School; Monash University; Melbourne Victoria Australia
| | - P. Brooks
- Australian Health Workforce Institute (AHWI); Melbourne Victoria Australia
| | - P. Komesaroff
- Department of Medicine; Alfred Hospital; Monash University; Melbourne Victoria Australia
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Robins-Browne K, Palmer V, Komesaroff P. An unequivocal good? Acknowledging the complexities of advance care planning. Intern Med J 2015; 44:957-60. [PMID: 25302719 DOI: 10.1111/imj.12556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 07/30/2014] [Indexed: 11/30/2022]
Abstract
Over the past few decades advance care planning (ACP) has become the subject of debate, research and legislation in many countries. Encouraging people to express their preference for treatment in advance, ideally in written form, seems a natural way to identify what someone might have wanted when they can no longer participate in decision-making. The notion of ACP as an unequivocal good permeates much of the research and policy work in this area. For example, ACP is now actively encouraged in Australian federal and state government policies and the Victorian Government has recently published a practical ACP strategy for Victorian health services (2014-2018). However, advance care plan is ethically complex and the introduction of the Victorian health services strategy provides an opportunity to reflect on this complexity, particularly on the benefits and risks of ACP.
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Affiliation(s)
- K Robins-Browne
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
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Couch D, Han GS, Robinson P, Komesaroff P. Public health surveillance and the media: a dyad of panoptic and synoptic social control. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1049539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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35
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Komesaroff P. Mandatory reporting of impaired doctors: protecting the community or increasing the risk? Intern Med J 2014; 44:1154-5. [PMID: 25442755 DOI: 10.1111/imj.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/14/2014] [Indexed: 12/01/2022]
Affiliation(s)
- P Komesaroff
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
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36
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Affiliation(s)
- Paul Komesaroff
- Centre for Ethics in Medicine and Society, Monash University Faculty of Medicine, Nursing and theHealth Sciences, Melbourne, Australia,
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37
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38
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Komesaroff P. Ethics and law for the health professions. 4th ed. Aust Prescr 2014. [DOI: 10.18773/austprescr.2014.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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39
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Couch D, Han GS, Robinson P, Komesaroff P. "At 150 kg, you can't run" men's weight loss stories in a popular health magazine provide appropriate examples of good health practice. Health Psychol Behav Med 2014; 2:252-267. [PMID: 25750780 PMCID: PMC4345825 DOI: 10.1080/21642850.2014.891947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022] Open
Abstract
We explore weight loss stories from 47 men collected from the Australian edition of Men's Health magazine between January 2009 and December 2012. Our analysis uses a mixed methods approach that combines thematic analysis and descriptive statistics to examine weight loss strategies against clinical practice guidelines for the management of overweight and obesity. All the stories reported the use of physical activity for weight loss and most stories detailed dietary changes for weight loss. Our findings indicate that most of the men reportedly used some form of behavioural strategies to assist them in their behaviour change efforts. The weight loss methods used were consistent with clinical practice guidelines, with the exception of some dietary practices. As narratives may assist with behaviour change, stories like those examined in this study could prove to be very useful in promoting weight loss to men.
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Affiliation(s)
- Danielle Couch
- The Monash Centre for the Study of Ethics in Medicine and Society, Monash University, The Alfred Centre Level 6, 99 Commercial Road, Melbourne, Victoria3004, Australia
| | - Gil-Soo Han
- School of Media, Film and Journalism, Monash University, Clayton, Victoria3800, Australia
| | - Priscilla Robinson
- School of Public Health and Human Biosciences, La Trobe University, Bundoora, Victoria3086, Australia
| | - Paul Komesaroff
- The Monash Centre for the Study of Ethics in Medicine and Society, Monash University, The Alfred Centre Level 6, 99 Commercial Road, Melbourne, Victoria3004, Australia
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Fiddes PJ, Brooks PM, Komesaroff P. The patient is the teacher: ambulatory patient-centred student-based interprofessional education where the patient is the teacher who improves patient care outcomes. Intern Med J 2013; 43:747-50. [DOI: 10.1111/imj.12197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- P. J. Fiddes
- Peninsula Clinical School; Peninsula Health, Monash University
| | - P. M. Brooks
- Australian Health Workforce Institute; The University of Melbourne
| | - P. Komesaroff
- Monash Centre for Ethics in Medicine and Society, Alfred Hospital; Monash University; Melbourne; Victoria; Australia
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Robins-Browne K, Hegarty K, Palmer V, Guillemin M, Komesaroff P. HOW RECOGNITION OF RELATIONAL KNOWING EXPANDS THE GENERAL PRACTITIONER'S ROLE IN ADVANCE CARE PLANNING. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Komesaroff P, Kerridge I, Carney S, Brooks P. Is it too late to turn back the clock on managerialism and neoliberalism? Intern Med J 2013; 43:221-2. [PMID: 23441656 DOI: 10.1111/imj.12078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 11/29/2022]
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Moore A, Komesaroff P, O'Brien K. P04.64. Chinese medicine in Australia: the nature of practice and perspectives of practitioners. Altern Ther Health Med 2012. [PMCID: PMC3373909 DOI: 10.1186/1472-6882-12-s1-p334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Thomas S, Karunaratne A, Lewis S, Castle D, Knoesen N, Honigman R, Hyde J, Kausman R, Komesaroff P. ‘Just Bloody Fat!’: A Qualitative Study of Body Image, Self-Esteem and Coping in Obese Adults. International Journal of Mental Health Promotion 2012. [DOI: 10.1080/14623730.2010.9721805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nheu L, Nazareth L, Xu GY, Xiao FY, Luo RZ, Komesaroff P, Ling S. Physiological effects of androgens on human vascular endothelial and smooth muscle cells in culture. Steroids 2011; 76:1590-6. [PMID: 22019845 DOI: 10.1016/j.steroids.2011.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 05/24/2011] [Accepted: 09/30/2011] [Indexed: 11/24/2022]
Abstract
Androgenic hormones are associated with atherosclerotic cardiovascular disease, although the underlying cellular and molecular mechanisms remain unclear. This study examines the impact of androgens on the physiology of human vascular endothelial cells (EC) and smooth muscle cells (SMC) in culture. Cells were incubated with testosterone, dihydrotestosterone (DHT) or dehydroepiandrosterone (DHEA) at various physiological concentrations (5-50 nM) in the present or absence of an androgen receptor (AR) blocker flutamide (100 nM). Cell growth and death, DNA and collagen synthesis, and gene protein expression were assessed. It was shown that: (1) DHEA protected EC from superoxide injury via AR-independent mechanisms; (2) testosterone induced DNA synthesis and growth in EC via an AR-independent manner with activation of ERK1/2 activity; (3) DHT inhibited DNA synthesis and growth in EC in an AR-dependent manner; (4) testosterone and DHT enhanced ERK1/2 activation and proliferation in SMC via AR-independent and -dependent pathways, respectively; and (5) these androgens did not significantly affect collagen synthesis in SMC. We conclude that androgens possess multiple effects on vascular cells via either AR-dependent or -independent mechanisms. Testosterone and DHEA may be "beneficial" in preventing atherosclerosis by improving EC growth and survival; in contrast, stimulation of VSMC proliferation by testosterone and DHT is potentially "harmful". The relationship of these in vitro effects by androgens to in vivo vascular function and atherogenesis needs to be further clarified.
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Affiliation(s)
- Lina Nheu
- Department of Medicine, Monash University Central Clinical School, Prahran, Melbourne, Victoria 3181, Australia
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Currey J, Komesaroff P, Hagan N. 490 Living with Mechanical Cardiac Support: Patients and Families in Crisis. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Komesaroff P, Kerridge I. It is time to move beyond a culture of unexamined assumptions, recrimination, and blame to one of systematic analysis and ethical dialogue. Am J Bioeth 2011; 11:31-33. [PMID: 21240804 DOI: 10.1080/15265161.2011.534954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Thomas SL, Lewis S, Hyde J, Castle D, Komesaroff P. "The solution needs to be complex." Obese adults' attitudes about the effectiveness of individual and population based interventions for obesity. BMC Public Health 2010; 10:420. [PMID: 20633250 PMCID: PMC2912819 DOI: 10.1186/1471-2458-10-420] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 07/15/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Previous studies of public perceptions of obesity interventions have been quantitative and based on general population surveys. This study aims to explore the opinions and attitudes of obese individuals towards population and individual interventions for obesity in Australia. METHODS Qualitative methods using in-depth semi-structured telephone interviews with a community sample of obese adults (Body Mass Index >or=30). Theoretical, purposive and strategic recruitment techniques were used to ensure a broad sample of obese individuals with different types of experiences with their obesity. Participants were asked about their attitudes towards three population based interventions (regulation, media campaigns, and public health initiatives) and three individual interventions (tailored fitness programs, commercial dieting, and gastric banding surgery), and the effectiveness of these interventions. RESULTS One hundred and forty two individuals (19-75 years) were interviewed. Participants strongly supported non-commercial interventions that were focused on encouraging individuals to make healthy lifestyle changes (regulation, physical activity programs, and public health initiatives). There was less support for interventions perceived to be invasive or high risk (gastric band surgery), stigmatising (media campaigns), or commercially motivated and promoting weight loss techniques (commercial diets and gastric banding surgery). CONCLUSION Obese adults support non-commercial, non-stigmatising interventions which are designed to improve lifestyles, rather than promote weight loss.
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Affiliation(s)
- Samantha L Thomas
- Consumer Health Research Group (CHaRGe), Primary Care Research Unit, Monash University, Melbourne, Australia
| | - Sophie Lewis
- Consumer Health Research Group (CHaRGe), Primary Care Research Unit, Monash University, Melbourne, Australia
| | - Jim Hyde
- Department of Health, Victoria and Faculty of Medicine, Deakin University, Melbourne, Australia
| | - David Castle
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Paul Komesaroff
- Department of Medicine, Monash University, Melbourne, Australia
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Ling S, Nazareth L, Nheu L, Komesaroff P. MS166 IMPACT OF ANDROGENS ON VASCULAR CELL PHYSIOLOGY. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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