Tim Dare - Academia.edu (original) (raw)
Papers by Tim Dare
Pediatric Anesthesia, Oct 1, 2009
SummaryMost countries grant parents rebuttable legal rights to make treatment decisions on behalf... more SummaryMost countries grant parents rebuttable legal rights to make treatment decisions on behalf of their young children, creating a presumption in favor of parental rights. This article identifies and provides a preliminary assessment of a perhaps surprising variety of arguments for the presumption in favor of this parental right. The arguments considered include those flowing from ideas that parents are motivated by their child’s best interests; that they have privileged insight into their child’s preferences and capacities; that parental support has clinical significance and may be contingent upon respect for the presumption; that parents and families typically bear the burden of treatment decisions; that parents’ views often have a religious basis; that it would be improper to override parents’ wishes other than in conditions of complete certainty; and that parents have ‘natural authority’ over their children. It is unlikely that this is an exhaustive list of the arguments that could be offered in favor of the presumption, and the treatment in the paper is brief. Nevertheless, it is hoped that enough is said to suggest that it is harder to defend the presumption than we might have supposed.
Pediatric Anesthesia, Aug 18, 2021
Routledge eBooks, Jun 19, 2023
Australasian Journal of Philosophy, Jun 1, 2012
explanatory claims. My guess is that many critics of EM would say that sorting out the relevant m... more explanatory claims. My guess is that many critics of EM would say that sorting out the relevant metaphysical issues is both non-trivial and essential if one hopes to generate explanations that not only earn their keep on pragmatic grounds but turn out to be true. In contrast, it seems to me that proponents of EM tend to give much more emphasis to whether an explanatory strategy looks to have the potential to be productive, where this is understood in a fairly immediate way that abstracts from underlying metaphysical issues. Of course, once one takes the bait of embracing various metaphysical assumptions—for example that there is an important causal/ constitutive distinction—the methodological pragmatism that I am describing does not undercut the need to draw (or at least to assume) relevant metaphysical conclusions. (For a view that does not take this bait and explicitly rejects the need for such metaphysical commitments, see the contribution by Ross and Ladyman [ch. 7].) However, embracing pragmatism does help to grease a slide from the appearance of explanatory power to relatively quick and straightforward ontological conclusions. If this last worry is correct, it might mean that at least some of the issues that are dividing the two camps in the debate about EM are deeper and more difficult to resolve than one might assume on a relatively quick engagement with that debate. Moreover, it is not easy for a debate that starts with questions as concrete and attention-grabbing as whether or not one’s iPhone could be a proper part of one’s mind to transition to abstract, tedious, and in some ways well-worn questions in philosophy of science and the metaphysics of mind. A brief summary: in this reviewer’s opinion, The Extended Mind is an ideal collection for someone wanting to get a handle on the debate about EM and/or how the main thesis has been applied and extended. The collection would be a great starting point for a specialized graduate seminar or advanced-level undergraduate class. While I have some minor quibbles about the introductory chapter and worries about the current state of the debate (at least as represented by the contributions in this volume), this is a collection whose contents are interesting and engaging and whose timing is perfect. I suspect it will end up with canonical status in the literature on the extended mind.
Pediatric Anesthesia, May 9, 2014
Clinical pharmacologists have contributed greatly to our understanding of drugs used in anesthesi... more Clinical pharmacologists have contributed greatly to our understanding of drugs used in anesthesia and the perioperative period. Anesthesiologists, as practicing clinical pharmacologists, have readily adopted many of the techniques used by these scientists to further our specialty. Population pharmacokinetics and pharmacodynamics, modeling, and simulation are now common in our literature. This is particularly true for the intravenous anesthetic combination of propofol and remifentanil. We incorporate pharmacokinetic parameters (e.g., Marsh (1), Kataria (2), Paedfusor (3)) into our target controlled infusion pumps and make use of display screens to demonstrate drug concentration in the plasma and effect site for a typical child. Complex pharmacodynamic interactions between propofol and remifentanil are understood and used clinically (4). And yet, there still remains a divide between what the pharmacologists suggest based on science and what the clinician does, often based on empirical beliefs. We clinicians seem to believe that our field is special and sometimes separated from what the pharmacologist studies and reports. This is true even of common drugs such as acetaminophen (paracetamol); this analgesic/antipyretic has come under increased scrutiny since the introduction of the intravenous preparation. The basic pharmacokinetic parameters (clearance and volume of distribution) are unchanged no matter what formulation is used. The only parameters that might change are those describing enteral formulation absorption and bioavailability. The basic pharmacodynamic parameters (EC50, Emax) have been described in both children (5) and adults (6). Future studies should be planned to simply confirm what is known or explore differences in other populations, rather than re-learning what is known. This principle has been espoused for clinical drug development (7). Modeling and simulation are now integral parts of drug development (8), and yet we continue to design simple clinical studies without using this valuable resource. Adults and children are subjected to bloodletting for studies where the results could be predicted or where available knowledge could be used to improve study design or lessen patient numbers. Children are unnecessarily allocated to placebo groups in order to demonstrate drug effectiveness (9,10). Newly reported acetaminophen time-concentration profiles conform to known pharmacokinetic parameter estimates (11). Simulation will readily demonstrate that there will be differences in plasma concentrations in the immediate postoperative period between those given enteral and those given parental formulations, and yet there continue to be clinical studies demonstrating this (e.g., (12,13)). Although these studies may claim that ‘therapeutic plasma concentrations’ are achieved in the postoperative period, they often fail to recognize that it is the concentration in the effect site, rather than plasma that relates to analgesia (5). Plasma and effect site concentrations may be equivalent at steady state after regular dosing, but this is not so after a single dose. There is an equilibration delay between the central and effect compartments of 30–50 min (5,6). This delay has been demonstrated clinically in both children after inguinal hernia repair (14) and adults after third molar tooth surgery (15). Analgesic onset is more rapid after intravenous than after oral administration. These studies simply confirm what is already known. It is possible to use the different formulations to children’s benefit. Rectal absorption of acetaminophen is slow. Consequently, we might anticipate rectal administration to be associated with delayed onset of analgesia, but with an increased duration of effect. A simulation, based on known PK and PD, demonstrates this prolonged analgesic effect after a suppository in Figure 1. Analgesic duration in children 2–5 years presenting for adenotonsillectomy given either 15 mg kg 1 IV or 40 mg kg 1 PR intraoperatively have been compared in a clinical study (16). Kaplan–Meier survival curves show that the time to first analgesic request was longer in children receiving rectal acetaminophen (median 10 h, interquartile range 9–11 h) compared with those receiving intravenous acetaminophen (7.6–10 h). This prolonged duration of effect after rectal acetaminophen 40 or 60 mg kg 1 in day-case pediatric surgery has been demonstrated by others (17). However, those studies could have been undertaken with fewer pediatric patients by using those children to confirm known characteristics of formulation differences rather than using randomized controlled trials that require high patient numbers to generate the magic P < 0.05 (18). The potential usefulness of the learning versus confirming principle is highlighted by investigations into the analgesic effectiveness of acetaminophen after cleft palate surgery. Acetaminophen is a mild analgesic with efficacy (Emax) of 5.2/10 (visual analogue scale 0–10).…
Edward Elgar Publishing eBooks, Dec 30, 2016
Australian Journal of Legal Philosophy, 2011
Daniel Markovits' book 'A Modern Legal Ethics: Adversary Advocacy in a Democratic Age'... more Daniel Markovits' book 'A Modern Legal Ethics: Adversary Advocacy in a Democratic Age' is reviewed. The focus is on the issue of lawyers' integrity in legal ethics. Markovits believes adversarial lawyering destroys integrity while the reviewer believes the two may accommodate each other. Includes footnotes.
Pediatric Anesthesia, Mar 6, 2023
Treatments of deep disagreement often hint at sinister implications but I will argue that we need... more Treatments of deep disagreement often hint at sinister implications but I will argue that we need not accept these pessimistic consequences. Settling disagreements by way of rhetoric or incentive, for instance, may fall short of ideals of rational argumentation, but the moral issues raised by such strategies are different from those raised by compulsion, and realizing that a disagreement is deep might have positive implications providing an incentive to seek other defensible strategies for resolution.
Oxford Journal of Legal Studies, Jun 1, 1997
... Waluchow's defence of inclusive positivism, namely Waluchow's response to what he d... more ... Waluchow's defence of inclusive positivism, namely Waluchow's response to what he describes as the most powerful argument for Razian or ... Recent explicit attempts to develop similar positions include David Lyons 'Principles, Positivism and Legal Theory' (1977) 87 Yale Law ...
Journal of Value Inquiry, Nov 21, 2016
It is easy to motivate the intuition that roles generate obligations, but harder to say just how ... more It is easy to motivate the intuition that roles generate obligations, but harder to say just how they do so. How could it be right, Macaulay asked, ''that a man should, with a wig on his head and a band around his neck, do for a guinea what, without these appendages, he would think it wicked and infamous to do for an empire?'' 1 How can a role make a moral difference? Following a brief account of roles and role obligations I sketch considerations that appear to support the starting intuition that roles do indeed make a moral difference before considering three accounts of how they do so. Two of these accounts, the direct and less direct routes, portray roles as social or institutional structures that bring ordinary or background morality to bear on role occupants. According to the direct route, role-obligations are essentially ''complex instances of ordinary morality''. 2 Discussing the possibility that lawyers might have distinct, role-differentiated permissions to bluster from time to time, David Luban insists that ''if a lawyer is permitted to puff, bluff or threaten on certain occasions this is … because in such circumstances anyone would be permitted to do these things''. 3 According to the less direct route, role-occupants are constrained by role-specific obligations, but those obligations are themselves subject to ordinary morality. Such obligations, writes Luban (having moved from the direct to the less direct route) may always ''be overridden in exigent circumstances, and thus [role-occupants] must always be ready to scrutinize particular acts to determine & Tim Dare
CRC Press eBooks, May 26, 2021
For 21 st century ethicists, one's character is thought to be a matter of one's internal disposit... more For 21 st century ethicists, one's character is thought to be a matter of one's internal dispositions and their external manifestation in action. This assumption, which is universally accepted among contemporary authors, would not have been shared by 18 th century writers. Alongside one's internal dispositions, Butler, Hutcheson, Hume, and their peers also considered one's social roles to be part of one's character. This paper outlines some of the attractions of the earlier conception of character and responds to objections that must be faced by any account that includes social roles among character's ingredients. What is character? According to most contemporary accounts, a person's character consists in a collection of psychological dispositions, known as character traits, which manifest themselves in how she thinks, feels, and acts. 1 She can change her fashion, her musical tastes, her favourite food, or her preferred pastime and remain, in all interesting senses, who she was. She may move from one school to another, one state to another, one country to another and still be the same person. She may go so far as to change her political party, her name, and her marital status, and yet remain fundamentally unchanged. But change her character and you change her identity. A person's character goes to the heart of who she is. Even within this core, some aspects are more central than others. A person can act like someone other than she is, i.e. her behaviour can be out of character, without that changing who she really is. Thus, within this core, the most internal aspects-namely, how she thinks and feels-are what really matter for the constitution of her character. Actions, on
Bioethics, Apr 1, 1998
Most countries promote mass immunisation programmes. The varying policy details raise a raft of p... more Most countries promote mass immunisation programmes. The varying policy details raise a raft of philosophical issues. I have two broad aims in this paper. First, I hope to begin to remedy a rather curious philosophical neglect of immunisation. With this in mind, I take a broad approach to the topic hoping to introduce rather than settle a range of philosophical issues. My second aim has two aspects: I argue that the states should have pro-immunisation policies, and I advance a view on the subsequent and more specific question as to which sorts of proimmunisation policies they should prefer. I use the immunisation policies of the United States and New Zealand to frame my discussion of these substantive questions. Immunisation is effectively compulsory in the United States. New Zealand, by contrast, requires evidence not of immunisation but of immunisation status upon school enrolment: New Zealand's policy effectively makes immunisation choice compulsory. I argue that, as between the pro-immunisation policies of the United States and New Zealand, the latter should be preferred. Though the threshold question as to whether states should have pro-immunisation policies should be answered affirmatively, the move to compulsory immunisation cannot be justified.
Journal of Medical Ethics, May 1, 2010
Recent research conducted in Australia shows that many oncologists withhold information about exp... more Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73-99% in New Zealand and 72-94% in Australia depending on the scenario) the percentage who would not discuss expensive unfunded drugs was substantially lower in New Zealand (6.4-11.1%) than it was in Australia (28-41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced.
Pediatric Anesthesia, Oct 1, 2009
SummaryMost countries grant parents rebuttable legal rights to make treatment decisions on behalf... more SummaryMost countries grant parents rebuttable legal rights to make treatment decisions on behalf of their young children, creating a presumption in favor of parental rights. This article identifies and provides a preliminary assessment of a perhaps surprising variety of arguments for the presumption in favor of this parental right. The arguments considered include those flowing from ideas that parents are motivated by their child’s best interests; that they have privileged insight into their child’s preferences and capacities; that parental support has clinical significance and may be contingent upon respect for the presumption; that parents and families typically bear the burden of treatment decisions; that parents’ views often have a religious basis; that it would be improper to override parents’ wishes other than in conditions of complete certainty; and that parents have ‘natural authority’ over their children. It is unlikely that this is an exhaustive list of the arguments that could be offered in favor of the presumption, and the treatment in the paper is brief. Nevertheless, it is hoped that enough is said to suggest that it is harder to defend the presumption than we might have supposed.
Pediatric Anesthesia, Aug 18, 2021
Routledge eBooks, Jun 19, 2023
Australasian Journal of Philosophy, Jun 1, 2012
explanatory claims. My guess is that many critics of EM would say that sorting out the relevant m... more explanatory claims. My guess is that many critics of EM would say that sorting out the relevant metaphysical issues is both non-trivial and essential if one hopes to generate explanations that not only earn their keep on pragmatic grounds but turn out to be true. In contrast, it seems to me that proponents of EM tend to give much more emphasis to whether an explanatory strategy looks to have the potential to be productive, where this is understood in a fairly immediate way that abstracts from underlying metaphysical issues. Of course, once one takes the bait of embracing various metaphysical assumptions—for example that there is an important causal/ constitutive distinction—the methodological pragmatism that I am describing does not undercut the need to draw (or at least to assume) relevant metaphysical conclusions. (For a view that does not take this bait and explicitly rejects the need for such metaphysical commitments, see the contribution by Ross and Ladyman [ch. 7].) However, embracing pragmatism does help to grease a slide from the appearance of explanatory power to relatively quick and straightforward ontological conclusions. If this last worry is correct, it might mean that at least some of the issues that are dividing the two camps in the debate about EM are deeper and more difficult to resolve than one might assume on a relatively quick engagement with that debate. Moreover, it is not easy for a debate that starts with questions as concrete and attention-grabbing as whether or not one’s iPhone could be a proper part of one’s mind to transition to abstract, tedious, and in some ways well-worn questions in philosophy of science and the metaphysics of mind. A brief summary: in this reviewer’s opinion, The Extended Mind is an ideal collection for someone wanting to get a handle on the debate about EM and/or how the main thesis has been applied and extended. The collection would be a great starting point for a specialized graduate seminar or advanced-level undergraduate class. While I have some minor quibbles about the introductory chapter and worries about the current state of the debate (at least as represented by the contributions in this volume), this is a collection whose contents are interesting and engaging and whose timing is perfect. I suspect it will end up with canonical status in the literature on the extended mind.
Pediatric Anesthesia, May 9, 2014
Clinical pharmacologists have contributed greatly to our understanding of drugs used in anesthesi... more Clinical pharmacologists have contributed greatly to our understanding of drugs used in anesthesia and the perioperative period. Anesthesiologists, as practicing clinical pharmacologists, have readily adopted many of the techniques used by these scientists to further our specialty. Population pharmacokinetics and pharmacodynamics, modeling, and simulation are now common in our literature. This is particularly true for the intravenous anesthetic combination of propofol and remifentanil. We incorporate pharmacokinetic parameters (e.g., Marsh (1), Kataria (2), Paedfusor (3)) into our target controlled infusion pumps and make use of display screens to demonstrate drug concentration in the plasma and effect site for a typical child. Complex pharmacodynamic interactions between propofol and remifentanil are understood and used clinically (4). And yet, there still remains a divide between what the pharmacologists suggest based on science and what the clinician does, often based on empirical beliefs. We clinicians seem to believe that our field is special and sometimes separated from what the pharmacologist studies and reports. This is true even of common drugs such as acetaminophen (paracetamol); this analgesic/antipyretic has come under increased scrutiny since the introduction of the intravenous preparation. The basic pharmacokinetic parameters (clearance and volume of distribution) are unchanged no matter what formulation is used. The only parameters that might change are those describing enteral formulation absorption and bioavailability. The basic pharmacodynamic parameters (EC50, Emax) have been described in both children (5) and adults (6). Future studies should be planned to simply confirm what is known or explore differences in other populations, rather than re-learning what is known. This principle has been espoused for clinical drug development (7). Modeling and simulation are now integral parts of drug development (8), and yet we continue to design simple clinical studies without using this valuable resource. Adults and children are subjected to bloodletting for studies where the results could be predicted or where available knowledge could be used to improve study design or lessen patient numbers. Children are unnecessarily allocated to placebo groups in order to demonstrate drug effectiveness (9,10). Newly reported acetaminophen time-concentration profiles conform to known pharmacokinetic parameter estimates (11). Simulation will readily demonstrate that there will be differences in plasma concentrations in the immediate postoperative period between those given enteral and those given parental formulations, and yet there continue to be clinical studies demonstrating this (e.g., (12,13)). Although these studies may claim that ‘therapeutic plasma concentrations’ are achieved in the postoperative period, they often fail to recognize that it is the concentration in the effect site, rather than plasma that relates to analgesia (5). Plasma and effect site concentrations may be equivalent at steady state after regular dosing, but this is not so after a single dose. There is an equilibration delay between the central and effect compartments of 30–50 min (5,6). This delay has been demonstrated clinically in both children after inguinal hernia repair (14) and adults after third molar tooth surgery (15). Analgesic onset is more rapid after intravenous than after oral administration. These studies simply confirm what is already known. It is possible to use the different formulations to children’s benefit. Rectal absorption of acetaminophen is slow. Consequently, we might anticipate rectal administration to be associated with delayed onset of analgesia, but with an increased duration of effect. A simulation, based on known PK and PD, demonstrates this prolonged analgesic effect after a suppository in Figure 1. Analgesic duration in children 2–5 years presenting for adenotonsillectomy given either 15 mg kg 1 IV or 40 mg kg 1 PR intraoperatively have been compared in a clinical study (16). Kaplan–Meier survival curves show that the time to first analgesic request was longer in children receiving rectal acetaminophen (median 10 h, interquartile range 9–11 h) compared with those receiving intravenous acetaminophen (7.6–10 h). This prolonged duration of effect after rectal acetaminophen 40 or 60 mg kg 1 in day-case pediatric surgery has been demonstrated by others (17). However, those studies could have been undertaken with fewer pediatric patients by using those children to confirm known characteristics of formulation differences rather than using randomized controlled trials that require high patient numbers to generate the magic P < 0.05 (18). The potential usefulness of the learning versus confirming principle is highlighted by investigations into the analgesic effectiveness of acetaminophen after cleft palate surgery. Acetaminophen is a mild analgesic with efficacy (Emax) of 5.2/10 (visual analogue scale 0–10).…
Edward Elgar Publishing eBooks, Dec 30, 2016
Australian Journal of Legal Philosophy, 2011
Daniel Markovits' book 'A Modern Legal Ethics: Adversary Advocacy in a Democratic Age'... more Daniel Markovits' book 'A Modern Legal Ethics: Adversary Advocacy in a Democratic Age' is reviewed. The focus is on the issue of lawyers' integrity in legal ethics. Markovits believes adversarial lawyering destroys integrity while the reviewer believes the two may accommodate each other. Includes footnotes.
Pediatric Anesthesia, Mar 6, 2023
Treatments of deep disagreement often hint at sinister implications but I will argue that we need... more Treatments of deep disagreement often hint at sinister implications but I will argue that we need not accept these pessimistic consequences. Settling disagreements by way of rhetoric or incentive, for instance, may fall short of ideals of rational argumentation, but the moral issues raised by such strategies are different from those raised by compulsion, and realizing that a disagreement is deep might have positive implications providing an incentive to seek other defensible strategies for resolution.
Oxford Journal of Legal Studies, Jun 1, 1997
... Waluchow's defence of inclusive positivism, namely Waluchow's response to what he d... more ... Waluchow's defence of inclusive positivism, namely Waluchow's response to what he describes as the most powerful argument for Razian or ... Recent explicit attempts to develop similar positions include David Lyons 'Principles, Positivism and Legal Theory' (1977) 87 Yale Law ...
Journal of Value Inquiry, Nov 21, 2016
It is easy to motivate the intuition that roles generate obligations, but harder to say just how ... more It is easy to motivate the intuition that roles generate obligations, but harder to say just how they do so. How could it be right, Macaulay asked, ''that a man should, with a wig on his head and a band around his neck, do for a guinea what, without these appendages, he would think it wicked and infamous to do for an empire?'' 1 How can a role make a moral difference? Following a brief account of roles and role obligations I sketch considerations that appear to support the starting intuition that roles do indeed make a moral difference before considering three accounts of how they do so. Two of these accounts, the direct and less direct routes, portray roles as social or institutional structures that bring ordinary or background morality to bear on role occupants. According to the direct route, role-obligations are essentially ''complex instances of ordinary morality''. 2 Discussing the possibility that lawyers might have distinct, role-differentiated permissions to bluster from time to time, David Luban insists that ''if a lawyer is permitted to puff, bluff or threaten on certain occasions this is … because in such circumstances anyone would be permitted to do these things''. 3 According to the less direct route, role-occupants are constrained by role-specific obligations, but those obligations are themselves subject to ordinary morality. Such obligations, writes Luban (having moved from the direct to the less direct route) may always ''be overridden in exigent circumstances, and thus [role-occupants] must always be ready to scrutinize particular acts to determine & Tim Dare
CRC Press eBooks, May 26, 2021
For 21 st century ethicists, one's character is thought to be a matter of one's internal disposit... more For 21 st century ethicists, one's character is thought to be a matter of one's internal dispositions and their external manifestation in action. This assumption, which is universally accepted among contemporary authors, would not have been shared by 18 th century writers. Alongside one's internal dispositions, Butler, Hutcheson, Hume, and their peers also considered one's social roles to be part of one's character. This paper outlines some of the attractions of the earlier conception of character and responds to objections that must be faced by any account that includes social roles among character's ingredients. What is character? According to most contemporary accounts, a person's character consists in a collection of psychological dispositions, known as character traits, which manifest themselves in how she thinks, feels, and acts. 1 She can change her fashion, her musical tastes, her favourite food, or her preferred pastime and remain, in all interesting senses, who she was. She may move from one school to another, one state to another, one country to another and still be the same person. She may go so far as to change her political party, her name, and her marital status, and yet remain fundamentally unchanged. But change her character and you change her identity. A person's character goes to the heart of who she is. Even within this core, some aspects are more central than others. A person can act like someone other than she is, i.e. her behaviour can be out of character, without that changing who she really is. Thus, within this core, the most internal aspects-namely, how she thinks and feels-are what really matter for the constitution of her character. Actions, on
Bioethics, Apr 1, 1998
Most countries promote mass immunisation programmes. The varying policy details raise a raft of p... more Most countries promote mass immunisation programmes. The varying policy details raise a raft of philosophical issues. I have two broad aims in this paper. First, I hope to begin to remedy a rather curious philosophical neglect of immunisation. With this in mind, I take a broad approach to the topic hoping to introduce rather than settle a range of philosophical issues. My second aim has two aspects: I argue that the states should have pro-immunisation policies, and I advance a view on the subsequent and more specific question as to which sorts of proimmunisation policies they should prefer. I use the immunisation policies of the United States and New Zealand to frame my discussion of these substantive questions. Immunisation is effectively compulsory in the United States. New Zealand, by contrast, requires evidence not of immunisation but of immunisation status upon school enrolment: New Zealand's policy effectively makes immunisation choice compulsory. I argue that, as between the pro-immunisation policies of the United States and New Zealand, the latter should be preferred. Though the threshold question as to whether states should have pro-immunisation policies should be answered affirmatively, the move to compulsory immunisation cannot be justified.
Journal of Medical Ethics, May 1, 2010
Recent research conducted in Australia shows that many oncologists withhold information about exp... more Recent research conducted in Australia shows that many oncologists withhold information about expensive unfunded drugs in what the authors of the study suggest is unacceptable medical paternalism. Surprised by the Australian results, we ran a version of the study in New Zealand and received very different results. While the percentages of clinicians who would prescribe the drugs described in the scenarios were very similar (73-99% in New Zealand and 72-94% in Australia depending on the scenario) the percentage who would not discuss expensive unfunded drugs was substantially lower in New Zealand (6.4-11.1%) than it was in Australia (28-41%). This seems surprising given the substantial similarities between the two countries, and the extensive interaction between their medical professions. We use the contrast between the two studies to examine the generalisability of the Australian results, to identify influences on clinicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; decisions about what treatment information to give patients, and so the tendency towards medical paternalism and, more pragmatically, about how such decisions might be influenced.