Applied Ethics, Bioethics and Clinical Ethics Research Cluster
This strand develops interdisciplinary collaborative research projects in applied ethics and bioethics on a range of issues with significant practical implications for public policy and professional practice in legal and health contexts. The focus of this cluster is distinctive in that it brings together philosophers, legal scholars, bioethicists and practitioners, to undertake projects characterized by theoretical sophistication and practical applicability.
Conscience and Conscientious Objection (2015-2017)
Stephen P. Clarke, Jeanette M. Kennett, and Julian Savulescu
ARC Discovery Project. (2015-2017) Funding: $333,333
Summary: Medical professionals sometimes decline to provide particular forms of safe, beneficial and legal health care, on the grounds that provision would go against their consciences. Bioethicists and policy makers have failed to identify legitimate limits to the scope of appeals to conscientious objection in health care. This is in large part because the underlying concept ''conscience" is unclear. This project aims to advance bioethical debate by producing a philosophically and psychologically informed analysis of conscience, and by applying this to discussions about the legitimate limits to conscientious objection in health care. It is expected to result in academic and non-academic publications and enable improvements to Australian health care policy.
Gender in Surgery: An Exploration of Biases Affecting Surgeons, Trainees and Patients (2016-2019)
Macquarie University Research Fellowship (2016-2019)
Summary: Gender biases are evident in the underrepresentation of women in the surgical profession and in the experiences of women surgical patients, suggesting systemic inequities in surgery. Surgery is a highly utilised healthcare modality, and surgeons are a highly paid professional group, so gender inequities in surgery are significant both in terms of health and wider social impact. The aim of this project is to investigate the causes of these disparities and connections between them, then to work with members of the Royal Australasian College of Surgeons to develop practical strategies for change based on the research findings. In addition to the development of these strategies, the research findings will be reported in academic and non-academic publications.
Defining Disease: addressing the problem of overdiagnosis (2014-2018)
ARC Future Fellowship FT130100346 (2013-2016). Awarded $820,156.
Summary: This project aims to investigate and define the limits of physical disease, to answer questions about when a presentation is a disease, and when it is simply a risk factor or mild condition. The ensuing account of disease will make a practical contribution to growing international concern about asymptomatic people being diagnosed and treated for conditions that will not cause any health problems ("overdiagnosis"). The research will provide normative grounds for evaluating disease claims. Results will reduce the harms caused by people receiving treatment that they do not require, make a practical contribution to debates about the scope of health care, and yield findings that can help to reduce the cost-burdens associated with overdiagnosis.
- Walker M and Rogers W. Diagnosis, identity, and the experience of asymptomatic disease. Theoretical Medicine and Bioethics (accepted June 2016)
- Walker MJ and Rogers WA. A new approach to defining disease. Journal of Medicine and Philosophy (accepted May 2016)
- Doust J, Walker M and Rogers W. Current dilemmas in defining the boundaries of disease. Journal of Medicine and Philosophy (accepted 13 October 2016; published online 21 April 2017: DOI: 10.1093/jmp/jhx009)
- Rogers W and Walker MJ. The line-drawing problem in disease definition. Journal of Medicine and Philosophy (accepted 19 August 2016; published online 21 April 2017: DOI; 10.1093/jmp/jhx010)
- Rogers WA and Mintzker Y. Response to Bjorn Hofmann: Clarifying overdiagnosis without losing conceptual complexity (invited response). Journal of Evaluation in Clinical Practice (published online 15 December 2016) DOI: 10.1111/jep.12682
- Walker M and Rogers W. Defining disease in the context of overdiagnosis. Medicine, Healthcare and Philosophy (first online: 15 November 2016; DOI: 10.1007/s11019-016-9748-8).
- Rogers W and Mintztker Y. Casting the net too wide on overdiagnosis: benefits, burdens and non-harmful disease (invited commentary) J Med Ethics 2016;42 (11): 717-719 (Published online 9 Aug 2016. doi:10.1136/medethics-2016-103715).
- Brown RCH, Rogers WA, Entwistle VA, Bhattacharya S. Reframing the debate about state responses to subfertility. Public Health Ethics 2016; 2016 9: 290-300. doi: 10.1093/phe/phw005
- Rogers WA and Mintzker Y. Getting clearer on overdiagnosis. Journal of Evaluation in Clinical Practice 2016; 22: 580-587. (doi:10.1111/jep.12556) [6 May 2016]
- Rogers W and Walker M. Fragility, uncertainty, and healthcare. Theoretical Medicine and Bioethics 2016: 37(1); 71-83. DOI: 10.1007/s11017-016-9350-3
- Rogers W and Mintzker Y. General Practice Ethics: Overdiagnosis, harm and paternalism Australian Family Physician 2015; 44 (10): 765-766.
- Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A. The challenge of overdiagnosis begins with its definition. BMJ 2015; 350: h869. Doi: http://dx.doi.org/10.1136/bmj.h869 http://www.bmj.com/specialties/digital-theme-issue-overdiagnosis
On the cutting edge: Promoting best practice in surgical innovation (2012-2015)
Wendy Rogers, Jane Johnson, Angela Ballantyne, Mianna Lotz, Denise Meyerson, Bernadette Richards, Tony Eyers, Guy Maddern and Colin Thomson
ARC Linkage grant LP110200217 (2012-2015). Awarded $255,000.
The project is also funded by a Macquarie University Linkage Projects Seeding Grant (2010).
Summary: Innovative surgery refers to the evolution of existing surgical procedures and the development of new ones. The practice is vital to progress in healthcare, yet it raises a number of ethical, legal and regulatory concerns since it falls into a 'grey area' between research and ordinary practice. The aim of this project is to use theoretical and empirical investigation to develop a framework for evaluating innovative surgery. The associated tools and resources that we develop will improve informed consent processes, training for surgeons undertaking new procedures, and the hospital regulation of innovative surgery. The outcomes of this research will deliver benefits to patients, practitioners, healthcare managers and regulators.
There are two PhD students associated with this project. Rebacca Tock is investigating issues to do with embodiment, personal autonomy and informed consent in relation to innovative surgery (supervisors Prof Rogers and Dr Johnson). Leigh Dayton is investigating Australian innovation policy using the bionic eye as an in-depth case study (supervisors Prof Rogers and Dr Hutchison).
How do we know what works?: Ethics and evidence in surgical research (2012-2015)
ARC Discovery Project (2012-2014). Awarded: $115,000.
Summary: This project aims to make surgery safer for patients by improving our understanding of evidence in surgery. We will look at the question "what works" in surgery; and the ethical implications of different ways of generating surgical research evidence.
Animals-as-patients: preventing human guinea pigs in innovative surgery (2012-2014)
Macquarie University Research Fellowship (2012-2014).
Summary: Innovative surgery is vital to medical progress, yet its practice creates substantial ethical risks, including harm to patients. Animal experimentation can overcome some of these risks but at an ethical cost of its own. This project aims to overcome issues in both these fields by developing a new model of animal experimentation which treats animals as patients. This model is significant because of the gravity of the problems it addresses in surgical innovation and animal experimentation. The research will contribute to better outcomes for human patients undergoing innovative surgery, and improved treatment of animals in experimentation.
Vulnerability, Autonomy and Justice (2011-2013)
(Joint project with Human Agency and Selfhood cluster)
Catriona Mackenzie, Wendy Rogers, Susan Dodds (UTas)
ARC Discovery Project (2011-2013).
Summary: Bioethicists demand that we protect the vulnerable, but the concept of vulnerability is poorly understood. How and why does vulnerability give rise to moral claims? What makes someone vulnerable? This project develops a philosophical analysis of vulnerability and elucidates the connections between vulnerability, autonomy and justice. We will test the applicability of our account using practical examples from bioethics, such as health promotion campaigns, drug trials in developing countries or research with mentally ill people. This project will help us to understand vulnerability in ways that avoid stereotyping or paternalism. Our account of vulnerability will be of relevance for ethical theory, bioethics, and health policy and practice.
A Novel Approach to Research Ethics: Using Social Epistemology to Investigate Social Responsibilities for Knowledge Generation and Use (2011-2012)
Cynthia Townley, Wendy Rogers
Macquarie University Research Development Grant (2011-2012).
Summary: Clinicians can prescribe novel (not yet approved) medical devices under special access provisions. Data from these treatments are collected and used to create unofficial pathways to regulatory approval. This process lacks the rigour and oversight of formal research, thereby undermining the integrity of our knowledge about safety and efficacy. Our analysis of special access schemes provides an original view of the ethical issues and suggests new ways of responding to these issues.
Ethics and Evidence in Surgical Research (2011)
Macquarie University Safety Net Funding Scheme (2011).
Summary: Surgery can relieve symptoms, cure diseases and even save lives. But to do this, surgery must be safe and effective, as proven by research into surgical techniques and interventions. Existing research into surgical procedures is however, unsystematic and often of low quality. This project uses scholarship in epistemology and ethics to investigate the theoretical, ethical and practical challenges of surgical research. The results will improve and expand understanding about how we know "what works" in surgery.
Animals as patients: addressing ethical challenges in innovative surgery
Macquarie University Safety Net Grant Scheme
Summary: Innovative surgery is vital to progress in medicine, yet its practice creates substantial ethical risks, including harm to patients. Animal experimentation can overcome some of these risks but at an ethical cost of its own. This project aims to overcome issues in both these fields by developing a new model of animal experimentation which treats animals as patients.
Donations after Cardiac Death: ethical issues encountered by practitioners (2008-2009).
Wendy Rogers and Sheryl de Lacey
Flinders University Faculty of Health Sciences Partnership Grant (2008-2009).
Summary: Recently Australia has re-introduced the practice of organ donations after cardiac death, in which organs are retrieved after the person's breathing and circulation have ceased. Donations after cardiac death raise a number of ethical issues that differ from those raised by the more traditional organ donations after certification of brain death. This research project is a pilot investigation of the views of health care professionals involved in all aspects of donations after cardiac death. The aim is to gain a comprehensive understanding of the ethical and legal issues that face practitioners in this challenging area of practice.
Consent in the void: moral, legal and community values in decisions about human biological donations (2007-2009)
Sheryl de Lacey, Wendy Rogers, Ngaire Naffine, Annette Braunack-Mayer, Bernadette Richards, Angela Ballantyne
ARC Discovery Grant (2007-2009)
Summary: Decisions about the newly dead and embryos are growing in frequency and complexity. Current law and practical guidance do not fully address the range of issues that now exist. Personal sovereignty over the use of our bodies after death or for frozen embryos is sacrificed, as decisions are overturned by third parties. This leads to lost opportunities for improved health care. This study will contribute to understanding of legal and moral duties, and community views in relation to consent decisions about the newly dead and frozen embryos. The findings will inform both practice and future legislative reform.
INCISIVE (ARC Linkage Project) updates
- Hutchison, K., Rogers, W., Eyers, A., Lotz, M. Getting clearer about surgical innovation: a new definition and a new tool to support responsible practice. Annals of Surgery. (First published online: 25 Feb 2015.)
- Richards, B., Porter, G., Lipworth, W. and Lysaght, T. The Medical Innovation Bill: Still More Harm than Good. Clinical Ethics. 2015.
- Meyerson, D. Is there a right to access innovative surgery? Bioethics. (First published online: 3 Sept 2014.)
- Johnson, J. and Rogers, W. Joint issues - conflicts of interest and the ASR hip. BMC Medical Ethics. 2014; 15: 63
- Rogers, W., Lots, M., Hutchison, K., Pourmoslemi, A., Eyers, A. Identifying surgical innovation: A quality study of surgeons' views. Annals of Surgery. 2014; 259 (2): 273-8.
- Lotz, M. Surgical innovation as sui generis surgical research. Theoretical Medicine and Bioethics. 2013; 34 (6): 447-459.
- Meyerson, D. Innovation Surgery and Precautionary Principle. Journal of Medicine and Philosophy. 2013; 38: 605-624.
- Myerson, D. What Chapell v Hart really stands for and some ramifications for innovative surgery. ANZ Journal of Surgery. 2013; 83 (9): 601-602.
- Rogers, W. and Johnson, J. Addressing within-role conflicts of interest in surgery. Journal of Bioethical Inquiry. 2013; 10 (2): 219-225.
- Johnson, J., Rogers, W., Jeffree, L. Controversy over Vertebroplasty. Journal of Medical Imaging and Radiation Oncology. 2012; 56: 449-451.
- Johnson, J. and Rogers, W. Innovative surgery: the ethical challenges. Journal of Medical Ethics. 2012; 38: 9-12.
- Johnson, J., Rogers, W., Lotz, M., Townley, C., Meyerson, D. and Tomossy, G. The ethical challenges of innovative surgery - a response to the IDEAL recommendations. Lancet. 2010; 376 (9746): 1113-1115.
For more information or copies of any publications, please contact Swantje Lorrimer-Mohr.