Journal of law and medicine
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The proposal of complete smoking bans in closed institutions, such as prisons and psychiatric hospitals, creates a tension between individual "rights" and the health of all members of that community. Smokers in closed institutions generally smoke more, suffer more health consequences and are less likely to quit than smokers in other settings. Complete smoking bans do not cause an increase in behavioural problems, nor do bans cause worsening of mental illness or quality of life. ⋯ A substantial cultural shift may be required from considering smoking a "rare pleasure" during detention to the realisation that smoking is the most significant reversible health risk factor for this population. The implementation of complete smoking bans in closed institutions is challenging and requires careful and proactive planning by staff. As complete smoking bans are being considered in many institutions and jurisdictions, this column presents a review of the evidence base and ethical issues involved.
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Private stem cell clinics throughout Australia are providing autologous stem cell therapies for a range of chronic and debilitating illnesses despite the lack of published literature to support the clinical application of these therapies. The Therapeutic Goods Administration has excluded autologous stem cell therapies from its regulatory domain leaving such therapies to be regulated by the same mechanisms that regulate research, such as the National Health and Medical Research Council Research Ethics Guidelines, and clinical practice, such as the Australian Health Practitioner Regulation Agency. However, the provision of these stem cell therapies does not follow the established pathways for legitimate medical advance--therapeutic innovation or research. The current regulatory framework is failing to achieve its aims of protecting vulnerable patients and ensuring the proper conduct of medical practitioners in the private stem cell industry.
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The ethical, social, psychological, legal and financial complexities associated with cross-border travel for reproductive services are gaining attention internationally. Travel abroad for surrogacy, and the transfer of gametes or embryos between countries for use in a surrogacy arrangement, can create conflict in relation to the rights of the parties involved: commissioning parents, surrogates and their families, gamete and embryo donors, and children born as a result of the arrangement. ⋯ This article discusses legislation, policy and practice as they relate to Australians' use of surrogacy in India. It reviews current surrogacy-related legislation and regulation in Australia and India and existing evidence about the challenges posed by transnational surrogacy, and considers how restrictive Australian legislation may contribute to the number of Australians undertaking surrogacy in India.
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A growing number of Australian children are seeking medical treatment for gender, dysphoria. Until recently, such treatment was available only to children whose parents received the authorisation of the Family Court. However, the 2013 Full Court of the Family Court decision of Re Jamie changed the legal landscape for children living with gender dysphoria by allowing parents to consent to stage one treatment (the administration of puberty "blockers"). ⋯ Stage two treatment was held to be a "special medical procedure" and thus subject to court authorisation, unless the child is Gillick competent. While Re Jamie improved the process of seeking treatment for gender dysphoria, this article argues that the Full Court failed to correctly apply the test for "special medical procedures" articulated in Marion's Case. Crucially, the court failed to grapple adequately with the distinction made in Marion's Case between therapeutic and nontherapeutic treatment.
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Re Jamie (No 2) is an important decision of the Full Family Court that significantly clarifies the law concerning "special medical procedures". The court has held that so-called stage one treatment for gender dysphoria, designed to suppress pubertal development, no longer requires judicial approval. ⋯ However, given the consequences of such treatment, and consistently with the authority in Marion's Case, the court will continue to have a "safeguard" role in determining whether Gillick competence exists. The article outlines some cautionary notes about the removal of court oversight at stage one, but argues that the decision is a positive one for enabling access to treatment and ameliorating the financial burden of legal proceedings on the families of transgender adolescents.