Supervising junior doctors and "on-call" responsibilities: Brus v Australian Capital Territory; Greater Southern Area Health Service v Angus.

The recent decisions of Brus v Australian Capital Territory [2007] ACTSC 83 and Greater Southern Area Health Service v Angus [2007] NSWSC 1211 highlight different aspects of the difficulties associated with supervision of junior doctors in the present public-funded Australian public hospital system. Their facts reveal how difficult it is for senior staff to achieve the fine balance required to assist trainees by according adequate experience and responsibility on the one hand, and to ensure patient safety, on the other. In addition, these cases highlight problems with the supervision process that are likely to be exacerbated in a privatised health care setting where senior staff may have less inclination to supervise struggling juniors unless adequately remunerated for such teaching, an issue of considerable controversy given the focus on profit of those institutions.

Carney v Newton: expert evidence about the standard of clinical notes.

In Carney v Newton [2006] TASSC 4 the Tasmanian Supreme Court heard a claim that the defendant breached his duty of care by failing to properly diagnose and treat a node positive carcinoma in the plaintiff's breast tissue. At trial, argument turned on the actual dialogue that took place during the initial consultation, with significant reliance on the clinical notes of the defendant. The court gave considerable weight to "expert" witnesses in ascertaining the acceptability of the defendant's conduct concerning the maintenance and interpretation of his clinical notes.

Whistleblowing and scientific misconduct: renewing legal and virtue ethics foundations.

Whistleblowing in relation to scientific research misconduct, despite the benefits of increased transparency and accountability it often has brought to society and the discipline of science itself, remains generally regarded as a pariah activity by many of the most influential relevant organizations. The motivations of whistleblowers and those supporting them continued to be questioned and their actions criticised by colleagues and management, despite statutory protections for reasonable disclosures appropriately made in good faith and for the public interest. One reason for this paradoxical position, explored here, is that whistle blowing concerning scientific misconduct lacks the policy support customarily derived from firm bioethical and jurisprudential foundations.

The Carhart case and late-term abortions -- what's next in Australia?

A recent case in the United States Supreme Court has indicated a change in course on the issue of abortion rights. In Gonzales v Carhart 127 S Ct 1610 (2007), the Supreme Court, in April 2007, upheld federal legislation banning a particular late-term abortion procedure with no exceptions (even to preserve the mother's life). This column examines the case in the context of recent Australian cases involving abortion issues.

Abandoning the common law: medical negligence, genetic tests and wrongful life in the Australian High Court.

The Australian High Court recently found that the common law could allow parents to claim tortious damages when medical negligence was proven to have led to the birth of an unplanned, but healthy, baby (Cattanach v Melchior (2003) 215 CLR 1). In Harriton v Stephens (2006) 80 ALJR 791; [2006] HCA 15 and Waller v James; Waller v Hoolahan (2006) 80 ALJR 846; [2006] HCA 16 the High Court in a six-to-one decision (Kirby J dissenting) decided that no such claim could be made by a child when medical negligence in failing to order an in utero genetic test caused the child severe disability. In an era when almost all pregnancies will soon require patented fetal genetic tests as part of the professional standard of care, the High Court, by barring so-called "wrongful life" (better termed "wrongful suffering") claims, may have created a partial immunity from suit for their corporate manufacturers and the doctors who administer them.

Reference pricing, generic drugs and proposed changes to the Pharmaceutical Benefits Scheme.

Draft legislation introduced to Parliament on 24 May 2007 proposes changes to the Pharmaceutical Benefits Scheme (PBS), including the creation of two formularies. The F1 formulary will contain single brand drugs that are not considered "interchangeable on an individual patient basis", while the F2 formulary will contain mainly older drugs (many of them generic) for which there is at least one alternative product considered to be clinically interchangeable. Drugs in F1 will not be compared with those in F2 for pricing purposes, even if clinical trial data show them to be equivalent (or even inferior) for the same clinical indication.