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Crime, government and civilization: Rethinking Elias in Criminology
10 May 2006
University of Sydney

van Krieken, Robert

The placement of criminal law under the control of the public authority of the sovereign or the state has always been part of an attempt to civilize its operation, both restraining the workings of law on those inflicting particular kinds of harms, and rendering those workings, supposedly, more effective. However, the reconfiguration of the authority of the state in relation to criminal law since the 1970s has led most criminologists to reject the whole notion of a long-term civilizing process encompassing criminal law, turning instead to analyses of the inner logic of the various new responses to crime characterizing advanced liberal societies over the past three decades. This article outlines the major features of contemporary crime control and punishment identified within this approach: the transition from disciplinary modes of exercising power to ‘governing through freedom’, the emphasis on ‘designing out crime’ or actuarial justice, and the changed place of emotions in ‘affective governance’, including a turn to popular punitiveness. It then identifies some central empirical and conceptual problems shared by these accounts of contemporary crime control, and outlines the contribution that Elias’s work on long-term processes of civilization and decivilization can make not just to understanding the historical development of punishment, but also current developments across the whole field of criminal justice, focusing on the examples of restorative justice and popular punitiveness.
Cybraries in paradise: new technologies and ethnographic repositories.
01 December 2006
University of Sydney

Barwick, Linda;Thieberger, Nicholas

Digital technologies are altering research practices surrounding creation and use of ethnographic field recordings, and the methodologies and paradigms of the disciplines centered around their interpretation. In this chapter we discuss some examples of our current research practices as fieldworkers in active engagement with cultural heritage communities documenting music and language in the Asia- Pacific region, and as developers and curators of the digital repository PARADISEC (the Pacific and Regional Archive for Digital Sources in Endangered Cultures: ). We suggest a number of benefits that the use of digital technologies can bring to the recording of material from small and endangered cultures, and to its re-use by communities and researchers. We believe it is a matter of social justice as well as scientific interest that ethnographic recordings held in higher education institutions should be preserved and made accessible to future generations. We argue that, with appropriate planning and care by researchers, digitization of research recordings in audiovisual media can facilitate access by remote communities to records of their cultural heritage held in higher education institutions to a far greater extent than was possible in the analog age.
Reliability of self-report of health in juvenile offenders
01 December 2008
University of Sydney

Kenny, Dianna T;Grant, Jennifer

The aim of the present study was to investigate the accuracy of self-reports of juvenile offenders on physical factors (e.g., sleep difficulties, weight related behaviors and weight perceptions), health risk behaviors (e.g., alcohol use), trauma history (e.g., physical and sexual abuse) and psychological factors (e.g., anxiety, suicidal and self-harm behaviors). Self-reports obtained via a Health Questionnaire from 242 incarcerated juvenile offenders were compared with standardized measures (Body Mass Index, Adolescent Psychopathology Scale and Child Trauma Questionnaire) to investigate the reliability (via construct validity) and veracity of their self-report. Using kappa estimates and receiver operating characteristic curves, results generally showed high agreement across measures, suggesting that self-report questions from the health survey could all be used reliably. The degree of accuracy indicated that young offenders are as reliable as clinical and community samples of adolescents in their self-report. These findings have implications for routine assessments and practice evaluations that rely on self-report as the method of data collection and as the basis for clinical formulation and treatment planning.
Moral reasoning of adolescent male offenders: Comparison of sexual and nonsexual offenders
11 December 2008
University of Sydney

Ashkar, Peter J;Kenny, Dianna T

This study compared the moral reasoning abilities of juvenile sex and non-sex offenders using a novel methodology that explored their responses to moral questions in a variety of offending contexts. Seven sexual and nine nonsexual adolescent male offenders from a maximum security detention facility in New South Wales, Australia, were presented with a variety of hypothetical offending situations involving sexual and non sexual offences and asked to discuss these. It was hypothesised that the quality of moral reasoning employed by offenders would be impaired in those offending contexts in which they had prior experience. Responses were assessed using a modified version of the Moral Judgment Interview Standard Issue Scoring Manual (MJI; Colby & Kohlberg, 1987). Assigned levels of moral reasoning ability were verified independently by two expert raters. Responses by sexual offenders in sexual offending contexts and by nonsexual offenders in nonsexual offending contexts were dominated by preconventional reasoning. Both groups employed a greater use of conventional reasoning in non-congruent offending contexts.
Redden, G. (2003). "Read the Whole Thing: Journalism, Weblogs and the Re-mediation of the War in Iraq."
11 February 2010
University of Sydney

Redden, Guy

The Net’s uses are now diverse, covering many aspects of commerical, public and private life. The idea that it transforms all activities in the same or equivalent ways is no longer tenable. This paper examines a particular form of online activity—weblogging, and how it has allowed for specific new forms of popular political communication in the context of the Second Gulf War. After describing the basics of weblogging, the paper discusses Western media coverage of the war and then shows how ‘warbloggers’ positioned themselves vis-à-vis media coverage and propaganda, creating commentaries that frequently combined media and political criticism. While bloggers of every political hue offered a range of perspectives and personal styles, some general tendencies are evident in warblogging discourse. The piece ends by questioning the significance of warblogging in terms of its potential contribution to democratic communication.
Crime Prevention Practice Paper 1: An Overview of CPTED DCPs and Related Council Policies in NSW
15 February 2011
University of Sydney

Clancey, Garner;Chiu, Dave Yue Kim

Crime prevention through environmental design (CPTED) is increasingly adopted by councils across New South Wales (NSW). This can be done in a variety of ways. Introducing Development Control Plans (DCPs) focusing on CPTED or integrating CPTED into larger DCPs are two key ways that this has been achieved. This Crime Prevention Practice Paper provides an overview of some of the methods used by councils to embed CPTED into local planning regimes and provides examples of documents developed by various NSW councils.
Journal of Digital Research & Publishing 2008
16 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Sourcing the Freedom: Free Software vs. Open Source Software (Nicole-Kate Anderson) // Be the Media (Yue Hu) // Bloggers as Gatekeepers: Issues of Gatewatching in Journalism (Janine Corbin) // Social Capital and ICTs (Daniel Kille) // The New Media (Chufan Han) // ‘Doing’ the Online Identity (Rebecca Cornell) // Social interaction in virtual environments (Samuray Ozay) // Plug Me In: Connecting With the Net Generation (Katie Pittard) // Netspeak: An Earthquake in the Language World (Jiang Ning) //The iPod and iCulture (Zhou Yuan) // China Digital Times: the Appearance of DTV (Yin Guan) // Information Revelation and Privacy in Virtual Social Networks: Our Willingness to Divulge Personal Information (Madeleine Wood) // English-language Magazines in China (Wenjing Wille Wu) // Online expression repressed (Rhonda Prsntice) // Multivariant Narratives in World of Warcraft (Adam W Ruch) // Instant Messaging (Suneesh T. Mathews)
Journal of Digital Research & Publishing Semester 1 2010 (1pm class)
16 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Refolding the fold: the complete representation of actuality in digital culture (Sonia Therese Chan) // Mind over media? A philosophical view on user-generated media and social identity (Romina Cavagnola) // Outsiders looking in: How everyday bloggers are gaining access to the elite fashion world (Tiana Stefanic) // New media revolution: personal ads expand to the Internet (David James Misner) // Online publishing: (Anime) Fan fiction and identity (Nicola Santilli) // The practicality of magazine websites (Emma Turner) // A Cultural Historical Approach to Virtual Networking (Kate Fagan) // How social media is changing public relation practices (Katharina Otulak) // The 3D evolution after AVATAR: Welcome to 3D at homes (Jaeun Yun) // The interaction between technology, people and society —In the case of Happy Farm (Chen Chen) // Technical solutions to business challenges: the Content Management System of today (Bujuanes Livermore) // Hidden Consumerism: ‘Advergames’ and preschool children. Parents give the thumbs up? (Kathryn Lewis) // Google’s library of Alexandria: The allure and dangers of online texts (Leila Chacko) // Google’s Taking on China:an Ingenious Publicity Campaign (Junying Cui) // Redifining Glamour: Capturing Queer Subculture on TheNightBloomers.com (Ron O’Berst) // Patient Advocates in the Internet Age: a threat to traditional notions of authority in health care? (Allison Jones) // Fashion Blogs: the new menber in fashion industry (Chi Zhang) // Twitter Wave Will Drown The World? (Jie He) // The influence of cultural differences on electronic commerce (Yuan Shen).
Journal of Digital Research & Publishing Semester 1 2011 (1pm class)
16 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): An Analysis of Online Discussion Impacts on Adult Students’ Learning (Tao Wang) // Are We Living in the Same World? Social media platforms in Australia and China compared (Kai Tang) // Choose Your Own World: The convergence of hypertext, literature and gaming (John Band) // Digital Evolution: The changing face of video game journalism (Nicholas Barkl) // Facebook Features and MySpace Memoirs: Does user behaviour within social networking sites qualify as a form of digital publishing? (Nadia Junaideen) // I, Consumer, Produser: The rise of collaborative content creation and its impact on producer/user relationships (Olivia Porter) // Indigenous Storytelling and the Digitised Future (Alexandra Hirst) // Online Campaigning: Web 2.0 and the Australian federal election (Keyang Yang) // Online News Content: How reading news online affects users’ understanding of news events (Kelly Stock) // Teens, Consumerism, and Converse: How lifestyle and identity are portrayed through digital publishing (Priska Febrinia Handojo) // The Impact of Technological Advancements upon Language and Communication in an Increasingly Digitised Society (Pippa Lyons)
Journal of Digital Research & Publishing Semester 1 2009 (5pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Automated Content Authorship: The ‘Real’ Death of the Author (Rochelle Deighton) // Facebook ‘Friends’: The Validity of Online Friendships (Kate Bateman) // Misconceived End-User Expectations to Privacy on Facebook (Ailin Bezzo) // To tweet or not to tweet Grunig’s model to brand engagement (Louise Veyret) // Gmail: Friend or Foe? (Angela Wade) // The Construct of Digital Identity: A Case Study of Self Portraits and Profile Pictures as Simulacra on Web Platforms (Tom Okagami) // Ease of Access: Suicide and Prevention (Kerilynn Petersen) // Amazon’s Impending Monopoly of E-book Markets (Ouchen Wei) // Picking Up the Pages: Discussing the Materiality of Magazines (Joy Enriquez) // Digital Footprints: a case study (Michael Schanzer) // Virtual work spaces: The changing face of communication (Gina Spithakis) // Keeping it Simple: The Shift in Video Game Development (Kimberley Lau) // Lurkers and Lolcats: An Easy Way From Out To In (Claudia Leigh)
Journal of Digital Research & Publishing Semester 1 2009 (7pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Just zeroes and ones’: Nine Inch Nails and the move to online music publishing (Anon) // The evolution of Public Relations in the rhetorical public sphere of Web 2.0 Case study: Edelman PR representing Wal-Mart (Anita Sulentic) // Google Book Search: Digitisation of books as a positive invention (Remi Otani) // The Digital Business Ecosys¬tem and the Corporate Wiki: toward knowledge creation and innovation (Beth Powell) // Web 2.0 Activism and the battle for online space (Harry Mills) // The World Wide Web and the demise of quality journalism (Kyle Anderson)
Journal of Digital Research & Publishing Semester 1 2009 (1pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Down the rabbit hole: literature’s adventures in e-readerland (Kathryn Knight) // Ditching the dead-tree medium (Heidi Cassell) // PEACE OR WAR? Design metaphors behind e-book readers (Gao Qun) // ‘THIS IS THE INTERNET SPEAKING’ Wikipedia, Hwang Woo-Suk, Norms, and the Social Construction of Scientific Knowledge (Katherine Calhau) // Beyond bias: Wikipedia and the construction of knowledge (Michelle Tran) // University publishing 2.0: a preliminary investigation (Agata Marczewska) // The public gain equal rights by Indymedia: depending on the technical application of Indymedia (Jing Cao) // The movement from traditional journalism to citizen journalism A case study of online newspaper website OhmyNews (Jialing Su) // The Comparison of Emergency Coverage between America and China (Wenjuan Shi) // A content analysis of the posts on Twitter and Xiaonei (Yu Cheng) // How Facebook and other social networks are changing information production and circulation (Emel Gusic) // Facebook, Privacy and Criminality (Wenbo Chen) // Podcast: Useful tool to facilitate learning behaviour in higher education (XiaoLi Pei)
Journal of Digital Research & Publishing Semester 1 2010 (5pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Can’t Stop the Signal: How publishing companies are taking advantage of existing readerships online (Vanessa Williams) // An Improved Digital Divide: How Chile’s political efforts have positively affected the educational divide (Paula Comandari Andueza) // E-publishing: a dictator, or a co-operator? (Huan Zhang) // iPad Invades the E-reader Market (Jianwei Zhang) // E-books and the Ownership Myth: The Limitations of Digital Rights Management on Consumers (Elizabeth Riley) // Online publishing: extensions and challenges of traditional journalism (Luqi Lin) // Online journals emerge: the audiences’ choice (Ge Xuan) // The New Journalism: Weblogs as News Sources (Hanne Kristine Fjellheim) // Why online news could influence printed newspapers (Tao Zhai) // Online and Offline Newspapers Readerships and Features (Wanxin Mei) // Online Journalism: Recycled News or Innovative Reporting (Suzi Heaton) // Magazine Publishers Go Digital (Anastasiya Kostolyndina) // Fashioning Magazines in the Digital Realm (Yeong Sassall) // Pirates or Criminals? (Martina Marsic) // Legal P2P File Sharing is Possible: A Case Study of ‘Spotify’ (XIA JU) // A new cinematic aesthetic: The effect of the digital revolution on the construction of the ‘real’ (Eliza Hansell) // Virtual Wealth: A New Kind of Property in China (Hanbing Song) // Generation Me or Generation We? Social Media Technologies, Narcissism and Online Interaction (Ola Bednarczuk)
Journal of Digital Research & Publishing Semester 1 2010 (7pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Lost online: TV series as multi-author, multi-platform metafictions (César Albarrán Torres) // Join the Group: Facebook (Marta Conejo Sobrino) // Is Twitter making news more interpersonal? (Ella Pong) // Love or Lies: Deception in internet dating (Bridget Slater) // To be or not to be: T.Sina in China (Jin Xing) // Cyberbullying and the “Net Generation” (Annie Chiv) // The rise of social media and the creation of a new digital divide (Allen Liu) // Building the Wheel: Popular Education in the Digital Era (Dan O’Reilly-Rowe) // Publishers Attempt To Reconnect With Readers (Kim Kooren) // Blooks: A New Era of Literature? (Amanda Lansdowne) // The ‘Death of the Author’ and the birth of the reader? (Tamsin Lloyd) // Crisis Communications and New Media (Tom Champion) // The Influence of Online Reviews (Amy Fong) // I Blog. You Buy. (Miren Mendoza) // ‘Will 2020 still be a Great Year to be a Fashion Blogger?’ (Kate Pagett) // The Necessity for Social Media Plans in Business Strategies (Alicia Fong Yee Shum)
Journal of Digital Research & Publishing Semester 1 2011 (5pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR):Digital Publishing: what we gain and what we lose (Shutong Wang) // Making Online Pay: the prospect of the paywall in a digital and networked economy (Yi Wang) // E-mail Spam: advantages and impacts in digital publishing (Haoyu Qian) // Advertising in the new media age (Quan Quan Chen) // Twitter Theatre: notes on theatre texts and social media platforms (Alejandra Montemayor Loyo) // The appearance and impacts of electronic magazines from the perspective of media production and consumption (Ting Xu) // Pirates Versus Ninjas: the implications of hacker culture for eBook publishing (Shannon Glass) // Online Library and Copyright Protection (Yang Guo) // Identities Collide: blogging blurs boundaries (Jessica Graham) // How to Use Sina Microblog for Brand Marketing (Jingjing Yu) // Inheriting the First Amendment: a comparative framing analysis of the opposition to online content regulation (Sebastian Dixon) // The Impact of Convergence Culture on News Publishing: the rise of the Blogger (Renae Englert) // The New Design of Digital Contents for Government Applications: new generations of citizens and smart phones applications (Lorena Hevia) // Solving the Digital Divide: how the National Broadband Network will impact inequality of online access in Australia (Michael Roberts) // The Blurring of Roles: journalists and citizens in the new media landscape (Nikki Bradley) // Wikileaks and its Spinoffs: new models of journalism or the new media gatekeepers? (Nadeemy Chen)
Journal of Digital Research & Publishing Semester 2 2011 (1pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Open Access Journals for School Teachers in Indonesia (Laila Alfizanna) // Virtual Worlds, Real Money: The Economic, Legal and Social Dimensions of Virtual Property (Alexander Apte) // Keep Calm and Google It: How digital technology changes how we work with knowledge (Henrietta Ashton) // Twitter Usage in Times of Crisis (Stephanie Brown) // The Impact of Bookscan on the Australian Publishing Industry (Guo Chen) // Battle of the Bands (Sikhanyiso Dlamini) // The Impact of China’s Microblog and Chinese Government’s Censorship (Layla Dong) // Is Wikipedia Making Traditional Reference Books Shrinking? (Yanxi Fan) // Research in the Digital Age: Our Use of Twitter (Patrick Hsiao) // Hypertext and Literature (Li Xiaoxi) // Social Media in China: Past, Present and Future (Jingqi Liu) // Expanding electronic magazines in China (Liu Ying) // Txt Tlk: Language in the Digital World (Renelle Mower) // Journalism Practices in Remix Culture: How New Media Affects the Producction and Distribution of News (Diana Marcela Roldan) // Is the picture book dead? The rise of the iPad as a turning point in children’s literature (Lisa Margarete Schons) // The Rise of User-Generated Content and its Potential Threats (Ut Ieng Tang) // The Preservation of Cultural Heritage in Digital Publishing Context (Xi Wang)
Journal of Digital Research & Publishing Semester 2 2011 (5pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Spreading the message: How social networks and paywalls can save Publishers (Brett McKeehan) // Are social network websites breeding antisocial young people? (Alanna Bromley) // Content curators: The DJs of the web (Claudine Pache) // Connecting with a click: Using social media as a new marketing strategy (Xingya Zhou) // Hesitations and difficulties in setting up a corporate wiki (Marie Louisa Althans) // Born to be wired: The advantages and disadvantages for Australian children growing up in a digital age (Amanda Nicholls) // Every tool is a weapon if you hold it right* (Cobie Dellicastelli) // Will newspapers survive in the digital age? (Kokkai Ng) // Is microblog changing the way we read news? (Mina Yizhen Wang) // Journalism 2.0: The business of news (Paul Giannakis) // Death to the watchdog? The Fourth Estate in a 2.0 world (Natasha Parsons) // Old news? Are new technologies causing news reporting to change track or simply speed up existing trends? (Suzanne Stebbings) // Internet @Censorship.com (Dan Lin) // Why is“Human flesh search” only popular in China? (Jingsi Wei) // Digital library: A long way to go (Hui Zheng) // From parlours to pixels: How the digital revolution is changing the way we read (Angela Shetler) // Poetry and the digital age: Friends or foes? (Stephanie Littlewood) // Has the e-book caused the death of the printed book? (Xiaoxiao Hua) // DNA match identification of copyright works system (Shen Chao) // What do you love? The optimisation of personalised searches (Monica Moruzzi)
Reaching “an audience that you would never dream of speaking to”: influential public health researchers’ views on the role of news media in influencing policy and public understanding.
22 May 2012
University of Sydney

Chapman, Simon;Haynes, Abby S;Derrick, Gemma E.;Sturk, Heidi;Hall, Wayne D;St.George, Alexis

While governments and academic institutions urge researchers to engage with news media, traditional academic values of public disengagement have inhibited many from giving high priority to media activity. In this interview-based study, we report on the views about news media engagement and strategies used by 36 peer-voted leading Australian public health researchers in six fields. We consider their views about the role and importance of media in influencing policy; their reflections on effective or ineffective media communicators; and strategies used by these researchers about how to best retain their credibility and influence while engaging with the news media. A willingness and capacity to engage with the mass media was seen as an essential attribute of influential public health researchers.
Consequences of Play: A Systematic Review of the Effects of Online Gaming
28 June 2012
University of Sydney

Sublette, Victoria;Mullan, Barbara

Massively Multiplayer Online Games (MMOGs) have received considerable attention in news headlines describing gamers who have died while engaging in excessive play. However, more common physical and psychosocial effects attributed to online video gaming are social isolation, increased aggression, and negative academic and occupational consequences. In consideration of the bias in reporting negative consequences of video gaming, a systematic review was conducted to evaluate the evidence of the effects of MMOGs on those who play them. In the sixteen studies that met the inclusion criteria, analysis revealed that only those players who were classified as “addicted” or engaged in “problematic game play” experienced significant negative consequences, with many gamers finding positive aspects to video gaming such as enjoyment, feelings of achievement, friendship, and a sense of community. However, significant limitations in the studies point to the need for further research so that appropriate treatments and interventions can be developed for problematic game play.
Governing Indigenous Alterity: Towards A Sociology of Australian Indigenous Issues
26 November 2012
University of Sydney

Watson, Virginia

In this paper I explore some of the ways in which the notion of liberal governmentality – the idea of governing through freedom – might usefully generate a specifically sociological insight into some of the ways in which Indigenous peoples are currently governed in the Australian context. It will be my argument that although much current research takes the development of Indigenous rights premised on the recognition of Indigenous difference as foundational to liberal governmentality there is a tendency, nonetheless, to continue to regard this mode of governing as continuous with earlier coercive, colonial forms of power. Drawing on some fieldwork I hope to show some of the (small ways) in which rights and freedoms rather than opposing power can in fact be said to be constitutive of new fields of (liberal governmental) power.
Can Theory Disempower? Making Space for Agency in Theories of Indigenous Issues
26 November 2012
University of Sydney

Petray, Theresa

Aboriginal and Torres Strait Islander people are often presented by the media and academics as marginalised, dispossessed, and downtrodden. Historical narratives and statistics are used to strengthen this position. While this historical and ongoing reality must be acknowledged in order for meaningful reconciliation to occur, it must not come at the expense of Indigenous agency. Many Aboriginal and Torres Strait Islander people exercise considerable control over their own circumstances. Activists and other advocates for Aboriginal rights exercise agency “as resistance”, demanding changes to current structures. Other people engage in agency “as project”, adopting different tactics to achieve their goals. These tactics are often productive – creating Aboriginal services, for example – but agency is sometimes expressed in more 'repugnant' ways, such as crime or riots, such as the event following the Palm Island death in custody in 2004. This paper argues that a sociology of Indigenous issues must incorporate agency to ensure that our theories do not deny Aboriginal people a voice. Aboriginal people have the ability to make changes and resist norms, and this should not be ignored in favour of structural causes of dysfunction. Drawing on the work of social movement theory, supplemented by Giddens, Ortner, Cowlishaw, and Scott, I explore the “two faces” of agency and suggest that research which privileges agency should be a key feature in a sociology of Indigenous issues.
When news becomes entertainment: Representations of corruption in Indonesia’s media and the implication of scandal
21 November 2013
University of Sydney

Kramer, Elisabeth

In the current political climate, the Indonesian media is able to report openly on a range of previously taboo political issues (Sen & Hill, 2000; Kakiailatu, 2007; Tapsell, 2010). One issue that garners substantial attention is that of corruption. In stark contrast to the limited media reporting on corruption prior to 1998, it has been a stalwart issue for the press since the Reformation era (1998–), dominating both print and television media. This paper explores how corruption has been portrayed in the media, concluding that there is a clear tendency towards a ‘politics-as-entertainment’ depiction of corruption cases, as evidenced by the inclination towards ‘scandalising’ the issue. This paper argues that this format of reporting has broad implications for the anti-corruption movement in Indonesia because it trivialises a key political issue and can ultimately discourage meaningful public debate and engagement with the anti-corruption movement.
Academic Language, Power and the Impact of Western Knowledge Production on Indigenous Student Learning
02 January 2014
University of Sydney

Karen, O'Brien

This paper explores the prescriptive, distancing and separating qualities that exist in western systems of knowledge production. It examines scientific language and how discrimination takes place in the university setting and explores the ways in which academic knowledge production affects the learning experiences, participation and completion rates of Indigenous students. It suggests improving teaching and learning strategies; to enhance unacknowledged learning processes towards providing inclusive learning practices; and to strengthen educational outcomes for Indigenous students with the prospect of improving their completion rates at Universities.
Regulating Women: The ‘Mass Media’ of Early Modern Society?
03 January 2014
University of Sydney

O'Brien, Karen

People in early modern England went to great lengths in court to protect themselves from the wrath of the female tongue and crimes of speech increased fourfold in England between 1580 and 1680. This paper explores legal attempts to regulate and censor the speech of women. It examines the processes of cultural transmission in Cheshire as represented in petitions and court documents during the decade of 1660 to 1670 and charts the attempts of ruling bodies to regulate the behaviour of ‘unruly’ women to prevent them from informing the community at large through issuing prohibitive petitions and by publishing them. Evidence of censorship of the female voice is derived from hundreds of manuscripts from the Chester Consistory Courts and Quarter Sessions Courts. These archival sources have been closely read and organised and the readership is respectfully invited to enter the fascinating world of Nantwich townsfolk as they are brought to life - larger than life, on this historical canvas, as the intricacies of their lives and the attempts to censor female behaviour unfold during an investigation of their actions, language and private lives.
Law and the Crime of Practicing Popular Medicine in Early Modern Society
06 January 2014
University of Sydney

O'Brien, Karen

Research into the ecclesiastical court records of Northwest England suggests that legal accusations initiated by the community were spontaneous demonstrations of fear that increased during periods of social dislocation, principally when large numbers of children died at any one time in a particular community. There is evidence to suggest that the cunning folk were caught up in these community outpourings of anguish and were often held responsible by members of the community for causing the misfortune. The primary documents consulted for this investigation provide an important historical source. They offer an insight into a little understood social account of the widespread affairs and popular form of treatment that contributes a unique perspective of popular medicine and the connection with the supernatural world, while offering an insight into the lives and mentalities of villagers and townspeople of early modern England.
An empirical reappraisal of public trust in biobanking research: rethinking restrictive consent requirements
23 June 2014
University of Sydney

Lipworth, W;Morrell, B;Irvine, R;Kerridge, I

Collections of human tissue removed from patients in the course of medical diagnosis or therapy are believed to be an increasingly important resource for medical research (biobank research). As a result of a number of tissue-related "scandals" and increasing concern about ownership and privacy, the requirements to obtain consent from tissue donors are becoming increasingly stringent. The authors' data show that members of the general public perceive academic biobank researchers and their institutions to be highly trustworthy and do not see the need for recurrent, project-specific consent. They argue, on the basis of their empirical findings, that we should question the trend, at least in some settings, toward ever more stringent consent requirements for the use of tissue in research. They argue that this approach, while perhaps counterintuitive in the current regulatory environment, can be both ethically and legally sound so long as channels of communication are maintained and third-party relationships are tightly controlled.
The Lockhart Committee: developing policy through commitment to moral values, community and democratic processes
23 June 2014
University of Sydney

Skene, L;Kerridge, I;Marshall, B;McCombe, P;Schofield, P

The Lockhart Committee was appointed by the federal government in 2005 to review the Prohibition of Human Cloning Act 2002 (Cth) and the Research Involving Human Embryos Act 2002 (Cth). The issues in the review are ones on which community views differ widely and many people hold strong and diverging opinions. Yet all members of the committee were able to agree on their recommendations when the committee reported to Parliament in December 2005 and since that time, most of its recommendations have been implemented in amendments to federal and State legislation. This article describes the committee's process in considering the issues in the review, in consulting stakeholders and the broader community and in formulating its recommendations.
Missing the point: Rogers v Whitaker and the ethical ideal of informed and shared decision making
23 June 2014
University of Sydney

Kerridge, I;Mitchell, K

The High Court's judgment in Rogers v Whitaker (1992) 175 CLR 479 has belatedly recognised as persuasive the values and attitudes of particular patients in what constitutes for them a significant treatment risk. The importance now attached to these subjective patient factors was shown in the High Court's determination that physicians now have a duty to disclose and warn regarding material risks specific to the particular patient. It is our belief that the Rogers v Whitaker emphasis on the requirements for disclosure underscores much of the misinterpretation of consent as a single event or action rather than as an ever-present sequela of a process which informs decision-making. What is required is a shift in focus from disclosure to understanding and from unilateral information-transfer to the integrated process of shared and informed decision-making.
SARS and Security: Health in the 'New Normal'
24 June 2014
University of Sydney

Hooker, C;Ali, H

In "SARS and Security: Health in the "New Normal,"" Claire Hooker and Harris Ali illustrate how the boundaries between public health and national security are being blurred in the present age. The authors show how the "new normal" is an ideology that constructs the world as inherently insecure. Their paper demonstrates how this ideology converges along a number of tangents with neoliberalism that has repercussions for how matters of public health and national security are being reimagined in North America. The new normal, as the authors argue, is a discursive frame that shapes how governments interpret and respond to crises in the aftermath of the 9/11 terrorist attacks and the worldwide outbreak of SARS.
Sex work and HIV in Cambodia: trajectories of risk and disease in two cohorts of high-risk young women in Phnom Penh, Cambodia
07 July 2014
University of Sydney

Page, K;Stein, E;Sansothy, N;Evans, J;Couture, MC;Sichan, K;Cockroft, M;Mooney-Somers, Julie;Phlong, P;Kaldor, J;Maher, L

Objectives HIV prevalence among Cambodian female sex workers (FSW) is among the highest in Southeast Asia. We describe HIV prevalence and associated risk exposures in FSW sampled serially in Phnom Penh, Cambodia (Young Women's Health Study (YWHS)), before and after the implementation of a new law designed to combat human trafficking and sexual exploitation. Design Cross-sectional analysis of baseline data from two prospective cohorts. Setting Community-based study in Phnom Penh, Cambodia. Participants Women aged 15–29 years, reporting ≥2 sexual partners in the last month and/or engaged in transactional sex in the last 3 months, were enrolled in the studies in 2007 (N=161; YWHS-1), and 2009 (N=220; YWHS-2) following information sessions where 285 and 345 women attended. Primary outcomes HIV prevalence, sexual risk behaviour, amphetamine-type stimulant (ATS) and alcohol use, and work-related factors were compared in the two groups, enrolled before and after implementation of the new law. Results Participants in the two cohorts were similar in age (median 25 years), but YWHS-2 women reported fewer sex partners, more alcohol use and less ATS use. A higher proportion of YWHS-2 compared with YWHS-1 women worked in entertainment-based venues (68% vs 31%, respectively). HIV prevalence was significantly lower in the more recently sampled women: 9.2% (95% CI 4.5% to 13.8%) vs 23% (95% CI 16.5% to 29.7%). Conclusions Sex work context and risk have shifted among young FSW in Phnom Penh, following implementation of anti-prostitution and anti-trafficking laws. While both cohorts were recruited using the same eligibility criteria, more recently sampled women had lower prevalence of sexual risk and HIV infection. Women engaging more directly in transactional sex have become harder to sample and access. Future prevention research and programmes need to consider how new policies and demographic changes in FSW impact HIV transmission.
Making decisions in the mechanistic, probabilistic and scientific domains of medicine: a qualitative study of medical practitioners
07 August 2014
University of Sydney

Little, M;Gordon, J;Markham, P;Lipworth, W;Kerridge, I

Rationale, aims and objectives: To find out how medical practitioners perceive the processes of decision-making in the context of the individual patient and to examine the importance of decision- making in the development and identity of medical practitioners throughout their clinical lives and to suggest how these perceptions might influence medical pedagogy. Method:A qualitative study of medical practitioners of varying ages and specialties, using loosely structured biographical interviews that were read to determine the different ways in which decisions were constructed and recalled and the impact these decisions were felt to have onboth the decision-maker and othersfor whom the decision was salient. Results: Personal decisions about career choice were important because they shaped the life of the practitioner and made a significant impact on those around them. Professional decisions were made in the domains of the mechanistic and probabilistic scientific world of medicine and in the domain of human relationships, emotions and suffering. There was often a tension between the different domains and the context of the life-world often modified decisions that might logically have been determined by evidence-based medicine and its bio-knowledge. Conclusions: Decisions had a strong effect on the development of identity within the field of practice. Individuals came to see themselves as doctors who made certain kinds of decisions of immediate relevance to the individual patient. Teaching medical students and graduates how to apply evidence to their decisions and how to use formal computational decision aids may well have a useful place in pedagogy, but the impact of decision-making on the lives of doctors and their individual patients deserves at least equal emphasis. Keywords Bio-knowledge, decisions, identity, life-world, personal development
China’s pharma scandal and the ethics of the global drug market
09 August 2014
University of Sydney

Lipworth, W;Kerridge, I

China is in the midst of conducting a series of corruption investigations of pharmaceutical companies that have been operating in the country. It all started with the investigation of officials from pharmaceutical company GlaxoSmithKline, who were reportedly engaged in “bribery and corruption” in China. The officials apparently used travel agencies to funnel illegal payments to doctors and government officials. That was in July. In August, Associated Press reported French drug company Sanofi was being investigated for bribing Chinese doctors in 2007. And late last week, South China Morning Post reported that German pharmaceutical conglomerate Bayer had joined the ranks of companies being investigated by the Chinese. That report mentioned pharmaceutical companies Eli Lilly, Novo Nordisk, H Lundbeck, AstraZeneca and UCB had also been contacted by Chinese investigators. This wide-ranging, ongoing scandal highlights the many regulatory and ethical challenges of globalised drug development
Widening the debate about conflict of interest: addressing relationships between journalists and the pharmaceutical industry
14 August 2014
University of Sydney

Lipworth, W;Kerridge, I;Sweet, M;Jordens, C;Bonfiglioli, C;Forsyth, R

The phone-hacking scandal that led to the closure of the News of the World newspaper in Britain has prompted international debate about media practices and regulation. It is timely to broaden the discussion about journalistic ethics and conduct to include consideration of the impact of media practices upon the population’s health. Many commercial organizations cultivate relationships with journalists and news organizations with the aim of influencing the content of health-related news and information communicated through the media. Given the significant influence of the media on the health of individuals and populations, we should be alert to the potential impact of industry-journalist relationships on health care, health policy and public health. The approach taken by the medical profession to its interactions with the pharmaceutical industry provides a useful model for management of industry influence. Keywords Journalism, mass media, pharmaceutical industry, conflict of interest, ethics, media regulation
Medicine, the media and political interests
18 August 2014
University of Sydney

Lipworth, W;Kerridge, I;Morrell, B;Bonfiglioli, C;Forsyth, R

The news media is frequently criticised for failing to support the goals of government health campaigns. But is this necessarily the purpose of the media? We suggest that, while the media has an important role in disseminating health messages, it is a mistake to assume that the media should serve the interests of government as it has its own professional ethics, norms, values, structures and roles that extend well beyond the interests of the health sector, and certainly beyond those of the government. While considerable attention has been given to the ways in which uncritical publication of industry perspectives by news media can negatively impact on public understandings of health and health behaviours, we would argue that it is equally important that journalists not become the ‘lapdogs’ of government interests. Further, we suggest that the interests of public health may be served more by supporting the ongoing existence of an independent media than by seeking to over-determine its purpose or scope. Keywords Journalism, mass media, government, conflict of interest, ethics, media regulation
Don't show me the money: the dangers of non-financial conflicts
26 August 2014
University of Sydney

Komesaroff, P;Kerridge, I;Lipworth, W

The popular media frequently feature stories about surgeons profiting from installation of devices made by companies they hold shares in; professional bodies receiving sponsorship from industry; conference speakers whose travel has been paid for by the makers of products they’re commenting on; and GPs using software displaying drug company logos. This concern about conflicts of interest (a situation that exists where two or more interests are contradictory and compel incompatible outcomes) is undoubtedly well founded, as a large volume of research shows that financial links between individuals and industry do, in fact, influence decision-making. And now virtually every institution in the country has a process for addressing the issue and governments, peak bodies and professional bodies all, to a greater or lesser extent, require disclosure of financial interests in settings where a conflict of interest (CoI) may arise. But for all the attention the subject has attracted, the response has been curiously limited and partial. This reveals a major blind spot in the understanding of both interests and the conflicts they produce. The discussion has focused almost exclusively on pecuniary, or financial, interests. But these may play a relatively minor role in medicine. Most doctors or researchers don’t do what they do primarily to increase their material wealth. If making money was their primary goal, they could choose more effective ways of doing so.
Should the food industry resign from the health department too?
08 September 2014
University of Sydney

Mayes, C

Furore over links between Assistant Minister for Health Fiona Nash’s office and industry continues today with revelations that her former chief of staff is connected to the alcohol, as well as the food industry. Alastair Furnival resigned last Friday over his role in shutting down a website about the health star rating food labelling system and it’s now been revealed that he played a key role in cancelling the funding of the Alcohol and other Drugs Council of Australia. Furnival is co-owner of a lobbying firm that has represented major food companies opposed to the new front-of-pack labelling system. According to Fairfax, he and his wife also co-own a company, which, in turn, owns another that lobbied for the alcohol industry in 2012. Such conflicts of interest place question marks over an individual’s capacity to judge a situation, perform a duty or make a decision in a fair and impartial manner. But what if a public institution, such as the Department of Health itself, has conflicted interests? Furnival’s conflict of interest is worrying and should be thoroughly scrutinised. But the influence of the food and alcohol industries at the institutional-level precedes Furnival and will continue despite his resignation.
Book Review: Johanna Oksala, Foucault, Politics, and Violence (Evanston, Il: Northwestern University Press, 2012)
08 September 2014
University of Sydney

Mayes, C

In Foucault, Politics and Violence, Johanna Oksala provides a sophisticated intervention into feminist, political, and Foucauldian literatures addressing the relationship between the politi‐ cal and violence. Oksala lays out a post‐structuralist inquiry into the relationship between violence and political ontology. Adopting Foucault’s approach of “ontology of the present”, Oksala aims to reveal that ontologies are not foundational of the political, but are themselves politicized realities contingent on historical and political struggles. Foucault’s pow‐ er/knowledge is used to “question the ontological necessity” of violence and critically re‐ think the ontological commitments of political theories that regard violence as essential or in‐ strumental to the political. Oksala troubles these commitments in contending that political reality cannot be assumed as given, but is constituted through interpretive struggles and his‐ torical practices of violence. It is therefore necessary to critically examine the ontological un‐ derstanding of the nature of politics in order to critique practices of violence and the rationali‐ ties enabling them. The primary object of Oksala’s critique is political theories that hold violence and poli‐ tics as irreducible. Her main claim “is to show that the connection between violence and the political is not internal or essential, but contingent: violence is not an ineliminable part of politics”
Death tourism: Travelling for life-ending procedures
17 September 2014
University of Sydney

Callaghan, Sascha

This was how the final morning in the life of Dr John Elliot was reported on the front page of the Sydney Morning Heraldin January 2007. Dr Elliot, from NSW, was gravely ill with multiple myeloma, and had travelled to the Dignitas clinic in Switzerland for assisted suicide. About 200 people seek assisted suicide in Switzerland each year, including a cohort of foreign nationals, and a spokesman for Dignitas recently said that it has so far helped over 1,000 foreigners to die. 2 Earlier this year, a referendum proposing a ban on both assisted suicide and so-called ‘suicide tourism’ was overwhelmingly rejected by voters in the Canton of Zurich, with 78 per cent of voters opposing the ban on euthanasia for foreigners. 3 In a magazine issue devoted to international torts and travel law – which for most people is associated with exploration, business opportunities, relaxation, the living of life – this article focuses on a type of travel that has come to be known, arrestingly, as ‘death tourism’. Of course, it is commonplace for people to find themselves travelling on death-related missions. Most such trips involve visiting a dying relative, attending a funeral, or visiting a grave. Some people travel to a special destination to suicide spectacularly.4 Some will travel with the intention of importing a lethal medicine, such as the notorious barbiturate pentobarbital,5 to facilitate a suicide at home. And every now and then, gravely ill people like Dr Elliott will seek to travel overseas for a life-ending procedure in one of the few jurisdictions where this is lawful. This article looks at the reasons why some people travel to die in these circumstances, what legal barriers might prevent more of us from doing the same, and whether recent developments in UK law might be re-played here, creating, if not a ‘right to die’, a right to travel to die without interference.
Proposed changes to the function of the Mental Health Act will erode patient rights
17 September 2014
University of Sydney

Ryan, CR;Callaghan, Sascha;Large, M

Imagine for a moment you ind yourself arrested in some foreign clime – Queensland, for example. You are told you have transgressed some northern law and are looking at several weeks inside. You are anxious, to be sure, but not dismayed. You know you are innocent and you’re sure you’ll be able to persuade a judge that there has been a miscarriage of justice. You also know that under Queensland law the police must present you to court “as soon as reasonably practicable” and you know that, like all Australian jurisdictions, this time frame is normally interpreted as being within 24 hours, 365 days of the year. All Australians enjoy a basic right to freedom of movement. Australians who ind themselves detained against their will have a right to be brought before a court to ensure that the terms of the detention are lawful. This ancient right is protected in the civil law through habeas corpus and is also relected in the prompt review of criminal procedure. Timely independent review of restrictions on liberty is also applied in the medico-legal context. For example, while the NSW Guardianship Act allows a person responsible or guardian to consent for a patient who lacks capacity, if that patient objects to the treatment, the Act stipulates that, a quasijudicial body - the Guardianship Tribunal – must authorise this consent to check that this deprivation of freedom is justiied. The Tribunal is available to hear urgent matters around the clock and urgent orders are usually made within a week.
Deliberately Personal: The politics of tobacco control in NSW
31 October 2014
University of Sydney

Hooker, C;Chapman, Simon

In this paper we examine some of the main features of public discourse concerning tobacco control, analysing parliamentary debate in New South Wales between 1980 and 2003. We ask both how deeply tobacco industry discursive frames (eg, the ‘right to smoke’) penetrated and organized parliamentary discourse and identify what kinds of ideas were mobilized to justify tobacco control despite government reluctance to intervene. We find that the overall evolution of tobacco control policy was shaped by legislators’ commitment to the ideals of deliberative democracy. We argue firstly that parliamentary debate on tobacco control was conducted in highly moralised language that effectively excluded the tobacco industry’s arguments. Secondly, we show that this discourse was constructed and validated through the extensive use of personal anecdote and references, through which MPs sought to reflect public opinion and engage in authentic deliberation. Finally we argue that MPs positioned this concern for authentic deliberation as part of the debate on tobacco itself, associating tobacco control with ideal government.
Structural elements in achieving legislative tobacco control in NSW, 1955-95: political reflections and implications.
31 October 2014
University of Sydney

Hooker, C;Chapman, Simon

Objective: To analyse structural factors revealed by politicians that shaped legislation on tobacco control in New South Wales, 1955-1995. Methods: Parliamentary debates and other records were collected. Open-ended interviews were conducted with 17 of the Members of Parliament (MPs) and health advocates who were significantly involved, and analysed for structural elements. Results: Tobacco industry lobbying had a significant but limited influence on policymaking, being exerted largely through social interactions with executives and based on concerns for the economic impacts on third parties. MPs saw health advocates’ chief functions as (1) generating community concern about the issue and support for control measures, and (2) bringing any new information to political attention, providing pro-control arguments and data through the media. Factors that delayed tobacco control policies included: the conservative stance of Premiers and major parties, commitments to unanimous federal action, and rivalry between parties. Factors that facilitated control policies included: reforms that gave the Legislative Council increased power, the use of Parliamentary committees, and backbencher and grass roots support. Conclusions: Tobacco control policy and legislation has been the product of political structures that gave power to those MPs in the least powerful positions – minor parties, Members of the Legislative Council (MLCs), backbenchers, women and party rank and file – rather than to major parties and their executives. Implications: Advocates should make the most of their access points to the political process, providing information, arguments and support to interested backbenchers, party and parliamentary health committees, the health ministers’ conference, minor parties and independents, and demonstrating public opinion in favour of further control.
Defending ‘secrecy’: why removing donor anonymity may not be a good idea
10 November 2014
University of Sydney

Newson, A.J.

Should children conceived through the use of donated gametes have access to information identifying their donors when they reach maturity? The UK Government is expected soon to decide that, from now on, the answer to this question is to be 'yes'. But is this a good idea? Even though there are sound reasons for relaxing absolute secrecy in the use of donor gametes, donor identification represents an unnecessary step. And it's a bad idea whether or not identifying donors will lead to a decrease the numbers of people donating gametes. Why do people want to remove anonymity? Those lobbying for its removal give several reasons, such as the right of children to know about their genetic heritage taking priority over donor's rights. Knowledge of genetic parentage is also significant to our sense of personal identity, including our cultural and ethnic ties. Additionally, the importance of openness for the welfare of children dictates a need for identifying information. Against this, supporters of donor anonymity highlight the significance of donors' rights to confidentiality and privacy. Anonymity also ensures donors donate for 'good' reasons anonymous donors are more likely to harbour an altruistic desire to assist people to have children, rather than a narcissistic wish to increase one's genetic offspring. Moreover, allowing or compelling a visible third party's entry into donor insemination (DI) families could lead to disruption and hurt on all sides. Weighing up these competing claims is difficult. Whose rights are paramount? How can the dynamics of each unique family be accounted for? These are thorny issues, but respecting the rights of those involved does not necessarily entail the removal of donor anonymity. However, total secrecy is also unwarranted and so some change to current regulations is justified.
Views of health journalists, industry employees and news consumers about disclosure and regulation of industry-journalist relationships: An empirical ethical study
05 January 2015
University of Sydney

Lipworth, W;Kerridge, I;Morrell, B;Forsyth, R;Jordens, C

Bioethicists and policymakers are increasingly concerned about the effects on health journalism of relationships between journalists and private corporations. The concern is that relationships between journalists and manufacturers of medicines, medical devices, complementary medicines, and food can and do distort health reporting. This is a problem because health news is known to have a major impact on the public’s health-related expectations and behaviour. Commentators have proposed two related approaches to protecting the public from potential harms arising from industry-journalist interactions: greater transparency and external regulation. To date, few empirical studies have examined stakeholders’ views of industry-journalist relationships and how these should be managed. We conducted interviews with 13 journalists and 12 industry employees, and two focus groups with consumers. Our findings, which are synthesised here, provide empirical support for the need for greater transparency and regulation of industry-journalist relationships. Our findings also highlight several likely barriers to instituting such measures, which will need to be overcome if transparency and regulation are to be accepted by stakeholder and have their intended effect on both the quality of journalism and the actions of news consumers.
Health promotion: an ethical analysis
12 January 2015
University of Sydney

Carter, SM

Thinking and practising ethically requires reasoning systematically about the right thing to do. Health promotion ethics – a form of applied ethics – includes analysis of health promotion practice and how this can be ethically justified. Existing frameworks can assist in such evaluation. These acknowledge the moral value of delivering benefits. But benefits need to be weighed against burdens, harms or wrongs, and these should be minimised: they include invading privacy, breaking confidentiality, restraining liberty, undermining self-determination or people’s own values, or perpetuating injustice. Thinking about the ethics of health promotion also means recognising health promotion as a normative ideal: a vision of the good society. This ideal society values health, sees citizens as active and includes them in decisions that affect them, and makes the state responsible for providing all of its citizens, no matter how advantaged or disadvantaged, with the conditions and resources they need to be healthy. Ethicists writing about health promotion have focused on this relationship between the citizen and the state. Comparing existing frameworks, theories and the expressed values of practitioners themselves, we can see common patterns. All oppose pursuing an instrumental, individualistic, health-at-all-costs vision of health promotion. And all defend the moral significance of just processes: those that engage with citizens in a transparent, inclusive and open way. In recent years, some Australian governments have sought to delegitimise health promotion, defining it as extraneous to the role of the state. Good evidence is not enough to counter this trend, because it is founded in competing visions of a good society. For this reason, the most pressing agenda for health promotion ethics is to engage with communities, in a procedurally just way, about the role and responsibilities of the citizen and the state in promoting and maintaining good health.
Exploring young people's dignity: A qualitative approach
13 January 2015
University of Sydney

Narayan, K;Hooker, C;Jarrett, C;Bennett, D

Aim: Human dignity as an important consideration in health care has been primarily investigated from an adult perspective. This paper explores young people's perceptions of dignity and how it impacts on their health-care experience. Method: A qualitative pilot study was undertaken at the Children's Hospital, Westmead in from 2010 to 2011. Semi structured interviews were conducted with five inpatients, and data were analysed using a grounded theory approach. Results: The adolescents interviewed perceived dignity as a way of protecting their personhood. Privacy and maintaining integrity were the means by which dignity could be preserved in a health-care setting. Conclusions: The study found that young people had unique perceptions of privacy and personhood with regards to dignity. Of the concepts of dignity in the existing literature, the dignity of identity was most applicable to adolescents' conceptions. This understanding of young people's views of dignity could prevent dignity violations in health care and beneficially impact their development. Keywords: adolescent; behavioural; ethics
Enhancing Citizen Engagement in Cancer Screening Through Deliberative Democracy
14 January 2015
University of Sydney

Rychetnik, L;Carter, SM;Abelson, J;Hazel, T;Barratt, A;Entwistle, V;Mackenzie, G;Salkeld, G;Glaziou, P

Cancer screening is widely practiced and participation is promoted by various social, technical, and commercial drivers, but there are growing concerns about the emerging harms, risks, and costs of cancer screening. Deliberative democracy methods engage citizens in dialogue on substantial and complex problems: especially when evidence and values are important and people need time to understand and consider the relevant issues. Information derived from such deliberations can provide important guidance to cancer screening policies: citizens’ values are made explicit, revealing what really matters to people and why. Policy makers can see what informed, rather than uninformed, citizens would decide on the provision of services and information on cancer screening. Caveats can be elicited to guide changes to existing policies and practices. Policies that take account of citizens’ opinions through a deliberative democracy process can be considered more legitimate, justifiable, and feasible than those that don’t.
Getting evidence into policy: The need for deliberative strategies?
21 January 2015
University of Sydney

Flitcroft, K;Gillespie, James;Salkeld, G;Carter, SM;Trevena, L

Getting evidence into policy is notoriously difficult. In this empirical case study we used document analysis and key informant interviews to explore the Australian federal government’s policy to implement a national bowel cancer screening programme, and the role of evidence in this policy. Our analysis revealed a range of institutional limitations at three levels of national government: within the health department, between government departments, and across the whole of government. These limitations were amplified by the pressures of the 2004 Australian federal election campaign. Traditional knowledge utilisation approaches, which rely principally on voluntarist strategies and focus on the individual, rather than the institutional level, are often insufficient to ensure evidence-based implementation. We propose three alternative models, based on deliberative strategies which have been shown to work in other settings: review of the evidence by a select group of experts whose independence is enshrined in legislation and whose imprimatur is required before policy can proceed; use of an advisory group of experts who consult widely with stakeholders and publish their review findings; or public discussion of the evidence by the media and community groups who act as more direct conduits to the decision-makers than researchers. Such deliberative models could help overcome the limitations on the use of evidence by embedding public review of evidence as the first step in the institutional decision-making processes. Highlights  Achieving evidence-based policy implementation is much harder than the rhetoric suggests.  Our case study showed traditional voluntarist approaches are not enough to overcome institutional filtering of the evidence.  Deliberative strategies open up the decision-making processes to greater expert and public scrutiny.  Our framework illustrates the potential for deliberative strategies to increase the relative weight of evidence in policy.  This article challenges researchers and policy-makers to acknowledge and address the institutional context of decision-making. Keywords: Australia; Health policy; Decision-making; Evidence; Knowledge utilisation; Bowel cancer; Screening; Deliberative
Shared Health Governance: The Potential Danger of Oppressive “Healthism”.
21 January 2015
University of Sydney

Carter, SM;Entwistle, V;McCaffery, K;Rychetnik, L

We share an interest in public health and in the capabilities approach developed by Amartya Sen, Martha Nussbaum, and others (Comim, Qizilbash, and Alkire 2008; Sen 2009; Nussbaum 1999), so were curious to see how Jennifer Prah Ruger would apply her “health capability paradigm” to health governance. The resulting model—shared health governance (SHG)—has real potential to promote justice in health in some contexts. However, based on the description provided in this issue (Ruger 2011), aspects of SHG seem at odds with important features of the capabilities approach. We suggest that SHG will better safeguard the freedoms of individuals—including their health capabilities—if modified in two ways: (1) if the scope of application is reduced, and (2) if a focus on capabilities for health rather than achievements of health is more consistently maintained.
Communication, Confidentiality and Consent in Mental Health Care
23 January 2015
University of Sydney

Ryan, C;Callaghan, Sascha;Large, M

Families and friends play a vital role in the care and support of people with serious mental illness. However, caregivers often complain that treating teams do not adequately inform them of their loved one’s condition and management plan. Failure or refusal to disclose such information can be very distressing for those offering support and, in circumstances where people with mental illness behave in threatening, violent or self-destructive ways, it can have serious repercussions. Health care professionals owe a duty of confidentiality to their patients. As a general rule, clinicians should seek a patient’s permission before disclosing information to others. This obligation is enforced in law. If health care professionals ignore this obligation, they risk civil liability for breach of confidentiality or statutory provisions that protect privacy, or a finding of professional misconduct by a professional standards tribunal. Generally, if a patient is able to understand the nature and effect of a disclosure of information and refuses to agree to that disclosure, it would be both unlawful and unethical to make the disclosure simply because the professional feels it to be the better course. On the other hand, the right to confidentiality and privacy is not without its limits, and it is widely accepted that confidentiality can be breached if a higher obligation is involved, such as a serious threat to the health and safety of the person or others.
The role of patients in Clinical Ethics Support: A snapshot of practices and attitudes in the United Kingdom
30 January 2015
University of Sydney

Newson, A.J.

Clinical ethics committees (CECs) in the United Kingdom (UK) have developed significantly over the past 15 years. The issue of access to and participation in clinical ethics consultation by patients and family members has, however, gone largely unrecognized. There are various dimensions to this kind of contact, including patient notification, consent and participation. This study reports the first specific investigation of patient contact with UK CECs. A questionnaire study was carried out with representatives from UK CECs. Results suggest that patient participation in clinical ethics consultation is low and unlikely to change significantly in the near future. Attitudes towards patients having a role in clinical ethics consultation are mixed, with a variety of reasons put forward both for and against patient participation. These results are discussed in the light of common themes in the literature and the practical and political context of clinical ethics support in the UK.
Return of the Memento Mori: imaging death in public health.
23 March 2015
University of Sydney

Noonan, E;Little, M;Kerridge, I

Death has always held a morbid fascination for humans. Indeed, awareness of one’s own mortality may well be one of the defining features of the ‘human condition’ – symbols of death appearing in most civilizations since artefacts have been made. The Latin phrase memento mori, meaning literally ‘remember to die’, encapsulates a rich and varied artistic tradition, dating back to the Middle Ages, of figuring death by symbolizing its literal processes and remainders. From the decomposed effigies of 15th-century ‘cadaver tombs’, to the humorous medieval iconography of the skeletal danse macabre, the works of this genre draw on the destructive physical changes that are a part of our understanding of death. Prolific within its morbid imagery are the use of skull, skeleton and verminous or rotting flesh as ‘trope’ or symbol of the processes that eventually take away the person who lived, and who was once like us. At the height of its popularity between the 16th and 18th centuries, Church walls, tombs, jewellery, paintings, and so on frequently depicted death and decay. The entreaty to ‘remember’ death in memento mori was more than simply a call for ‘therapeutic contemplation’1 or the banal acceptance of the imminence of death; it was a call to piety, to conformity. Damnation would be added to death if the individual transgressed the rules of Catholic doctrine, such that scholars often trace a continuity between the motives of memento mori, and the biblical injunction: ‘Whatsoever thou takest in hand, remember the end, and thou shalt never do amiss’ (Ecclesiasticus 7:36).2 Even within the iconophobic Protestantism of the post-Reformation era, the memento mori trope persisted as a privileged mode of pious warning. In the visually secular effigy monuments of the Elizabethan gentry, inscriptions urging the reader to ‘(r)emember the last things and…not sin again’ signified that death would come to everyone – but only spiritual public health would reduce the risk of eternal punishment and separation from God.3 The memento mori trope survives into the present day, albeit in differing locations. Loosely discernible in the ‘corpse chic’ of contemporary haute couture, and entrenched within the aesthetics of punk and gothic subcultures, the skull and skeleton loom large as Western symbols of cultural rebellion.4 Similarly, the fully enfleshed ‘corpse’ continues to haunt the zone of 2 | P a g e contemporary representation – saturating the realm of Hollywood film and ‘hard news’ reportage alike, and asserting its dominance in forensics-inspired television programmes such as CSI. Representing death, it would seem, has never been more popular. Indeed, depictions of death have emerged as ‘mainstream advertising strategy’4 – their gore and horror satisfying a perverse voyeurism that many would attribute to the alienating effects of mass media saturation. While the ‘pornography’ of suffering5 in contemporary culture appears to have little in common with classical memento mori, if one looks closely, certain elements particular to this once-spiritual genre of death depiction can be unearthed, most notably in the secular arena of public health.
"Improving the legitimacy of medicines funding decisions: A critical literature review"
25 March 2015
University of Sydney

Pace, J;Pearson, S;Lipworth, W

Many healthcare systems globally provide publicly subsidised access to prescribed medicines. Decisions about which medicines to fund affect a range of stakeholders and it is not reasonable to expect that medicines funding decisions are supported by all stakeholder groups all the time. A more realistic aim may be for decisions to be understood and accepted as legitimate by stakeholders, however several shortcomings of existing processes make it difficult to achieve this aim. To date, the main strategy to address these shortcomings has been to increase stakeholder involvement in decision-making, either by eliciting stakeholder values or increasing stakeholder participation in decision-making. Despite these efforts, there is growing evidence that decision-makers are falling short when it comes to the perceived legitimacy of their resource allocation processes and decisions. As such, there is a pressing need for decision-makers to think seriously and creatively about ways to increase the legitimacy of their processes and to make them more acceptable to a wider range of stakeholders. In this article we summarise and critique existing literature on the legitimacy of public resource allocation processes, and make some practical suggestions for those who are concerned about this issue. Keywords: pharmaceutical funding decisions, legitimacy, stakeholder engagement, resource allocation, priority setting.
Which public and why deliberate? – A scoping review of public deliberation in public health and health policy research.
01 April 2015
University of Sydney

Degeling, C;Carter, SM;Rychetnik, L

Deliberative methods are of increasing interest to public health researchers and policymakers. We systematically searched the peer-reviewed literature to identify public health and health policy research involving deliberative methods and report how deliberative methods have been used. We applied a taxonomy developed with reference to health policy and science and technology studies literatures to distinguish how deliberative methods engage different publics: citizens (ordinary people who are unfamiliar with the issues), consumers (those with relevant personal experience e.g. of illness) and advocates (those with technical expertise or partisan interests). We searched four databases for empirical studies in English published 1996–2013. This identified 78 articles reporting on 62 distinct events from the UK, USA, Canada, Australasia, Europe, Israel, Asia and Africa. Ten different types of deliberative techniques were used to represent and capture the interests and preferences of different types of public. Citizens were typically directed to consider community interests and were treated as a resource to increase democratic legitimacy. Citizens were preferred in methodological studies (those focused on understanding the techniques). Consumers were directed to focus on personal preferences; thus convened not as a source of policy decisions, but of knowledge about what those affected by the issue would accept. Advocates—who are most commonly used as expert witnesses in juries—were sometimes engaged to deliberate with consumers or citizens. This almost always occurred in projects directly linked to policy processes. This suggests health policymakers may value deliberative methods as a way of understanding disagreement between perspectives. Overall however, the ‘type’ of public sought was often not explicit, and their role not specified. This review provides new insight into the heterogeneity and rising popularity of deliberative methods, and indicates a need for greater clarity regarding both the constitution of publics and the relative usefulness of different deliberative techniques. Keywords Deliberative methods; Public health; Health policy; Public participation; Policy making
Black-market lottery: organ donation and the international transplant trade
02 May 2015
University of Sydney

Bendorf, A

Estimates suggest more than two million people worldwide would benefit from an organ transplant. While the donation rates vary greatly between countries, the contrast between the increasing numbers of people in need and the inadequate numbers of organs being donated mean many will die while they wait. Last night, ABC’s Four Corners screened Tales from the Organ Trade, an HBO documentary that highlights the desperation that links the world’s poor, who sell their organs, together with first-world recipients who buy them on the black market. While accurate statistics are difficult to find, some suggest that up to 15% of the world’s transplants are performed using illegally obtained organs via an international black market web of organ brokers. The brokers bring recipients and donors together with transplant surgeons working out of fly-by-night medical clinics. The process is unregulated, illegal and the risks to both donor and recipient are high. The documentary raises challenging questions about this illegal trade in organs that sometimes benefits both the donor and recipient and other times imperils the well-being of both. There are, no doubt, many more untold horror stories. While some experts argue the sale of organs should be regulated and legalised, most medical professionals strongly discourage their patients from travelling overseas to undergo organ transplants because they have significantly poorer outcomes than those who receive transplants here. So, with Australia widely regarded as a world leader in transplantation outcomes, what would compel anyone to consider such a risky proposition? And why would anyone participate in exploitation like this?
Power and control in interactions between journalists and health-related industries – the view from industry.
05 May 2015
University of Sydney

Morrell, B;Lipworth, W;Forsyth, R;Jordens, C;Kerridge, I

The mass media is a major source of health information for the public, and as such the quality and independence of health news reporting is an important concern. Concerns have been expressed that journalists reporting on health are increasingly dependent on their sources – including representatives of industries responsible for manufacturing health-related products – for story ideas and content. Many critics perceive an imbalance of power between journalists and industry sources, with industry being in a position of relative power, however the empirical evidence to support this view is limited. The analysis presented here – which is part of a larger study of industry-journalist relationships – draws on in-depth, semi-structured interviews with representatives of health-related industries in Australia to inductively examine their perceptions of power relations between industry and journalists. Participants painted a picture in which journalists, rather than themselves, were in a position to control the nature, extent, and outcome of their interactions with industry sources. Our results resonate with the concept of “mediatisation” as it has been applied in the domain of political reporting. It appears that, from the perspective of industry representatives, the imposition of media logic on health-related industries may inappropriately influence the information that the public receives about health-related products. KEYWORDS: journalism, ethics, power, public health, qualitative research
Conflicting rights: How the prohibition of human trafficking and sexual exploitation infringes the right to health of female sex workers in Phnom Penh, Cambodia
12 June 2015
University of Sydney

Maher, L;Dixon, C;Phlong, P;Mooney-Somers, Julie;Stein, Ellen;Page, K

While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced anti-trafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers’ human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia’s AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers.
Why we shouldn’t always compensate people for historical wrongs
10 July 2015
University of Sydney

Dawson, Angus

Human research ethics has often been formulated in response to scandals. However, the majority of research ethics cases are actually quite mundane. They involve committees making decisions about the likely balance between risks and benefits of the proposed research. Most researchers are well-intentioned and much research is conducted for public benefit. But what should we do when things go wrong? What about when evidence of wrongdoing is uncovered long after the event? Are survivors entitled to compensation? A current example of just such a case provides an opportunity to examine the issues involved.
The social and cultural significance of women’s sexual identities should guide health promotion: an analysis of the Sydney Women and Sexual Health (SWASH) survey
25 August 2015
University of Sydney

Germanos, Rada;Deacon, Rachel M;Mooney-Somers, Julie

Our analysis aimed to identify the major risk behaviors and health issues for young lesbian, bisexual and queer women, and combine this with lifestyle and community engagement data to guide targeted health promotion for these groups.We conducted statistical analysis of 379 self-complete surveys from women aged 17–30 years attending lesbian, gay, bisexual, trans, and queer (LGBTQ) community events during the Sydney Gay and Lesbian Mardi Gras Festival period in February 2010 and 2012. We found concerning rates of tobacco, alcohol, and illicit drug use across all groups; a mental illness diagnosis and formal psychological support access were common. Queer women had the highest rates of illicit drug use, experiences of sexual coercion, and anti-LGBTQ discrimination. They were also the most proactive with their health. Bisexual women had low STI testing despite having high rates of sexual activity with both men and women. Lesbian women had the poorest uptake of Pap smears and STI testing. Findings demonstrate that meaningful sexual behavior is irrelevant for the majority of health disparities affecting sexual minority women. Meaningful engagement with contemporary sexual identities and their local social and cultural significance is essential for the development of appropriate and effective targeted public health interventions.
Commentary on 'Case for BJOG compliance with prospective trial registration
14 March 2016
University of Sydney

Duley, Leila;Askei, Lisa;Tharyan, Prathap

Prospective registration of clinical trials before enrolment of the first participant is an ethical and scientific. Registering clinical trials reduces duplication of research and aids better identification of gaps in our knowledge, as when all research on a topic can be identified it is easier to know when a new study is not needed, as the question has already been answered; and if all research is identified it becomes easier to see where there are gaps, and so where new studies are needed. Prospective registration of clinical trials reduces publication bias and bias due to selective reporting of studies with equivocal or ‘negative’ results, since studies are identified and registered before their results are known, and there is less likelihood that our understanding of research evidence is distorted by studies that have disappeared without a trace, or are slow to appear. Prospective registration of trials additionally reduces bias due to selective reporting of outcomes that are ‘positive’ as outcomes are disclosed at registration and can be compared with published reports. Prospective registration thus contributes to less scientific misconduct, as failure to report research findings accurately and make them publicly available, is a betrayal of trust of the people who participated in that research, and can lead to harm in patient care. Prospective registration also makes it harder to fabricate research results, and can result in less scientific fraud
The epistemic challenges of CTOs
19 April 2016
University of Sydney

Light, E

Controversy around the use of community treatment orders (CTOs) arises in part from their ambiguous evidence base. Recent research has provided valuable new insights into the effects of CTOs, while also highlighting the critical importance of first understanding what CTOs are and what they are meant to achieve. A genuine public discourse on the significance of CTOs will have multiple perspectives. This necessitates a more pluralistic approach to constructing the necessary knowledge of CTOs to enable communities to make sound decisions about their use. Despite the controversies surrounding their efficacy, the utilisation of community treatment orders (CTOs) is increasing worldwide.1,2 Debates about ethical and human rights issues relating to CTOs span all jurisdictions, whether CTOs are a recent development (as in the 2007 Mental Health Act provisions in England and Wales) or more established (as in the provisions first introduced in the Australian state of New South Wales in 1990). These debates concern the principle of using coercion in clinical practice, the impact of CTOs on the autonomy and privacy interests of individuals, and the provision of appropriate mental healthcare that is not reliant on unnecessary compulsion to compensate for under-resourced community services.3–6 Such issues are common to all jurisdictions, despite the variations in legislative provisions for CTO systems, which include differences in the criteria for applying CTOs and the powers given to healthcare providers. These concerns are highlighted by the significant variation in the rates of use of CTOs around the world,7 which has prompted concerns about their use being determined by various factors besides clinical need.8,9 The controversy arises, in part, from the inconsistent results of research into CTOs, which has failed to demonstrate positive clinical outcomes and which reveals that patients, carers and clinicians have mixed views about CTOs.4,10,11 Although existing research into CTOs may be accurately representing variation and inconsistencies in their application, the heterogeneity and inadequacies of the evidence base10,12 make it difficult to draw conclusions from the published literature. Nevertheless, it is important to take proper account of the data that do exist.
Characteristics of persons convicted for offences relating to animal hoarding in New South Wales
20 April 2016
University of Sydney

Joffe, M;O’Shannessy, D;Dhand, Navneet K.;Westman, M;Fawcett, A

Objective To highlight the characteristics of persons convicted for offences related to animal hoarding in New South Wales, Australia, document the outcomes of cases and compare them with overseas studies. Design Retrospective case series. Methods Records of finalised prosecutions for offences relating to animal hoarding between 2005 and 2011 were examined. Data recorded included: the age of each subject at the first offence, sex, postcode, occupation, living conditions, number of charges, number of prosecutions, title of each charge, number and species of live animals, whether animals needed veterinary attention, the medical conditions that the animals suffered, whether dead animals were on the property, how animals were obtained, veterinary and legal costs accrued and case outcomes. The data were analysed to obtain frequencies and relative frequencies for categorical variables and summary statistics for quantitative variables. Observed frequencies were compared using Chi-square test with the expected frequencies calculated based on the Australian Bureau of Statistics data for NSW. Results The number of persons included was 29. Most were female (72.4%) and 23 were 40–64 years of age at their first offence. Almost one-third identified themselves as breeders, eight as pensioners and four as unemployed. Most resided in inner regional Australia (45%), 28% lived in major cities and 28% lived in outer regional Australia. Dogs were the species hoarded in 80% of cases. Animals requiring veterinary attention were identified in all cases. Dead animals were found on premises in 41.4% of cases. Conclusions Persons prosecuted for charges relating to animal hoarding in NSW have similar characteristics to those of previous studies, although the outcomes may be different. More farm animals and horses were hoarded in NSW and hoarders in NSW were more likely to live in inner regional and outer regional areas (rural areas) than animal hoarders in the USA. Keywords: animal hoarding;animal welfare
Relational conceptions of paternalism: a way to rebut nanny-state accusations and evaluate public health interventions
26 April 2016
University of Sydney

Carter, SM;Entwistle, V;Little, M

Objectives: ‘Nanny-state’ accusations can function as powerful rhetorical weapons against interventions intended to promote public health. Public health advocates often lack effective rebuttals to these criticisms. Nanny-state accusations are largely accusations of paternalism. They conjure up emotive concern about undue governmental interference undermining peoples’ autonomy. But autonomy can be understood in various ways. We outline three main conceptions of autonomy, argue that these that can underpin three different conceptions of paternalism, and consider implications for responses to nanny-state accusations and the assessment of public health interventions. Study design and methods: Detailed conceptual analysis. Results: The conceptions of paternalism implicit in nanny-state accusations generally depend on libertarian conceptions of autonomy. These reflect unrealistic views of personal independence and do not discriminate sufficiently between trivial and important freedoms. Decisional conceptions of paternalism, like their underlying decisional conceptions of autonomy, have limited applicability in public health contexts. Relational conceptions of paternalism incorporate relational conceptions of autonomy, so recognise that personal autonomy depends on socially shaped skills, self-identities and self-evaluations as well as externally structured opportunities. They encourage attention to the various ways that social interactions and relationships, including disrespect, stigmatisation and oppression, can undermine potential for autonomy. While nanny-state accusations target any interference with negative freedom, however trivial, relational conceptions direct concerns to those infringements of negative freedom, or absences of positive freedom, serious enough to undermine self-determination, self-governance and/or self-authorisation. Conclusion: Relational conceptions of autonomy and paternalism offer public health policymakers and practitioners a means for rebutting nanny-state accusations, and can support more nuanced and more appropriately demanding appraisals of public health interventions. (249 words) Keywords: Paternalism; autonomy; nanny-state; public health; ethics
Autonomy and Chronic Illness: Not Two Components But Many
12 May 2016
University of Sydney

Scanlan, Camilla Louise;Kerridge, I

Naik et al argue that ‘decisional autonomy’ is insufficient to account for nonadherence in the context of chronic illness and that what is required is a two compartment re-conceptualisation of autonomy that includes both decisional autonomy and ‘executive autonomy’. While the authors correctly point out the concentration on the cognitive aspects of competence in the bioethics and medical literature, the model of autonomy that they propose is consistent with process or discursive models of consent, and with the work of Bergsma and Thomasma,1 Gillon,2 Beauchamp and Childress,3 all of whom describe the importance of action or enactment in medical decision-making. Indeed, while autonomy is usually defined in terms of self government, it can usefully be described as being a cluster of notions that together signify control of decision-making. Included in this cluster according to Bergsma and Thomasma1 is the ability to set life-plans, and the capacity to adapt to changing circumstances. To successfully carry out a decision three functions come into play (i) autonomy of thought (ii) autonomy of will and (iii) autonomy of action. It follows then that the patients in the study described by Naik et al have autonomy of thought (occurrent aspect), and of will (intentionality), evidenced by their participation in developing self management plans, but according to Gillon,2 are deficient in autonomy of action (disposition aspect). This agrees with Beauchamp and Childress’ principles3 underpinning autonomy as being liberty (independence from controlling influences) and agency (capacity for intentional action). The primacy of autonomy in medical care has been extensively critiqued over the past two decades. Naik et al provide yet another reason to be sceptical of simplistic formulations of autonomy and decision-making in medicine. At the same time, however, we believe that the authors continue to over-emphasise rationality, deemphasise the social and relational basis of autonomy and agency, and provide an insufficiently complete model of capacity in chronic illness. As much can be seen by their description of ‘biopsychosocial correlates of autonomy’ which draws upon recent developments in neurobiology but says nothing about the social or relational basis of illness.
Rhetoric, power and legitimacy: A critical analysis of the public policy disputes surrounding stem cell research in Australia (2005-6).
16 May 2016
University of Sydney

Lysaght, T;Kerridge, I

In December 2006, the Australian Parliament liberalized regulation governing stem cell research. This decision and preceding legislative review generated considerable public debate, which centred on objections to the deliberate creation and destruction of human embryos for research purposes. This paper draws on qualitative research conducted on the public debate surrounding this policy episode. The aim of this research was to examine how science and scientific knowledge is mobilized by participants in these debates to support their arguments. Data was collected from 109 newspaper opinion editorials as well as 23 in-depth interviews and examined using qualitative content and thematic analysis. Results of this analysis depict science as a rhetorical, moral and political resource that provides opportunities for participants to gain legitimacy, negotiate meaning and assert authority in the public domain. The mobilization of science in public discourse is discussed along with suggestions that are aimed at encouraging greater transparency and inclusiveness in public debates around contested science and emergent technologies.
The devil is in the detail: best practice or catholic practice?
17 May 2016
University of Sydney

Douglas, C;Jansen, M;Kerridge, I

Rendell and colleagues state an honorable mission – “to safeguard the rights of research subjects in Catholic institutions” (Rendell, Casey et al. 2012). However we think a close inspection of their paper reveals a concern not with the rights of research subjects, but with the rights of Catholic health providers. If ‘Catholic moral teaching’ is ‘respected’ as a matter of policy in Catholic medical institutions, far from safeguarding the rights of subjects, it has the potential to deny patients options and to deny them the best possible medical care - regardless of the moral beliefs of the individuals. We illustrate these points by referring to developments at the Calvary Mater Newcastle, a publicly funded oncology hospital in regional New South Wales, Australia, that has come into conflict with local researchers and oncologists over the conduct of oncology trials (Robotham 2011).
Moving beyond the rhetoric of consumer input in health technology assessment deliberations
01 June 2016
University of Sydney

Wortley, Sally;Wale, Janet;Grainger, David;Murphy, Peter

At a health system level the importance of patient and public input into healthcare decision-making is well recognised. Patient and public involvement not only provides a mechanism to legitimise decisions but also contributes to improved translation of these decisions into practice, ultimately leading to better patient outcomes. Recent reviews in the health technology assessment space have identified the need for, and increased use of, patient input through systematic methodologies. Yet what does this mean in practical terms? This paper outlines both short and longer-term options for strengthening patient input into health technology assessment deliberations. This is particularly important given the planned reforms in this area and the commitment to public consultation as part of the reform process.
Embedding Decision Heuristics in Discrete Choice Models: A Review
07 July 2016
University of Sydney

Hensher, David A.;Leong, Waiyan

Contrary to the usual assumption of fixed, well-defined preferences, it is increasingly evident that individuals are likely to approach a choice task using rules and decision heuristics that are dependent on the choice environment. More specifically, heuristics that are defined by the local choice context, such as the gains or losses of an attribute value relative to the other attributes, seem to be consistently employed. Recent empirical findings also demonstrate that previous choices and previously encountered choice tasks shown to respondents can affect the current choice outcome, indicating a form of inter-dependence across choice sets. This paper is primarily focused on reviewing how heuristics have been modelled in stated choice data. The paper begins with a review of the heuristics that may be relevant for coping with choice task complexity and then proceeds to discuss some modelling approaches. Next, relational heuristics, such as prospect theory, random regret minimisation and extremeness aversion (compromise effect) are discussed. These are heuristics which operate within the local choice set. Another major class of heuristics reviewed in this paper pertains to ordering effects and more generally, on past outcomes and past attribute levels of the alternatives.
Ethical Frameworks in Public Health Decision-Making: Defending a Value-Based and Pluralist Approach
26 July 2016
University of Sydney

Grill, K;Dawson, Angus

A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim’s and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health. Keywords Decision-making Ethical frameworks Justification Public health Value pluralism
Pre-notification letter type and response rate to a postal survey among women who have recently given birth
28 July 2016
University of Sydney

Todd, Angela L.;Porter, Maree;Williamson, Jennifer;Patterson, Jillian A.;Roberts, Christine L.

Background: Surveys are commonly used in health research to assess patient satisfaction with hospital care. Achieving an adequate response rate, in the face of declining trends over time, threatens the quality and reliability of survey results. This paper reports on a postal satisfaction survey conducted with women who had recently given birth, and explores the effect of two strategies on response rates. Methods: A sample of 2048 Australian women who had recently given birth were invited to participate in a postal survey about their recent experiences with maternity care. The study design included two different strategies intended to increase response rates: a randomised controlled trial testing two types of pre-notification letter (with or without the option of opting out of the survey), and a request for consent to link survey data with existing routinely collected health data (omitting the latter data items from the survey reduced survey length and participant burden). Results: The survey had an overall response rate of 46%. Women receiving the pre-notification letter with the option of opting out of the survey were more likely to actively decline to participate than women receiving the letter without this option, although the overall numbers of women were small (27 versus 12). Letter type was not significantly associated with the return of a completed survey. Among women who completed the survey, 97% gave consent to link their survey data with existing health data. Conclusions: Seeking consent for record linkage was highly acceptable to women who completed the survey, and represents an important strategy to add to the arsenal for designing and implementing effective surveys. In addition to aspects of survey design, future research should explore how to more effectively influence personal constructs that contribute to the decision to participate in surveys.
No chance, no value or no way: Reassessing the place of futility in healthcare and bioethics
28 July 2016
University of Sydney

Winch, A;Kerridge, I

Throughout its history, and particularly in the modern age, medicine has fought to conquer disease and to “tame” death. There have been remarkable successes. Yet clearly there are limits to the reach of medicine that are influenced by context and time. In other words, there are points beyond which medicine should not go—either because it will not be effective in achieving its goals (however these are defined) or because it will cause more harm than benefit. While there is general agreement that medicine is, and should be, limited—there is little consensus on how this point can be defined, who has the authority to define it, what the implications are of such judgements, and what processes should be enacted both to guide decision-making and to resolve contest around the ends and goals of medicine. Three decades of debate on medical futility have provided little clarity and have produced a plethora of definitions, procedures, and conceptual models, with futility being both hailed as the way to preserve medical professionalism (Schneiderman and Jecker 1993) and rejected as largely unworkable in clinical practice (Halevy and Brody 1996). A review of this literature illustrates how futility is conceptually and practically challenging. It attempts to reconcile evidence and ethics, medical professionalism, and patient-centred care while acknowledging increasing patient expectations and the growth of technologies that extend the transition between life and death.
The limit of labels: ethical food is more than consumer choice
12 September 2016
University of Sydney

Mayes, C

Over the past hundred years, industrial agriculture and the globalised food system have produced cheaper, longer lasting and more diverse food items. We can now enjoy tropical fruits in winter, purchase whole chickens at the price of a cup of coffee, and eat fresh bread long after it was baked. Once celebrated as the benevolent results of food science and ingenuity of farmers, these cheap and safe foods are dismissed by critics as the tainted fruits of “Big Food” – the culinary version of Big Tobacco and Big Oil. Food is no longer simply a matter of taste or convenience. Our food choices have become ethical and political issues. An innocuous but central strategy in these debates is the food label. In recent years there has been an explosion of ethico-political food labels to address concerns such as slavery, nutrition, environmental degradation, fair trade and animal cruelty. These disparate concerns are unified by their connection to the amorphous culprit “Big Food”. The idea is that by knowing what is in our food and how it was produced, we will reject unethical food corporations, buy from ethical producers and thereby promote justice. But is this necessarily so?
Networked Framing Between Source Posts and Their Reposts: An Analysis of Public Opinion On China's Microblogs
27 September 2016
University of Sydney

Nip, Joyce Y. M.;Fu, King-wa

Retweeting a post on a social media platform is a part of a process of growing significance through which public opinion formation takes place. A ‘retweet count’ on, say Twitter or weibo, can be taken as a measure of user influence. The assumption is that when B retweets A’s message, B empathizes with A and wishes to disseminate the message more widely. But this assumption has hardly been tested and preliminary evidence suggests practices for retweeting on Twitter vary. Nor can retweeting practices on Twitter be assumed to apply on weibo. This paper makes the first effort to understand the practice of reposting on China’s weibo, focusing on the content of reposts in comparison to that of the original messages. A quantitative comparison is made of the frame [Entman, R. M. (1993). Framing: Toward clarification of a fractured paradigm. Journal of Communication, 43(4), 51–58; Gamson, W. A., & Modigliani, A. (1989). Media discourse and public opinion on nuclear power: A constructionist approach. American Journal of Sociology, 95, 1–37] of the source post of 21 cases, and their reposts. The posts and reposts all refer to the issue of officials being exposed for corruption on Sina Weibo. The study finds sound evidence of networked framing, in which reposters revised frames of the source posters while disseminating them. Although over half of the reposts merely republished the source post without added content, what emerged were new communicative functions, case definitions, and a diagnosis of the consequences of exposing the cases. However, different types of user accounts drew different reposting frames, which points to a consistent paradigm between the source accounts and the reposters. The results are important for understanding the mechanisms behind the formation of public opinion on weibo.
Challenging Official Propaganda? Public Opinion Leaders on Sina Weibo.
27 September 2016
University of Sydney

Nip, Joyce Y. M.;Fu, King-wa

This article examines the prominence of various user categories as opinion leaders, defined as initiators, agenda setters or disseminators, in 29 corruption cases exposed on SinaWeibo. It finds that ordinary citizens made up the largest category of initiators but that their power of opinion leadership was limited as they had to rely on media organizations to spread news about the cases. News organizations and online media were the main opinion leaders. Government and Party bodies initiated a fair number of cases and, despite not being strong agenda setters or disseminators, were able to dominate public opinion owing to the fact that news organizations and online media mainly published official announcements about the cases. Media organizations also played a secondary role as the voice of the people. While individuals from some other user categories were able to become prominent opinion leaders, news workers are likely to be the most promising user category to challenge official propaganda.
CJCheck Stage 1: development and testing of a checklist for reporting community juries – Delphi process and analysis of studies published in 1996–2015
12 October 2016
University of Sydney

Thomas, R;Sims, R;Degeling, C;Street, JM;Carter, SM;Rychetnik, L;Whitty, JA;Wilson, A;Ward, P;Glaziou, P

Background Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer-reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. Design Using the literature and expertise from CJ researchers and policy advisors, a list of important CJ reporting items was suggested and further refined. We then reviewed published CJs within the health literature and used the checklist to assess the comprehensiveness of reporting. Results CJCheck was developed and examined reporting of CJ planning, juror information, procedures and scheduling. We screened 1711 studies and extracted data from 38. No studies fully reported the checklist items. The item most consistently reported was juror numbers (92%, 35/38), while least reported was the availability of expert presentations (5%, 2/38). Recruitment strategies were described in 66% of studies (25/38); however, the frequency and timing of deliberations was inadequately described (29%, 11/38). Conclusions Currently CJ publications in health and health policy literature are inadequately reported, hampering their use in policy making. We propose broadening the CJCheck by creating a reporting standards template in collaboration with international CJ researchers, policy advisors and consumer representatives to ensure standardized, systematic and transparent reporting.
Beyond Chapter 4.7
24 October 2016
University of Sydney

Bandler, Lilon Gretl

Chapter 4.7 of the National Statement on Ethical Conduct in Human Research refers specifically to Aboriginal and Torres Strait Islander Peoples. It lays out the points at which researchers working with Aboriginal and Torres Strait Islanders must consider their approach, and the engagement with individuals, communities or groups who are involved in or affected by their research. History, of Australia and of research involving Aboriginal and Torres Strait Islander Australians, has informed this approach. The response to that history has been a rational, institutionalised, systematic demand for a different perception of what should direct research and research processes to ensure engagement with and service to the community with whom the researchers wish to do the work. This paper considers whether these principles could inform the approach to other research work.
Contextualising professional ethics: the impact of the prison context on the practices and norms of health care practitioners.
31 October 2016
University of Sydney

White, K;Jordens, C;Kerridge, I

Health care is provided in many contexts—not just hospitals, clinics, and community health settings. Different institutional settings may significantly influence the design and delivery of health care and the ethical obligations and practices of health care practitioners working within them. This is particularly true in institutions that are established to constrain freedom, ensure security and authority, and restrict movement and choice. We describe the results of a qualitative study of the experiences of doctors and nurses working within two women’s prisons in the state of New South Wales (NSW), Australia. Their accounts make clear how the provision and ethics of health care may be compromised by the physical design of the prison, the institutional policies and practices restricting movement of prisoners and practitioners, the focus on maintaining control and security, and the very purpose of the prison and prison system itself. The results of this study make clear the impact that context has on professional practice and illustrate the importance of sociology and anthropology to bioethics and to the development of a more nuanced account of professional ethics. Keywords Prisoners, Health care, Human rights, Professional practice, Professional ethics, Nursing ethics
The Travelling Objectivity Norm: Examining the case of the first Chinese journalism handbook
16 November 2016
University of Sydney

Maras, Steven;Nip, Joyce Y. M.

This study investigates the significance of Xu Baohuang’s 1919 textbook Xin wen xue on the articulation of an objectivity norm in the early Republican-era in China. It addresses issues raised by cross-cultural or comparative analysis of journalistic norms. It also considers the need to maintain awareness of differences in the political and journalistic field in Republican-era China. Following Michael Schudson’s 1981 essay “The Objectivity Norm in American Journalism,” our analysis focuses on the articulation of the objectivity norm and looks for unique aspects of norm formation arising out of the Chinese context. As such, we see Xu’s role as more than importing an American norm into China. Rather he codifies and legitimizes a norm that has a distinct relationship to local issues and media practice. We argue that while Xu’s text articulates what can only be considered a nascent ideal, and not a fully matured objectivity norm, his work nevertheless codifies a new sense of news, and also a journalistic commitment to the cultivation of healthy public opinion.
Exploring the second phase of public journalism
17 November 2016
University of Sydney

Nip, Joyce Y. M.

This paper examines the new forms of audience participation in journalism with regard to their possibility in achieving the goals of public journalism.2 A typology of five models of audience connections is proposed: (1) traditional journalism, (2) public journalism, (3) interactive journalism, (4) participatory journalism, and (5) citizen journalism. Identifying the higher goal of public journalism as engaging the people as citizens and helping public deliberation, I argue that the new forms of audience participation could further these goals only by infusing the value from and learning the techniques of public journalism. The concept of community, of public deliberation, past research on the Internet, and data obtained from my field study is drawn upon.
Trade Unions, Forced Labour and Human Trafficking
29 November 2016
University of Sydney

Ford, Michele

This article examines the dilemmas facing trade unions seeking to engage on questions of forced labour and human trafficking. The International Labour Organization and elements of the international trade union movement have succeeded in getting forced labour on the policy agenda globally and within many national settings. However, trade unions have limited capacity to effect real change in relation to these issues because of limitations on their influence, determined largely by membership density and the limited number of sectors in which they are present, but also internal assessments of what constitutes ‘core business’. As a consequence, while trade unions may advocate for legislative or policy change, partner with non-governmental organisations to deal with particular cases, or even engage directly with vulnerable populations, the integration of those populations into the day to day concerns of trade unions necessarily remains elusive—particularly in the global south, where forced labour is most prevalent.
Employment Relations and the State in Southeast Asia
03 January 2017
University of Sydney

Ford, Michele;Gillan, Michael

This article engages critically with the comparative employment relations literature, assessing its capacity to explain and analyse the relationship between state objectives – accumulation, pacification, legitimation – and employment relations. Having engaged with approaches that have influenced the discipline in recent decades, it draws on insights from capitalist Southeast Asia to identify determining factors not accounted for in comparative employment relations models developed from and applied to the Global North. These include the relatively high degree of fluidity in forms of governance characteristic of contexts where there is a dynamic interplay between democratic and authoritarian rule, which challenges the assumption that employment relations are underpinned by a relatively strong, stable and autonomous state. Equally significant is the impact of interstate and international interests and influences, only some of which are economic, on the balance between different state objectives as they pertain to employment relations.
The State, Democratic Transition and Employment Relations in Indonesia
03 January 2017
University of Sydney

Ford, Michele;Sirait, George Martin

Indonesia’s transition since 1998 from authoritarian developmentalism to democracy has had a fundamental effect on employment relations. Although the basic structure of the economy has not changed, the twin processes of democratisation and decentralisation have seen the return of a degree of political space not available in Indonesia since the 1950s. This transformation was underpinned by a shift in the balance between the primary logics of the state that has seen an enhanced emphasis on legitimation. It has reshaped expectations of workplace-level employment relations practice in the country’s small formal sector and of trade unions’ engagement with policy-making and electoral politics. This article traces the processes through which this transformation occurred and analyses both its successes and the ongoing challenges to more robust implementation of the country’s industrial relations framework.
Translating Membership into Power at the Ballot Box? Trade Union Candidates and Worker Voting Patterns in Indonesia’s National Elections
03 January 2017
University of Sydney

Caraway, Teri L.;Ford, Michele;Nugroho, Hari

This article analyses the effectiveness of trade unions’ electoral engagement in the union-dense electoral localities of Bekasi and Tangerang in Indonesia’s 2009 legislative elections. Our analysis reveals that legacies of authoritarianism, electoral rules, and union fragmentation pushed unions to pursue an ineffective electoral strategy of running union cadres on various party tickets. In Bekasi, local leaders within the Federation of Indonesian Metalworkers Unions (FSPMI) chose not to mobilize resources to support union candidates because the union’s national leadership had failed to convince them of the soundness of its strategy. In Tangerang, local leaders embraced the National Workers Union’s (SPN) national electoral strategy, but had inadequate membership data to conduct electoral mapping and did not provide candidates with financial and leadership support. Neither union, meanwhile, gave much consideration to the problem of translating membership to votes: survey data reveal that most members could not name union candidates, and many of those who could did not vote for them. The article argues that, despite its flaws, trade unions’ strategy of engagement in the electoral arena constitutes an important step forward in the consolidation of Indonesia’s democracy.
Learning by Doing: Trade Unions and Electoral Politics in Batam, Indonesia, 2004-2009
03 January 2017
University of Sydney

Ford, Michele

Academic studies of local politics in post-Suharto Indonesia focus on the emergence of coalitions between parties and candidates, arguing that the entrenched and dominant role of political elites has effectively excluded non-elite interests from the electoral arena. The question, then, given the very real and serious obstacles to popular participation, is: what possibility is there for non-elite actors to engage in a meaningful way in electoral politics? One example of an attempt at such engagement can be found in the industrial city of Batam, where the local branch of the Federation of Indonesian Metalworkers Unions set up a purpose-specific structure to promote the political interests of its members in successive local executive and legislative elections. This paper argues that, despite the ultimate failure of the union’s electoral experiments between 2004 and 2009, the process of ‘learning by doing’ embedded in them presents a significant challenge to analyses that discount the possibility of substantive popular participation in electoral politics.
Migrant Worker Organizing in Indonesia
03 January 2017
University of Sydney

Ford, Michele

This article examines attempts by Indonesian migrant labor NGOs, migrant worker organizations and trade unions to promote the labor rights of Indonesian migrant workers employed overseas. In recent years trade unions in Indonesia have increasingly been forced to acknowledge the existence of overseas labor migrants. But NGOs have dominated migrant labor advocacy initiatives, and grassroots migrant labor organizations such as the Indonesian Migrant Workers’ Union (IMWU) have developed independently of existing trade unions. Unions in Indonesia, like unions in other countries of origin, have been only marginally involved in migrant worker issues because of their physical boundedness within the nation-state and their focus on the formal sector. In other words, the fact that unions operate primarily at the national and sub-national scales and the difficulties they have had incorporating workers employed in less structured workplaces, and particularly in the informal sector, limits their capacity to assist or organize citizens employed outside the boundaries of the nation-state. This paper argues that unions must move beyond their traditional structures and spheres of influence in order to address the needs of overseas migrant workers, who represent an increasingly important union constituency in countries such as Indonesia.
Migrant Labor NGOs and Trade Unions: A Partnership in Progress?
03 January 2017
University of Sydney

Ford, Michele

Over the last two decades, the needs and interests of temporary international labor migrants in Southeast Asia have overwhelmingly been the concern of non-governmental organizations (NGOs) rather than trade unions. However, in recent years unions have increasingly been forced to acknowledge that migrant workers are a potentially important trade union constituency. This introduction provides the theoretical framework for a collection of articles which grew out of a project involving academics, trade unionists and migrant labor NGO activists on the extent of union-NGO cooperation on migrant worker issues. It argues that while unions are now much more engaged with both with temporary migrant workers and the NGOs who advocate on their behalf, unions’ approaches towards transnationalism and citizenship (and the concomitant issue of legality) – along with entrenched inter-sectoral divisions and prejudices – continue to limit their preparedness and ability to engage fully with issues concerning temporary labor migration.
Legal Issues Associated with the Study of Sexual Content on the Internet in Australia
04 January 2017
University of Sydney

Lyons, Lenore;Williams, Sophie;Ford, Michele

Scholarly recognition of the research potentials of the Internet has resulted in a growing interest in using computer-mediated communication to study different aspects of human sexuality. Although there is a growing literature on the ethical issues associated with Internet-based research, little attention has been given to the legal issues associated with conducting scholarly research on Internet sexual content. This lacuna stands in contrast to the growing public debate about the legal issues associated with attempts by authorities to restrict adult access to Internet content through filtering services and age-restricted access technologies. These measures appear to be focused on three issues — controlling access to sexually explicit content in order to protect children from accessing sexually inappropriate material; restricting the production and dissemination of child pornography; and addressing national security concerns by blocking content related to the promotion of terrorism and cybercrime. In Australia, critics of laws designed to restrict Internet content focus their discussion on the dangers of censorship and the associated undermining of freedom of speech. But within the scholarly community there has been little concomitant interest in addressing the impact that Australian Commonwealth and State legislation related to Internet content has on academic research.
‘Where Are Your Victims?’
04 January 2017
University of Sydney

Lyons, Lenore;Ford, Michele

The United States has played a key role in international efforts to address trafficking in Indonesia, as elsewhere. In October 2001, the US State Department established an Office to Monitor and Combat Trafficking in Persons, which prepares the annual Trafficking in Persons Report, widely known as the TIP Report. In the reports, countries are divided into three tiers according to their efforts to comply with minimum standards for the elimination of trafficking. Tier One consists of those countries who fully comply with the minimum standards outlined in the US Victims of Trafficking and Violence Protection Act (TVPA); Tier Two of those who do not fully comply but are making efforts to ensure compliance; and Tier Three of those who do not comply and are not making significant efforts to bring themselves into compliance (US Department of State 2000). Countries in Tier Three are subject to sanctions, including the termination of non-humanitarian aid and US opposition to assistance from international financial institutions (Ould 2004: 61). Critics argue that the TIP reports ignore forms of forced labour other than forced sexual labour, gloss over state complicity in trafficking and are vague about numbers of victims, convictions and sentencing rates (Caraway 2006: 298). Concerns have also been expressed about the impact of United States Agency for International Development (USAID) policy regarding the funding of programmes promoting safe sexual practices within brothels, which stipulate that in order to be eligible for US funding non-governmental organizations (NGOs) working in the trafficking field must declare their opposition to prostitution (Ditmore 2005; Weitzer 2007). Organizations that do not take a position on prostitution, as well as those that favour decriminalization or legalization are thus ineligible for funding from the US government.
Developing a Movement? Aid-Based Mediated Diffusion as a Strategy to Promote Labour Activism in post-Tsunami Aceh
05 January 2017
University of Sydney

Ford, Michele;Dibley, Thushara

In this article we examine the extent to which mediated diffusion through trade union development aid succeeded in helping to establish a labour movement in Aceh after the 2004 tsunami. The international labour movement organisations involved in the post-tsunami reconstruction effort in Aceh focused their efforts primarily on humanitarian aid, physical infrastructure and vocational education. However, they also supported trade union-building programs, which succeeded in strengthening individual trade unions and instilling a sense of shared identity amongst Acehnese labour activists but ultimately failed to ensure the sustainability of the movement. We argue that while the Aceh case highlights the importance of local context to the outcomes of such interventions, the constraints imposed on international labour donors and their local counterparts by their focus on reconstruction and the time pressures of the post-tsunami aid cycle raise questions about the efficacy of the aid model as a means of promoting the growth of a social movement.
Experiments in Cross-Scalar Labour Organizing: Reflections on Trade Union-Building Work in Aceh after the 2004 Tsunami
05 January 2017
University of Sydney

Ford, Michele;Dibley, Thushara

As part of the post-tsunami reconstruction effort Aceh, international labour movement organizations “jumped scale” in an attempt to revitalize a moribund local labour movement. This article provides a close analysis of the four internationally sponsored trade union-building projects undertaken as part of that process. This unique intervention sheds light on the crucial role of local context and the extent to which the principles of international solidarity and the pragmatics of trade union diplomacy are mediated through money, institutions, individuals and day-to-day activities. The Aceh case underscores the importance of contingency and the agency of individuals in shaping an international intervention of this kind. In doing so it demonstrates how circuits of labour activism can be affected by constraints and opportunities unrelated to trade union politics or the relations of production.
The Global Union Federations and Temporary Labour Migration in Malaysia
05 January 2017
University of Sydney

Ford, Michele

Since the mid-2000s, the Global Union Federations have played a pivotal role in the reshaping of Malaysian trade unions’ attitudes towards temporary migrant workers, providing the conceptual tools and material resources – and, in many cases, the motivation – required to reach out to this most non-traditional of non-traditional constituencies. This article documents the different approaches taken by a number of Global Union Federations as they seek to apply lessons learnt from the experience of their European affiliates in the Malaysian context. It argues that while Global Union Federation agendas are largely determined by donor and head office priorities, those agendas are mediated, and sometimes transformed, as they are rolled out through the Global Union Federations’ regional offices and to local affiliates in ‘target countries’ like Malaysia. This finding not only has consequences for temporary migrant workers in particular destinations, but also for our understanding of the structures of the international labour movement and the practices of trade union aid.
Temporary Labour Migration and Care Work: The Japanese Experience
05 January 2017
University of Sydney

Ford, Michele;Kawashima, Kumiko

Around the world, advanced industrial societies are facing a demographic time bomb that has enormous implications for the workforce in general, but for workforce planning and industrial relations in the health sector and related industries in particular. Japan, which has traditionally resisted structured forms of labour migration, has responded by establishing labour migration schemes for nurses and other care workers from selected South and Southeast Asian countries. This article examines the responses of different industrial relations actors to the first of these schemes. It begins by describing the opening up of hospitals and residential care facilities to temporary labour migrants from the Philippines and Indonesia, before turning to a discussion of the roles played by trade unions and employers and an evaluation of the outcomes of the programme to date. The article demonstrates the potential pitfalls of trade-driven labour migration schemes and their implications for the sector and the migrant workers concerned.
Vaccines – but not as we know them: An ethical evaluation of HPV vaccination policy in Australia
23 January 2017
University of Sydney

Rae, M;Kerridge, I

Objective: To show how systematic ethical evaluation of public health policy may reveal issues of moral significance for critical examination. Method: Using Australia's human papillomavirus (HPV) vaccination program as an exemplar and adopting an approach outlined elsewhere, we determine whether conditions of effectiveness, proportionality, necessity and least infringement, and public justification, are met such that any breach of autonomy or justice principles associated with this intervention can be defended. Conclusions: While the HPV vaccine itself may be efficacious, some aspects of the program lack sufficient moral justification and raise concerns around procedural and social justice and gender equity. Implications: Public health interventions deploying new technologies against new targets – such as vaccines against cancer and chronic illness – require approaches crafted to their specific risk-benefit profiles that have carefully considered the ethical issues involved. Systematic ethical reflection is a useful tool for this.
Policy Development and Implementation for Disability Services in Rural New South Wales, Australia
06 March 2017
University of Sydney

Dew, Angela;Gallego, Gisselle;Bulkeley, Kim;Veitch, Craig;Brentnall, Jennie;Lincoln, Michelle;Bundy, Anita;Griffiths, Scott

Throughout their lives, all people, including those who have a disability, use a broad range of community services. Community services are important in assisting people with a range of impairments to participate in their communities. Vast geographic distances and a lack of therapists in rural and remote regions of Australia pose significant barriers for implementing policy aimed at supporting people with a disability. The aim of this study was to investigate the extent to which metropolitan-formulated policy encompassed the unique geographic, demographic, and sociocultural challenges experienced by rural therapists and people with a disability in New South Wales (NSW). Twenty-seven policy documents were reviewed and categorized into tier 1 (higher level strategic policies) and tier 2 (specific operational policies). Tier 1 policy documents provided consistent messages about the need to develop strategies and service delivery options to address geographic, cultural, and age-related barriers facing all people in NSW including those who have a disability. Tier 2 documents revealed a lack of attention to the practical differences between implementing the policy principles in metropolitan compared with rural areas. Study findings identify that the implementation of metropolitan-formulated policy does not always encompass the unique challenges experienced by therapists providing services to rural people with a disability and their carers. This study highlights the importance of “rural proofing” policy to consider people who live and work in rural areas.
Decision Making in the Shadow of Death
26 April 2017
University of Sydney

Scanlan, Camilla Louise;Stewart, C;Kerridge, I

It is often assumed that decision-making is a completely rational process. In reality, of course, numerous heuristics and biases influence the way we think and the decisions we make in clinical, research and policy contexts. While Blumenthal-Barby elegantly describes various types of heuristics and biases, and the effect that they may have on one’s autonomy, we suggest that there is insufficient attention given to the heuristics that may be most determinative in medical contexts – hope, and its attendant emotion, fear. Our insights are drawn from an empirical study of the legal and ethical 'limits' of consent in the setting of decision-making around a high risk medical interventions (bone marrow transplantation - BMT) which revealed that every formal element of consent is shaped or transmogrified by a patient’s ‘hope for a future’. In this qualitative study we examined the accounts of patients with haematological malignancies, their loved ones and the health care professionals caring for them regarding the decision to offer, and go through with, BMT - where BMT provided the possibility of ‘cure’ but carried a high risk of death (particularly in the first year post-BMT) and long-term morbidity. While the heuristics described by Blumenthal-Barby were evident in the narratives of all of the participants in this study and undoubtedly impacted upon understanding, intentionality and effective autonomy, what was most striking was the degree to which hope, and its attendant emotion, fear, impacted upon decision-making and overwhelmed all other considerations that may have been relevant to the decision to proceed to BMT.
What factors determine the choice of public engagement undertaken by health technology assessment decision-making organizations?
31 July 2017
University of Sydney

Wortley, S;Street, J;Lipworth, W;Howard, KA;Dickinson, H;Robinson, S

Purpose: Public engagement in health technology assessment (HTA) is increasingly considered crucial for good decision-making. Determining the “right” type of engagement activity is key in achieving the appropriate consideration of public values. Little is known about the factors that determine how HTA organizations decide on their method of public engagement, and there are a number of possible factors that might shape these decisions. This paper seeks to understand the potential drivers of public engagement choice from an organizational perspective. Design/Methodology/: The published HTA literature is reviewed alongside existing frameworks of public engagement in order to elucidate key factors influencing the choice of public engagement process undertaken by HTA organizations. A conceptual framework is then developed to illustrate the factors identified from the literature that appear to influence public engagement choice. Findings: Determining the type of public engagement to be undertaken in HTA is based on multiple factors, some of which are not always explicitly acknowledged. These factors include: perceived complexity of the policymaking issue, perceived impact of the decision, transparency and opportunities for public involvement in governance, as well as time and resource constraints. The influence of these factors varies depending on the context, indicating that a one size fits all approach to public engagement may not be effective. Originality/value: Awareness of the various factors that might influence the type of public engagement undertaken would enable decision-makers to reflect on their choices and be more accountable and transparent about their choice of engagement process in eliciting public values and preferences in a HTA organization.
The Contemporary Significance of the Holocaust for Australian Psychiatry.
14 August 2017
University of Sydney

Robertson, M;Light, E;Lipworth, W;Walter, G

In this paper we survey briefly the components of the Holocaust directly relevant to the psychiatric profession and identify the main themes of relevance to contemporary psychiatry. The euthanasia program, the persecution of lesbian, gay, bisexual, transgender and intersex (LGBTI) citizens and the complex relationship between the psychiatric profession and Nazi state are the main themes to emerge from this survey. We then compare this period with key themes in the history of Australian psychiatry and link these themes to some of the contemporary ethical challenges the profession faces.
Legitimacy of medicines funding in the era of accelerated access
21 September 2017
University of Sydney

Pace, J;Pearson, SA;Lipworth, W

Objectives: In recent years, numerous frameworks have been developed to enhance the legitimacy of health technology assessment processes. Despite efforts to implement these “legitimacy frameworks”, medicines funding decisions can still be perceived as lacking in legitimacy. We therefore sought to examine stakeholder views on factors that they think should be considered when making decisions about the funding of high-cost breast cancer therapies, focusing on those that are not included in current frameworks and processes. Methods: We analyzed published discourse on the funding of high-cost breast-cancer therapies. Relevant materials were identified by searching the databases Google, Google Scholar and Factiva in August 2014 and July 2016 and these were analyzed thematically. Results: We analyzed 50 published materials and found that stakeholders, for the most part, want to be able to access medicines more quickly and at the same time as other patients and for decision-makers to be more flexible with regards to evidence requirements and to use a wider range of criteria when evaluating therapies. Many also advocated for existing process to be accelerated or bypassed in order to improve access to therapies. Conclusions: Our results illustrate that a stakeholder-derived conceptualization of legitimacy emphasizes principles of accelerated access, and is not fully accounted for by existing frameworks and processes aimed at promoting legitimacy. However, further research examining the ethical, political and clinical implications of the stakeholder claims raised here is needed before firm policy recommendations can be made. Keywords pharmaceutical funding decisions; resource allocation; stakeholder engagement; breast cancer; accelerated access
Institutions and Collective Action in Divided Labour Movements: Evidence from Indonesia
12 December 2017
University of Sydney

Caraway, Teri;Ford, Michele

Under what conditions do trade unions in divided labour movements cooperate? Does cooperation in one domain increase the likelihood of cooperation in the other? Do institutions facilitate or discourage cooperation? We explore these questions through an examination of collective action across federation and confederation lines in post-Suharto Indonesia. Using a comparison of union cooperation in the policy and electoral domains, we demonstrate that tripartite wage-setting institutions have played a central role in facilitating collective action in the policy domain, encouraging unions to look beyond shop-level issues to policy issues identified by their respective national organizations as affecting workers. The relative absence of collective action across organizational divides in the electoral domain, meanwhile, can be explained by the institutional context, which creates higher barriers to unions working together.
Australia’s 1996 gun law reforms halted mass shootings for 22 years: a response to criticism from Gary Kleck
21 May 2018
University of Sydney

Chapman, Simon;Alpers, Philip

We reply to criticisms made by prominent anti-gun control researcher Gary Kleck of our widely reported 2016 study on the impact of Australia’s historic 1996 gun law reforms on mass shootings and firearm-related deaths. Thirteen mass fatal shootings in 18 years were followed by 22 years with no such incidents, with the probability of this being a chance occurrence calculated at 1:200,000 against. We concentrate on Kleck’s efforts to repudiate our conclusions by redefining mass shootings; his argument that mass shooters do not maximise the lethal potential of their semi-automatic weapons and so could just as well use (legal) single shot firearms; and that when mass shooters move about in their shooting locations, such events are improperly classified as mass shootings, rather than “sprees”.
Decoding disclosure: Comparing conflict of interest policy among the United States, France, and Australia.
05 June 2018
University of Sydney

Grundy, Q;Habibi, R;Shnier, A;Mayes, C;Lipworth, W

“Sunshine” policy, aimed at making financial ties between health professionals and industry publicly transparent, has recently gone global. Given that transparency is not the sole means of managing conflict of interest, and is unlikely to be effective on its own, it is important to understand why disclosure has emerged as a predominant public policy solution, and what the effects of this focus on transparency might be. We used Carol Bacchi’s problem-questioning approach to policy analysis to compare the Sunshine policies in three different jurisdictions, the United States, France and Australia. We found that transparency had emerged as a solution to several different problems including misuse of tax dollars, patient safety and public trust. Despite these differences in the origins of disclosure policies, all were underpinned by the questionable assumption that informed consumers could address conflicts of interest. We conclude that, while transparency reports have provided an unprecedented opportunity to understand the reach of industry within healthcare, policymakers should build upon these insights and begin to develop policy solutions that address systemic commercial influence.

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