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A postgraduate research opportunity at the University of Otago.


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Academic background
Health Sciences
Host campus
Psychological Medicine (Wellington)
Associate Professor Giles Newton-Howes, Professor John McMillan, Professor Sharon Lawn


Modern medicine is rapidly evolving, with increasingly complex interventions and increasing information as to risks, benefits and consequences. In parallel with this there is a growing understanding of the place of personhood in modern society with increasing emphasis on individual rights and active participation in decision making. This questions the fundamental basis on which doctors engage with patients, how doctors, patients and society (via the courts) adjudicate on their interactions and what actually happens.

Currently the doctor-patient relationship is fundamentally grounded in principlism, the bioethical grounding as described by Beauchamp and Childress[1]. Their four principles approach is appealing to clinicians for multiple reasons; largely it is easily grasped by the busy medical fraternity, simple to operationalise and is reflected by the courts which tend to make judgements that give weight to autonomy and treat competence as the bright line test that determines whether beneficence and non-maleficence should trump. The four principles approach has been dominant in medical ethics for more than five decades and appears to be increasingly unfit for purpose in the modern medical world. Evidence of this can be found both in the amount of defensive practice, the growth of medical indemnity and increasingly legislation against doctors by patients. Paradoxically this may mean patients are harmed by engagements that are more defensive than potentially in the patient's best interests, at least by their own perspective.

This research opportunity aims to examine these issues and problems in greater detail. A close examination of the practical application of principlism, and alternative bioethical models will be followed by a qualitative examination of the theoretical underpinnings by engaged stakeholders: patients, families, doctors, bioethicists and other engaged groups. From this, potential alternatives to principlism will be developed, with an emphasis of a capacity to be operationalised by the medical profession.

1. Beauchamp TL, Childress JF (2001) Principles of biomedical ethics. Oxford university press.


Associate Professor Giles Newton-Howes
Tel +64 4 385 5587

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