AIM: To determine whether the guidance from the New Zealand medical programmes' national consensus statement on obtaining informed consent from patients for sensitive examinations are being met, and to explore medical students' experience of obtaining consent. METHOD: A self-reported, online, anonymous questionnaire was developed. Data were collected in the period just after graduation from final year medical students at The University of Auckland in 2019. RESULTS: The response rate was 35% (93/265). Most students reported that they were "not always compliant" with the national consensus statement for obtaining informed consent for almost all sensitive examinations. The main exception was for the female pelvic examination (not in labour) under anaesthesia, where most students reported being "always compliant". We identified factors related to students, supervisors, institution, and the learning context as reasons for lack of compliance. CONCLUSION: Adherence to the national consensus statement on obtaining informed consent for sensitive examinations is unsatisfactory. The medical programme needs to review the reasons for lapses in implementing the policy in practice, to ensure a safe learning environment for patients and our students.

BACKGROUND:Happiness is a core ingredient of health and well-being, yet relatively little is known about what happiness means for individuals near the end of life, and whether perceptions of happiness change as individuals approach the end of their lives.AIM:The aim of this study was to explore, through interviews, how individuals experiencing hospice care understood and conceptualized happiness.DESIGN:Qualitative interviews with hospice patients were analyzed thematically.SETTING/PARTICIPANTS:Adult patients (n = 20) in a New Zealand hospice who were receiving palliative care and who could give their informed consent were invited by hospice nurse coordinators to an interview.RESULTS:Four themes emerged from analysis of the transcribed interviews. Participants defined happiness most frequently and in most depth in relation to connection with others. They identified being in the present moment, particularly in relation to nature, and that happiness had become less associated with money, status, or possessions. They had an attitude of determination to focus on what mattered now.CONCLUSION:Patients receiving palliative care were generally happy with their lives, appreciated the simpler aspects of life away from the material. There was a common exhortation to young people to avoid focusing too much on acquisition and the internet and to prioritize instead social connection and engagement with the natural world.

Alongside increasing rates of dementia diagnoses worldwide, efforts to seek alternative end-of-life options also increase. While the concept of assisted dying remains controversial, the discussion around its provision for people with dementia raises even more sensitivity. In this study, we explored how the practice of assisted dying for people with dementia is conceptualized and understood using the shared narratives of online contributors. An observational netnography over 20 months was carried out within five open Facebook communities. Thematic analysis was conducted on 1,007 online comments about assisted dying and dementia. Results reflected four central themes and five subthemes: understanding dementia; understanding assisted dying laws; caregivers' feelings; and moral/personal dilemmas. Findings reveal that the majority of communities' contributors fear developing dementia. They support the provision of advance euthanasia directives-written by competent patients-to prevent unnecessary suffering, and protect patients' wishes and freedom of choice when decision-making competency is lost.

Dementia is one of the prominent conditions for which an aging population has been seeking end-of-life solutions such as assisted dying. Individuals with dementia, however, are often unable to meet the eligibility criteria of being mentally competent and are thus discriminated against in relation to assisted dying laws. Provided that the assisted death directive is being made in sound mind, it is still of concern whether these advance directives can be appropriately framed and safeguarded to protect the wish of these vulnerable individuals while preventing harm. Therefore, to establish consensus views of experts on primary issues of, and concerns about, assisted dying for individuals with dementia as well as exploring tentative conceptual framework to safeguard practice and application, a three-round Delphi study was conducted. A core group of 12 experts from five countries was recruited comprising expertise in domains relevant to assisted dying and dementia. A semantic–thematic approach was applied to analyze the 119 generated statements. Evaluation of these research statements resulted in full consensus of 84 (70%) items. Our primary findings highlight seven core domains: applicability of assisted dying for dementia; ethical, practical, and pathological issues regarding the application of assisted dying; and ethical, legal, and professional recommendations for the ways forward. Despite the issues surrounding the provision of assisted death for individuals with dementia, our findings lead us to cautiously conclude that devising “adequate” safeguards is achievable. The result of this research may benefit future research and practice.

The monarch butterflies so abundant around the small pond are slowly disappearing. Tomatoes from the vine that curled its way up the drainage spout are now lined up on the kitchen windowsill to capture the sun's rays. Summer draws to an end as my father's life also draws to a close.As part of my narrative, I have included, in italics, entries from my journal from this time.

Add-on treatments are the new black. They are provided (most frequently, sold) to patients undergoing in vitro fertilization on the premise that they will improve the chances of having a baby. However, the regulation of add-ons is consistently minimal, meaning that they are introduced into routine practice before they have been shown to improve the live birth rate. Debate on the adequacy of this light-touch approach rages. Defenders argue that demands for a rigorous approval process are paternalistic, as this would delay access to promising treatments. Critics respond that promising treatments may turn out to have adverse effects on patients and their offspring, contradicting the clinician's responsibility to do no harm. Some add-ons, including earlier versions of preimplantation genetic testing for aneuploidy, might even reduce the live birth rate, raising the prospect of desperate patients paying more to worsen their chances. Informed consent represents a solution in principle, but in practice there is a clear tension between impartial information and direct-to-consumer advertising. Because the effects of a treatment cannot be known until it has been robustly evaluated, we argue that strong evidence should be required before add-ons are introduced to the clinic. In the meantime, there is an imperative to identify methods for communicating the associated risks and uncertainties of add-ons to prospective patients. (C) 2019 by American Society for Reproductive Medicine.

There is strong evidence that dishonesty occurs amongst medical students, and other allied health students and growing evidence that it occurs amongst medical academics. We believe that accidental dishonesty (or not knowing about the rules of regulations governing academic integrity) is a common attribution describing engagement in dishonesty; however, we believe that dishonest action is more often influenced and determined according to circumstance. In this paper, we aim to work through the literature that frames dishonest action with a focus on medical education, research and publication. We argue that the implications for medical education are far reaching and the root causes of many instances of dishonesty need to be more fully understood so that comprehensive, case-by-case ameliorative strategies can be developed.

The educational advantages of simulation stem from its ability to recreate clinical experience, but in a controlled and systematic way, facilitating guided reflection on experience, and application of new learning to subsequent practice. The degree of realism in immersive simulations can provoke an emotional response in learners—for example challenge, frustration, anxiety, or stress—similar to that seen in the clinical environment.1Fraser K. Ma I. Teteris E. et al.Emotion, cognitive load and learning outcomes during simulation training.Med Educ. 2012; 46: 1055-1062Crossref PubMed Scopus (170) Google Scholar, 2Okuda Y. Bryson E.O. DeMaria Jr., S. et al.The utility of simulation in medical education: what is the evidence?.Mt Sinai J Med. 2009; 76: 330-343Crossref PubMed Scopus (597) Google Scholar This is its strength and its educational power, but also its danger. In this issue of the British Journal of Anaesthesia, Burnett and colleagues3Burnett G. Goldberg A. DeMaria S. et al.Knowledge retention following simulated crisis: does independent practice or simulated mortality matter more?.Br J Anaes. 2019; 123: 81-87Scopus (4) Google Scholar make a welcome addition to our understanding of the theoretical underpinnings of simulation-based education. They explore two different concepts—independent practice and patient mortality as they pertain to learning and knowledge retention in the context of a simulated patient presenting with life-threatening hyperkalaemia. In their study, anaesthesia residents were initially divided into two cohorts: one cohort was supported in the simulation in their decision-making by a senior clinician, and the other practiced independently, taking responsibility for their own decisions with potential for failure. Each of these two cohorts were further divided into two groups: in the first group, if the expected treatment for hyperkalaemia was not provided, the simulation was terminated before manikin death; in the second group, the manikin was allowed to die if the hyperkalaemia was not correctly managed. The authors hypothesised that the potential for mortality would have more impact than independent practice on subsequent performance in a similar scenario of hyperkalaemia. Their results to some extent confirmed their hypothesis. The cohort experiencing both independent practice and potential for mortality did better than other cohorts, with evidence that permitting the death of the manikin was of additional benefit to learning over independent practice alone. The authors acknowledge that this is a small, single-institution study and some caution is required when applying these findings to other training programmes or with other learner groups. Of note, the authors state that the debriefing focused on the diagnosis and treatment of hyperkalaemia, and not learners’ responses to mortality. Although this could have been effective reinforcement of the management of hyperkalaemia, it does raise some questions about the potential unintended consequences of the exercise on the well-being of junior doctors participating in such scenarios. Burnett and colleagues3Burnett G. Goldberg A. DeMaria S. et al.Knowledge retention following simulated crisis: does independent practice or simulated mortality matter more?.Br J Anaes. 2019; 123: 81-87Scopus (4) Google Scholar refer to the contentious debate around the issue of simulated mortality as a learning tool.4Yardley S. Death is not the only harm: psychological fidelity in simulation.Med Educ. 2011; 45 (1062–62)Google Scholar, 5Calhoun A.W. Boone M.C. Miller K.H. et al.Case and commentary: using simulation to address hierarchy issues during medical crises.Simul Healthc. 2013; 8: 13-19Crossref PubMed Scopus (30) Google Scholar The debate, which has been developing over the past 10 yr, hinges on this question: to what extent is it helpful for simulation participants to experience the unexpected ‘death’ of a manikin patient? Advocates for simulation death suggest that it is educationally valuble.4Yardley S. Death is not the only harm: psychological fidelity in simulation.Med Educ. 2011; 45 (1062–62)Google Scholar, 6DeMaria Jr., S. Bryson E.O. Mooney T.J. et al.Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance.Med Educ. 2010; 44: 1006-1015Crossref PubMed Scopus (126) Google Scholar In their study, DeMaria and colleagues6DeMaria Jr., S. Bryson E.O. Mooney T.J. et al.Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance.Med Educ. 2010; 44: 1006-1015Crossref PubMed Scopus (126) Google Scholar showed that emotional stressors in simulation training increased participant anxiety but also enhanced participant performance during simulation; this performance was maintained 6 months later. DeMaria and colleagues6DeMaria Jr., S. Bryson E.O. Mooney T.J. et al.Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance.Med Educ. 2010; 44: 1006-1015Crossref PubMed Scopus (126) Google Scholar therefore interpreted the emotional stressors as ‘educationally advantageous’. The stressors included, for example a distressed actor ‘son’ of a dying manikin patient being present during a cardiac arrest, shouting ‘what's happening to my Dad?’ and crying. In another scenario, a nurse confederate attending the arrest call who ‘repeatedly says: “Oh no, he's going to die!” asks the participant to pronounce the patient dead at the end of the scenario and to talk to the family member who is waiting outside, and at the end of the session, states: “We're all going to get sued!”’ Yardley4Yardley S. Death is not the only harm: psychological fidelity in simulation.Med Educ. 2011; 45 (1062–62)Google Scholar explains that although communication concerning death is challenging, she would not ‘shield’ students from such ‘psychologically realistic’ situations. Yardley4Yardley S. Death is not the only harm: psychological fidelity in simulation.Med Educ. 2011; 45 (1062–62)Google Scholar writes, ‘seeking to protect junior students simply defers the necessity for them to come to terms with [patient death]’. She concludes that the key factor to informing successful learning in manikin death scenarios is an appropriate debriefing. On the other side of this debate are those who see simulation death as potentially causing ‘greater harm than good’.7Bruppacher H.R. Chen R.P. Lachapelle K. First, do no harm: using simulated patient death to enhance learning?.Med Educ. 2011; 45: 317-318Crossref PubMed Scopus (16) Google Scholar, 8Truog R.D. Meyer E.C. Deception and death in medical simulation.Simul Healthc. 2013; 8: 1-3Crossref PubMed Scopus (40) Google Scholar Bruppacher and colleagues7Bruppacher H.R. Chen R.P. Lachapelle K. First, do no harm: using simulated patient death to enhance learning?.Med Educ. 2011; 45: 317-318Crossref PubMed Scopus (16) Google Scholar propose that increasing emotional content of the simulation through manikin death can be educationally and psychologically harmful, the consequences of which may be far reaching and more (negatively) influential than other intended consequences of skill enhancement. Similarly, Truog and colleagues8Truog R.D. Meyer E.C. Deception and death in medical simulation.Simul Healthc. 2013; 8: 1-3Crossref PubMed Scopus (40) Google Scholar criticise Calhoun and colleagues'5Calhoun A.W. Boone M.C. Miller K.H. et al.Case and commentary: using simulation to address hierarchy issues during medical crises.Simul Healthc. 2013; 8: 13-19Crossref PubMed Scopus (30) Google Scholar training whereby if the participants speak up to the clinician in authority the child manikin lives, and if they do not it dies. Truog and colleagues8Truog R.D. Meyer E.C. Deception and death in medical simulation.Simul Healthc. 2013; 8: 1-3Crossref PubMed Scopus (40) Google Scholar warn that such training ‘risk[s] serious psychological consequences for the learners’, who are faced with the question, ‘Am I the kind of person who is unwilling or unable to challenge a respected colleague who I think is making bad medical judgments, even when this may result in serious injury to the patient, or even death?’ Both Calhoun and colleagues' study and the infamous 1960 Milgram experiments9Milgram S. Behavioral study of obedience.J Abnorm Soc Psychol. 1963; 67: 371-378Crossref PubMed Scopus (2536) Google Scholar prove that many of us are that kind of person. Truog and colleagues8Truog R.D. Meyer E.C. Deception and death in medical simulation.Simul Healthc. 2013; 8: 1-3Crossref PubMed Scopus (40) Google Scholar suggest that realising this—during an intense simulation—is disturbing for learners. If such realisation is coupled with shame or humiliation the risk is even greater. Kardong-Edgren10Kardong-Edgren S. Thoughts on the evolution of unexpected death in simulation.Clin Simul Nurs. 2015; 11: 317Abstract Full Text Full Text PDF Scopus (2) Google Scholar tells of her colleagues' past ‘cavalier thinking’ in some of the things said to learners in the simulated environment: ‘too bad you killed the patient … let's do it again and maybe you will figure it out this time.’ The ethical justification underpinning simulation-based education stems from professional obligations to ensure that healthcare professionals are appropriately skilled to diagnose and treat actual patients. Training institutions are ethically obliged to provide clinical students and junior doctors with a safe, controlled training environment in which to learn clinical skills, including challenges in ethical decision-making. Simulation-based learning supports the development of knowledge, skills, and attitudes, whilst protecting patients from unnecessary risk11Lateef F. Simulation-based learning: just like the real thing.J Emerg Trauma Shock. 2010; 3: 348-352Crossref PubMed Scopus (362) Google Scholar; better that the simulated patient dies than a real patient! However, if the simulation environment is not managed well and the patient dies unexpectedly, there may be adverse consequences for participants. Doctors' accounts of the stress of memorable patient deaths12Boisvert N. My first patient, my first death: the doctor weighs in.2017https://thedoctorweighsin.com/my-first/Date accessed: January 8, 2019Google Scholar, 13Rhodes-Kropf J. Carmody S.S. Seltzer D. et al.“This is just too awful; I just can’t believe I experienced that…”: medical students’ reactions to their “most memorable” patient death.Acad Med. 2005; 80: 634-640Crossref PubMed Scopus (117) Google Scholar, 14Shorter M. Stayt L.C. Critical care nurses’ experiences of grief in an adult intensive care unit.J Adv Nurs. 2010; 66: 159-167Crossref PubMed Scopus (66) Google Scholar and terminally ill patients15Paice E. Rutter H. Wetherell M. et al.Stressful incidents, stress and coping strategies in the pre-registration house officer year.Med Educ. 2002; 36: 56-65Crossref PubMed Scopus (93) Google Scholar are compelling. In one study16Whitehead P.R. The lived experience of physicians dealing with patient death.BMJ Support Palliat Care. 2014; 4: 271-276Crossref PubMed Scopus (26) Google Scholar a doctor recalled, ‘this unbelievable image of a 21-year-old guy who'd been in a car accident … This was 20 years ago, and it's still one of the most vivid experiences that stays with me’. Kardong-Edgren10Kardong-Edgren S. Thoughts on the evolution of unexpected death in simulation.Clin Simul Nurs. 2015; 11: 317Abstract Full Text Full Text PDF Scopus (2) Google Scholar suggests that greater awareness about how unexpected death scenarios impact upon learners is an important evolution in simulation education. Memorable patient deaths occurring early in a doctor's career can have significant impacts on career choices.16Whitehead P.R. The lived experience of physicians dealing with patient death.BMJ Support Palliat Care. 2014; 4: 271-276Crossref PubMed Scopus (26) Google Scholar Evidence suggests that these early experiences carry a clarity and intensity reminiscent of traumatic memories.16Whitehead P.R. The lived experience of physicians dealing with patient death.BMJ Support Palliat Care. 2014; 4: 271-276Crossref PubMed Scopus (26) Google Scholar Internationally, we are facing a crisis of physician burnout.17West C.P. Dyrbye L.N. Shanafelt T.D. Physician burnout: contributors, consequences and solutions.J Intern Med. 2018; 283: 516-529Crossref PubMed Scopus (858) Google Scholar, 18West C.P. Dyrbye L.N. Erwin P.J. Shanafelt T.D. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis.Lancet. 2016; 388: 2272-2281Abstract Full Text Full Text PDF PubMed Scopus (1047) Google Scholar With this in mind, we suggest that although simulated mortality exercises can provide a safe environment for trainees learning how to manage death scenarios, they need to be well managed with appropriate care for participants. It may be beneficial to draw on the expertise of palliative care physicians in dealing with the death of a simulated patient.16Whitehead P.R. The lived experience of physicians dealing with patient death.BMJ Support Palliat Care. 2014; 4: 271-276Crossref PubMed Scopus (26) Google Scholar Additionally, we are suggesting that emotion is a significant influence on learning19Kolb D.A. Experiential learning: experience as the source of learning and development. Prentice-Hall, Englewood Cliffs, NJ1984Google Scholar, 20Heron J. Cooperative inquiry: research into the human condition. Sage, Thousand Oaks, CA1996Google Scholar, 21Yorks L. Kasl E. Toward a theory and practice for whole-person learning: reconceptualizing experience and the role of affect.Adult Educ Q. 2002; 52: 176-192Google Scholar and therefore effective simulation debriefing should include an affective learning paradigm. In order to promote effective learning in and through emotionally charged simulations, those running simulations might do well to embed into debriefs the theoretical positioning of Kolb19Kolb D.A. Experiential learning: experience as the source of learning and development. Prentice-Hall, Englewood Cliffs, NJ1984Google Scholar (i.e. emotion and intellectual thought transforms experience into meaning and a positive learning experience) and Yorks and Kasl21Yorks L. Kasl E. Toward a theory and practice for whole-person learning: reconceptualizing experience and the role of affect.Adult Educ Q. 2002; 52: 176-192Google Scholar (i.e. ‘learning-within-relationship’ informs affective learning, emphasising the importance of relationship and empathy in co-creating meaning from the diverse perspectives within a group). In short, we should approach simulator death with care. A scenario specifically designed to increase skills in end-of-life decision-making, and managing expected death seems to have clear benefits for medical students and junior doctors. However, unexpected or avoidable death, both in the clinical environment and in a realistic simulated clinical scenario, is different, potentially raising feelings of guilt, shame, inadequacy, and terror at the prospect of being responsible for a future patient's death. Although the evidence supporting a simulated, unexpected death as a way to enhance learning in post-graduate learners is inconclusive, it is uncontentious to argue that good ethical management of such sessions ought to include careful consideration of the emotional impact on learners, careful planning and debriefing, and follow-up of students to identify negative consequences. In particular, we would urge those running simulations to ensure that debriefs include attention to the emotional content of such scenarios. Without a better understanding of the immediate and longer-term impact of unexpected simulator death on students and junior doctors, we consider it premature to recommend it as an educational strategy. Writing paper: all authors. JW is a member of the editorial board of the British Journal of Anaesthesia. TJ and PM have no conflicts of interest to declare. Knowledge retention after simulated crisis: importance of independent practice and simulated mortalityBritish Journal of AnaesthesiaVol. 123Issue 1PreviewSimulation is an important component of postgraduate medical education, but optimal parameters for simulation are not known. Managing simulations independently and allowing simulated morbidity and mortality have been shown to improve follow-up performance in simulation. We hypothesised that allowing simulated mortality improves performance in follow-up simulations more than independent practice. Full-Text PDF Open ArchiveResponse to ‘Learning from death’ (Br J Anaesth 2019;123: 12–14)British Journal of AnaesthesiaVol. 123Issue 5PreviewEditor—The recent editorial by Jowsey and colleagues1 on simulated death brought back a painful memory that I thought I had long overcome. Full-Text PDF Open Archive

AIM We set out to explore the question, what ethical challenges do medical students identify when asked to perform or observe a sensitive examination, given a historical background relevant to this context. METHOD Thematic analysis of 21 Ethics Reports from 9 female and 12 male students. RESULTS Overall 14 students undertook a sensitive examination without the patient's consent; three did not carry out a sensitive examination because of a lack of consent; and two students (or their senior colleagues) gained the patient's written consent for the student to undertake the examination. One patient refused the student's request for consent to perform a digital rectal examination; and in the final case, verbal consent was given by the patient for the student to observe a bimanual examination only. Three interrelated core themes arose from thematic analysis of the research question: systemic constraints on getting consent; internal conflicts of interest; and, power and hierarchy. CONCLUSIONS A number of senior medical students at our institution disclosed observing or performing sensitive examinations on patients without the patients' knowledge or consent.

Aims: This study investigated New Zealand nurses' views on legalising assisted dying across a range of clinical conditions, nurses' willingness to engage in legal assisted dying, potential deterrents and enablers to such engagement, and nurses' perceptions of the proper role of their professional bodies in relation to legalising assisted dying. Background: A Bill for legalising assisted dying is currently before the New Zealand parliament. Of the 16 jurisdictions where assisted dying has been specifically legislated, only the Canadian federal statute provides nurses with explicit legal protection for their performance of assisted dying-related tasks. An absence of policy development and planning for safe nursing practice prior to legalisation of assisted dying results in a gap in professional support and guidance. Design: Exploratory cross-sectional survey. Respondents: A self-selected sample of 475 New Zealand nurses responded to an anonymous online survey disseminated through the newsletters and websites of relevant medical and nursing professional bodies. A sub sample of nurses who expressed support for or ambivalence about legalisation (n = 356): rated their level of support for legalising assisted dying in New Zealand across a range of medical conditions, and their willingness to participate in a range of assisted dying tasks; identified barriers and facilitators to potential participation; and assessed the responsibility of the professional bodies to provide practice supports. Method: Mixed-method approach using descriptive analysis of quantitative data; qualitative data were analysed thematically. Results: Nurses supported legalisation at a rate (67%) significantly greater than that of doctors (37%) and for a diverse range of medical conditions. Most supporting nurses were willing to engage in the full range of relevant assisted dying roles. They identified several practical and ethical supports as essential to safe engagement, in particular practice guidelines, specific training, legal protections, clinical supervision and mentoring, and independent review of assisted dying service provision. They saw the facilitation of these supports as primarily the responsibility of their professional bodies. Implications for policy: Nursing bodies should proactively facilitate workforce awareness and development of assisted dying policy and practice supports in anticipation of legalisation. This can be done through information campaigns and by adapting assisted dying policy, practice materials and systems already developed internationally. Nursing bodies need to engage in formulating legislation to ensure inclusion of explicit protections for participating nurses and to delegate relevant responsibilities to regulatory bodies.

BACKGROUND:Compassion is a core virtue in medicine and lies at the heart of good medical care. It connects us to each other and reflects our need for relationships with others.AIM:Our aim is to explore how palliative care patients perceive, understand and experience compassion from health professionals, and to inform clinical practice.METHODS:Seven hospice managers in the North Island of New Zealand were contacted and invited to join the study. Twenty participants expressed a desire to participate and were involved in semi-structured face-to-face interviews. A set of questions guided the interviewers with interviews lasting between 15-60 minutes.RESULTS:In regards to the question, what is your understanding of compassion?, four central themes emerged: connection, presence and warmth, respect and caring. When asked, what advice can you give to trainee health professionals?, participants articulated four themes: connecting with patients and talking in a way they can understand, treating the person with respect, showing interest in them and being a positive presence for them.CONCLUSIONS:Compassion was seen as a connection between the carer and the patient. Compassion is having a positive presence and warmth; an attitude of respect and caring. The main advice given by research participants to enhance compassion is for doctors and nurses to connect, to talk in a way that can be understood, and show interest and respect to patients facing the end of their lives.

This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand's medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the "professionalism" and "professional development" in medical curricula.

ABSTRACT Background: People with dementia receive worse end of life care compared to those with cancer. Barriers to undertaking advanced care planning (ACP) in people with dementia include the uncertainty about their capacity to engage in such discussions. The primary aim of this study was to compare the Advance Care Planning–Capacity Assessment Vignette tool (ACP–CAV) with a semi-structured interview adapted from the MacArthur Competence Assessment Tool-Treatment (MacCAT-T). The secondary aim was to identify demographic and cognitive functioning variables that may predict whether a person has capacity to discuss ACP. Methods: 32 older people (mean age = 84.1) with a Mini-Mental State Examination of 24 or above were recruited from two retirement villages in Auckland. Participants also completed Trail Making Test Part A & Part B and Geriatric Depression Scale (GDS-15) before undertaking the two capacity assessments that were video recorded to enable further analysis by four independent old age psychiatrists. Results: Using the MacCAT-T as the gold standard, over half (53.1%) of the participants were considered as lacking in capacity to engage in ACP. Participants struggled with the “Understanding ACP” domain the most. Capacity was not predictable by any of the demographic or cognitive functioning variables. When compared to the gold standard, ACP–CAV was accurate in assessing capacity in 68.8% of the cases. Conclusion: Clinicians should routinely explain ACP to older people and ensure they fully understand it prior to an ACP discussion. If there is any concern about their understanding, further exploration and documentation of their capacity using the capacity assessment framework would be necessary. However, capacity assessment is a complex iterative process that does not easily lend itself to screening methodology and requires a high level of clinical judgment.

During an initial palliative care assessment, a dying man discloses that he had killed several people whilst a young man. The junior doctor, to whom he revealed his story, consulted with senior palliative care colleagues. It was agreed that legal advice would be sought on the issue of breaching the man’s confidentiality. Two legal opinions conflicted with each other. A decision was made by the clinical team not to inform the police. In this article the junior doctor, the palliative medicine specialist, a medical ethicist, and a lawyer consider the case from their various perspectives.

In this viewpoint article we consider the situation of organ procurement from China, and address some of the ethical aspects arising for health professionals when New Zealand transplant patients contemplate traveling to China for an organ. We also consider some of the challenges facing health professionals involved in providing care to such patients.

This article was migrated. The article was marked as recommended. Over the past 50 years, advances in medical technology have revolutionised the medical landscape. The ways in which patients, their families, and health professionals connect and interact together in the medical endeavour have also changed. At the same time as advances in medical technology resulted in tremendous gains for society, criticism began emerging that the patient as a whole person had been overshadowed by the disease the person had. The interface of medicine and the humanities concerns itself with our relationships with others, the ways in which we confront challenges to our mortality, how we understand human behaviour, and the meanings we give to situations within the medical context. In this paper we outline the genesis of a medical humanities programme at the University of Auckland, and how the programme has advanced over the past twenty years. The programme promotes important social aspects of medicine such as cultural competence and person-centred engaged care. It also encourages students to improve their academic and reflective writing skills. We discuss how one course within the programme promotes student cultural awareness of - and responsiveness to - Maori people and Deaf people. Specific attention is paid to current leading pedagogy, as well as how the use of space and language contribute to student learning. We conclude that medical humanities remains an essential and valued element in medical curricula.

AIMS To develop a policy governing the taking and sharing of photographic and radiological images by medical students. METHODS The Rules of the Health Information Privacy Code 1994 and the Code of Health and Disability Services Consumers' Rights were applied to the taking, storing and sharing of photographic and radiological images by medical students. Stakeholders, including clinicians, medical students, lawyers at district health boards in the Auckland region, the Office of the Privacy Commissioner and the Health and Disability Commissioner were consulted and their recommendations incorporated. RESULTS The policy 'Taking and Sharing Images of Patients' sets expectations of students in relation to: photographs taken for the purpose of providing care; photographs taken for educational or professional practice purposes and photographic or radiological images used for educational or professional practice purposes. In addition, it prohibits students from uploading images of patients onto image-sharing apps such as Figure 1. The policy has since been extended to apply to all students at the Faculty of Medical and Health Sciences at the University of Auckland. CONCLUSIONS Technology-driven evolutions in practice necessitate regular review to ensure compliance with existing legal regulations and ethical frameworks. This policy offers a starting point for healthcare providers to review their own policies and practice, with a view to ensuring that patients' trust in the treatment that their health information receives is upheld.