This thesis was scanned from the print manuscript for digital preservation and is copyright the a... more This thesis was scanned from the print manuscript for digital preservation and is copyright the author. Researchers can access this thesis by asking their local university, institution or public library to make a request on their behalf. Monash staff and postgraduate students can use the link in the Reference field.
This is a welcome and timely collection. Just before starting on this review I came across a quot... more This is a welcome and timely collection. Just before starting on this review I came across a quote advertising an event on childhood attachment stating that how people respond to the emotional need...
The introduction of new technologies in medical treatment has led to innovation in medical device... more The introduction of new technologies in medical treatment has led to innovation in medical devices that are highly technical in their application and operation. The medical technology landscape is changeable and healthcare providers often turn to the medical device representatives (MDRs), employed by device manufacturers to help navigate the shifts and uncertainties. While the relationship between MDRs and healthcare providers can be a positive one focusing on appropriate use, selection and safety of devices, it is one that has evolved over time and is not independently regulated. In addition, patients, for the most part, are usually unaware of the involvement of MDRs in their healthcare. It is this knowledge gap with regard to the role of MDRs that is the focus of this paper. We argue that trust is at the heart of healthcare relationships and explore the nature of trust alongside the models of regulation of the medical device industry. We argue that MDRs may currently present a thr...
With over 75 uterus transplants performed, and reported live births from the procedure now number... more With over 75 uterus transplants performed, and reported live births from the procedure now numbering 25 worldwide, 1 ethical evaluation of this newest and most radical form of assisted reproduction has begun to extend beyond the initial focus on patient safety, efficacy, and informed consent. Bioethical analysis is expanding to questions of resource allocation and prioritization as well as to other-broader-social and moral concerns, such as those about the nature and source of demand for uterus transplantation (UTx), and the wider impacts of its provision. 2 Such broadening and deepening 1 Accurate figures are difficult to obtain at any given time owing to delays between births and reporting. But the current publicly reported figure is 25 live births (including five from deceased donors). See Hammond-Browning, N. (2021) Deceased donation uterus transplantation: A review.
It has been suggested that there is a troubling antagonism between the potential goods afforded f... more It has been suggested that there is a troubling antagonism between the potential goods afforded for parents in the parent-child relationship, and the goods of childhood. Indeed, the problem appears deep: on one way of framing it the problem is not merely that realisation of the goods of parenting for parents is incompatible with realisation of the goods of childhood for children; it is that realisation of the parental goods of parenting is dependent on precisely what it is that makes childhood bad for children, namely their dependency and vulnerability. In this paper I consider this supposed 'vulnerability paradox', as I will refer to it. I argue for a re-assessment and revaluation of the vulnerability in the parent-child relationship by developing an account of the crucial role that vulnerability plays in underpinning and facilitating what is a corebut as yet unrecognisedgood of that relationship for both parents and children: namely what I call the good of 'mutual reflexive co-constitution' that the relationship enables.
In the fast-expanding literature on the ethics of uterus transplantation (UTx) close consideratio... more In the fast-expanding literature on the ethics of uterus transplantation (UTx) close consideration of key features of the socio-moral context in which it will be offered, and of the alternatives to it, remains underdeveloped. In this paper, I address that deficit by challenging current assumptions about what constitutes an alternative to UTx, and by directing attention to certain weighty moral imperatives relating to the procreative context in which UTx is offered. I argue that these moral imperatives are currently neglected to an unacceptable extent. My focus is specifically on the adoption alternative, since I regard that to be the most readily dismissed UTx alternative, and since I believe it is in relation to adoption, rather than gestational surrogacy, that the most pressing unmet needs exist and therefore the most important reforms are called for. My argument rests on two core suppositions. The first is that injustice occurs when persons are denied something to which they are morally entitled. The second is that significant moral needs establish entitlement in a way that preferences and desires, however deeply socially embedded and legitimized, do not. My predominant focus on adoption rather than gestational surrogacy may be queried and warrants justification at the outset. 1 It might be argued that gestational surrogacy is surely the most salient UTx alternative, given that it secures biological relatedness to one or both commissioning parents (depending on whether third-party donor gametes are used) in a way that adoption cannot; and given also that it is a significantly less resource-and risk-intensive mode of procreation than UTx. Why, then, do I set it aside in favour of adoption reform as the strongest imperative? My reason for doing so is threefold. First, surrogacy is a highly ethically contested procreative practice. Depending on the type of surrogacy under consideration-commercial or altruistic-significant and vexed ethical questions arise regarding women's consent and autonomy as well as potential commodification and 1 Thanks to an anonymous referee of this journal for prompting me to make clearer my reasons for not advocating gestational surrogacy as the most salient UTx alternative.
Increasing philosophical attention has recently focused on questions of the nature of vulnerabili... more Increasing philosophical attention has recently focused on questions of the nature of vulnerability, and of the implications of recognizing and responding to vulnerability in human agents and subjects. Within that field of interest, explorations and analyses of the specific vulnerability of children have raised many interesting questions regarding the nature of childhood and the vulnerability-responsive obligations of parents. By contrast, there has been no philosophical recognition or discussion of parental vulnerability within the parent-child relationship. In this paper I seek to address that theoretical gap, exploring the distinct ways in which parents are vulnerable qua parents, as well as some of the normative implications that follow from a recognition of that vulnerability. These implications include claims of a vulnerability-based foundation for extensive parental authority over children, and the significant role of expanded social structures and mechanisms to more adequately support the parenting of our children.
Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and int... more Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and intentionally impose conditions of vulnerability on others; and sometimes we knowingly and intentionally enter into and assume conditions of vulnerability for ourselves (for example, when we decide to trust or forgive, enter into intimate relationships with others, become a parent, become a subject of medical or psychotherapeutic treatment, and the like). In this article, I propose a presently overlooked basis on which one might evaluate whether the imposition or assumption of vulnerability is acceptable, and on which one might ground a significant class of vulnerability-related obligations. Distinct from existing accounts of the importance of promoting autonomy in conditions of vulnerability, this article offers a preliminary exploration of the nature, role, and importance of resilience promotion, its relationship to autonomy promotion, and its prospects for improving human wellbeing in autonomy inhibiting conditions.
Dominant constructions of professionalism in early childhood education can diminish early childho... more Dominant constructions of professionalism in early childhood education can diminish early childhood teachers' and educators' undertaking of advocacy at the systems or political level. In this paper, we propose an ethically grounded construction of professionalism that provides space for professional practice to move beyond the classroom and into the political sphere. Findings from interviews with four early childhood teachers from Australia who undertake systems advocacy as part of their professional practice show that this work is driven by ethical influences that extend beyond the rulebased imperative, in ethical codes, that teachers should undertake systems advocacy. Findings highlight the value of considering systems advocacy as practice that emerges from an interplay of three theoretical foundations of ethics: deontology, utilitarianism and virtue ethics. Implications for teacher professionalism and the building of a teacher disposition that incorporates systems advocacy are considered.
Objectives: This article presents an original definition of surgical innovation and a practical t... more Objectives: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. Background: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. Methods: Using conceptual analysis, this article synthesizes findings from relevant literature, and from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. Results: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation (newness and degree of change), is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new." Conclusions: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations.
Human uterus transplantation (UTx) is currently under investigation as a treatment for uterine in... more Human uterus transplantation (UTx) is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies (ART) and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such as face and limb grafts, and shares some of the ethical concerns raised by these non-life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx.
Successful innovative 'leaps' in surgical technique have the potential to contribute exponentiall... more Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes earlystage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations-of planning, regulation, monitoring, reporting, and publication-associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.
This thesis was scanned from the print manuscript for digital preservation and is copyright the a... more This thesis was scanned from the print manuscript for digital preservation and is copyright the author. Researchers can access this thesis by asking their local university, institution or public library to make a request on their behalf. Monash staff and postgraduate students can use the link in the Reference field.
This is a welcome and timely collection. Just before starting on this review I came across a quot... more This is a welcome and timely collection. Just before starting on this review I came across a quote advertising an event on childhood attachment stating that how people respond to the emotional need...
The introduction of new technologies in medical treatment has led to innovation in medical device... more The introduction of new technologies in medical treatment has led to innovation in medical devices that are highly technical in their application and operation. The medical technology landscape is changeable and healthcare providers often turn to the medical device representatives (MDRs), employed by device manufacturers to help navigate the shifts and uncertainties. While the relationship between MDRs and healthcare providers can be a positive one focusing on appropriate use, selection and safety of devices, it is one that has evolved over time and is not independently regulated. In addition, patients, for the most part, are usually unaware of the involvement of MDRs in their healthcare. It is this knowledge gap with regard to the role of MDRs that is the focus of this paper. We argue that trust is at the heart of healthcare relationships and explore the nature of trust alongside the models of regulation of the medical device industry. We argue that MDRs may currently present a thr...
With over 75 uterus transplants performed, and reported live births from the procedure now number... more With over 75 uterus transplants performed, and reported live births from the procedure now numbering 25 worldwide, 1 ethical evaluation of this newest and most radical form of assisted reproduction has begun to extend beyond the initial focus on patient safety, efficacy, and informed consent. Bioethical analysis is expanding to questions of resource allocation and prioritization as well as to other-broader-social and moral concerns, such as those about the nature and source of demand for uterus transplantation (UTx), and the wider impacts of its provision. 2 Such broadening and deepening 1 Accurate figures are difficult to obtain at any given time owing to delays between births and reporting. But the current publicly reported figure is 25 live births (including five from deceased donors). See Hammond-Browning, N. (2021) Deceased donation uterus transplantation: A review.
It has been suggested that there is a troubling antagonism between the potential goods afforded f... more It has been suggested that there is a troubling antagonism between the potential goods afforded for parents in the parent-child relationship, and the goods of childhood. Indeed, the problem appears deep: on one way of framing it the problem is not merely that realisation of the goods of parenting for parents is incompatible with realisation of the goods of childhood for children; it is that realisation of the parental goods of parenting is dependent on precisely what it is that makes childhood bad for children, namely their dependency and vulnerability. In this paper I consider this supposed 'vulnerability paradox', as I will refer to it. I argue for a re-assessment and revaluation of the vulnerability in the parent-child relationship by developing an account of the crucial role that vulnerability plays in underpinning and facilitating what is a corebut as yet unrecognisedgood of that relationship for both parents and children: namely what I call the good of 'mutual reflexive co-constitution' that the relationship enables.
In the fast-expanding literature on the ethics of uterus transplantation (UTx) close consideratio... more In the fast-expanding literature on the ethics of uterus transplantation (UTx) close consideration of key features of the socio-moral context in which it will be offered, and of the alternatives to it, remains underdeveloped. In this paper, I address that deficit by challenging current assumptions about what constitutes an alternative to UTx, and by directing attention to certain weighty moral imperatives relating to the procreative context in which UTx is offered. I argue that these moral imperatives are currently neglected to an unacceptable extent. My focus is specifically on the adoption alternative, since I regard that to be the most readily dismissed UTx alternative, and since I believe it is in relation to adoption, rather than gestational surrogacy, that the most pressing unmet needs exist and therefore the most important reforms are called for. My argument rests on two core suppositions. The first is that injustice occurs when persons are denied something to which they are morally entitled. The second is that significant moral needs establish entitlement in a way that preferences and desires, however deeply socially embedded and legitimized, do not. My predominant focus on adoption rather than gestational surrogacy may be queried and warrants justification at the outset. 1 It might be argued that gestational surrogacy is surely the most salient UTx alternative, given that it secures biological relatedness to one or both commissioning parents (depending on whether third-party donor gametes are used) in a way that adoption cannot; and given also that it is a significantly less resource-and risk-intensive mode of procreation than UTx. Why, then, do I set it aside in favour of adoption reform as the strongest imperative? My reason for doing so is threefold. First, surrogacy is a highly ethically contested procreative practice. Depending on the type of surrogacy under consideration-commercial or altruistic-significant and vexed ethical questions arise regarding women's consent and autonomy as well as potential commodification and 1 Thanks to an anonymous referee of this journal for prompting me to make clearer my reasons for not advocating gestational surrogacy as the most salient UTx alternative.
Increasing philosophical attention has recently focused on questions of the nature of vulnerabili... more Increasing philosophical attention has recently focused on questions of the nature of vulnerability, and of the implications of recognizing and responding to vulnerability in human agents and subjects. Within that field of interest, explorations and analyses of the specific vulnerability of children have raised many interesting questions regarding the nature of childhood and the vulnerability-responsive obligations of parents. By contrast, there has been no philosophical recognition or discussion of parental vulnerability within the parent-child relationship. In this paper I seek to address that theoretical gap, exploring the distinct ways in which parents are vulnerable qua parents, as well as some of the normative implications that follow from a recognition of that vulnerability. These implications include claims of a vulnerability-based foundation for extensive parental authority over children, and the significant role of expanded social structures and mechanisms to more adequately support the parenting of our children.
Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and int... more Not all forms of human fragility or vulnerability are unavoidable. Sometimes we knowingly and intentionally impose conditions of vulnerability on others; and sometimes we knowingly and intentionally enter into and assume conditions of vulnerability for ourselves (for example, when we decide to trust or forgive, enter into intimate relationships with others, become a parent, become a subject of medical or psychotherapeutic treatment, and the like). In this article, I propose a presently overlooked basis on which one might evaluate whether the imposition or assumption of vulnerability is acceptable, and on which one might ground a significant class of vulnerability-related obligations. Distinct from existing accounts of the importance of promoting autonomy in conditions of vulnerability, this article offers a preliminary exploration of the nature, role, and importance of resilience promotion, its relationship to autonomy promotion, and its prospects for improving human wellbeing in autonomy inhibiting conditions.
Dominant constructions of professionalism in early childhood education can diminish early childho... more Dominant constructions of professionalism in early childhood education can diminish early childhood teachers' and educators' undertaking of advocacy at the systems or political level. In this paper, we propose an ethically grounded construction of professionalism that provides space for professional practice to move beyond the classroom and into the political sphere. Findings from interviews with four early childhood teachers from Australia who undertake systems advocacy as part of their professional practice show that this work is driven by ethical influences that extend beyond the rulebased imperative, in ethical codes, that teachers should undertake systems advocacy. Findings highlight the value of considering systems advocacy as practice that emerges from an interplay of three theoretical foundations of ethics: deontology, utilitarianism and virtue ethics. Implications for teacher professionalism and the building of a teacher disposition that incorporates systems advocacy are considered.
Objectives: This article presents an original definition of surgical innovation and a practical t... more Objectives: This article presents an original definition of surgical innovation and a practical tool for identifying planned innovations. These will support the responsible introduction of surgical innovations. Background: Frameworks developed for the safer introduction of surgical innovations rely upon identifying cases of innovation; oversight cannot occur unless innovations are identified. However, there is no consensus among surgeons about which interventions they consider innovative; existing definitions are vague and impractical. Methods: Using conceptual analysis, this article synthesizes findings from relevant literature, and from qualitative research with surgeons, to develop an original definition of surgical innovation and a tool for prospectively identifying planned surgical innovations. The tool has been developed in light of feedback from health care professionals, surgeons, and policy makers. Results: This definition of innovation distinguishes between variations, introduction of established interventions, and innovations in surgical techniques or use of devices. It can be applied easily and consistently, is sensitive to the key features of innovation (newness and degree of change), is prospective, and focuses on features relevant to safety and evaluation. The accompanying tool is deliberately broad so that appropriate supports may, if necessary, be provided each time that a surgeon does something "new." Conclusions: The definition presented in this article overcomes a number of practical challenges. The definition and tool will be of value in supporting responsible surgical innovation, in particular, through the prospective identification of planned innovations.
Human uterus transplantation (UTx) is currently under investigation as a treatment for uterine in... more Human uterus transplantation (UTx) is currently under investigation as a treatment for uterine infertility. Without a uterus transplant, the options available to women with uterine infertility are adoption or surrogacy; only the latter has the potential for a genetically related child. UTx will offer recipients the chance of having their own pregnancy. This procedure occurs at the intersection of two ethically contentious areas: assisted reproductive technologies (ART) and organ transplantation. In relation to organ transplantation, UTx lies with composite tissue transplants such as face and limb grafts, and shares some of the ethical concerns raised by these non-life saving procedures. In relation to ART, UTx represents one more avenue by which a woman may seek to meet her reproductive goals, and as with other ART procedures, raises questions about the limits of reproductive autonomy. This paper explores the ethical issues raised by UTx with a focus on the potential gap between women's desires and aspirations about pregnancy and the likely functional outcomes of successful UTx.
Successful innovative 'leaps' in surgical technique have the potential to contribute exponentiall... more Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes earlystage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations-of planning, regulation, monitoring, reporting, and publication-associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.
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Papers by Mianna Lotz