Jeanne Snelling

The practice of surrogacy in New Zealand

Commercial surrogacy is prohibited in New Zealand by the Human Assisted Reproductive Technology Act 2004 (HART Act). However, altruistic clinic‐assisted surrogacy is permitted. Couples wishing to attempt altruistic surrogacy must apply for approval to a statutorily appointed ethics committee. One of seven principles that underpin the HART Act stipulates that the needs, values and beliefs of Maori (NZs indigenous population) should be considered and treated with respect.

Embryonic HLA Tissue Typing and Made-To-Match Siblings: The New Zealand Position

In the absence of an HLA-identical donor, the parents of a seriously ill child in need of a haematopoietic stem cell (HSC) transplant may wish to conceive another child who is a tissue match and who may act as an HSC donor for their sick child. Embryonic human leukocyte antigen (HLA) tissue typing by means of preimplantation genetic diagnosis involves testing embryos to determine whether they are a tissue match with a would-be sibling in need of a transplant. Ethical Guidelines for performing PGD with HLA tissue typing were first introduced in New Zealand in March 2005. These guidelines have since been designated interim guidelines of the New Zealand statutory policy-making body, the Advisory Committee on Assisted Reproductive Technology, pursuant to provisions of the Human Assisted Reproductive Technology Act 2004. The interim guidelines are currently under review. This article argues that the restrictive position adopted by the interim guidelines and the proposed replacement guideline is problematic.

Incidental findings in surgery

Occasionally during a surgical procedure a surgeon will discover a further condition not anticipated before surgery1–3. With the patient unconscious, the surgeon now holds critical information that was not available at the time consent was obtained. A surgeon must decide whether to treat the incidental finding (IF) or not. The problem arises because, although treating the IF may be in the patient’s best interest, the patient has not consented. Conversely, delaying intervention to seek consent may not be in the patient’s interest. These situations can generate considerable medicolegal challenges for surgeons. Many surgeons will be wary of acting beyond the scope of the initial consent, owing either to a desire to respect patient autonomy, or to concern regarding the potential for legal proceedings if the patient subsequently objects and the intervention is considered contrary to the patient’s interests. There are currently no specific guidelines to assist surgeons dealing with IFs. The authors have developed a tool that uses a traffic-light framework to guide clinical decisionmaking. The framework identifies the common situations where the surgeon should proceed (‘green light’) or not (‘red light’) in the event of an IF. The ‘orange light’ includes situations where the best course of action is more difficult to determine, and careful structured reflection is required. The authors acknowledge that this framework constitutes a recommendation only and has not been tested clinically. Defining an incidental finding

New Zealand sports physiotherapy code of conduct

The objective of the Sports Physiotherapy Code of Conduct (SPCC) is to provide a comprehensive set of guidelines for the professional behaviour expected of physiotherapists providing sports physiotherapy services. The SPCC applies to any physiotherapist providing sports physiotherapy services, including immediate care, injury assessment and management, rehabilitation, exercise prescription, injury prevention or enhancement of sporting performance in individuals involved in any level of exercise or sport. The SPCC acknowledges the varied work environments of a sports physiotherapist. Sports physiotherapists work in recreational sports and leisure industries, as physiotherapists working with athletes at all levels, within sporting organisations as a physiotherapy/medical coordinator, or in physiotherapy clinics. A patient/client in this setting is the individual receiving sports physiotherapy services, or the group of people for whom the sports physiotherapist is contracted or otherwise engaged to provide sports physiotherapy services. The same ethical principles that apply to the practice of all physiotherapists in New Zealand also apply to those physiotherapists who provide sports healthcare. The Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct , produced by the New Zealand Physiotherapy Board (NZPB) and Physiotherapy New Zealand (PNZ), is the code for all physiotherapists in New Zealand (see http://www.physioboard.org.nz). Aotearoa New Zealand Physiotherapy Code of Ethics and Professional Conduct 1. Physiotherapists respect patients/clients and their whanau and families. 2. Physiotherapists act to promote the health and well-being of the patient/client, while acknowledging, respecting and facilitating patient/client autonomy. 3. Physiotherapists respect confidentiality, privacy and security of patient/client information. 4. Physiotherapists treat people fairly. 5. Physiotherapists practice in a safe, competent and accountable manner. 6. Physiotherapists act with integrity in all dealings. 7. Physiotherapists strive for excellence in physiotherapy standards. 8. Physiotherapists communicate effectively and cooperate with colleagues, other health professionals and agencies for the benefit of their patients/clients and the wider community. 9. Physiotherapists take responsibility to maintain their own health …

Regulation of cognitive enhancement devices: commentary

Maslen et al. (2013) have provided us with a comprehensive overview of the current legislation regulating non-clinical cognitive enhancement devices (CEDs) in the European Union and have proposed a specific model whereby CEDs would be regulated in the same way as medical devices. An alternative model would be to require manufacturers to quantify risks only. Irrespective of the purported ‘benefits’ of a product, this would allow the consumer freedom of choice to use the product at their will and allow the periodic review of worthwhile indications and unexpected adverse events. Although this departs from the standard Cochrane-type assessment, it takes into account the facts that (i) the evaluation of clinically used cognitive enhancement techniques may not be as rigorous as one might expect, (ii) variations and case-by-case use might be widespread, and (iii) independent variables of significance and useful endpoints may not be obvious ab initio. We consider cerebrospinal fluid diversion techniques which are widely used clinically to enhance cognition in patients with normal pressure hydrocephalus despite any large-scale clinical studies demonstrating substantial benefit, and the real risks of paralysis and death from these invasive procedures. The risks of CEDs which have been available for some time need to be kept in perspective: are the risks really more than using conventional cognitive enhancement techniques such as imbibing too caffeinated drinks? Furthermore, the loss of Europe as a market for CEDs which do not comply with the proposed regulatory model implies a potential gain in the market for other parts of the world. This could impact on the ability of companies in Europe being able to compete in an evolving market demand for CEDs. Legislation to regulate CEDs should be guided by the principle of ‘do no harm’ and allow for innovation and competition.

Implications for providers and patients: a comment on the regulatory framework for preimplantation genetic diagnosis in New Zealand

Preimplantation Genetic Diagnosis (PGD) is a reproductive genetic technology that was first introduced into clinical medicine over a decade and a half ago.2 PGD enables the detection of genetic anomalies in embryos created via IVF prior to implantation. On the basis of the genetic information derived from PGD, choices may be made as to which embryo, or embryos, are transferred to a womans uterus. This technology was undertaken for the first time in New Zealand in late 2005. The provision of PGD by fertility services in New Zealand was preceded by the formulation of Guidelines on Preimplantation Genetic Diagnosis by the National Ethics Committee on Assisted Human Reproduction. Since the introduction of the Human Assisted Reproductive Technology Act 2004, these have been designated as interim Guidelines of the statutory policy-making body created by the Act, the Advisory Committee on Assisted Reproductive Technology. An Order in Council has since authorised a category of PGD, in almost identical terms to those specified in the Guidelines, which may be carried out as a routine clinical procedure without external oversight. This article examines the scope of these regulatory initiatives. It argues that there are inherent uncertainties in both the Guidelines and the Order in Council which may pose difficulties for providers and patients in the clinical context.