Robert Wheeler

Nottinghamshire Healthcare NHS Trust, Nottigham, England, United Kingdom

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Publications (27)137.71 Total impact

  • R Wheeler
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    ABSTRACT: When describing the risks of surgery to a patient, there is a common and mistaken supposition by surgeons that there exists a numeric threshold of improbability beyond which there is no need to disclose. Where should the line be drawn?
    Annals of The Royal College of Surgeons of England 03/2012; 94(2):81-2. · 1.33 Impact Factor
  • Robert Wheeler, Paul Spargo, Anneke Lucassen
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    ABSTRACT: The past few decades have seen patient autonomy ascend to a prime position in health care. Patient consent is seen as a key component to expression of autonomy. Yet, interventions may also be justified without consent because they are deemed to be in the public interest. We observe some subtle shifts in balance in these justifications in health care and illustrate these with a range of examples. We hope thereby to stimulate a more explicit debate so that health-care professionals can manage these competing interests.
    Clinical Ethics 12/2011; 6(4):203-206.
  • Robert A Wheeler
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    ABSTRACT: The incidence of appendicitis has its peak between 12 and 18 years of age. It is one of the commonest, and familiar, emergency surgical conditions in this age group, but it appears to be difficult to diagnose, since it is one of the most frequent causes of litigation on the basis of ‘missed diagnosis’. This paper explores why appendicitis should pose such difficulties to clinicians.
    Clinical Risk 07/2011; 17(4):126-129.
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    ABSTRACT: People under the age of 18 with cancer sometimes require treatments that render them infertile. It may therefore be necessary, during the brief interval between diagnosis and the commencement of cancer treatment, to offer them the opportunity to produce sperm, through masturbation, for cryopreservation.
    Clinical Risk 01/2011; 17(1):15-18.
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    Robert Wheeler
    Annals of The Royal College of Surgeons of England 09/2010; 92(6):539-40; author reply 540. · 1.33 Impact Factor
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    Tom Woodcock, Robert Wheeler
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    ABSTRACT: This article in the series describes how UK law and medical ethics have evolved to accommodate developments in organ transplantation surgery. August committees have formulated definitions of the point of death of the person which are compatible with the lawful procurement of functioning vital organs from cadavers. Some of the complexities of dead donor rules are examined. Live donors are a major source of kidneys and the laws that protect them are considered. Financial inducements and other incentives to donate erode the noble concept of altruism, but should they be unlawful?
    Annals of The Royal College of Surgeons of England 05/2010; 92(4):282-5. · 1.33 Impact Factor
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    Anneke Lucassen, Robert Wheeler
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    ABSTRACT: This paper reviews the legal rules that govern the way surgeons deal with human tissues during the course of diagnosing and treating their patients. The topic is dominated by the Human Tissue Act 2004, which was enacted in September 2006; thus, the article applies specifically only to England, Wales and Northern Ireland, since Scotland has separate legislation (Human Tissue (Scotland) Act 2006). Although the Human Tissue Act 2004 was built largely upon a plethora of legal principles that were developed throughout the Commonwealth and in the US, some of the principles underlying it will be equally familiar and applicable to surgeons across the world. Much everyday clinical activity falls outside the remit of the Act, and depends both upon other statutes, and on common law rules, principally those relating to consent.
    Annals of The Royal College of Surgeons of England 04/2010; 92(3):189-92. · 1.33 Impact Factor
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    Robert Wheeler
    Annals of The Royal College of Surgeons of England 03/2010; 92(2):91-2. · 1.33 Impact Factor
  • A Lucassen, R Wheeler
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    ABSTRACT: This paper reviews the legal rules that govern the way surgeons deal with human tissues during the course of diagnosing and treating their patients. The topic is dominated by the Human Tissue Act 2004 which was enacted in September 2006 thus the article applies specifically only to England Wales and Northern Ireland since Scotland has separate legislation [Human Tissue [Scotland] Act 2006]. Although the Human Tissue Act 2004 was built largely upon a plethora of legal principles that were developed throughout the Commonwealth and in the US some of the principles underlying it will be equally familiar and applicable to surgeons across the world. Much everyday clinical activity falls outside the remit of the Act and depends both upon other statutes and on common law rules principally those relating to consent.
    Annals of The Royal College of Surgeons of England 03/2010; · 1.33 Impact Factor
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    John Coggon, Robert Wheeler
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    ABSTRACT: This paper offers an exploration of the right to confidentiality, considering the moral importance of private information. It is shown that the legitimate value that individuals derive from confidentiality stems from the public interest. It is re-assuring, therefore, that public interest arguments must be made to justify breaches of confidentiality. The General Medical Council's guidance gives very high importance to duties to maintain confidences, but also rightly acknowledges that, at times, there are more important duties that must be met. Nevertheless, this potential conflict of obligations may place the surgeon in difficult clinical situations, and examples of these are described, together with suggestions for resolution.
    Annals of The Royal College of Surgeons of England 03/2010; 92(2):113-7. · 1.33 Impact Factor
  • R. Wheeler
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    ABSTRACT: Paediatric and neonatal surgery is the smallest of the nine surgical specialties, with fewer than 120 consultants in the United Kingdom. The national arrangements for children's surgery, and some of the difficulties these create, are described. Illustrations of some frequent and recurring areas of paediatric surgical practice that frequently lead to claims are provided.
    Clinical Risk 01/2010; 16(4):149-152.
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    ABSTRACT: 2 as it legally terminates the child's relationship with their birth family. Adoption medical advisors (the usual title for doctors, generally paediatricians, who work with adoption agencies) play an important role in collating and interpret- ing the child's medical and developmental history which is then shared with pro- spective adopters. A key part of this history is a child's family medical history. Contemporary adoption practice encourages frank disclosure of such med- ical information to prospective adoptive parents. Indeed, the Adoption Act Regulations 2005 state that: ''The adop- tion agency must obtain, so far as is reasonably practicable, the information about the health of each of the child's natural parents and his brothers and sisters (of the full blood or half-blood)''. Adoption medical advisors are privy to information about birth parents' medical history through a variety of sources but do not always have consent to share this. 3 Using fictitious cases based on clinical practice this article highlights the tensions about information sharing in adoption practice, reviews current professional guidelines and legislation, and suggests possible solutions. ADOPTION PAST AND PRESENT Before the 1976 Adoption Act most children adopted in the UK were ''illegi- timate'' infants. Social policy and legisla- tion prioritised the rights of adopters to privacy about the fact of their child's adoption over the needs of the child and their birth parents. As a consequence adoptive parents and birth parents often remained ignorant of one another's iden- tity; children were issued with a new birth certificate and had no right to trace their birth family. Research recognising the ''genealogical bewilderment'' and psy- chological trauma experienced by adop- tees ignorant of their genetic identity 4
    Archives of Disease in Childhood 01/2010; 95(1):7-11. · 3.05 Impact Factor
  • A M Lucassen, C M Hill, R Wheeler
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    ABSTRACT: Several different companies now sell 'DNA ancestry' or 'ethnicity' testing kits via the internet. A small sample of a person's blood or saliva can be sent via the post, its DNA extracted, and a panel of polymorphic genetic markers can be analysed. This information is then used to provide a breakdown of a person's 'racial origins' by categorizing someone as a percentage of their ancestry that is African, East Asian, Native American or European. Whilst these kits have proved very popular with adults interested in genealogy, we have recently become aware of their use in adoption and fostering cases in attempts to determine a child's ethnicity. We believe such use is inappropriate and indicates both a misunderstanding of the concept of ethnicity and the technical limitations of such genetic tests. We urge extreme caution in their use in any adoption and fostering decisions.
    Archives of Disease in Childhood 10/2009; 95(6):404-5. · 3.05 Impact Factor
  • Robert Wheeler
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    ABSTRACT: Genetic testing as a preliminary to adoption has been discussed in the literature [BAAF/BSHG Statement on the use of DNA testing to determine racial background], together with the medical benefits derived from such testing ASHG/ACMG Statement [Am J Hum Genetics, 66: 761-767, 2000]. But specific cases that reach court are rare. Such a case was recently discussed on national radio [http://www.bbc.co.uk/radio4/science/ethicscommittee_s4_tr3.shtml], disclosing sufficient facts to allow analysis of the ethical and legal issues encountered. Furthermore, the outcome of the case, a court order to test the child in infancy, can be reviewed in the light of the current law, together with the geneticist's response to this order.
    Familial Cancer 07/2009; 9(1):71-4. · 1.94 Impact Factor
  • Robert Wheeler
    BMJ (online) 02/2009; 339:b3321. · 17.22 Impact Factor
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    Richard Robinson, Erica Makin, Robert Wheeler
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    ABSTRACT: The aim of this study was to assess whether surgeons are conforming to guidance laid down by professional organisations and the courts in obtaining dual parental consent for non-therapeutic circumcision. A retrospective case-note review over a 12-month period (April 2005 to April 2006) of circumcisions in boys under the age of 16 years in a tertiary paediatric surgical unit was undertaken. A total of 62 boys aged 1-14 years (median age, 4 years) underwent non-therapeutic circumcision. Written consent from both parents was obtained in only 4 cases (6.4%). In no case was written consent obtained from the patient or their views documented. In 58 cases, the written consent was provided by only one parent; the mother in 34 (55%), the father in 24 (45%). Of these 58 cases, in 25 (43%) both parents attended with the child on the day of surgery. The data reveal a consistent non-conformity with recommended practice and the common law. It seems unlikely that the doctors involved are deliberate and inveterate law-breakers. The reason for this non-compliance may be ignorance of the rules, or due to the impracticality of their implementation. There is evidence that doctors are ignorant of the legal rules pertaining to their patients, and the results may reflect this ignorance. However, there are also practical difficulties in obtaining dual consent that may be partially responsible for the variance. Inevitably, investment will be required to overcome these difficulties. Cost may tempt service providers to abandon the provision, leaving parents to their own devices.
    Annals of The Royal College of Surgeons of England 01/2009; 91(2):152-4. · 1.33 Impact Factor
  • Robert Wheeler
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    ABSTRACT: For most surgical procedures and clinical interventions on children who lack the capacity to consent, a single consent from a person with parental responsibility for the child will suffice, provided it is given voluntarily, and is informed by proper disclosure.
    Archives of Disease in Childhood 06/2008; 93(10):825-6. · 3.05 Impact Factor
  • Robert Wheeler
    The Lancet 05/2008; 371(9619):1148-9. · 39.21 Impact Factor
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    Robert Wheeler
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    ABSTRACT: A review of consent for surgery is timely. As the length of surgeons' training diminishes, despite the increasing interest in the content of the surgical curriculum, the law governing the process of gaining consent has been given scant attention. The advent of non-medically qualified surgical practitioners raises questions about the breadth of knowledge that is required to ensure that valid consent is obtained. Consent is as fundamental as any other basic principle on which surgical practice relies, and its use in patient care is a clinical skill. The 'traditional' approach to consent contained some negative elements. A doctor who was incapable of performing the proposed operation often obtained consent. In a genuine attempt to protect patients from anxiety, the rare-but-grave potential complications were sometimes not discussed. There was uncertainty about what should properly be disclosed, compounded by conflicting messages from the courts. The consent was sometimes taken from people who were ineligible to provide it. These could be viewed as aberrations, and some persist. Having clarified the necessity for consent, this review concludes that it should be obtained by the operating surgeon. The threshold for interventions that need formal consent is discussed, together with the legal tests for capacity. In considering the recent law, it becomes clear that any potential complication that the reasonable patient would need to take into consideration before deciding to give their consent is one that should be disclosed.
    Annals of The Royal College of Surgeons of England 06/2006; 88(3):261-4. · 1.33 Impact Factor
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    Robert Wheeler
    BMJ (online) 05/2006; 332(7545):807. · 17.22 Impact Factor

Publication Stats

69 Citations
137.71 Total Impact Points

Institutions

  • 2005–2012
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom
  • 2004–2011
    • University of Southampton
      Southampton, England, United Kingdom
  • 2010
    • The University of Manchester
      • Centre for Social Ethics and Policy
      Manchester, ENG, United Kingdom
  • 2009
    • University Hospital Southampton NHS Foundation Trust
      Southampton, England, United Kingdom