Lynley C Anderson

University of Otago · Centre for Bioethics

Enabling patients to consent to or decline involvement of medical students in their care is an essential aspect of ethically sound, patient-centred, mana-enhancing healthcare. It is required by Aotearoa New Zealand law and Te Kaunihera Rata o Aotearoa Medical Council of New Zealand policy. This requirement was affirmed and explored in a 2015 Consen...

Background: The ethics of using horses in sport is receiving increasing attention and media scrutiny. Sports medicine ethics is an important and well-established discipline within human medicine and biomedical ethics, which has, thus far, received little application to the equine veterinary field. Objectives: The purpose of this scoping review w...

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clini...

Background: Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or "stand up" to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke)...

The COVID-19 global pandemic has highlighted the potential roles and responsibilities of medical students in healthcare systems. Senior clinical students may be able to contribute practically, but all medical students, regardless of their level of training have the opportunity to assist public health measures, eg supporting vaccination uptake. Medi...

It is difficult to develop good arguments when the central terms of the discussion are unclear – as with the current confused state of sex and gender terminology. Sports organisations and sports researchers often talk in gender terms when they mean sex; or use the sex and gender vocabularies interchangeably. We propose the use of terminology that d...

This article considers the complexity and diversity of ethical concepts and beliefs held by Māori, the indigenous people of Aotearoa New Zealand (hereafter New Zealand), relating to animals. A combination of interviews and focus group discussions were conducted with individuals who identify as Māori and were working with wildlife, primarily in an e...

Objective: The COVID-19 pandemic has affected all elements of global society, and sport is not exempt. Many sporting events have been either postponed or canceled, and national sporting organizations have had to make highly complex decisions in the face of scientific uncertainty and risk. This article applies these lessons to the world of sport wi...

Background Recent findings of neurodegenerative pathology in former professional football players have once again called into question the role that “heading”, a fundamental aspect of the game, plays in the onset of neurological disease. By introducing guidelines aimed at limiting heading among youth players, the United Kingdom recently joined the...

Our research is focused on how Māori understand animal welfare-what it means for an animal to live a good life-and how this relates to traditional Māori values and concepts. This is a pilot study to lay the groundwork for future research and policy development in this area. We conducted a literature review across an array of databases, conducted et...

Cage-Fighting, also known as Mixed Martial Arts (MMA), is a combat sport that allows participants to grapple, punch, kick, elbow and knee—a combination of elements from many martial arts. While it is debatable whether adults ought to be free to engage in risky sports such as MMA, the question of whether children ought to partake in MMA is even more...

High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contraception. In this paper, we discuss using a proactive contraception provision (PCP) model to overcome barriers that prevent effective contraceptive uptake. After outlining steps taken to assess acceptability of PCP in NZ, we cover three issues to consider w...

Background It is well established that transgender people experience considerable health inequities, which are sustained in part by limited teaching about transgender healthcare for trainee health professionals. Aims The aim of this study was to explore the perspectives of both teaching staff from health professional education programmes and trans...

Medical considerations for supporting elite athletes during the post-peak phase of the New Zealand COVID-19 pandemic: a New Zealand sporting code consensus

Background: Instruments that measure exposure to bullying and harassment of students learning in a clinical workplace environment (CWE) that contain validity evidence are scarce. The aim of this study was to develop such a measure and provide some validity evidence for its use. Method: We took an instrument for detecting bullying of employees in th...

INTRODUCTIONAdolescents’ uptake of long-acting reversible contraceptives (LARCs) in New Zealand is low. We created the concept of a proactive LARC provision programme to overcome barriers to LARC uptake. Previously, this concept was discussed with adolescents and positively received. Lack of provider awareness is a barrier to LARC use identified in...

We support gender equality and freedoms in cases in which ‘like equals like’. Such inclusion is central to a progressive society. However, inclusion could potentially conflict with fairness in cases concerning transgendered athletes in elite sport. Accepted science regarding male and female physiology suggests that transwomen have an advantage over...

Background: Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effe...

The inclusion of elite transwomen athletes in sport is controversial. The recent International Olympic Committee (IOC) (2015) guidelines allow transwomen to compete in the women’s division if (amongst other things) their testosterone is held below 10 nmol/L. This is significantly higher than that of cis-women. Science demonstrates that high testost...

Purpose: In order to foster positive student experiences in the clinical learning environment, we wanted to better understand which teaching practices they regard highly. Methods: In 2016, the authors undertook a paper 'exemplar' survey (ES) of all fifth year medical students at one tertiary teaching site. Students had experienced all assigned c...

Background: Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented a...

Background Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented as...

In New Zealand, there are adolescents who are at risk of pregnancy and who do not want to become pregnant, but are not using contraception. Cost and other barriers limit access to contraception. To address the gap between contraceptive need and contraceptive access, this paper puts forward the concept of proactive contraception provision, where ado...

Aim: In New Zealand, there are sexually active adolescents who are using poor or no methods of contraception, and who do not intend to become pregnant. The most effective methods of contraception suitable to this population are long acting reversible contraceptive (LARC) methods. A proactive LARC provision (PLP) programme has been proposed, and th...

Student bullying in clinical practice remains a concern, and evidence regarding what works to specifically help the student appears rather piecemeal. At the same time, emergent literature indicates that some bullying interventions can be ineffective for behaviour change, or even deleterious to the staff which they target. Considering the potentiall...

Boundaries between research and clinical practice blur in health research conducted by clinician-researchers. We describe a typology, of clinician-researcher dual-role tensions, with two overarching catalysts: (1) acting as a clinical resource for patient-participants and (2) forming researcher–participant relationships mirroring clinician–patient...

Aim: Sometimes during an elective surgical procedure, an abnormality is found which is unrelated to the scheduled procedure. In many instances, immediate treatment of this unexpected pathology is in the patient's medical interests, however, specific patient consent has not been obtained. This study investigates current surgical practice when confr...

Aim: During a surgical procedure, incidental findings (IF) may be found and often the immediate treatment is in the patient's best interest. Due to the nature of IFs, specific patient consent cannot be obtained under such circumstances. The dilemma is whether the surgeon should proceed or delay until consent is obtained, as there are significant e...

Background Social media and Internet technologies present several emerging and ill-explored issues for a modern healthcare workforce. One issue is patient-targeted Googling (PTG), which involves a healthcare professional using a social networking site (SNS) or publicly available search engine to find patient information online. The study’s aim was...

Background Many health researchers are clinicians. Dual-role experiences are common for clinician-researchers in research involving patient-participants, even if not their own patients. To extend the existing body of literature on why dual-role is experienced, we aimed to develop a typology of common catalysts for dual-role experiences to help clin...

Early mobilization of patients while in hospital has been demonstrated to provide better outcomes for patients, and use less resources. Physiotherapy-based rehabilitation is central to achieving those goals. Successful rehabilitation requires that patient and therapist goals align, and this is commonly the case. However, occasionally physical thera...

Purpose and scope: This Position Statement has been written expressly for members of the Australasian College of Sports Physicians (ACSP); however, it may also be of interest to the wider medical community, sporting organisations, athletes and the general community. It has been informed by a comprehensive review of the scientific literature and th...

Despite considerable scientific dispute the science of concussion, there has been a proliferation of position statements and professional guidelines published on sports concussion management over the last 15 years. A number of ethical and clinical problems associated with concussion management protocols remain concerning, (i) diagnosis and manageme...

To develop a national consensus statement to promote a pragmatic, appropriate and unified approach to seeking consent for medical student involvement in patient care. A modified Delphi technique was used to develop the consensus statement involving stakeholders. Feedback from consultation and each stakeholder helped to shape the final consensus sta...

The issue of concussion in sport is a matter of global public interest that is currently under dispute by educational , legal, and medical professionals and scientists. In this article we discuss the problem from philosophical, bioethical, and sports ethical perspectives. We articulate conceptual differences in approaches to definition and therefor...

Guidance for a complex issue

PREAMBLE The objective of the Sports Physiotherapy Code of Conduct (SPCC) is to provide a comprehensive set of guidelines for the professional behavior expected of physiotherapists providing sports physiotherapy services. the SPCC applies to any physiotherapist providing sports physiotherapy services including immediate care, injury assessment and...

Social networking sites (SNS) are now part of everyday life, and SNSs such as Facebook, YouTube, and Twitter are among the most accessed Web sites on the Internet. Although SNSs are primarily used for staying in touch with friends and family, they are increasingly being used for health-related purposes for a variety of conditions, including concuss...

This paper explores the ways in which the environment of elite-level and, in particular, commercial sport produces expectations and pressures on sports doctors that may compromise their professional standards. Specifically, this paper addresses the pressures and demands that emerge from varying groups and individuals with whom doctors have relation...

ETHICS The ETHICS column explores issues around practising ethically in primary health care and aims to encourage thoughtfulness about ethical dilemmas that we may face. THIS ISSUE: Readers are invited to reflect on clinical teaching from an ethical perspective.

Background: This article describes the process of rewriting the code of ethics for New Zealand physical therapists. There was concern that the previous code was no longer fit for purpose, due to confusing terminology, inconsistencies about the level of detail, and the development of new ethical concerns in clinical practice. To ensure that the code...

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 stipu...

Medical schools are required to adequately prepare students to work in increasingly diverse and multi-ethnic societies. Students need to be able to integrate clinical knowledge with an understanding of the society they live in. Pacific peoples are a disadvantaged migrant minority ethnic group in New Zealand. This paper discusses the development of,...

Sudden cardiac death (SCD) in young athletes is a distressing event and it is not surprising that some physicians working with sports people are proposing that preventive action should be taken. There is a push for a system similar to that established in some countries, which involves screening and mandatory exclusion of those at risk. We argue tha...

The Bloodgate saga is finally being resolved for the two medical team members involved (the doctor was given a warning, while the physiotherapist was initially struck off). But were the differences in punishments justified, and by focusing on the individuals, are we missing the real problem? The term Bloodgate was given to events that occurred in...

Medical students at the University of Otago are now required to sign a 'student code' on beginning medical school. This new requirement has been put in place in response to changes to the medical curriculum that have resulted in earlier and increased contact with patients, healthcare staff and the general public, and in order to recognise and forma...

A code of ethics for sports physicians needs to be clear, appropriate and practically useful to clinicians in everyday clinical circumstances and for situations that may be difficult or contentious. For a code of ethics to be so opposite requires that it have some basis in the ethical concerns of clinicians. This article reflects on the recent expe...

As an employee, a sports doctor has obligations to their employer, but also professional and widely accepted obligations of a doctor to the patient (in this case the individual team member). The conflict is evident when sports doctors are asked by an athlete to keep personal health information confidential from the coach and team management, and ye...

Athletes who wish to compete in spite of high risk of injury can prove a challenge for sports doctors. Overriding an athlete’s choices could be considered to be unnecessarily overbearing or paternalistic. However simply accepting all risk-taking as the voluntary choice of an individual fails to acknowledge the context of high-level sport and the ci...

Without Abstract

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doc...

Without Abstract

In this paper we consider the three categories offered by Howard Brody for understanding power in medicine. In his book The Healer's Power, Brody separates out power in medicine into the categories of Aesculapian, Social, and Charismatic power. We examine these three categories and then apply them to a case. In this case set in an Obstetric ward, a...