Publications by authors named "Jordan A Parsons"

11 Publications

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Deemed consent for organ donation: a comparison of the English and Scottish approaches.

Authors:
Jordan A Parsons

J Law Biosci 2021 Jan-Jun;8(1):lsab003. Epub 2021 Mar 4.

Bristol Medical School, University of Bristol, UK.

Deemed consent for organ donation has long been discussed as a potential solution to the shortage of organs for transplantation, with several countries having implemented it. In Great Britain, Wales was the first nation to introduce such a system, having done so in 2015. Now, the other two nations are following suit. In this paper, I compare the approaches of England and Scotland in moving to systems of deemed consent for organ donation. After outlining both sets of legislation, I focus on three points on which the two nations differ. First, the role of those close to the deceased in the consent process and the extent to which clinicians are required to consult them ahead of consent being deemed. Second, the role of government ministers in ensuring widespread public awareness. Third, the ways in which the two nations responded to the challenge of the COVID-19 pandemic in relation to the implementation of deemed consent. I conclude that on all three points, the Scottish approach is preferable.
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http://dx.doi.org/10.1093/jlb/lsab003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989506PMC
March 2021

Dialysis decisions concerning cognitively impaired adults: a scoping literature review.

BMC Med Ethics 2021 03 5;22(1):24. Epub 2021 Mar 5.

Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, UK.

Background: Chronic kidney disease is a significant cause of global deaths. Those who progress to end-stage kidney disease often commence dialysis as a life-extending treatment. For cognitively impaired patients, the decision as to whether they commence dialysis will fall to someone else. This scoping review was conducted to map existing literature pertaining to how decisions about dialysis are and should be made with, for, and on behalf of adult patients who lack decision-making capacity. In doing so, it forms the basis of a larger body of work that is exploring how these decisions ought to be made.

Methods: To identify relevant papers, searches were conducted on Ovid MEDLINE(R), Embase, PsychINFO, The Cochrane Library, and Web of Science. Inclusion criteria were then applied, requiring that papers: report on empirical studies about how decisions about dialysis are made and/or discuss how decisions about dialysis should be made with, for, and on behalf of adult patients who lack decision-making capacity; be published from 1961 onwards; and be published in English. This resulted in 27 papers eligible for inclusion.

Results: Of note, the majority of papers originated in the United States. There was wide variation across the included papers. Extracted data were grouped under the following themes: involving various parties (patient involvement, family dominance, and wider communication); objectivity about care options (including difficulties with family detachment); cultural sensitivity; medical versus non-medical factors; managing nonadherent patients; and the role and prevalence of substituted judgement. The literature shows that there is inconsistency in the principles and processes surrounding decisions made about dialysis with, for, and on behalf of adult patients who lack decision-making capacity.

Conclusions: This scoping review demonstrates that there is significant variation in both the practice and theory of dialysis decision making with, for, and on behalf of cognitively impaired adult patients. Complexity arises in considering who should get a say, how influential their say should be in a decision, and what factors are most relevant to the decision. A lack of up-to-date literature exploring this issue is highlighted, with this scoping review providing a useful groundwork from which further research can be undertaken.
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http://dx.doi.org/10.1186/s12910-021-00591-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7932834PMC
March 2021

The telemedical imperative.

Authors:
Jordan A Parsons

Bioethics 2021 05 15;35(4):298-306. Epub 2021 Feb 15.

Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland.

Technology presents a means of improving health outcomes for vast numbers of individuals. It has historically been deployed to streamline healthcare delivery and reach those who would previously have faced obstacles to accessing services. It has also enabled improved health education and management. Telemedicine can be employed in everything from primary care consultations to the monitoring of chronic diseases. Despite recommendation by the World Health Organization, countries have been slow to embrace such technology in the health sector. Nonetheless, it is expected to become more prevalent with increased digitization. Further, amidst the COVID-19 pandemic, there was a rush to implement forms of telemedicine where possible to prevent patients breaking social distancing rules. In this paper, I present and defend what I term the 'telemedical imperative'. The telemedical imperative represents a duty for healthcare systems to implement remote access to services where possible, thereby furthering the mission of equity in access to healthcare. It is intended as an addition to in-person services rather than a replacement. After highlighting the benefits of telemedicine, I provide four criteria that must be met for the telemedical imperative to arise. The first three-safety, effectiveness, and acceptability-are consistent and essential. The fourth adapts to the service in question and requires that there be no other obstacles specific to that service that cannot reasonably be overcome. Finally, I address several potential objections to the telemedical imperative based on more general concerns around the implementation of telemedicine.
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http://dx.doi.org/10.1111/bioe.12847DOI Listing
May 2021

From proband to provider: is there an obligation to inform genetic relatives of actionable risks discovered through direct-to-consumer genetic testing?

J Med Ethics 2020 Dec 9. Epub 2020 Dec 9.

Oxford Medical School, University of Oxford, Oxford, UK.

Direct-to-consumer genetic testing is a growing phenomenon, fuelled by the notion that knowledge equals control. One ethical question that arises concerns the proband's duty to share information indicating genetic risks in their relatives. However, such duties are unenforceable and may result in the realisation of anticipated harm to relatives. We argue for a shift in responsibility from proband to provider, placing a duty on test providers in the event of identified actionable risks to relatives. Starting from Parker and Lucassen's (2004) 'joint account model', we adapt Kilbride's (2018) application of the rule of rescue and balance it against the relative's right not to know, placing responsibility on the providers of direct-to-consumer genetic testing. Where the risk of disease to a relative is actionable, we argue providers ought to share results even in the face of the proband's objections. Confidentiality issues are navigated by a pre-emptive consent model, whereby consumers agree to the sharing of certain information with their relatives ahead of testing and as a condition of testing. When a relative is informed, the proband's privacy is protected by maximal deidentification, and the rights of the relative are met by a stepwise approach to informing that allows them to decide how much information they receive.
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http://dx.doi.org/10.1136/medethics-2020-106966DOI Listing
December 2020

2020 developments in the provision of early medical abortion by telemedicine in the UK.

Health Policy 2021 01 16;125(1):17-21. Epub 2020 Nov 16.

Durham Law School, Durham University, United Kingdom. Electronic address:

The COVID-19 pandemic has necessitated the rapid implementation of telemedical health services. In the United Kingdom, one service that has benefitted from this response is the provision of early medical abortion. England, Wales, and Scotland have all issued approval orders to this effect. These orders allow women to terminate pregnancies up to certain gestational limits, removing the need for them to contravene social distancing measures to access care. However, they are intended only as temporary measures for the duration of the pandemic response. In this paper, we chart these developments and further demonstrate the already acknowledged politicisation of abortion care. We focus on two key elements of the orders: (1) the addition of updated clinical guidance in the Scottish order that suggests an extended gestational limit, and (2) sunset clauses in the English and Welsh orders, as well as an indication of similar intentions in Scotland. In discussing these two issues, we suggest that the refusal of UK governments to introduce telemedical provision of early medical abortion previously has not been based on health concerns. Further, we question whether it would be appropriate for the approval orders to be lifted following the pandemic, suggesting that to do so would represent regressive and harmful policy.
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http://dx.doi.org/10.1016/j.healthpol.2020.11.006DOI Listing
January 2021

Ethics of kidney care in the era of COVID-19.

Kidney Int 2020 12 7;98(6):1424-1433. Epub 2020 Oct 7.

George Institute for Global Health India, University of New South Wales (UNSW), New Delhi, India; School of Public Health, Imperial College, London, UK; Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.

The coronavirus disease 2019 pandemic presents significant challenges for health systems globally, including substantive ethical dilemmas that may pose specific concerns in the context of care for people with kidney disease. Ethical concerns may arise as changes in policy and practice affect the ability of all health professionals to fulfill their ethical duties toward their patients in providing best practice care. In this article, we briefly describe such concerns and elaborate on issues of particular ethical complexity in kidney care: equitable access to dialysis during pandemic surges; balancing the risks and benefits of different kidney failure treatments, specifically with regard to suspending kidney transplantation programs and prioritizing home dialysis, and barriers to shared decision-making; and ensuring ethical practice when using unproven interventions. We present preliminary advice on how to approach these issues and recommend urgent efforts to develop resources that will support health professionals and patients in managing them.
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http://dx.doi.org/10.1016/j.kint.2020.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539938PMC
December 2020

Legal and policy responses to the delivery of abortion care during COVID-19.

Int J Gynaecol Obstet 2020 Dec 5;151(3):479-486. Epub 2020 Oct 5.

Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, UK.

Access to abortion care has long been a global challenge, even in jurisdictions where abortion is legal. The COVID-19 pandemic has exacerbated barriers to access, thereby preventing many women from terminating unwanted pregnancies for an extended period. In this paper, we outline existing and COVID-specific barriers to abortion care and consider potential solutions, including the use of telemedicine, to overcome barriers to access during the pandemic and beyond. We explore the responses of governments throughout the world to the challenge of abortion access during the pandemic, which are an eclectic mix of progressive, neutral, and regressive policies. Finally, we call on all governments to recognize abortion as essential healthcare and act to ensure that the law does not continue to interfere with providers' ability to adapt to circumstances and to guarantee safe and appropriate care not only during the pandemic, but permanently.
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http://dx.doi.org/10.1002/ijgo.13377DOI Listing
December 2020

COVID-19 and reproductive justice in Great Britain and the United States: ensuring access to abortion care during a global pandemic.

J Law Biosci 2020 Jan-Jun;7(1):lsaa027. Epub 2020 May 18.

T.H. Chan School of Public Health, Harvard University, USA.

In this paper we consider the impact that the COVID-19 pandemic is having on access to abortion care in Great Britain (GB) (England, Wales, and Scotland) and the United States (US). The pandemic has exacerbated problems in access to abortion services because social distancing or lockdown measures, increasing caring responsibilities, and the need to self-isolate are making clinics much more difficult to access, and this is when clinics are able to stay open which many are not. In response we argue there is a need to facilitate telemedical early medical abortion in order to ensure access to essential healthcare for people in need of terminations. There are substantial legal barriers to the establishment of telemedical abortion services in parts of GB and parts of the US. We argue that during a pandemic any restriction on telemedicine for basic healthcare is an unjustifiable human rights violation and, in the US, is unconstitutional.
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http://dx.doi.org/10.1093/jlb/lsaa027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313859PMC
May 2020

2017-19 governmental decisions to allow home use of misoprostol for early medical abortion in the UK.

Authors:
Jordan A Parsons

Health Policy 2020 07 23;124(7):679-683. Epub 2020 May 23.

Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, BS8 2BN, United Kingdom. Electronic address:

Home use of misoprostol for early medical abortion has long been an established practice in several countries. It is a safe, effective, and dignified means of obtaining a legal abortion, with a low risk of complications. In the UK, however, the practice has only recently been permitted. Prior to the change, women were required to attend a clinic to be observed taking the drug, before being discharged to go home and see through the process. The requirement to attend a clinic was a result of political rather than medical reasoning; a desire not to provoke pro-life groups. It also highlighted an inconsistency whereby misoprostol was prescribed for home use to women who had suffered an incomplete miscarriage. Failure to permit home use of misoprostol for early medical abortion has caused women to suffer trauma when experiencing the effects of the drug when returning home from clinics, in addition to acting as an obstacle to access for women living in remote areas with no nearby clinic. Through an overview of recent developments in UK abortion policy, I demonstrate the lack of good, medical reasons for the delayed change. Further, I suggest appropriate future steps to be taken by policymakers.
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http://dx.doi.org/10.1016/j.healthpol.2020.04.014DOI Listing
July 2020

Best interests versus resource allocation: could COVID-19 cloud decision-making for the cognitively impaired?

J Med Ethics 2020 07 6;46(7):447-450. Epub 2020 May 6.

Centre for Ethics in Medicine, Bristol Medical School, University of Bristol, Bristol, UK.

The COVID-19 pandemic is putting the NHS under unprecedented pressure, requiring clinicians to make uncomfortable decisions they would not ordinarily face. These decisions revolve primarily around intensive care and whether a patient should undergo invasive ventilation. Certain vulnerable populations have featured in the media as falling victim to an increasingly utilitarian response to the pandemic-primarily those of advanced years or with serious existing health conditions. Another vulnerable population potentially at risk is those who lack the capacity to make their own care decisions. Owing to the pandemic, there are increased practical and normative challenges to following the requirements of the Mental Capacity Act 2005. Both capacity assessments and best interests decisions may prove more difficult in the current situation. This may create a more paternalistic situation in decisions about the care of the cognitively impaired which is at risk of taking on a utilitarian focus. We look to these issues and consider whether there is a risk of patients who lack capacity to make their own care decisions being short-changed.
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http://dx.doi.org/10.1136/medethics-2020-106323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239662PMC
July 2020