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5. How to do things with rights-claims : an ordinary language approach to parental rights

Author

Hitchen, Sarah Anne

Subjects
346.01
Abstract

This work takes an ordinary language approach to the question of parental rights in order to try to disentangle some of the problems, theoretical and practical, which arise when we try to decide between the various rights claims which arise in relation to the family. Family relationships are always complex; however, the challenges presented by non-nuclear families and artificial reproductive technologies place new demands upon traditional ways of thinking about the legal and moral relationships between parents, children and society. At the same time the use of rights-language has proliferated and courts must therefore juggle complex claims and counter claims. This expansive use of rights-language can lead to misunderstandings about the nature of rights and rights-claims. If these misunderstandings are imported into the technical spheres of law and philosophy this may lead to a further clouding of rights theory. This in turn allows us to become entangled in seemingly irresolvable conflicts of right A significant portion of this work addresses two traditional approaches to parental rights in order to show why these models fail to give us an adequate account of parental rights, it is argued that this failure is in part due to linguistic confusions and in paJi to theoretical ones. At the close, I offer a model which allows us to judge whether or not a rights-claim is successful. This success is measured, not in the right being met, but in the claim made succeeding as a rights-claim. Whether or not a rights-claim is viewed as a right in fact will depend upon the context in which it is made. This model applies to rights in general and as such may help us to begin to disentangle the knot of claims and counter claims we find in relation to the family.

Published
2013

6. Barriers to prescribing proprotein convertase subtilisin‐kexin type 9 inhibitors after coronary revascularisation.

Author

Nguy, Jenny, Hitchen, Sarah A., Lan, Nick S. R., Dwivedi, Girish, Larbalestier, Robert, Yeap, Bu B., and Fegan, P. Gerry

Subjects
*STATINS (Cardiovascular agents), *LENGTH of stay in hospitals, *CORONARY artery bypass, *ANTILIPEMIC agents, *PROTEASE inhibitors, *SCIENTIFIC observation, *REVASCULARIZATION (Surgery), *CARDIOVASCULAR diseases, *MEDICAL care costs, *RETROSPECTIVE studies, *TERTIARY care, *LOW density lipoproteins, *DRUG prescribing, *PHYSICIAN practice patterns, *ELECTRONIC health records, *GOVERNMENT aid, *PHARMACODYNAMICS
Abstract

Background: Guidelines advocate for intensive lipid‐lowering in patients with atherosclerotic cardiovascular disease (ASCVD). In May 2020, evolocumab, a proprotein convertase subtilisin‐kexin type 9 (PCSK9) inhibitor, became government subsidised in Australia for patients with ASCVD requiring further low‐density lipoprotein cholesterol (LDL‐C) lowering. Aim: To identify barriers to prescribing PCSK9 inhibitors in hospitalised patients with ASCVD. Methods: A retrospective 3‐month, single‐site, observational analysis was conducted in consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Lipid‐lowering therapy prescriptions, including PSCK9 inhibitors, were assessed using electronic medical records, compared against the Australian Pharmaceutical Benefits eligibility criteria, and barriers to PCSK9 inhibitor use identified. Results: Of 331 patients, 244 (73.7%) underwent PCI and 87 (26.3%) underwent CABG surgery. A lipid profile during or within 8 weeks of admission was measured for 202 (82.8%) patients undergoing PCI and 59 (67.8%) undergoing CABG surgery. In patients taking high‐intensity statins on admission (n = 109), LDL‐C ≥1.4, ≥1.8 and >2.6mmol/L was seen in 64 (58.7%), 44 (40.4%) and 19 (17.4%) patients respectively. High‐intensity statin prescribing at discharge was high (>80%); however, ezetimibe was initiated in zero patients with LDL‐C ≥1.4 mmol/L. There was variable advice given by clinicians for LDL‐C targets. No patients met the criteria for subsidised PSCK9 inhibitor therapy, largely due to lack of qualifying lipid levels following combined statin and ezetimibe therapy. Conclusion: Prescribing of non‐statin LDL‐C‐lowering therapies remains low in patients with ASCVD. Underprescribing of ezetimibe and suboptimal lipid testing rates are barriers to accessing subsidised PCSK9i therapy using current Australian eligibility criteria. [ABSTRACT FROM AUTHOR]

Published
2023
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