Current projects

Dr Clark Hobson and Professor José Miola are co-investigators on a project, funded by the NIHR (£587,000), entitled ‘In-silico trials of targeted screening for abdominal aortic aneurysm using linked healthcare data: can the efficiency of the NHS Abdominal Aortic Aneurysm Screening Programme be improved whilst maintaining publicly acceptable levels of disease detection in an ethically acceptable manner?’

Can the efficiency of the NHS Abdominal Aortic Aneurysm Screening Programme be improved whilst maintaining publicly acceptable levels of disease detection in an ethically acceptable manner? To reduce the number of people dying from ruptured abdominal aortic aneurysms (AAA) the NHS offers a screening service to men at the age of 65 (women rarely get AAA). About 280,000 men are invited for screening each year. One in every 100 men screened are found to have an AAA.

This screening programme costs the NHS about £7.75 million per year, much of which spent on screening the 99% of men who do not have AAAs. The screening invitation and testing process may also lead to unnecessary worry for some men who are found not to have an AAA. As AAAs are becoming less common, the screening cost per person is becoming higher and eventually the NHS will not be able to justify spending money on AAA screening.

This research project aims to find out whether a new way of delivering the screening programme can be designed that is both more economical for the NHS and acceptable to the public. To do this, the project team will analyse combined results from the NHS AAA Screening Programme from 2013-2021 and (anonymised) general practice records of around one fifth of the men invited for screening.

The team aims to work out what would have happened if only men with known risk factors for AAA had been invited for AAA screening, and whether there are other details in general practice records that can be used to identify men at high, or low, risk of AAA. The information will be used to see if AAA screening can be targeted at groups of men who are at a high risk of having an AAA and, if so, whether such a targeted screening programme will still identify the majority of men with AAAs.  The ethics and acceptability of targeted screening will be explored with members of the public. The team will also consult extensively with the public to determine what is important to those who might be affected by changes to the AAA screening programme.

The project team will use its established links with UK public health bodies to ensure the results of this research are acted upon, and make them available to the public and to researchers.

Dr Nataly Papadopoulou and Professor Liz Wicks are collaborating with a LIAS-funded interdisciplinary group (including Professor Sarah Tarlow (Archaeology and Ancient History), Dr Sarah Gunn (Psychology), Dr Michaela Senkova (Archaeology and Ancient History), Professor Tim Coats (Emergency Medicine), Dr van Oppen (Health Science) on a project looking at deliberate dying.

We have no choice about the fact of our death as we will all die. Deliberate dying is about making choices (or having choices made for us) about the place and manner of our death - whether through end-of-life planning or choices about level of medical care, such as resuscitation. Some may plan the end of their life through suicide or need the help of others in assisted dying. These are complex choices and deliberate dying is not a moment but a process. It involves the dying person and the institutional and personal systems around them. It must also include the wider social, cultural and legal constellations around individuals, including belief. Most people do not achieve the death that they wish for, so there is an urgent need for new approaches to promote holistic understanding around deliberate dying across these contexts – hopefully leading to practical interventions to enabling more of us to achieve a ‘good death’.

Find out more about the working group

Dr Tracey Elliott and Professor José Miola have been awarded a Prestigious Research Chair to submit a funding bid of over £1 million to lead an international project assessing what the barriers to responsible medical innovation are, and how they might be lowered.

Dr Nataly Papadopoulou and Professor Liz Wicks are working on a project that will culminate in an edited collection on Human Rights, Law and Health to be published by Edward Elgar in 2025.

The topic of health engages human rights in a way that is remarkable and increasingly difficult to ignore. On a global level, the existence of a right to health, or at least to the highest attainable level of health, is now well established and highlights that taking steps to protect and promote health is a core obligation of all state governments. Beyond a right to health, however, human rights are also relevant to health in many other ways. For example, autonomy based rights impose obligations to respect the choices of patients in relation to medical treatment, reproduction and the dying process. A right to dignity imposes standards of treatment of relevance in the health care process and the right to life has a wide variety of potential (but controversial) applications to health care, from requiring the provision of emergency life-saving treatment, to creating the conflict of rights in maternal-foetal conflicts such as abortion, to raising challenging questions about prolonging the dying process. Beyond the core rights life, dignity and autonomy, there are yet more human rights of potential relevance in health care, such as freedom of religion and conscience, and a right to reproduce, because our health touches all aspects of our lives and identity.

This Research Handbook will engage with these varied elements of human rights in the context of health, but will also reflect current debates which challenge traditional perspectives of rights, such as decolonisation, feminism and social models of disability. It will adopt a forward-looking perspective in which leading experts challenge the status quo and seek to identify the future directions of human rights and health.

Dr Louise Austin and Professor José Miola are putting together an edited collection on Medical Consent, to be published by Edward Elgar in 2025.

This book will sit alongside existing Research Handbooks in the Edward Elgar series. It will provide an overview of some of the key research areas in medical consent, whilst also outlining areas of future research interest. It is divided into five parts and features contributions not only from legal academics and ethicists but also from others involved in medical consent such as medics.

Part I will encompass ‘Informed consent and the impact of Montgomery v Lanarkshire Health Board’. This Part will also feature contributions from Australian, and Singaporean perspectives outlining the decision in Montgomery, its significance in relation to informed consent, and its impact in this area. Montgomery drew heavily upon Australian case law when revising the standard of disclosure in informed consent, and Singapore case law has adopted a modified Montgomery test in order to overcome some of the perceived problems with the case.

Part II will feature broader ‘Perspectives on Informed Consent’ including philosophical understandings of autonomy in consent, guidelines and consent, causation and consent, the relationship between law and medical ethics, and the role of patient safety in consent.

Part III will focus on ‘New and Experimental Treatments and Procedures’ and will explore consent to innovative and experimental treatments from a Singaporean perspective and from an ethical perspective with reference to the global south, and in the context of medical devices and consent. Part III will also explore perspectives on consent in health research including dynamic consent, consent in the context of data and tissue research, and consent to research from an EU perspective.

Part IV looks at ‘Consent at the Margins’ and explores medical consent within the broader question of consent in the law, consent in pregnancy, adolescent consent to treatment for gender dysphoria, consent in emergency medicine and the role of consent within medical assistance in dying in Canada.

Finally, Part IV is titled ‘Proxy Consent’ and will offer UK and international perspectives on consent on behalf of babies and young children, consent on behalf of adults with learning disabilities, and proxy consent and relational autonomy.

Dr Louise Austin and Professor José Miola are working on a funding bid with colleagues from the University of Bristol to look at shared decision-making in maternity care. It will be submitted to NIHR in 2024.

Our research asks how communication in maternity care can be improved? The overall aim of this research is to improve communication of information in maternity care to facilitate shared decision-making.

This research aims to identify:

1. what information should be communicated during maternity care;
2. how information about maternity care should be communicated; and
3. when information about maternity care should be communicated.

The research will draw upon the answers to these questions to develop a communication aid for healthcare professionals utilising the what, how, and when framework to guide antenatal consultations. A corresponding communication aid will be drawn up for pregnant women, again using the what, how, and when framework to aid them in communicating their information preferences.