Nola Ries has expertise in health law and policy, with a particular focus on: law, ageing and health; legal aspects of health system reform; governance of health research; regulation of health practitioners; public health law; and health technology regulation.
A cross-disciplinary researcher, Nola applies empirical methods to investigate intersecting health and legal problems. Her research is reform-oriented and aims to build an evidence base to inform better law, policy and practice. She has a keen interest in interprofessional collaboration, including health-justice partnerships, to improve access to justice and health outcomes through integrated service provision.
Nola publishes widely in legal, health and policy journals, with over 50 peer-reviewed articles and approximately 45 book chapters, major reports, commissioned papers and other publications. Across team and individual projects,she has received competitive grants totalling over $2M from funders including the National Health and Medical Research Council, the NSW Department of Family and Community Services and the Canadian Institutes of Health Research.
Nola joined UTS in 2017 after three years at the University of Newcastle Law School, where she served as Deputy Dean, Research and established an Evidence-based Law and Practice research group.
Prior to moving to Australia in 2013, Nola was a legal academic and practitioner in Canada. She practiced in human rights litigation and constitutional and administrative law and served as a legal consultant to government departments and health professional organisations.
Member, Law | Health | Justice Research Centre, UTS:Law
Admitted as a Solicitor of the Supreme Court of New South Wales
Member (Non-practicing), Law Society of British Columbia, Canada
Health Justice Australia Research Fellowship (2019)
Australian Research Fellowship in Health Services and Policy Research (2015/16): Choosing Wisely: Understanding Law’s Contribution as a Cause of and a Cure for Unwise Healthcare Choices
Australia-Japan Emerging Research Leader Award, Australian Academy of Technology and Engineering (2016): Socio-Legal Aspects of Assistive Technologies for Dementia Care
James Kreppner Fellowship in Blood System Studies, Canadian Blood Services (2010-2012): Consent, Privacy and Property: An Analysis of Legal Principles and Rules Relevant to a National System for Blood, Organs and Tissues in Canada
Service (selected activities)
Divisional Committee Member, Australian Association of Gerontology (NSW), 2017 - present
Member, Reference Group on Elder Abuse in the Hunter, 2016 - present
Law School Representative (elected), Board of the Faculty of Business and Law, University of Newcastle, 2015 – 2017
Member, National Professional Practice and Standards Committee, Occupational Therapy Australia, 2014 – 2015
Member, Joint University of Victoria-Vancouver Island Health Authority Research Ethics Review Panel, 2008-2010
Member, Advisory Board, School of Public Health and Social Policy, University of Victoria, 2009-2010
Member, Canadian Institutes of Health Research Ethical, Social and Legal Issues Advisory Committee for the Canadian Longitudinal Study on Aging, 2008-2010
Editorial Board Member - HIV/AIDS Policy & Law Review, 2007-2009
Can supervise: YES
Law, Health and Ageing
- Advance planning for health and financial matters
- Decision-making capacity
- Elder abuse
- Interprofessional collaboration across legal and health sectors
Legal Aspects of Health Service Delivery and System Reform
- Impact of litigation and complaints on behaviour
- Defensive practice and low value care
Law, Ethics and Health Research
- Research involving participants with cognitive impairment
- Decision-making capacity and consent
- Empirical methods in legal research
- Experimental law and regulation
- Evidence-based law
Ries, N 2013, Public Health Law and Policy in Canada, 3rd, LexisNexis Canada.
Castle, D & Ries, N 2009, Nutrition and Genomics Issues of Ethics, Law, Regulation and Communication, Academic Press.
Issues of Ethics, Law, Regulation and Communication David Castle, Nola Ries.
The chapters in this book follow nutrigenomics from the laboratory bench, to the
market, regulatory domains, individuals and health care professionals, the
Nutrigenomics is the rapidly developing field of science that studies nutrient-gene interaction. This field has broad implications for understanding the interaction of human genomics and nutrition, but can also have very specific implications for individual dietary recommendations in light of personal genetics. Predicted applications for nutrigenomics include genomics-based dietary guidelines and personalized nutrition based on individual genetic tests. These developments have sweeping ethical, legal and regulatory implications for individuals, corporations and governments. This book brings together experts in ethics, law, regulatory analysis, and communication studies to identify and address relevant issues in the emerging field of nutritional genomics. Contributing authors are experts in the social aspects of biotechnology innovation, with expertise in nutrigenomics. From addressing the concern that nutrigenomics will transform food into medicine and undermine pleasures associated with eating to the latest in the science of nutrigenomics, this book provides a world-wide perspective on the potential impact of nutrigenomics on our association with food. Explores the rapidly developing, yet not fully understood, impact of nutrigenomics on the relationship to food medicalization, genetic privacy, nutrition and health. Provides ground for further exploration to identify issues and provide analysis to aid in policy and regulation development Provides ethical and legal insights into this unfolding science, as well as serving as a model for thinking about issues arising in other fields of science and technology. © 2009 Elsevier Inc. All rights reserved.
Ries, N 2020, 'Enduring Powers of Attorney and Financial Exploitation of Older People: A Conceptual Analysis and Strategies for Prevention', Journal of Aging and Social Policy: a journal devoted to aging and social policy.
Enduring powers of attorney (POAs) are commonly used legal instruments that enable older people to plan for asset management in the event of future incapacity. The policy objective of POAs – empowering control over money and property – are frustrated when POAs are misused to financially exploit older people. This article integrates theory and evidence to propose a conceptual framework for POA-facilitated financial exploitation (POA-FE). Identified risk factors include: inadequate knowledge about the POA role; family conflicts; attitudes of entitlement; and lack of planning and preparation for financial decision-making. POA-FE occurs on a continuum of behavior and strategies for preventing POA-FE are suggested using strengths-based approaches for older people and their attorneys.
Ries, N, Mansfield, E & Sanson-Fisher, R 2020, 'Ethical and legal aspects of research involving older people with cognitive impairment: A survey of dementia researchers in Australia', International Journal of Law and Psychiatry, vol. 68.View/Download from: Publisher's site
People with dementia are under-represented in clinical research, in part due to the ethical and legal complexities of involving people in studies who may lack capacity to consent. Excluding this population from research limits the evidence to inform care. The attitudes and practices of researchers are key to the inclusion of people with dementia in research, however, there are few empirical studies on researchers' perspectives in this area.
A cross-sectional study involved researchers in Australia who had experience in the ethical aspects of conducting dementia-related studies with human participants (n = 70). Data were collected via an online survey from November 2017 to January 2018.
Most respondents (97%) agreed with the importance of including people at all stages of dementia in research, yet around three-quarters of respondents perceived ethical and legal rules and processes as unduly restrictive or time-consuming. Researchers reported variable practices in assessing prospective participants' capacity to consent to their studies. Various tools are used for this purpose, ranging from tools designed for research (eg, MacArthur Competence Assessment Tool for Clinical Research) to more general cognitive function screens (eg, Mini Mental State Exam).
Few respondents (14%) routinely exclude people from studies who are unable to give their own consent, but instead seek permission from proxy decision-makers, such as legally appointed guardians or family carers. Respondents reported positive and negative outcomes of ethics review processes. Positive outcomes included strengthening the protections for participants with cognitive impairment while negative outcomes included delays and inconsistent decisions from different ethics committees.
The findings suggest a need for improved strategies in the research context to assess and enhance the decision-making capacity of people with dementia to support appropriate opportunities for inclusion. Education for ethics commi...
Ries, N & Mansfield, E 2020, 'Action on Elder Abuse: A New South Wales pilot project on the role of legal and health practitioners in elder abuse screening, response and prevention', University of New South Wales Law Journal, vol. 43, no. 2.
This article reports on an elder abuse pilot project that involved legal and health practitioners (n=17) in a regional centre in New South Wales. The aim of the project was to design and test the feasibility and acceptability of a pilot intervention to improve detection and response for older clients at risk of or experiencing various forms of elder abuse. Using a qualitative approach, interviews and focus groups elicited practitioners' experiences in identifying and responding to elder abuse among their older clients and their views on the use of structured screening processes. Participants reported they mostly encounter situations of financial exploitation and psychological abuse, perpetrated by adult children against older parents. No practitioners reported the use of an elder abuse-specific screening tool, but perceived the benefits of structured screening questions to enable conversations about elder abuse and to support earlier identification of problem situations. Barriers to elder abuse screening included practitioners' concerns about communication strategies, professional role boundaries, and inadequate response options. Participants supported a 'triage' approach with graduated use of screening questions and responses scaled to the immediacy and severity of the problem. Respect for the autonomy of older people was emphasised, along with professionals' key role in providing advice and resources to empower their older clients. This study applies the contextual theory of elder abuse, which highlights the individual, relational, community and societal contexts in which abuse occurs and can be identified, mitigated and prevented. Investigation of the role and perspectives of legal and health professionals helps to further develop this contextual theory.
Ries, N, Mansfield, E & Sanson-Fisher, R 2020, 'Advance Research Directives: Legal and Ethical Issues and Insights from a National Survey of Dementia Researchers in Australia', Medical Law Review, vol. 28, no. 2, pp. 375-400.View/Download from: Publisher's site
Advance research directives (ARDs) are a means by which people can document their wishes about research participation in the event of future incapacity. The concept of ARDs emerged in literature in the 1980s and they have since been endorsed in some ethics guidelines and position statements. To date, formal legal recognition is limited. A few empirical studies have investigated the views of researchers and other stakeholders on ARDs and tested strategies to implement such directives. To further knowledge in this area, we undertook a survey of dementia researchers in Australia (n=63) to examine their views on ARDs. Recent law reform initiatives in Australia aim to provide a statutory framework for ARDs and the National Statement on Ethical Conduct in Human Research supports advance research planning, especially for participants who may experience cognitive impairment. Most of the survey respondents (>80%) thought ARDs would promote autonomy in decision-making and enable opportunities for people with cognitive impairment to be included in research. Respondents indicated concern about directives not being available when needed (71%) and that ethics committees would not accept ARDs (60%). Few respondents had used ARDs, but a majority (from 57–80%) would be willing to offer ARDs for a range of research activities, such as observing behaviour, taking measures, accessing records, and taking blood samples or scans. Nearly all respondents (92%) agreed that current dissent should override prior wishes stated in an ARD. The survey findings are contextualised with attention to ethics guidelines, laws and practices to support advance research planning.
Hosie, A, Kochovska, S, Ries, N, Gilmore, I, Parker, D, Sinclair, C, Sheehan, C, Collier, A, Caplan, GA, Visser, M, Xu, X, Lobb, E, Sheahan, L, Brown, L, Lee, W, Sanderson, CR, Amgarth-Duff, I, Green, A, Edwards, L & Agar, MR 2020, 'Older Persons' and Their Caregivers' Perspectives and Experiences of Research Participation With Impaired Decision-Making Capacity: A Scoping Review.', The Gerontologist.View/Download from: Publisher's site
BACKGROUND AND OBJECTIVES:Human research ethics statements support equitable inclusion of diverse groups. Yet older people are under-represented in clinical research, especially those with impaired decision-making capacity. The aim of this study was to identify perspectives and experiences of older persons and their caregivers of research participation with impaired decision-making capacity. RESEARCH DESIGN AND METHODS:Scoping review of literature and online sources in January-February 2019 (updated June 2020) according to Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews. English-language peer-reviewed research articles and Australian online narratives were included. Data were tabulated and narratively synthesized. RESULTS:From 4171 database records and 93 online resources, 22 articles (2000-2019, 82% United States, 16 first authors) and one YouTube webinar (2018) were initially included; updated searches yielded an additional article (2020) and YouTube webinar (2020). Studies were heterogeneous in terminology, methods and foci, with hypothetical scenarios, quantitative analyses and examination of proxy consent predominating. Participants (n=7331) were older persons (71%), caregivers of older persons with dementia/cognitive impairment (23%) and older persons with dementia/cognitive impairment (6%). Synthesis identified two themes: willingness to participate and decision-making approaches. DISCUSSION AND IMPLICATIONS:Research participation by older persons with dementia may be optimized through reducing risks and burdens and increasing benefits for participants, greater consumer input into study development, and shared and supported decision-making. Older persons' and caregivers' perspectives and experiences of research participation with impaired decision-making capacity require investigation in a greater range of countries and conditions other than dementia, and dissemination through more varied media.
Ries, N & Thomson, M 2020, 'Bioethics & Universal Vulnerability: Exploring the Ethics & Practices of Research Participation', Medical Law Review, vol. 28, no. 2, pp. 293-316.View/Download from: Publisher's site
In this article we advocate the adoption of universal vulnerability as a core value in bioethics. We argue that understanding vulnerability as the universal human condition – and rejecting the labelling of particular individuals or groups as vulnerable – would benefit bioethics and the research it governs. Bioethics first engaged with vulnerability in the context of participation in research and this continues to define how the value is typically understood. Thus, vulnerability is generally deployed to describe individuals (or populations) where real or perceived deficiencies limit the ability to function and to protect themselves from risks. Revisiting this initial context and the participation in research of people living with dementia, we note that the bioethical position of excluding the 'vulnerable' from research has led to major gaps in evidence and knowledge to inform care and support. Turning to universal vulnerability, we consider the research design and practices that the approach would mandate. We emphasise the importance of inclusive design, and mechanisms of institutional support that enable participation. We argue that these positively impact on the scientific value of research and address social justice concerns around social inclusion. Our aim is to provoke a fundamental reassessment of how vulnerability is conceived of in bioethics.
Ries, N, Mansfield, E & Sanson-Fisher, R 2019, 'Planning Ahead for Dementia Research Participation: Insights from a Survey of Older Australians and Implications for Ethics, Law and Practice', Journal of Bioethical Inquiry, vol. 16, no. 3, pp. 415-429.View/Download from: Publisher's site
People with dementia have commonly been excluded from research. The adverse impacts of this exclusion are now being recognized and research literature, position statements, and ethics guidelines increasingly call for inclusion of people with dementia in research. However, few published studies investigate the views of potential participants on taking part in research should they experience dementia-related cognitive impairment. This cross-sectional survey examined the views of people aged sixty and older (n=174) attending hospital outpatient clinics about clinical research participation if they had dementia and impaired decision-making ability. Over 90 percent of respondents were agreeable to participating in a wide range of research activities, such as cognitive testing, physical measurements, imaging procedures, and blood draws. For drug studies, however, agreement dropped to 60 percent. Altruism was a strong motivator for research participation. In regard to who should be involved in decisions about their participation in research during periods of incapacity, respondents mostly preferred the person they appoint as their substitute decision-maker for healthcare matters (88%) or a doctor or health professional on the research team (78%). Over three-quarters (79%) expressed interest in making an advance research directive. The study findings are discussed in relation to law reforms in Australia that aim to strengthen respect and inclusion for people with impaired decision-making capacity, especially by providing frameworks for advance planning for research participation.
Smith, T, McNeil, K, Mitchell, R, Boyle, B & Ries, N 2019, 'A study of macro-, meso- and micro-barriers and enablers affecting extended scopes of practice: the case of rural nurse practitioners in Australia.', BMC Nursing, vol. 18, pp. 14-14.View/Download from: Publisher's site
Background:Shortages of skills needed to deliver optimal health care in rural and remote locations raises questions about using extended scopes of practice or advanced practice models in a range of health professions. The nurse practitioner (NP) model was introduced to address health service gaps; however, its sustainability has been questioned, while other extended scope of practice roles have not progressed in Australia. This study aimed to explore the experiences and perceptions of NPs and their colleagues about barriers to and enablers of extended scope of practice and consider the relevance of the findings to other health professions. Methods:Semi-structured, in-depth interviews were conducted with primary, nurse practitioner informants, who were also invited to nominate up to two colleagues, as secondary informants. Data analysis was guided by a multi-level, socio-institutional lens of macro-, meso- and micro-perspectives. Results:Fifteen primary informants and five colleagues were interviewed from various rural and remote locations. There was a fairly even distribution of informants across primary, aged, chronic and emergency or critical care roles. Key barriers and enablers at each level of analysis were identified. At the macro-level were legal, regulatory, and economic barriers and enablers, as well as job availability. The meso-level concerned local health service and community factors, such as attitudes and support from managers and patients. The micro-level relates to day-to-day practice. Role clarity was of considerable importance, along with embedded professional hierarchies and traditional role expectations influencing interactions with individual colleagues. Given a lack of understanding of NP scope of practice, NPs often had to expend effort promoting and advocating for their roles. Conclusions:For communities to benefit from extended scope of practice models of health service delivery, energy needs to be directed towards addressing legislative ...
Ries, N, Douglas, M, Simon, J & Fassbender, K 2018, 'How Do Lawyers Assist Their Clients with Advance Care Planning? Findings from a Cross-Sectional Survey of Lawyers in Alberta', Alberta Law Review, vol. 55, no. 3, pp. 683-701.
Advance care planning (ACP) is the process of thinking about, discussing and documenting one's preferences for future health care. ACP has important benefits: people who have a written directive are more likely to receive care that accords with their preferences, have fewer hospitalizations, and die in their preferred location. This article focuses on the important role that legal professionals have in advising and assisting clients with ACP. Studies report that people who have a written advance care plan are more likely to have received assistance in preparing the document from a lawyer than from a doctor. Yet virtually no research engages with the legal profession to understand lawyers' attitudes, beliefs, and practices in this important area. This article starts to fill this gap by reporting the findings of a survey of lawyers in the province of Alberta. The results reveal lawyers' practices in relation to ACP, their perceptions of their professional role and factors that support or hinder lawyers in working with clients on ACP, and their preferences for resources to assist them in helping their clients. To the authors' knowledge, this is the first survey of lawyers on their practices in relation to ACP
Ries, N & Mansfield, E 2018, 'Elder Abuse: The role of general practitioners in community-based screening and multidisciplinary action', Australian Journal of General Practice, vol. 47, no. 4, pp. 132-135.
There are growing calls for elder abuse screening to be conducted by a range of community-based service providers, including general practitioners (GPs), practice nurses, home care workers and lawyers. Improved screening may be a valuable first step towards improving elder abuse detection and response; however, practitioners need evidence-based strategies for screening and follow-up.
This article summarises several brief screening tools for various forms of elder abuse. Screening tool properties and evidence gaps are noted. As elder abuse often requires multidisciplinary responses, initiatives to connect health, legal and other service providers are highlighted.
GPs are trusted professionals who are well placed to identify older patients at risk of, or experiencing, various forms of abuse. They should be aware of available screening tools and consider how best to incorporate them into their own practice. They also play an important role in multidisciplinary action to address elder abuse.
Waller, A, Sanson-Fisher, R, Ries, N & Bryant, J 2018, 'Increasing advance personal planning: the need for action at the community level', BMC Public Health, vol. 18.View/Download from: Publisher's site
Elder abuse is a serious and under-detected problem. Law reform agencies and legal profession regulatory authorities have called for action to ensure that lawyers meet their ethical obligations to older clients, including identifying and acting on risk factors for abuse. Screening tools to detect situations of elder abuse exist, but they are targeted mainly at health and social care practitioners. Drawing on international literature, this article identifies and discusses screening tools that could be adapted for use by legal professionals. Three general categories of screening are relevant for lawyers who serve older clients: (1) elder abuse screening tools that cover all domains of abuse or target specific behaviours, such as financial exploitation; (2) screening for decision-making capacity, especially taking account of the impact of abuse or neglect on capacity; and (3) screening to probe the suitability of a person to act in a formal decision-making role for an older person. The article emphasises the importance of implementing screening processes and follow-up actions in a manner that fosters a therapeutic relationship between the older client and the lawyer. It concludes with recommendations for further research in this important area.
Ries, N & Kypri, K 2018, 'Government-funded Health Research Contracts in Australia: A Critical Assessment of Transparency', Sydney Law Review, vol. 40, no. 3, pp. 367-394.
Australian governments claim to be committed to improving transparency and democratic accountability. Yet they are increasingly contracting out research to external consultants, 'think tanks' and universities and the contractual relationships formed can, in fact, promote secrecy and undermine the goals of transparency and public scrutiny of government actions. This article reports on a first-in-kind study of research contracts between Commonwealth and New South Wales Government entities and external providers. Our analysis reveals that 'control clauses' are prevalent: contractually, governments can insist on the rights to determine whether, when and how the results of research are publicly disseminated, to claim intellectual property rights over work produced, and to terminate contractual relationships at will and without cause. These findings have troubling implications for government openness and accountability, for academic freedom when university researchers face restrictions on publication, and for evidence-informed policymaking. We propose solutions for proactive information disclosure to ensure that government transparency promises are realised in practice. We advocate for comprehensive public release of contract details and urge governments to publish the findings of contract research in an online repository.
Connor, T, Ries, N, Ross, N, Sobel-Read, K & Matas, D 2018, 'Becoming Global Citizens and Global Lawyers: Incorporating International Work and Study Experiences into the Australian Law School Curriculum', Clinical Law Review: a journal of lawyering and legal education, vol. 25, no. 1, pp. 63-94.
Much of the literature on global citizenship education asserts a
perceived tension between "neoliberal cosmopolitanism" (enhancing
students' employability) and "critical democratic cosmopolitanism"
(enhancing students' critical understanding of cultural diversity and
political and economic inequality). Lilley, Barker and Harris recently
argued these two approaches need not necessarily be in tension be-
cause employers value the skills developed through more critical
This article analyzes the reflective journals of 39 Australian law
students who participated in intensive work and study experiences in
Indo-Pacific countries. The students' journals lend further weight to
the thesis of Lilley, Barker and Harris, here specifically in regard to
law studies. In line with the goals of "critical democratic cosmopoli-
tanism," the overseas experiences motivated the students to become
more open-minded, self-critical and reflective in their thinking, and
more confident, respectful and empathetic in their interactions with
people of different cultures. A number of recent studies have indi-
cated these kinds of skills and attributes are highly valued by employ-
ers of law graduates. For the law students, rather than identifying a
tension between their ambition to become global lawyers and the re-
sponsibilities associated with global citizenship, the overseas exper-
iences instead led them to frame their understanding of global
lawyering in terms of positive global citizenship.
Ries, NM & Mansfield, E 2018, 'Elder abuse: The role of general practitioners in community-based screening and multidisciplinary action', Australian journal of general practice, vol. 47, no. 4, pp. 235-238.View/Download from: Publisher's site
BACKGROUND: There are growing calls for elder abuse screening to be conducted by a range of community-based service providers, including general practitioners (GPs), practice nurses, home care workers and lawyers. Improved screening may be a valuable first step towards improving elder abuse detection and response; however, practitioners need evidence-based strategies for screening and follow-up. OBJECTIVE: This article summarises several brief screening tools for various forms of elder abuse. Screening tool properties and evidence gaps are noted. As elder abuse often requires multidisciplinary responses, initiatives to connect health, legal and other service providers are highlighted. DISCUSSION: GPs are trusted professionals who are well placed to identify older patients at risk of, or experiencing, various forms of abuse. They should be aware of available screening tools and consider how best to incorporate them into their own practice. They also play an important role in multidisciplinary action to address elder abuse. .
Ries, NM 2017, 'Law matters: How the legal context in Canada influences interprofessional collaboration.', Journal of interprofessional care, vol. 31, no. 4, pp. 417-419.View/Download from: Publisher's site
Ries, NM, Thompson, KA & Lowe, M 2017, 'Including People with Dementia in Research: An Analysis of Australian Ethical and Legal Rules and Recommendations for Reform', Journal of Bioethical Inquiry, vol. 14, no. 3, pp. 359-374.View/Download from: Publisher's site
© 2017, Journal of Bioethical Inquiry Pty Ltd. Research is crucial to advancing knowledge about dementia, yet the burden of the disease currently outpaces research activity. Research often excludes people with dementia and other cognitive impairments because researchers and ethics committees are concerned about issues related to capacity, consent, and substitute decision-making. In Australia, participation in research by people with cognitive impairment is governed by a national ethics statement and a patchwork of state and territorial laws that have widely varying rules. We contend that this legislative variation precludes a consistent approach to research governance and participation and hinders research that seeks to include people with impaired capacity. In this paper, we present key ethical principles, provide a comprehensive review of applicable legal rules in Australian states and territories, and highlight significant differences and ambiguities. Our analysis includes recommendations for reform to improve clarity and consistency in the law and reduce barriers that may exclude persons with dementia from participating in ethically approved research. Our recommendations seek to advance the national decision-making principles recommended by the Australian Law Reform Commission, which emphasize the rights of all adults to make their own decisions and for those with impaired capacity to have access to appropriate supports to help them make decisions that affect their lives.
Ries, N 2017, 'Choosing Wisely: Law's Contribution as a Cause of and a Cure for Unwise Health Care Choices', Journal of Law and Medicine, vol. 25, no. 1, pp. 210-228.
The provision of unnecessary health care is a serious problem in Australia and involves two key legal issues. First, doctors' fear of litigation drives defensive practices – ordering tests and procedures, making referrals, and prescribing drugs to reduce perceived legal risks, rather than to advance patient care. Second, suboptimal communication and decision-making processes undermine a patient's right to make informed health care choices. This article critically analyses these problems and proposes solutions. An extensive body of medico-legal literature is synthesised to highlight the gaps between legal requirements and what happens in practice. Negligence case law is discussed to clarify legal principles and shows that courts discourage defensive practice. Finally, the article presents practical strategies to enhance communication and shared decision-making in the clinical encounter.
Ries, N 2016, 'Lawyers and Advance Care and End-of-Life Planning: Enhancing Collaboration between Legal and Health Professions', Journal of Law and Medicine, vol. 23, no. 4, pp. 887-906.
Ries, N, Johnston, B & McCarthy, S 2016, 'Legal education and the ageing population: Building student knowledge and skills through practical experiences in collaboration with community organisations', Adelaide Law Review, vol. 37, no. 2, pp. 495-522.
Ries, N 2016, 'Innovation in Healthcare, Innovation in Law: Does the Law Support Interprofessional Collaboration in Canadian Health Systems?', Osgoode Hall Law Journal, vol. 54, no. 1, pp. 97-124.
Interprofessional collaboration in health care describes a model of practice in which multiple health professionals work together in a team-based approach to patient care. A growing body of literature demonstrates that interprofessional collaboration advances health care quality and safety, improves patient outcomes and experiences of care, and promotes job satisfaction among health professionals. Governments and health organizations across Canada are working to advance interprofessional health care delivery. This article examines the importance of law in supporting a shift to interprofessional collaboration in Canadian health care and discusses two key aspects of the legal context in which health practitioners work. First, the article discusses trends in the legal regulation of health professions in Canada, including law reform initiatives aimed at promoting collaborative practice and at expanding scopes of practice to break down the historically siloed approach to health care delivery. Second, the article examines civil liability rules that courts apply when allegations of negligence are made against health care providers working in team-based situations. regarding responsibility for patient care and outcomes. The article illustrates how legal innovations, such as new models of health profession regulation and legal adaptability through judicial understanding of the modern context of health service delivery, are important to the advancement of interprofessional collaboration in Canadian health care.
Ries, N 2016, 'Prescribe with Caution: The Response of Canada's Medical Regulatory Authorities to the Therapeutic Use of Cannabis', McGill Journal of Law and Health, vol. 9, no. 2, pp. 215-254.
Canada was one of the first countries worldwide to legalize the use of cannabis for therapeutic purposes. The federally regulated cannabis access program has not had the support of medical regulatory authorities, however, and recent changes to federal rules are controversial in imposing responsibility on physicians to prescribe the drug, which is unapproved and illegal outside the medical use laws. This paper analyzes the response of Canada's ten medical regulatory authorities to these legal changes and provides critical commentary on the legal and ethical guidance provided to physicians who treat patients seeking to use cannabis therapeutically. The paper considers the role of doctors as gatekeepers, the profession's concerns about medico-legal risks of cannabis prescription, stigmatization and barriers to care for patients who use cannabis, and the need for research to continue to build the evidence base to inform therapeutic prescription of the drug. The Canadian experience provides lessons for other jurisdictions that are considering liberalizing cannabis use laws.
Ries, N, Douglas, M, Simon, J & Fassbender, K 2016, 'Doctors, Lawyers and Advance Care Planning: Time for Innovation to Work Together to Meet Client Needs', Healthcare Policy | Politiques de Santé, vol. 12, no. 2, pp. 13-18.View/Download from: Publisher's site
Nicol, D, Bubela, T, Chalmers, D, Charbonneau, J, Critchley, C, Dickinson, J, Fleming, J, Hewitt, AW, Kaye, J, Liddicoat, J, McWhirter, R, Otlowski, M, Ries, NM, Skene, L, Stewart, C, Wagner, J & Zeps, N 2016, 'Precision medicine: Drowning in a regulatory soup?', Journal of Law and the Biosciences, vol. 3, no. 2, pp. 281-303.View/Download from: Publisher's site
Ries, N, Johnston, B & McCarthy, S 2016, 'Technology-Enabled Legal Service Delivery for Older Adults: What Can Law Learn from TeleHealth? Findings from an International Review of Literature', Elder Law Review, vol. 10.
Ries, NM, Douglas, M, Simon, J & Fassbender, K 2016, 'Doctors, Lawyers and Advance Care Planning: Time for Innovation to Work Together to Meet Client Needs.', Healthcare policy = Politiques de sante, vol. 12, no. 2, pp. 12-18.
Health organizations in canada have invested considerable resources in strategies to improve knowledge and uptake of advance care planning (acp). Yet barriers persist and many canadians do not engage in the full range of acp behaviours, including writing an advance directive and appointing a legally authorized decision-maker. not engaging effectively in acp disadvantages patients, their loved ones and their healthcare providers. This article advocates for greater collaboration between health and legal professionals to better support clients in acp and presents a framework for action to build connections between these typically siloed professions.
Caulfield, T, Burningham, S, Joly, Y, Master, Z, Shabani, M, Borry, P, Becker, A, Burgess, M, Calder, K, Critchley, C, Edwards, K, Fullerton, SM, Gottweis, H, Hyde-Lay, R, Illes, J, Isasi, R, Kato, K, Kaye, J, Knoppers, B, Lynch, J, McGuire, A, Meslin, E, Nicol, D, O'Doherty, K, Ogbogu, U, Otlowski, M, Pullman, D, Ries, N, Scott, C, Sears, M, Wallace, H & Zawati, MH 2014, 'A review of the key issues associated with the commercialization of biobanks', Journal of Law and the Biosciences, vol. 1, no. 3, pp. 94-110.View/Download from: Publisher's site
Nicol, D, Hagger, M, Ries, N & Liddicoat, J 2014, 'Time to Get Serious about Privacy Policies: The Special Case of Genetic Privacy', Federal Law Review, vol. 42, no. 1, pp. 149-179.
Ries, N & Fisher, K 2013, 'The Increasing Involvement of Physicians in Complementary and Alternative Medicine: Considerations of Professional Regulation and Patient Safety', Queen's Law Journal, vol. 39, no. 1, pp. 273-299.
Ries, N 2013, 'Research with Blood Donated for Transfusion Purposes', Health law review, vol. 21, no. 2.
Ries, NM 2012, 'Nudge or not: can incentives change health behaviours?', Healthcare Papers, vol. 12, no. 4, pp. 37-41.
The approach of "nudging" people toward healthier behaviours is currently in vogue, and user financial incentives (UFIs) are one possible nudge tool. Interesting debates arise as to the criteria UFIs must meet to qualify as a nudge. The more pressing issue, however, is to determine how UFIs can be structured and implemented to motivate and sustain health behaviour change. To date, Canadian public health strategies to promote physical activity and balanced nutrition focus mainly on information provision, with some product regulation measures and indirect financial incentives. Governments cannot afford direct UFI programs to incent all 60% of overweight and obese Canadians to reduce their body mass, but governments could consider UFIs targeted to specific risk groups where a shorter-term intervention could have long-term payoffs.
Ries, N 2012, 'Legal and Policy Measures to Promote Healthy Behaviour: Using Incentives and Disincentives to Control Obesity', McGill Journal of Law and Health, vol. 6, no. 1, pp. 1-40.
This article examines incentives as a health policy option to encourage healthier behaviours and considers the emerging body of literature that evaluates the effectiveness and impact of incentives as public health policy tools. Incentives - including rewards and penalties - vary widely in their force, from indirect (or mild) to direct (or strong) incentives. At one end of the incentive spectrum are strategies that invite healthier behaviour, such as urban planning measures to encourage walking and cycling. In the middle of the incentive spectrum are measures such as tax credits for those who participate in sports and fitness programs or "fat taxes" on high-calorie, low-nutrition foods. These strategies target individuals' pocketbooks and thus may have a stronger influence on behaviour change. The most direct incentives are governmental or private sector schemes that use monetary payments or penalties to induce behaviour change. While this article focuses on incentives targeted at individuals, it briefly discusses several examples of incentives aimed at businesses, particularly food retailers.
The use of incentives as a health policy tool has several key legal dimensions. First, governments rely on legal powers, such as taxation laws and zoning regulations, to implement certain kinds of incentives. Second, in their operation and impact, incentives may infringe on legally protected rights. In particular, the use of "sticks" rather than "carrots" may be criticized on the grounds that they are coercive, discriminate unfairly, and promote individual blame. Third, public health law is concerned with the use of legal and policy measures to create conditions in which people may be healthy. It is important, therefore, to evaluate incentive programs to determine their effectiveness in ameliorating obesogenic environments and creating conditions for improved dietary and physical activity behaviours.
Rising rates of overweight and obesity are of serious concern in Canada. Until recently, discussion of policy options to promote healthier lifestyles has ignored the topic of direct financial incentives. The idea of paying people to lose weight or adopt healthier behaviours is now attracting study and debate. Some governments and companies are already experimenting with reward programs. Available evidence indicates that financial incentives help promote short-term change, but there is a dearth of evidence on longer-term programs and outcomes. Targeted incentives for specific risk groups have shown more success. With creative design, targeted use and evaluation, financial incentives for weight loss and healthy behaviour may be a useful addition to the health policy toolkit.
Ries, N 2011, 'Regulating Public Health Risks: Case Studies of Food Allergens and Transfusion Transmissible Infections', Health Law Journal, vol. 19, pp. 1-44.
Master, Z, Ries, NM & Caulfield, T 2011, 'Balancing Efficiency and the Protection of Research Participants: Canadian Allergy/Asthma Researchers' Perspectives on the Ethics Review of Multi-Site Health Research', Journal of Clinical Research & Bioethics, vol. 02, no. 05.View/Download from: Publisher's site
Rachul, C, Ries, N & Caulfield, T 2011, 'Canadian newspaper coverage of the A/H1N1 vaccine program', Canadian Journal of Public Health, vol. 102, no. 3, pp. 200-204.
Ries, N & von Tigerstrom, B 2011, 'Legal Interventions to Address Obesity: Assessing the State of the Law in Canada', University of British Columbia Law Review, vol. 43, no. 2, pp. 361-416.
Ries, NM, Rachul, C & Caulfield, T 2011, 'Newspaper reporting on legislative and policy interventions to address obesity: United States, Canada, and the United Kingdom', JOURNAL OF PUBLIC HEALTH POLICY, vol. 32, no. 1, pp. 73-90.View/Download from: Publisher's site
Caulfield, T, Ries, N & Barr, G 2011, 'Variation in Ethics Review of Multi-Site Research Initiatives', Amsterdam Law Forum, vol. 3, no. 1, pp. 104-122.
Arrandale, VH, Brauer, M, Brook, JR, Brunekreef, B, Gold, DR, London, SJ, Miller, JD, Oezkaynak, H, Ries, NM, Sears, MR, Silverman, FS & Takaro, TK 2011, 'Exposure Assessment in Cohort Studies of Childhood Asthma', ENVIRONMENTAL HEALTH PERSPECTIVES, vol. 119, no. 5, pp. 591-597.View/Download from: Publisher's site
Ries, NM 2010, 'Canadian Institutes of Health Research-Institute of Aging: Profile Ethics, Health Research, and Canada's Aging Population', CANADIAN JOURNAL ON AGING-REVUE CANADIENNE DU VIEILLISSEMENT, vol. 29, no. 4, pp. 577-580.View/Download from: Publisher's site
Weir, M, Morin, K, Ries, N & Castle, D 2010, 'Canadian health care professionals' knowledge, attitudes and perceptions of nutritional genomics', BRITISH JOURNAL OF NUTRITION, vol. 104, no. 8, pp. 1112-1119.View/Download from: Publisher's site
Ries, NM, LeGrandeur, J & Caulfield, T 2010, 'Handling ethical, legal and social issues in birth cohort studies involving genetic research: responses from studies in six countries', BMC MEDICAL ETHICS, vol. 11.View/Download from: Publisher's site
Ries, NM, Hyde-Lay, R & Caulfield, T 2010, 'Willingness to Pay for Genetic Testing: A Study of Attitudes in a Canadian Population', PUBLIC HEALTH GENOMICS, vol. 13, no. 5, pp. 292-300.View/Download from: Publisher's site
Caulfield, T, Ries, NM, Ray, PN, Shuman, C & Wilson, B 2010, 'Direct-to-consumer genetic testing: good, bad or benign?', CLINICAL GENETICS, vol. 77, no. 2, pp. 101-105.View/Download from: Publisher's site
Ries, NM 2010, 'Ethics, health research in Canada and the ageing populating', CANADIAN JOURNAL ON AGING-REVUE CANADIENNE DU VIEILLISSEMENT, vol. 29, no. 4, pp. 581-585.View/Download from: Publisher's site
Ries, NM 2010, 'Ethics, health research, and Canada's aging population', Canadian journal on aging = La revue canadienne du vieillissement, vol. 29, no. 4, pp. 577-585.
von Tigerstrom, B & Ries, N 2009, 'Cancer Surveillance in Canada: Analysis of Legal and Policy Frameworks and Tools for Reform', Health Law Journal, vol. 17, pp. 1-49.
Rodal, R, Ries, N & Wilson, K 2009, 'Influenza Vaccination for Health Care Workers: Towards a Workable and Effective Standard', Health Law Journal, vol. 17, pp. 297-337.
Farrell, J, Ries, NM, Kachan, N & Boon, H 2009, 'Foods and natural health products: Gaps and ambiguities in the Canadian regulatory regime', FOOD POLICY, vol. 34, no. 4, pp. 388-392.View/Download from: Publisher's site
Moran, T, Ries, N & Castle, D 2009, 'a cause of action for regulatory negligence? The regulatory framework for genetically modified crops in Canada and the potential for regulator liability', Revue de Droit et Technologie de l'Université d'Ottawa / University of Ottawa Law and Technology Journal, vol. 6, pp. 1-23.
Ries, N 2008, 'Piling on the Laws, Shedding the Pounds? The Use of Legal Tools to Address Obesity', Health Law Journal, pp. 101-126.
Ries, NM & Castle, D 2008, 'Nutrigenomics and Ethics Interface: Direct-to-Consumer Services and Commercial Aspects', OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY, vol. 12, no. 4, pp. 245-250.View/Download from: Publisher's site
Samuel, J, Ries, N, Malkin, D & Knoppers, BM 2008, 'Biobanks and Longitudinal Studies: Where are the Children?', GenEdit, vol. 6, no. 3, pp. 1-8.
Ries, N 2008, 'Regulating Nutrigenetic Tests: An International Comparative Analysis', Health law review, vol. 16, no. 3, pp. 9-20.
Spady, D, Ries, N, Ladd, BD, Buka, I, Osornio-Vargas, AR & Soskolne, C 2008, 'Governance Instruments that Protect Children's Environmental Health: Is Enough Being Done?', Environmental Law Review, vol. 10, no. 3, pp. 200-217.
Hailey, D, Jacobs, PD, Ries, NM & Polisena, J 2008, 'Reuse of single use medical devices in Canada: Clinical and economic outcomes, legal and ethical issues, and current hospital practice', INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, vol. 24, no. 4, pp. 430-436.View/Download from: Publisher's site
Polisena, J, Hailey, D, Moulton, K, Noorani, HZ, Jacobs, P, Ries, N, Normandin, S & Gardam, M 2008, 'Reprocessing and reuse of single-use medical devices: A national survey of Canadian acute-care hospitals', INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, vol. 29, no. 5, pp. 437-439.View/Download from: Publisher's site
Farrell, J, Ries, NM & Boon, H 2008, 'Pharmacists and natural health products: A systematic analysis of professional responsibilities in Canada', Pharmacy Practice, vol. 6, no. 1, pp. 33-42.View/Download from: Publisher's site
Natural health products such as herbs, vitamins and homeopathic medicines are widely available in Canadian pharmacies. Purpose: to conduct a systematic analysis of Canadian pharmacy policies and guidelines to explore pharmacists' professional responsibilities with respect to natural health pioducts. Methods: Legislation, codes of ethics, standards of practice and guidance documents that apply to the practice of pharmacy in each Canadian jurisdiction were systematically collected and examined to identify if, and how, these instruments establish professional duties in regard to natural health products. Results: The majority of Canadian jurisdictions now include some explicit reference to natural health products in standards of practice policy or guideline documents. Often natural health products are simply assumed to be included in the over-the-counter (OTC) product category and thus professional responsibilities for OTCs are relevant for natural health products. A minority of provinces have specific policies on natural health products, herbals or homeopathy. In addition, the National Association of Pharmacy Regulatory Authorities' Model Standards of Practice specifically refers to natural health products. Most policy documents indicate that pharmacists should inquire about natural health product use when counselling patients and, when asked, should provide accurate information regarding the efficacy, toxicity, side effects or interactions of natural health products. Public messaging also indicates that pharmacists are knowledgeable professionals who can provide evidence-based information about natural health products. Conclusions: Explicit policies or guidelines regarding pharmacists' professional responsibilities with respect to natural health products currently exist in the majority of Canadian jurisdictions.
Ries, N 2007, 'Growing Up as a Research Subject: Ethical and Legal Issues in Birth Cohort Studies Involving Genetic Research', Health Law Journal, pp. 1-41.
Ries, N 2007, 'Food, Fat and the Law: A Comment on Trans Fat Bans and Public Health', Windsor Review of Legal and Social Issues, vol. 23, pp. 15-26.
Castle, D & Ries, NA 2007, 'Ethical, legal and social issues in nutrigenomics: The challenges of regulating service delivery and building health professional capacity', MUTATION RESEARCH-FUNDAMENTAL AND MOLECULAR MECHANISMS OF MUTAGENESIS, vol. 622, no. 1-2, pp. 138-143.View/Download from: Publisher's site
Ries, N & Caulfield, T 2006, 'First Pharmacogenomics, Next Nutrigenomics: Genohype or Genohealthy?', Jurimetrics, vol. 46, no. 3, pp. 281-308.
Ries, N 2006, 'Patient Privacy in a Wired (and Wireless) World: Approaches to Consent in the Context of Electronic Health Records', Alberta Law Review, vol. 43, no. 3, pp. 681-712.
Ries, N 2006, 'Legal Rights, Constitutional Controversies, and Access to Health Care: Lessons from Canada', Medicine and Law, vol. 25, no. 1, pp. 45-57.
Ries, NM & Caulfield, T 2005, 'Legal foundations for a national public health agency in Canada', CANADIAN JOURNAL OF PUBLIC HEALTH-REVUE CANADIENNE DE SANTE PUBLIQUE, vol. 96, no. 4, pp. 281-283.View/Download from: Publisher's site
Ries, NM & Moysa, G 2005, 'Legal protections of electronic health records: issues of consent and security.', Health law review, vol. 14, no. 1, pp. 18-25.
Bailey, TM & Ries, NM 2005, 'Legal issues in patient safety: the example of nosocomial infection.', Healthcare quarterly (Toronto, Ont.), vol. 8 Spec No, pp. 140-145.
Ries, NM 2004, 'Public health law and ethics: lessons from SARS and quarantine.', Health law review, vol. 13, no. 1, pp. 3-6.
Ries, NM 2003, 'Section 7 of the Charter: a constitutional right to health care? Don't hold your breath.', Health law review, vol. 12, no. 1, pp. 29-35.
Ries, NM 2003, 'The uncertain state of the law regarding health care and section 15 of the charter.', Health law journal, vol. 11, pp. 217-239.
Ries, N & Shelley, JJ 2019, 'Legal Foundations of Public Health in Canada' in Public Health Law and Policy in Canada, LexisNexis Canada Inc., Toronto, pp. 9-39.
Ries, N & Robin, N 2019, 'Legal Aspects of the Blood System in Canada' in Public Health Law and Policy in Canada, LexisNexis Canada Inc, Toronto, pp. 279-317.
Ries, N, von Tigerstrom, B & Shelley, JJ 2019, 'Law and the Promotion of Healthy Nutrition and Physical Activity' in Public Health Law and Policy in Canada, LexisNexis Canada Inc., Toronto, pp. 629-686.
Ross, NM, Ries, N, Meredith, J & Campbell, S 2018, 'Local to Global: Incorporating Overseas Work and Study in the Law School Curriculum' in Hall, T, Gray, T, Downey, G & Singh, M (eds), The Globalisation of Higher Education - Developing Internationalised Education in Research and Practice, Springer, Germany, pp. 291-305.View/Download from: Publisher's site
Legal education traditionally focuses on domestic law, but a major shift is underway to internationalize the law school curriculum with the aim of developing twenty-first-century lawyers as global lawyers. This chapter first identifies important contextual factors influencing Australian law schools to incorporate overseas work and study immersion courses into the curriculum. Second, it presents a case study and proposed evaluation of internationalization initiatives at the University of Newcastle Law School, New South Wales, focused on overseas work-integrated learning and intensive study trips in the Asia–Pacific region. Third, the chapter concludes with reflections on the opportunities and challenges from the perspective of legal educators who must develop their own intercultural competence and navigate new ways of working with overseas service providers and academic institutions
Ries, N & Shelley, J 2018, 'Public Health Law' in White, B, McDonald, F & Willmot, L (eds), Health Law in Australia, pp. 697-727.
Turner, A, Ries, N & Baker, A 2017, 'Mental health-substance use' in Cooper, DB (ed), Ethics in Mental Health-Substance Use.
Ries, N 2015, 'Health Professionals and the Organisation of Healthcare: Current Trends'.
Ries, N 2014, 'Health Professionals and the Organisation of Healthcare: Current Trends' in Joly, Y & Knoppers, BM (eds), Routledge Handbook of Medical Law and Ethics, pp. 155-167.View/Download from: Publisher's site
Ries, N 2013, 'Human Health Care: The Promise of Animal Biotechnology' in Brunk, C & Hartley, S (eds), Designer Animals: Mapping the Issues in Animal Biotechnology, University of Toronto Press.
Ries, N 2011, 'Charter Challenges' in Downie, J, Caulfield, T & Flood, C (eds), Canadian Health Law and Policy, LexisNexis Canada, pp. 615-651.
Ries, N & Kellogg, K 2011, 'Canada' in Nys, H (ed), International Encylopaedia of Laws: Medical Law, Kluwer Law International.
Brunk, C, Ries, N & Rodgers, L 2009, 'Regulatory and Innovation Implications of Religious and Ethical Sensitivities Concerning GM Food' in Brunk, C & Coward, H (eds), Acceptable Genes: Religious Traditions and Genetically Modified Foods, SUNY Press.
Ries, N 2009, 'Longitudinal Studies Involving Children and Adolescents' in Knoppers, BM, Avard, D & Samuel, J (eds), Paediatric Research in Canada, Les Éditions Thémis.
Samuel, J, Ries, N, Malkin, D & Knoppers, BM 2009, 'Biobanks and Children: Comparative International Policies' in Knoppers, BM, Avard, D & Samuel, J (eds), Paediatric Research in Canada, Les Éditions Thémis.
Ries, N 2008, 'Legal Issues in Health Information and Electronic Health Records' in Kushniruk, A & Borycki, E (eds), Human, Social, and Organizational Aspects of Health Information Systems.
Caulfield, T & Ries, N 2006, 'Public Opinion, Consent and Population Genetic Biobanks' in Knoppers, BM (ed), Genomics and Public Health: Legal and Socio-Ethical Perspectives.
Caulfield, T & Ries, NM 2005, 'Politics and paradoxes: Chaoulli and the Alberta reaction' in Access to Care, Access to Justice: The Legal Debate Over Private Health Insurance in Canada, pp. 413-428.
Ries, N 2019, 'Identifying and Acting on Elder Abuse: A Toolkit for Legal Practitioners'.
This Toolkit may be downloaded at: https://www.uts.edu.au/sites/default/files/article/downloads/Elder%20Ab…
It was developed as part of a 2017/18 pilot project on elder abuse funded by the NSW Government. This Toolkit covers the following key topics:
- background information on elder abuse
- talking to clients about elder abuse – this section of the Toolkit includes short questionnaires/screening tools to aid conversations with clients
- assisting clients at risk for or experiencing abuse, with a focus on principles to guide responses
Ries, N 2018, 'When powers of attorney go wrong: Preventing financial abuse of older people by enduring attorneys', Australian Lawyers Alliance, pp. 9-13.