Medical Law Review最新文献

The Mental Capacity Act 2005 in England and Wales and Singapore's Mental Capacity Act 2008 (which substantially transplants provisions from the former statute) might appear to be twins on paper, but they have gone on to lead very different lives. In this article, we examine how two broadly identical laws have taken on divergent identities within their respective jurisdictions when implemented and interpreted in the courtroom. We reveal and analyse differences in parliamentary intent concerning at what stage a person's decision-making agency is putatively empowered; judicial development of central concepts; underlying socio-cultural commitments; and outline opportunities for bi-directional learning in mental capacity law across both jurisdictions.

Colonialism has left biological and social legacies that damage health. The resulting racialized health inequities re-enact past harms and are a profound social injustice. In response, this article brings together reparatory justice and health equity. Understandings of reparatory justice have evolved from a focus on compensation for past wrongs to the need for a more sustained and expansive politics of repair. This seeks to recognize the history and legacies of harm while diminishing the likelihood that such harms are repeated. Addressing racialized health inequities in the UK, and working with this articulation of reparatory justice, this article argues for the repair of bodies that continue to be damaged by historically rooted harms. Social determinants of health research has long linked socio-economic inequalities to poor health outcomes, and promoting health equity by addressing these inequalities can be an important element of the work to repair the past. This response acknowledges the moral case for both reparatory justice and health equity, while potentially addressing problems faced by traditionally articulated reparatory claims. Finally, exploring law's role in addressing racialized health inequities can help us better understand how law is a determinant of health and its role in advancing health equity.

Euthanasia has been legal in Belgium since 2002. Despite extensive research exploring Belgian euthanasia practice, investigations into its governing regulatory framework are limited. Existing studies that consider regulation take a 'siloed' approach, generally considering sources of regulation individually, including euthanasia legislation and euthanasia policies. This study obtains insights from providing health professionals on how the Belgian euthanasia regulatory landscape influences their euthanasia practice. We conducted semi-structured, in-depth interviews from September 2022 to March 2024 with eligible physicians and nurses and analysed them using a reflexive approach to thematic analysis. We generated three overarching themes describing the influence of regulation on euthanasia practice: the Act is a valuable, boundary-setting instrument; but the Act is limited, leaving space for gap filling and other forms of regulation; and relying on professional judgment can make practitioners feel vulnerable. Key findings include that practitioners respond to the Act's non-prescriptiveness and regulatory lacunae by relying on their professional judgment, and that the efficacy of the retrospective euthanasia oversight model depends on physicians' good faith participation. Policymakers in Belgium and internationally are encouraged to reflect on the implications of Belgium's euthanasia regulatory model for the consistency, quality, and control of euthanasia practice.

Artificial Intelligence (AI) is revolutionizing healthcare by enhancing patient care, diagnostics, workflows, and treatment personalization. The integration of AI in healthcare promises significant advancements and better patient outcomes. However, the lack of explainability in many AI models, known as 'black-box AI', raises concerns for patients, doctors, and developers. This issue, termed 'black box medicine', challenges the adoption of AI in healthcare. The demand for explainable AI has grown as AI systems become more complex. The absence of explanations in AI decisions, especially in critical situations like healthcare, has sparked debates and even suggestions to exclude black-box AI from healthcare provision. This article examines the impact and causes of unexplainable AI in healthcare, critically evaluates its performance, and proposes strategies to address this challenge.

The UK National Health Service general practice (GP) patient data constitute a rich research resource, but collecting, managing, and sharing patient data present challenges. In May 2021, to address these challenges, substantial changes to the system for processing pseudonymized GP patient data in England were announced. As part of an opt-out process, patient consent to sharing GP data was deemed to have been given. However, when over a million people quickly acted to opt out of the new system, the process was paused, and an engagement exercise commenced, whose aim was to inform a re-designed programme addressing patient concerns. In this article, we present and discuss the findings of the General Practice Data Trust pilot study, which has investigated people's reasons for opting out of sharing their data, and, looking for practical solutions to their concerns, has discussed with participants the concept of a 'data trust' to manage the sharing of patient data. Making a conceptual argument for the use of the (relatively new) charitable incorporated organization as a governance model for a GP data trust, we demonstrate how this could address patients' concerns and represent a more attractive means of stewarding GP data for research and service planning purposes.

It is widely accepted that voluntary assisted dying (VAD) should be regulated but little is known about the most effective way to regulate doctors in this setting. This article reports on empirical research conducted in two Australian states where VAD is lawful (Victoria and Western Australia). Interviews were conducted with 92 participants: one group comprised doctors providing VAD and the other group was regulators in this field. Participants were asked about how best to regulate doctors providing this service. Strikingly, both regulator and doctor participant groups were consistent with each other in their views on what constituted effective regulation. The nature of VAD was perceived by participants to require special regulation, although some felt this was overdone in these states. Reported features of effective regulation included regulators taking an educative approach, regulation being perceived as acceptable by doctors, and it being responsive and nimble to provide the guidance that doctors need. Participants also considered a range of regulatory tools were required to regulate VAD effectively, and some identified a need for these tools to be employed together in a holistic way. This article concludes with a set of principles for effective regulation of VAD, discerned from the views of participants.

Health, mental health, and well-being are not 'natural' but are shaped by social and environmental factors. This article aims to reorient the development of all laws and policies to do more to prevent mental ill-health and promote well-being as a core function of the contemporary state. It introduces a new conceptual and empirical model, the Public Mental Health Framework, based on three areas of research: (i) the social determinants of health and mental health, which include social structures and daily living conditions (such as poverty, inequality, education, employment, discrimination, adverse childhood experiences, and crime); (ii) health and human rights; and (iii) the intermediate social model of disability. It then explains how the Public Mental Health Framework can be incorporated into law and policy development through parliamentary analysis similar to that used for 'statements of compatibility' in the Human Rights Act 1998 (UK) and legislation such as the Wellbeing of Future Generations (Wales) Act 2015 (Wales), interdepartmental administrative structures, proactive strategic planning, and continued advocacy.

System-level decisions around the commissioning and provision of healthcare services in England have contributed to barriers in accessing the National Health Service. In this article, we ask how to better regulate resource allocation to ensure greater equity in access to healthcare services. First, we focus on the Health and Care Act 2022, which, drawing on principles of deliberative regulation to address health inequalities, initiates a shift away from previous regulatory approaches towards a collaborative decision-making model. We then shed light on the systemic factors creating and maintaining access barriers by considering shortcomings in previous regulatory approaches. With these in mind, we consider whether deliberative regulation-providing communities with resources to create normative solutions to intrinsic issues-could help address these systemic challenges. To assess the potential of laws or policies to achieve greater equity in healthcare, we also introduce an evaluative framework based on deliberative principles. We apply this framework to a case study of an Integrated Care System to gauge the extent to which the Health and Care Act 2022 has indeed been effectively adopting a deliberative approach by intentionally engaging marginalized communities in decision-making and devising accountability mechanisms for the allocation of healthcare resources.

Vaccination hesitancy is one of the critical threats to public health. The coronavirus disease pandemic reconfirmed that certain groups of populations are more reluctant to vaccinate than others, particularly migrants. This article examines legal obligations related to protecting the right to health in addressing vaccination barriers among newly arrived adult migrants, taking Ukrainians granted temporary protection as an example. From human rights law requirements delineated by the United Nations and Council of Europe, it maps out a framework of vaccination-related obligations. Furthermore, the article tests the framework created in one national legal system-Sweden-to show where the gaps in transposing obligations into national law still exist. To deepen the analysis, the interview study with Ukrainian refugees in Sweden is presented, which allows reflection on what obligations have not reached their recipients and resulted in vaccination barriers. The article advocates for further specification of obligations related to vaccinations in both national and international laws for better crisis preparedness.