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.

Healthcare professionals have long expressed concern about their exposure to litigation if they allow consultations to be recorded. There has been little evidence available as to the validity of this concern. To address this gap and to inform policy and practice, this study examined 46 cases decided by Australian courts. It focused on the characteristics of these cases, as well as the admissibility, lawfulness, and impact of recordings. Most of the consultation recordings in these matters were made in the context of pre-existing conflicts, primarily involving personal injury, professional misconduct, and family law. Recordings had the greatest value in matters involving professional misconduct. In other matters, findings were mixed. Patients were often motivated to record by a lack of trust in their healthcare provider. The cases do not feature any consented recordings made for broader patient benefit, underscoring the view that lawful, mutually agreed recordings of healthcare consultations present a very low risk of adverse medico-legal consequences. Courts have treated consultation recordings variably, sometimes using discretion to admit recordings as evidence, even where they were obtained unlawfully. These cases support recent calls for allowing regular consultation recording and also demonstrate the value of recordings for patients and regulators, particularly in instances of professional misconduct.

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.

Despite extensive literature examining intellectual property rights (IPRs) and access to health, there has been limited examination of how IPRs can potentially impact the development, access to, delivery of, and use of medical devices. This article fills this gap, focusing on patent and copyright protections applicable to elements of medical devices that are attachable to or implanted into the human body, such as prostheses or pacemakers. Although the human body itself is not patentable in Europe (Article 5, Biotechnology Directive), elements of medical devices created outside the body are patentable. Moreover, certain aspects of such medical devices can be subject to copyright, and other types of IPRs. This article provides an overview of the types of IPRs that can apply over attachable and implantable medical devices. Following this, and focusing specifically on copyright and patent rights, it argues that such IPRs, alongside incentivizing technological development in certain contexts, also give rightsholders significant control over key aspects of how individuals use and access IP-protected elements of such devices, with the potential for health-related impacts and bioethical implications. Accordingly, the article argues that greater understanding and scrutiny are needed within the health law and bioethics communities around the potential impacts of IPRs over medical devices.

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.