Journal of Law Medicine & Ethics最新文献

After dispensing major precedents affecting the public's health in each of its prior three terms, the 2024-2025 term of the US Supreme Court was arguably less impactful amid several unanimous decisions preserving existing jurisprudence (at least in part). However, this is an understatement. While the Court issued key decisions arguably favorable to communal health this prior year it also denied minors access to medical procedures sought by their doctors, diminished diversity, equity, and inclusion (DEI) initiatives in employment, allowed states to deny health providers access to Medicaid because they also provided abortions, disallowed rural hospitals from collecting specific costs for treating low-income patients, and provided a "script" of sorts for executive control of federal health advisory committees.

Periviable births, occurring between 20 and 25 weeks of gestation, present significant challenges due to varying survival rates and potential morbidities for survivors. Medical decision-making in this context raises ethical and legal questions, including considerations of sanctity of life versus quality of life and challenges in the clinician-parent relationship. This article outlines the complex ethical and legal landscape surrounding parental medical decision-making for periviable infants in the United States, discussing the evolution of federal and state laws. Existing laws highlight a vitalist approach that prioritizes life preservation despite potential harm and overlook non-heteronormative and non-traditional family structures, complicating decision-making. The impact of post-Dobbs state abortion bans on parental and clinician autonomy have exacerbated these challenges. We advocate for legislative support for inclusive definitions of legal parenthood to facilitate evidence-based decision-making centered on patients and families. Also needed are legal frameworks that accommodate the intricacies of periviable birth decisions while respecting patient autonomy and medical expertise, especially amidst the evolving legislative environment.

People use advance directives to express preferences that direct their future care when they lack decision-making capacity. One form of advance directive, a "dementia directive," records preferences about living in various stages of dementia. This is important because many Americans want to avoid living with advanced progressive dementia. Unfortunately, traditional advance directives cannot dependably achieve this goal. In contrast, some dementia directives can achieve this goal, by directing cessation of manually assisted feeding and drinking.While many dementia directives have been published, most have gaps and omissions that thwart the goal of avoiding extended intolerable life in advanced dementia. To overcome these problems, we formulated a new dementia directive. This article explains the value of this new directive. We proceed in six stages. First, we review the prevalence of advanced dementia. Second, we identify the disadvantages of another option for accomplishing the goal of not living into advanced dementia, preemptive VSED. Third, we distinguish notable court cases where dementia directives were unsuccessful. Fourth, we review nine prominent dementia directives, noting how the Northwest Justice Project's Advance Directive for VSED remedies those shortcomings. Fifth, we review this directive's legal status. Sixth, we articulate its ethical justification.

The "EU Vaccines Strategy" launched by the European Commission in June 2020 aimed to ensure vaccine safety, equitable access, affordability, swift distribution, and global solidarity for COVID-19 vaccines. This study critiques the Commission's centralized procurement approach, focusing on Advance Purchase Agreements (APAs) through a literature review, policy analysis, and a case study of the EU-AstraZeneca's APA. It identifies critical challenges, including transparency deficits, accountability gaps, and anticompetitive practices by vaccine producers that undermine equitable access. Drawing on these insights, the study proposes the FACER Framework - Fairness, Accountability, Competition Law, Ethics of Innovation, and Resilience - a novel model integrating the Treaty on the European Union (TEU) and the Treaty on the Functioning of the European Union (TFEU) oversight with ethical principles. By embedding legal and moral accountability, FACER offers EU policymakers a robust tool to enhance vaccine strategy and equity in future health crises.

Bullying is a public health concern that results in diminished well-being for children and adolescents. One approach that lawmakers have taken to address bullying is enacting anti-bullying laws, which require school districts to establish bullying prevention policies. In this study, researchers used standard legal epidemiology methods to systematically retrieve and analyze anti-bullying laws in the United States (US). While they found that every US state and the District of Columbia has a school anti-bullying law, there is wide variation in their scope and requirements. Some jurisdictions specified requirements that school districts must implement in their anti-bullying policies, while others deferred policy enactment entirely to school districts. Given the differences in requirements and scoping afforded in anti-bullying laws, understanding the important components included in such policies can help provide policymakers and practitioners with information about bullying prevention strategies across jurisdictions.

Focusing on intellectual property rights (IPRs) and their role in global access to vaccines during the COVID-19 pandemic, this article argues that key aspects of the current institutional system align towards delivering individualistic state/regional/rightsholders priorities in the use of IPRs over pandemic health technologies. This played a key role in the vaccine nationalism and global vaccine inequity that emerged during the pandemic. It critically analyzes the IPR provisions within the World Health Organisation's Pandemic Agreement and negotiation process. It argues that nationalistic/individualistic approaches toward the use of IPRs over health technologies also permeate such contexts. The final text of the Agreement leaves considerable discretion to states around IPRs, and much will depend on how it is implemented in practice. For effective future pandemic preparedness around how IPRs are used over health technologies, this article argues that a deeper bottom-up institutional change is needed - one which offers nuanced strategies to balance the potential incentivization role of IPRs with the implications certain uses of IPRs can have on access to downstream health technologies. A key element of this change is embedding a greater recognition of the range of resources provided by entities (e.g. funders, biobanks, and universities) necessary in the successful development of health technologies, including in pandemic contexts. Such entities should leverage these resources, including by attaching contractual conditions to access these, which mandate avenues for downstream access to pandemic health technologies. In the longer term such approaches could be part of a broader institutional change, which prioritises global collective health needs in pandemics.

The opioid overdose crisis has become a global public health emergency, claiming more than 100,000 lives each year. In North America, shifting opioid prescribing practices in response to the crisis have profoundly affected people living with chronic pain, who now face reduced access to prescription opioids. Against this backdrop, pain stakeholders have become increasingly active in policymaking arenas to shape how opioids and pain are understood. This study examines the Canadian Pain Task Force (CPTF) - a federal advisory body charged with creating a national pain strategy - by analyzing its reports, public and patient consultations, and internal documents. Through qualitative framing analysis, we find that stakeholders overwhelmingly depicted the overdose crisis as the result of illicit and irresponsible opioid use, while positioning stigma as both a driver and consequence of the crisis that compounded the challenges faced by people with chronic pain. From these problem definitions flowed policy proposals centered on expanding opioid access, reducing stigma, and advancing patient-centered care. These findings demonstrate how pain stakeholders shape, and are simultaneously shaped by, opioid policy debates - with consequences for both overdose prevention and chronic pain management.

This article discusses the prospects and pitfalls of a legally binding pandemic agreement under the auspices of the World Health Organization, currently under negotiation in Geneva. Such an agreement could foster a rules-based pandemic prevention, preparedness and response as a reaction to the failures by states during the COVID-19 pandemic, including a lack of effective coordination for sharing all kinds of data and the global inequity in the distribution of medical goods fueled by vaccine nationalism. Achieving these goals, however, will depend upon a meaningful engagement by delegations negotiating the agreement, a legally sound formulation of its provisions, and overcoming the currently pervasive emergency-bias in this field of global health law. Thus, as advocated by Lawrence Gostin in his seminal treatise on Global Health Law ten years ago, the pandemic agreement could help realize the transformative potential of law for facing one of the greatest health threats to humanity.

The field of global health law has evolved over the past decade to describe new legal and policy instruments that apply to a changing set of public health threats, non-state actors, and regulatory norms that structure the global response to public health challenges. This special issue-bringing together the O'Neill Institute for National & Global Health Law and the Global Health Law Consortium-examines the expansive evolution of the field of global health law and its continuing development to face new health threats.

Scientific advances to fight infectious diseases have been remarkable. International law and global governance have sought, and often failed, to keep pace, secure equity, and stop outbreaks. We trace the law and governance model emerging from early failure in the AIDS response and identify four elements: use of law by national governments to compel sharing; decentralized generic manufacturing; mechanisms for voluntary sharing of patents and technology transfer; international funding. In combination, these created a remarkable new ecosystem. We find that when COVID-19 hit and mRNA vaccines were rapidly developed, global North governments opposed mobilizing this synergistic model. Instead, equity efforts focused on financing purchase of vaccines from originator companies with little use of law. Amidst monopolies and scarcity of doses, vaccine nationalism fatally undermined this effort. Whether more synergistic law and governance emerges from rapidly changing global health law will likely dictate the efficacy of future global infectious disease response.