Journal of Law Medicine & Ethics最新文献

When Larry Gostin published the groundbreaking 2014 treatise on Global Health Law, building on the work of others like Virginia Leary, the field of global health law was still being developed. This treatise offered a comprehensive definition and understanding of global health law. Others, including myself, used Larry's work to formulate policy recommendations and strengthen references to the right to health in global health.

Two expert groups on global health from Norway and Denmark have recently made important strides in reenergizing the debate on the role of the Nordic countries in global health. Their tailored recommendations - emphasizing core values of human rights, equity, accountability, and local ownership alongside health security - have proven influential at a time when new forms of international collaboration in global health are urgently needed.

The evolution of the CJEU's jurisprudence has led to the emergence of a distinct, sector-specific notion of economic activity in the context of services delivered within public healthcare systems. This interpretation diverges markedly from the general framework applied in other sectors. This form of conceptual dualism lacks a clear normative foundation in the provisions of the TFEU and poses a potential challenge to the integrity of the role assigned to services of general economic interest under both the Treaty and established CJEU case law. Significantly, the exclusion of practically all activities within public healthcare systems from the ambit of EU competition law has the potential to generate significant distortions of competition. This is particularly relevant in the context of healthcare systems, such as that of Poland, which exhibit a mixed structure and where public and private providers engage in substantial competition.

Background: It is now acknowledged that possible negative effects of cancer therapies on future reproductive autonomy are a major concern. In the bioethics literature, some advocate that the child's right to fertility preservation (FP) should be recognized as a right to an open future.

Research objectives: The aim of this qualitative study is to (1) explore pediatric oncologists' perceptions regarding barriers and facilitators of OTC in prepubertal girls and (2) analyze the ethical, legal, social, and policy implications of these barriers and facilitators in Canada and France.

Participants and research design: Between November 2022 and August 2023, 10 French and 6 Canadian oncopediatricians took part in semi-directed interviews. The content of the interviews was analyzed using thematic content analysis.

Findings: All the participants emphasized the importance of FP, describing it as a fundamental right and central part of care. However, they identified ethical issues associated with the cost and the uncertainties of ovarian tissue cryopreservation (OTC). The majority thought that OTC should be covered by the public healthcare system to promote equity of access. French oncopediatricians of this study considered OTC to be standard of care, while the majority of Canadian oncopediatricians still considered it experimental, due to the risk of reintroducing malignant cells.

Discussion/conclusions: The results highlight the importance of FP for prepubertal girls as a right, linked to the child's right to an open future, as described in bioethics literature. According to these findings, the fact that OTC is not systematically discussed, offered, or not covered by the healthcare system constitutes a barrier and fails to protect patients, who may experience future infertility as a consequence of their treatment, thus curtailing their reproductive autonomy.

As both human longevity and diagnostic ability improve, more individuals are being diagnosed with Alzheimer's dementia disease (Alzheimer's). Yet there is a paucity of new Alzheimer's research trials. One obstacle to research is the large number of Alzheimer's patients deemed incapable of providing informed consent for clinical research. Research advance directives (RADs) offer patients the opportunity to provide informed consent before incapacity occurs. However, critics question whether RADs guarantee informed consent, claiming that due to the nature of the disease, the consenting agent is no longer the same person after becoming incapacitated. This paper assesses the debate while using a conception of personhood, informed by the latest Alzheimer's research, which does not reduce the concept of personhood to psychological capacities. It explains how personal identity can persist despite Alzheimer's, such that RADs can and should suffice for informed consent.

Farman Saeed Sedeeq and Percem Arman's article aims to develop a framework of AI governance that avoids shortcomings in existing models such as limited enforceability and rigid data-sharing rules. The goal of the weighty undertaking is to develop a "structured yet flexible approach" to balancing AI advancements in public health with ethical imperatives. Three core "pillars" are used for evaluation: ethical accountability, regulatory adaptability, and transparency. The concept of ethical accountability is explored briefly in this commentary.

Pronatalist policies are on the rise in many countries. These have stemmed from several motivators, including economic concerns, nationalism, and promotion of traditional family values. As global fertility rates have fallen, many countries have instilled pronatalist policies to encourage people to have more children. In other countries, including the United States, religious traditionalism and nationalist forces have fueled pronatalist policies as a counter to improved female empowerment and global immigration. No matter the stated motivation, government-sanctioned pronatalism overtly leads to reproductive coercion or covertly results in limited reproductive autonomy as collateral damage. Herein, we review global examples of prior and current pronatalist policies, outlining the motivators for their promotion within each case. We demonstrate how these policies are not only ineffective, but are dangerous to the health and well-being of women and other populations and are in direct conflict with modern reproductive goals, reproductive justice, and decades of efforts towards achieving gender parity.

The adoption of the main text of the Pandemic Agreement at the 2025 World Health Assembly is a milestone in global health law. The adopted text makes several key contributions, but there were several missed opportunities in the negotiating process, and key roadblocks remain for the future of the Pandemic Agreement.

The field of global health law encompasses both "hard" law treaties and "soft" law policies that shape global health norms. Transitioning from "international health law" to "global health law and policy," global health policymakers have increasingly looked to soft law instruments to address public health needs in a rapidly globalizing world - within the World Health Organization and across global health governance. Yet, as policymakers have expanded the landscape of soft law policy instruments to advance global health across state and non-state actors, the COVID-19 response revealed the limitations of this soft law approach to global health threats, with states now seeking hard law reforms to strengthen global health governance. As hard and soft law can provide complementary approaches to preventing disease and promoting health, future research must conceptualize how these normative frameworks interact in advancing global health.

In their article, Pope and colleagues examine the ethical, legal, and practical complexities associated with the use of advance directives (ADs) to pursue voluntarily stopping eating and drinking (VSED) in the context of patients with advanced dementia. The authors detail the shortcomings of current VSED ADs, and they review a new VSED AD that they argue addresses these shortcomings and provides a better solution to the complexities associated with implementing VSED ADs. While the authors make a robust argument for the overall need and supportability of VSED ADs, this commentary highlights a problem that still persists even with the new VSED AD, specifically the absence of a robust ethical justification for continuing to honor the VSED AD even when the advanced dementia patient is requesting to eat or drink in the context of distress and suffering. Without this robust ethical justification, moral distress of family and caregivers is likely to occur, which could jeopardize the larger implementation of the VSED AD. Rather than pursue this more extreme measure without robust ethical justification, the commentary argues that the authors' alternative proposal of minimal comfort feeding is the more practical and ethical strategy that best balances the patient's longer- and shorter-term interests.