Medical Law and Ethics

Il volume affronta il tema del consenso alle cure alla luce della nuova legge 22 dicembre 2017, n. 219 («Norme in materia di consenso informato e di disposizioni anticipate di trattamento»). Un discorso che vede coinvolti non solo giuristi, ma diverse professionalità, tra cui il medico, il bioeticista, il te-ologo, il sociologo, il pedagogista: un'ideale "comunità sanante", impegnata a costruire una relazione di cura basata sull'ascolto e sulla comunicazione. Un approccio interdisciplinare che favorisce il dialogo dei saperi, e apre alla comprensione della realtà clinica, al riconoscimento della soggettività del paziente e dei suoi bisogni reali. Il giurista, in particolare, è chiamato a professare un diritto "senza soglia": un diritto che attinge saperi dalle altre scienze e con esse si mette in dialogo, riconoscendosi scienza fra le altre scienze. Il suo compito è quello di aiutare il medico a mettere a fuoco le condizioni per una vera consensualità: ma oc-corre una lettura operosa della realtà dell'uomo che vive l'esperienza della malattia e della sofferenza; un'esperienza di immedesimazione e condivisio-ne cui il medico non può rinunciare se l'obiettivo è costruire una relazione di cura rispettosa della persona umana e della sua unicità.

Article 12 of the United Nations Convention on the Rights of Persons with Disabilities, as interpreted by the Committee on the Rights of Persons with Disabilities in General Comment No. 1, offers a vision for law's response to capacity impairments which differs in crucial ways from that contained in the Mental Capacity Act 2005. The Committee rejects the functional test for capacity and requires that a 'will and preferences' paradigm must replace the 'best interests' paradigm and that all substitute decision-making regimes must be abolished. This article draws on the position adopted in General Comment No. 1 in evaluating the best interests standard in the Mental Capacity Act. It sets out the normative case for a stronger legislative endorsement of will and preferences and the inclusion of greater support mechanisms but rejects the contention that all substitute decision-making can, or should, be abolished. It also argues that the best interests standard in the Mental Capacity Act retains some revolutionary potential and that, pending legislative reform, this can be further developed through the courts.

In this concluding chapter we will not seek to summarise all the points made throughout the volume. Rather we bring out from these discussions some practi- cal proposals for how the law might move forward. Three models for reform will be outlined:
– The law should recognise that human bodily material is subject to the laws of property that apply to other ‘things’. The tissue could then be owned, sold, stolen, commercially exploited, given away, and so on and these dealings would be governed by the developed principles of property, tort, criminal and other areas of law relevant to property. We shall call this the ‘property model’.
– Parliament should pass a statute governing the storage, use and control of bod- ily material, reflecting a balance between individual and communal interests in different contexts. We shall call this the ‘statutory model’.
– The courts should develop an ad hoc approach to bodily material allowing the case law to grow organically. We shall call this the ‘ad hoc model’.
These three models will be developed in more detail shortly.1
We will indicate the issues which all models need to address and those specific to each. The aim is not to fully flesh out any proposal, but to set out clearly the issues which will be raised with each model. Before undertaking that task, a few further comments on the academic debates will be useful.

In recent years there has been an increase in the number of requests for“mercy killings” by patients and their relatives. Under certain conditions,the patient may prefer death to a life devoid of quality. In contrast to thosewho uphold this “quality of life” approach, those who hold the “sanctity oflife” approach claim that life has intrinsic value and must be preservedregardless of its quality. This essay describes these two approaches,examines their flaws, and offers a “golden path” between the two extremepositions.We discuss the halachic and the secular views, arguing for a balancebetween the sanctity of life and the quality of life. We argue that, indeed,such a balance exists in practice, and that life is important, but it is not sacred. Life can be evaluated, but quality of life is not the solecriterion.

Στο έργο «Εγχειρίδιο Ιατρικής Ευθύνης και Δεοντολογίας» αναλύονται σύγχρονα θέματα ιατρικής ευθύνης. Ειδικότερα, περιλαμβάνει τους κανόνες του ιατρικού επαγγέλματος, την υποχρέωση ενημέρωσης και συναίνεσης του ασθενούς, το ιατρικό σφάλμα, το ιατρικό απόρρητο, την τήρηση ιατρικού αρχείου, τα ιατρικά συμβούλια, τα ιατρικά πιστοποιητικά, τα κωλύματα και ασυμβίβαστα, την αμοιβή του ιατρού, αλλά και ειδικότερα θέματα, όπως η ιατρική υποβοήθηση στην ανθρώπινη αναπαραγωγή, οι μεταμοσχεύσεις, η ύπαρξη και το τέλος του προσώπου και η ζημιογόνος τεκνοποίηση.

Περαιτέρω, στο βιβλίο παρουσιάζονται με σαφή και παραστατικό λόγο όλα τα ζητήματα που αφορούν το ιατρικό δίκαιο και την ιατρική δεοντολογία παρέχοντας πλήθος παραδειγμάτων. Το έργο διευκολύνει την κατανόηση του πεδίου της ιατρικής ευθύνης τόσο από νομικούς όσο και από ιατρούς.

This article explore the choices made in two Council of Europe member states with common law traditions, both of which have relatively recently introduced legislative frameworks for advance healthcare planning.  In England and Wales, the relevant measure is the Mental Capacity Act 2005 (MCA) which came into effect on 1 October 2007 while, in Ireland, the legislation is the Assisted Decision-Making (Capacity) Act 2015 (ADMA), which was signed in law on 30 December 2015 and is expected to come into effect in 2017. 

Notwithstanding a number of similarities between the MCA and the ADMA, some interesting variations may be identified, reflecting differences in approach to the underlying principles of autonomy and protection. This article undertakes a comparative exploration of  each measure, both in terms of background and also in terms of the detail of the approaches taken.

In everyday clinical practice, healthcare professionals (HCPs) are exposed to large quantities of confidential patient information, and many use WhatsApp groups to share this information. WhatsApp groups provide efficient mechanisms for clinical management advice, decision- making support and peer review. However, most HCPs do not fully understand the legal and ethical implications of sharing content in a WhatsApp group setting, which is often thought to be hosted on a secure platform and therefore removed from public scrutiny. In our paper, we unpack the legal and ethical issues that arise when information is shared in WhatsApp groups. We demonstrate that sharing content in this forum is tantamount to the publication of content; in other words, those who share content are subject to the same legal ramifications as a journalist would be. We also examine the role of the WhatsApp group administrator, who bears an additional legal burden by default, often unknowingly so. We consider the recommendations made by the Health Professions Council of South Africa in their guidelines for the use of social media, and highlight some areas where we feel the guidelines may not adequately protect HCPs from the legal repercussions of sharing content in a WhatsApp group. Finally, we provide a set of guidelines for WhatsApp group users that should be regularly posted onto the group by the relevant group administrator to mitigate some of the legal liabilities that may arise. We also provide guidelines for group administrators.

This essay will discuss the UK position surrounding patient autonomy when making decisions about their own care with a particular focus on end of life scenarios such as euthanasia, suicide and assisted suicide. The essay will contrast the UK position with the legal positions in other European jurisdictions in which euthanasia has been decriminalised. The essay will then discuss whether or not the UK should go further than that which most European countries have done in relation to euthanasia and decriminalise euthanasia for persons of any age, as has recently been voted on in the Belgian Parliament and become law on the 3rd March 2014.

My Review is divided into five parts. First, I will outline the book’s strengths. I proceed by speaking of the need for clear and cohesive terminology. I will then discuss end-of-life decision-making in some of the countries: Belgium, the Netherlands, and the State of Oregon in the United States, all allow physician-assisted suicide. Belgium and the Netherlands also allow euthanasia. I will also discuss Israel’s Dying Patient Law, enacted by the Knesset on December 5, 2005. Finally, I will make some suggestions for improvement, including a detailed proposal for physician-assisted suicide which I conceive to be the best policy when balancing one against the other the autonomy of the patient, on the one hand, and the safeguards against abuse when life might be considered too lightly, on the other.

Background: Informed consent is a basic concept of contemporary, autonomy-based medical practice and facilitates a shared decision-making model for relations between physicians and patients. Thus, the extent to which patients can comprehend the consent they grant is essential to the ethical viability of medicine as it is pursued today. However, research on patients' comprehension of an informed consent's basic components shows that their level of understanding is limited. Methods: Systemic searches of the PubMed and Web of Science databases were performed to identify the literature on informed consent, specifically patients' comprehension of specific informed consent components. Results: In total, 14 relevant articles were retrieved. In most studies, few clinical trial participants correctly responded to items that examined their awareness of what they consented to. Participants demonstrated the highest level of understanding (over 50%) regarding voluntary participation, blinding (excluding knowledge about investigators' blinding), and freedom to withdraw at any time. Only a small minority of patients demonstrated comprehension of placebo concepts, randomisation, safety issues, risks, and side effects. Conclusions: We found that participants' comprehension of fundamental informed consent components was low, which is worrisome because this lack of understanding undermines an ethical pillar of contemporary clinical trial practice and questions the viability of patients' full and genuine involvement in a shared medical decision-making process.

The book reflects on some of the troubling questions in medical ethics:  Medicine, Technology, Law and Decisions at the Beginning of Life; Planned Orphanage; Wrongful Life; Ethical Education and Research in Medical Schools and Hospitals; Organ Transplantation; Allocation of Resources, Health Care Systems and Health Rights; Decisions at the End of Life: Mercy Killings and the Right to Die in Dignity; Clinical Ethical Issues. The book is comprised of essays that were written by members of the Medical Ethics Think-tank that worked under the auspices of The Van Leer Jerusalem Institute during 1995-1998. The contributors come from different disciplines: physicians, philosophers, ethicists, legal theorists, social workers and religious authorities. The scholars represent all six Israeli universities and some of them are also affiliated to the principal medical centers in the country. These are top scientists, renowned for their quality research and scholarship, who have been working together for three years. The group has produced in its brain storming sessions high quality papers that will enrich the thinking and knowledge on various issues in the field of medical ethics, especially on decision making at the beginning of life and at the end of life. The book offers significant contribution to the analysis of practical questions from theoretical and analytical perspectives, combining theory and fieldwork conducted in hospitals.

We want this book to evoke a debate on major issues in medical ethics in Israel and to serve all those who are interested in the issue.












דילמות באתיקה רפואית
רפאל כהן-אלמגור (עורך)


תוכן עניינים

רפאל כהן-אלמגור
הקדמה

שער ראשון
על זכויות בריאות וחינוך לאתיקה רפואית

כרמל שלו
זכויות בריאות

שמעון גליק ועדנה בנשלום
ההתמודדויות האתיות של סטודנטים לרפואה

גרשון ב. גרונפלד
ועדות אתיקה במוסדות רפואיים


שער שני
תחילת החיים: על הזכות להורות, יתמות מתוכננת, והזכות לא להיוולד בפגם

רות הלפרין-קדרי
"להשאיר חיים אחריך": יילוד העובר מגוף הנפטרת - האמנם בכל מקרה?
ורדית רביצקי
הזכות להורות בעידן ההפריה הטכנולוגית
מרדכי הלפרין
הגדרת הורות וזכות איתור השורשים הביולוגים

רוזלי בר
סוגיות אתיות ביצירת ילדים באמצעות אם פונדקאית

רות לנדאו
יתמות מתוכננת

אסא כשר
"יתמות מתוכננת": התמונה המאוזנת

עמוס שפירא
הזכות לא להיוולד בפגם: פלוגתות של לוגיקה, ערכים ומדיניות משפטית

דוד הד
האם קיימת זכות לא להיוולד בפגם? תגובה פילוסופית לעמוס שפירא

שער שלישי
השתלות איברים וסוף החיים בראי ערכים הלכתיים וליברליים

משה זמר
תרומת איברים וההלכה

אברהם שטיינברג
החולה הסופני - מבט השוואתי בין "ערכים דמוקרטיים והלכתיים"

רפאל כהן-אלמגור
על אוטונומיה, המתות חסד והזכות למות בכבוד


שער רביעי
מדיניות טיפולית

איתי בנטוב וצ'רלס ספרונג
בעיות אתיות בברירת חולים לטיפול נמרץ

אבי עורי
היבטים אתיים ברפואה שיקומית

ברוך מודן ושלומית פרי
גורמי סיכון וגורמי פיצוי: מדיניות הממשלה מול מוקרני הגזזת

The aim in this paper is to challenge the increasingly common view in the literature that the law on end-of-life decision making is in disarray and is in need of urgent reform. The argument is that this assessment of the law is based on assumptions about the relationship between the identity of the defendant and their conduct, and about the nature of causation, which, on examination, prove to be indefensible. A clarification of the relationship between causation and omissions is provided which proves that the current legal position does not need modification, at least on the grounds that are commonly advanced for the converse view. This paves the way for a clarification, in conclusion, of important conceptual and moral differences between withholding, refusing and withdrawing life-sustaining measures, on the one hand, and assisted suicide and euthanasia, on the other.

Marriage is a voluntary and lifetime union between two people, unless there is an irreparable breakdown. Where mental health or balance is questionable, voluntariness of the mentally ill person is not considered in determining their marriage. The marriage is voidable if the mental illness is observed at the time of the marriage. Under the Marriage Act, epilepsy is grouped as a variant of mental illness. With the advancement in the knowledge, treatment and cure of mental illness, particularly, epilepsy, a redefinition of the archaic Lunacy Act, 1916 is advocated. This article examines the legal and ethical issues surrounding mental illness in divorce matters using Nigerian and other jurisdictions' case laws. It questions the justification of retaining epilepsy as a mental illness under the Matrimonial Causes Act as a legal basis for voiding a marriage. It critically examines the definitions of mental health and state of mind, mental illness and epilepsy. Next, it examines the psychosocial and legal elements of mental illness and epilepsy as grounds for the annulment of a marriage. This is followed by a review of International and Constitutional protection of the mentally ill and the epileptic. The article concludes that there should be an amendment of all legislations related to the outdated definitions of mental illness and epilepsy in Nigeria so as to protect the constitutional rights of mentally ill Nigerians.

Through the years, mental health has been clothed in secrecy in almost all African countries including Nigeria. Traditionally, the mentally ill were hidden from public view to preserve the honour of the family rather giving them empathy. The mentally ill were often victimized, driven to suicide due to lack of empathy from society, family and the law. The laws on mental health remained static for centuries from the pre 1900, a baggage from the European Colonial heritage. The changing needs of society and the socio-economic vicissitudes of life due to economic depression affected the mental state of many Nigerians, which subsequently drove many to attempt suicide.  Under the moribund Lunacy Act 1916, and the Criminal and Penal Codes 2004, attempted suicide is a criminal offence with sanctions, which further exacerbate the psychological mental state of the suicidal individual. There has been little focus to amend the Lunacy Act 1916 to make it relevant to the extant societal reality of Nigerians. This article examines the historical and social antecedents of the Lunacy Act, its relevance to extant Nigerians needs, the social and other factors that impede the amendment of the law. It also examines the Mental Health Act and state that these laws do not guarantee the social responsibility of government towards her citizens as enunciated in the Nigerian Constitution. Nigeria has reached a crossroad wherein the citizens demand that the Executive and Legislature carry reforms that the Constitution demands.
Primary Key words: Regulations, Reform, and Governance
Secondary Key words: Crime and victimization

This is a chapter from Herring & Goold, eds, Landmark Cases in Medical Law (Hart, 2015) (forthcoming). It compares two judgments, from the House of Lords and from the Australian High Court, reaching opposite results where negligent medical errors in the control of human fertility by public health services resulted in the unwanted conception of healthy babies. The causes and frequency of failed sterilisation are described, and the options open to the courts for the identification of the actionable harm to complete the cause of action in negligence, and consequential harm are critically analysed. The invocation of corrective justice, distributive justice and retributive justice by various judges on the two courts is also subjected to critical analysis. This analysis concludes that corrective justice, reflected by the judgment of the majority in Cattanach v Melchior, is a model which has a good fit with medical negligence: by requiring compensation of patients, it compels health professionals and the system within which they work to take responsibility for their errors and the consequences for patients, and provides an economic incentive to scrutinise and adjust procedures to avert further adverse incidents. The peculiar hybrid of corrective and distributive justice produced by McFarlane, Parkinson and Rees fails to meet the objectives of either model. Under the current mélange, where the loss falls as a consequence of the negligent medical services is usually a matter of chance. This is the only area of medical negligence law where a proven breach of the standard of care, resulting in proven foreseeable damage, leaves most of the loss to fall on the patient. The current arbitrary line-drawing represented by McFarlane and Parkinson arguably provides inadequate deterrence and incentivising of risk avoidance. It
is noteworthy that the medical literature in the UK in 2007, eight years after McFarlane, still pointed to simple measures which needed to be taken in the NHS not only to prevent failed
sterilisations through precautionary procedures in the operating theatre, but also to identify, record and explain them to reduce their incidence. Moreover, the model of distributive justice invoked in McFarlane fits ill with the corrective
justice model applied so rigidly by the majority in Chester v Afshar. In both cases the autonomy of the patient to make choices about her bodily integrity was infringed by the
negligence. The chapter concludes that McFarlane should not be treated as a landmark case for medical law as
a whole, but rather an outlier, consigned to be buffeted by the stormy seas of Rockall, whilst Cattanach has been wiped off the most populated parts of the map of Australia through legislation introduced to reverse the judgment as a consequence of a vigorous lobby by the medical profession.

This paper discusses recent arguments of Franklin Miller and Robert Truog about withdrawal of life-sustaining treatment and causation. The authors argue that traditional medical ethics, and the law, are mistaken to take the view that withdrawal merely allows the patient to die, rather than causing the patient’s death, describing such a view as ‘patently false’. They argue that the law’s continued position to the contrary stems from a moral bias, resulting in the moral and legal fiction that withdrawal does not cause death but lets the patient die. In so arguing, Miller and Truog join a long line of academic criticism of the law that extends back to the seminal decision of Airedale NHS Trust v Bland [1993] AC 789 (HL) and beyond. In this paper, I take issue with these claims. I argue that there are reasonable grounds upon which traditional medical ethics and the law can regard withdrawal of life-sustaining treatment as allowing the patient to die rather than causing death, and so the authors’ claims that such a view is patently false cannot be sustained. I then tease out the implications of my conclusions for the authors’ claim that there is not such a great distinction between withdrawal of life-sustaining treatment, euthanasia and assisted dying. I conclude by discussing some possible objections to my own view.

There are few issues more emotional and divisive than what has become known as “the right to die.” One camp advocates the “death with dignity” approach, according to which the patient is an autonomous being who can form his or her own judgment on the timing and process of dying. The other camp advocates the sanctity of life approach, in which life is intrinsically valuable and should be sustained as long as possible. Is
there a right answer?
    In The Right to Die With Dignity, Raphael Cohen-Almagor takes a balanced approach in analyzing this emotionally charged debate, viewing the dispute uniquely from public policy and international perspectives. This book offers an interdisciplinary, compelling study in medicine, law, religion and ethics. It is, arguably, the most comprehensive book yet to be written on the fascinating question of whether physician-assisted suicide should be allowed. Cohen-Almagor delineates the distinctions between active and passive euthanasia and discusses some of the legal measures that have been invoked in the United States and abroad. He outlines the reasons non-blood relatives should be given a role in deciding a patients’ last wishes. He examines euthanasia policies in the Netherlands and the 1994 Oregon Death with Dignity Act, suggesting improvements to each. Finally, he makes a circumscribed plea for voluntary physician-assisted suicide.

Barriers of many different types make successful circumcision-related
lawsuits extremely difficult to bring. Actual cases we and others have brought show that among factors impeding progress are (1) financial risks; (2) procedural difficulties; (3) misconceptions and compassion misallocation among judges, lawyers, jury members, the media, and the general public; (4) constraints unique to circumcision lawsuits that are imposed by statutes of limitation and statutes of repose; (5) need for parental participation in lawsuits; (6) problem of damages not being atrocious enough to justify litigation; and (7) the scarcity of helpful case law. Players whose roles we will be scrutinizing include clients, lawyers, judges, juries, courts and procedures, doctors, media, and fellow activists. We will discuss the many reasons why potential plaintiffs never even make it to the filing stage. We will look at why
judges and juries are starting to understand that just having a foreskin is not reason enough to have a circumcision.

Our aim in this article is to provide a counterbalance to the substantial body of academic opinion supportive of the decision in the medical non-disclosure case of Chester v Afshar [2004] UKHL 41, [2005] 1 AC 134, while at the same time identifying some misconceptions that have arisen about the case. Our critique is consistent with the reasoning of the High Court of Australia in its recent decision in Wallace v Kam [2013] HCA 19, (2013) 87 ALJR 648. The article is divided into three parts. In the first part, we argue that the decision in Chester was a departure from orthodox negligence principles. In the second part, we critically examine the autonomy-based justification the majority gave for departing from those principles. And in the third part we consider a number of alternative ways in which protection could be given to the autonomy interests at stake in medical non-disclosure cases. Several more general points relating to the autonomy concept and the scope of liability doctrine in negligence law emerge from our critique. Our analysis also suggests that negligence law is ill-suited to the task of providing an appropriate legal solution to the problem of medical non-disclosure.

Keywords: medical non-disclosure, informed consent, negligence, scope of liability, causation,  autonomy.

In this article we explore the ethics of manipulating verbal information for the sake of influencing health-outcomes through placebo and nocebo responses. Recent scientific research on placebo and nocebo effects has drawn attention to the ways in which communication by health professionals may modulate the symptoms of patients across an array of highly prevalent conditions such as pain, depression, anxiety, insomnia, irritable bowel syndrome, migraine and Parkinson’s disease. The positive and negative effects of clinicians’ communication on patient outcomes pose important ethical issues, which we describe in this article under the label of “the ethics of therapeutic communication” (TC). We begin by reviewing available evidence supporting the claim that doctor-patient communication has therapeutic effects. We then identify in truthfulness, helpfulness and pragmatism three morally relevant considerations that can guide clinicians in therapeutic communication with their patients. Finally, we examine the ethics of using TC to enhance the effectiveness of proven medical interventions and open-label placebos.

Alberto Giubilini and Francesca Minerva's controversial article ‘After‐Birth Abortion: Why Should the Baby Live?’ has received a lot of criticism since its publishing. Part of the recent criticism has been made by pro‐life philosopher Christopher Kaczor, who argues against infanticide in his updated book ‘Ethics of Abortion’. Kaczor makes four arguments to show where Giubilini and Minerva's argument for permitting infanticide goes wrong. In this article I argue that Kaczor's arguments, and some similar arguments presented by other philosophers, are mistaken and cannot show Giubilini and Minerva's view to be flawed. I claim that if one wants to reject the permissibility of infanticide, one must find better arguments for doing so.

In his film Hable con Ella (2002) Pedro Almodóvar features the character of Benigno, a nurse who is in permanent charge of Alicia, a young patient in a persistent vegetative state. Benigno talks continuously to Alicia. Almodóvar wants the audience to be torn between diagnosing insanity and rationality; and obtains his result in equipping Benigno with good arguments supporting his behaviour. I try to show that Benigno’s “talking to her” is not less reasonable than the doctors’ treating Alicia, since both acts can be found to be grounded in the same kind of Pascalian wager concerning the possibility of Alicia’s awakening.
Benigno also loves Alicia, and rapes her. Again, Almodóvar supply the audience with conflicting moral arguments, and tempts it to arrive at this frightening conclusion: Benigno may be not guilty. In fact, as an individual whose higher-brain is apparently dead, Alicia has lost forever her capacity to be conscious. If such capacity is constitutive of being a person, then Alicia properly is an ex-person – just as any dead body is. Since ex-persons cannot be harmed or wronged, it seems we cannot say that Benigno either harms or wrongs Alicia. May be we cannot even say that he rapes her, since the concept of rape may not apply to non-persons. But do all our moral feelings align with these conclusions? Indeed rival rational arguments seem to contrast them too. Almodóvar tries to render acceptable the idea of both moral condemnation and innocence of Benigno, and the film actually is a rational, open ethical discussion where opposite arguments collapse.

Postmortem sperm retrieval (PMSR) is a procedure to procure sperm from a man who has been dead for a short period of time, or a man who has been declared dead by neurological criteria and is being kept alive artificially. Requests for PMSR are typically made by widows with the intention of using the sperm for artificial insemination in the future, but this is not always the case. This article examines requests for postmortem sperm retrieval from parents and family members. I will first overview the legal landscape and policies regarding PMSR internationally. Next, I will provide two clinical cases of requests for postmortem sperm retrieval from parents and family members which occurred at a major medical center in California, USA. I will then analyze the salient ethical features with particular emphasis on  California laws and Israel posthumous grandparenthood policies. Requests for postmortem sperm retrieval from parents, which will not necessarily result in posthumous grandparenthood, will become more frequent. This is a compelling reason for major hospitals to draft policies. I conclude with policy suggestions for this rarified request, which I believe will become routine in the future.

The paper discusses Aldous Huxley’s dubious role in shaping the eugenic paradigm of the 1920-60s and his participation in Dartmouth Convocation on Great Issues of Conscience in Modern Medicine (September, 1960) which  he assessed as “rather disappointing.” Why did the event  disappoint him?

- Result of “the Onlife Initiative,” a one-year project funded by the European Commission to study the deployment of ICTs and its effects on the human condition
- Inspires reflection on the ways in which a hyperconnected world forces the rethinking of the conceptual frameworks on which policies are built
- Draws upon the work of a group of scholars from a wide range of disciplines including, anthropology, cognitive science, computer science, law, philosophy, political science

What is the impact of information and communication technologies (ICTs) on the human condition? In order to address this question, in 2012 the European Commission organized a research project entitled The Onlife Initiative: concept reengineering for rethinking societal concerns in the digital transition. This volume collects the work of the Onlife Initiative. It explores how the development and widespread use of ICTs have a radical impact on the human condition.

ICTs are not mere tools but rather social forces that are increasingly affecting our self-conception (who we are), our mutual interactions (how we socialise); our conception of reality (our metaphysics); and our interactions with reality (our agency). In each case, ICTs have a huge ethical, legal, and political significance, yet one with which we have begun to come to terms only recently.

The impact exercised by ICTs is due to at least four major transformations: the blurring of the distinction between reality and virtuality; the blurring of the distinction between human, machine and nature; the reversal from information scarcity to information abundance; and the shift from the primacy of stand-alone things, properties, and binary relations, to the primacy of interactions, processes and networks.

Such transformations are testing the foundations of our conceptual frameworks. Our current conceptual toolbox is no longer fitted to address new ICT-related challenges. This is not only a problem in itself. It is also a risk, because the lack of a clear understanding of our present time may easily lead to negative projections about the future. The goal of The Manifesto, and of the whole book that contextualises, is therefore that of contributing to the update of our philosophy. It is a constructive goal. The book is meant to be a positive contribution to rethinking the philosophy on which policies are built in a hyperconnected world, so that we may have a better chance of understanding our ICT-related problems and solving them satisfactorily.

The Manifesto launches an open debate on the impacts of ICTs on public spaces, politics and societal expectations toward policymaking in the Digital Agenda for Europe’s remit. More broadly, it helps start a reflection on the way in which a hyperconnected world calls for rethinking the referential frameworks on which policies are built.

This is a suicide note contains a real-life story of battling with severe mental illnesses. The author is a lecturer, a researcher, a mental health advocate, an author of several books in philosophy and psychology, and has an educational YouTube channel.

Medical law is a branch of law concerned with the prerogatives and legal responsibilities of healthcare professionals as well as the rights of patients.Regardless of practice, orthodox clinicians, homeopathic and alternative medical  practitioners confront major legal hurdles. Some of the cutting-edge issues in medical law today, include practise regulation (fitness to practise), patient rights, FDA issues, informed consent, d the law on confidentiality, the law of torts as it relates to negligence in medical treatment (e.g. medical malpractice), criminal law, contract law and bio-medical ethics.
This open learning information is provided under the auspices of the Ghana Association of Health Lawyers (GAHL)  to deepen knowlegde and discussion of health law, legal medicine and ethics, for the benefit of society, the advancement of human rights and rule of law. The aim of the GAHL is to promote the study of the consequences in jurisprudence, legislation and ethics in integrative medicine, health care and the life sciences. O.B.Dickson, President of GAHL

ABSTRACT

ORGAN TRANSPLANTATION IN MALAYSIA & JAPAN: A SOCIO LEGAL STUDY *


Japan is a fast rising industrialized country, which still retains its Asian features especially in terms of cultural heritage and religious beliefs.  Attentive of the impact of biomedical ethics in Japanese society, it has developed a center for biomedical ethics and law in 2003.  Unfortunately, we did not have such a center in Malaysia.  This is due to the fact that, advancement in biomedical ethics has been rather slow except for two important areas namely ‘Assisted reproduction technology’ and ‘Organ Transplantation’. However, organ transplantation has its own problem especially in terms of being accepted by the public. The government has made considerable efforts with the setting up of the National Transplant Registry to coordinate various organ transplant services such as bone and tissue, cornea, liver, heart, lung and renal transplants. It is instructive to note that the Malaysian society has been rather conservative when it comes to organ transplantation. This is compounded by the Asean culture and value systems, which are directly derived from our historical background and religious beliefs.  In 1997, Japan organ transplantation law was introduced to accommodate the growing needs of society; however it has yet to achieve the desired result. In view of this development, Malaysia has yet to revise its laws namely the Human Tissues Act 1974 to accommodate the current needs of society and biomedical advancements.  It is submitted that the 1997 Japanese organ transplantation laws would perhaps assist Malaysia because of the similarities in Asian ideology and cultural needs. Further, the law ought to reflect the current needs of today.



Authors:
Dr. Anisah Che Ngah (Phd) (Lead researcher, Faculty of Law, Universiti Kebangsaan Malaysia, Malaysia)
Prof. Tsuyoshi Awaya (Centre of law & Medical Ethics, Okayama University Japan)
Dr. Alireza Bhageri (School of law, Kyoto University, Japan)

There is unanimity among states to protect the continuation of life the individual as a safeguard against their collective extinction. The right to life is accordingly guaranteed but its antithesis, the right to die is the subject of unending debate. The controversy over the right to die is deepened by rapid advances in medicine creating the capability for prolongation of life beyond the span which one’s natural strength can endure. Ghana’s supreme law explicitly guarantees the right to life but remains ambiguous on right to die particularly euthanasia and assisted dying. Thus, some of the other rights, such as right to dignity and not to be tortured, can creatively be exploited to justify some instances of euthanasia. The Ghana’s criminal code largely proscribes euthanasia. Notwithstanding, proscription of euthanasia and assisted dying by the law in Ghana empirical work undertaken in some of the communities in Ghana suggest that euthanasia is practised on the quiet in health facilities and private homes especially in the rural areas. Contrary, to the popular reasons assigned, in the literature in the Western world, for the practice or quest for legalization of euthanasia being a necessity for providing relief from pain or hopeless quality of life, empirical data from social and anthropological studies conducted in Ghana reveal that poverty is the motivation for informal euthanasia practice in Ghana rather than genuine desire on part of patients to die or their relatives to see to their accelerated death. Apart from poverty, traditional cultural values of African societies consider non-natural death as a taboo and ignominy to the victim and his family. Thus, any move by the government to legalize euthanasia will need to be informed by a widely held consultations and possibly referendum; otherwise the law may be just a mere transplant of Western models of legislation on euthanasia without reflecting ethos of the African people.

W artykule odniesiono się do argumentów Polskiego Towarzystwa Ginekologicznego, zawierających krytykę rozwiązań prawnych proponowanych w głośnym projekcie ustawy, który był przedmiotem inicjatywy obywatelskiej „Stop Aborcji” w 2016 r. Tekst odnosi się zarówno do wątków medycznych, jak i prawnych podniesionych w Stanowisku PTG. Wskazano między innymi na przytoczone przez PTG nieaktualne dane medyczne dotyczące ryzyka zgonu kobiet w ciąży z nadciśnieniem płucnym oraz nieuwzględnienie aktualnych wytycznych European Society of Cardiology przy opisie przypadków klinicznych. Wykazano jednocześnie, że PTG całkowicie bezpodstawnie twierdziło, jakoby projekt stanowiący przedmiot inicjatywy obywatelskiej „Stop Aborcji” zabraniał stosowania diagnostyki prenatalnej w celach terapeutycznych. Jednocześnie zwrócono uwagę, że Stanowisko PTG tworzy wrażenie, jakoby diagnostyka prenatalna była wyłącznie ukierunkowana na działania o charakterze terapeutycznym, odwracając uwagę od faktu, że stanowi ona...