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Richard W.M. Law and Kartina A. Choong

Abstract

Advances made in medical care mean that many critically ill patients with an acquired brain injury may survive with a disorder of consciousness. This may be in the form of a vegetative state (VS) or a minimally conscious state (MCS). Medically, there is a growing tendency to view these conditions as occupying the same clinical spectrum rather than be considered as discrete entities. In other words, their difference is now understood as one of degree rather than kind. However, is English law keeping pace with this development in medical knowledge? This article seeks to highlight the duality that exists in the legal decision-making process in England and Wales, and question the justifiability and sustainability of this dichotomous approach in the light of medicine’s current understanding on disorders of consciousness.

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Liisa Nieminen

Abstract

This article combines two legal and ethical questions: a) the new Finnish method of citizens’ democratic participation (the citizens’ initiative), and b) the complex and controversial question of euthanasia. Both are currently pertinent questions in Finland. The citizens’ initiative institution is a success, especially for liberal people and human rights organisations in promoting issues which coalition governments are not ready to submit to the Parliament of Finland. The euthanasia question meets these requirements and the citizens’ initiative on euthanasia (KAA 2/2017) in principle has a good chance of succeeding in the Parliament, but the result is unpredictable. Many members of the Parliament have not yet decided their attitude to euthanasia, which is a more complicated issue than, say, same-sex marriage.

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Aisling de Paor

Abstract

With developments in the field of genetics, new technologies such as genetic testing are fast emerging. Although offering unparalleled opportunities, these developments raise many ethical, legal and other issues. One challenge relates to the duty of confidentiality and disclosure obligations on doctors. Considering the familial nature of genetic information, doctors will increasingly have access to predictive health information, about individuals and individuals’ relatives. This article examines whether disclosure obligations on doctors should be expanded to encompass an obligation to disclose genetic risk to family members, and whether the exceptions to the duty of confidentiality should recognise genetic risk as potential harm. With recognition of the competing rights, the article considers the implications of recent case law in the United Kingdom, indicating a willingness to extend the duty of disclosure. This article argues that there is a case to be made for expanding disclosure obligations on doctors in certain circumstances.

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Jenna Uusitalo

Abstract

Emergency medical service (EMS) is designed, above all, to provide urgent treatment for patients with sudden life-threatening diseases or injuries. In wider context, however, EMS is a part of state’s constitutional obligation to guarantee adequate medical care. Therefore, this analysis of how EMS legislation has been drafted and implemented in practice can also be seen to reflect the state’s attitude towards the protection of human rights. A comparison between legal provisions on EMS in Finland and Estonia has been performed in order to illustrate these differentiations. Essentially, the article argues that Estonian EMS legislation seems to contribute more significantly to human rights protection, whereas Finland is more economically oriented in its attitude. However, both jurisdictions also contain some advantageous provisions, which could enhance the quality and improve the recognition of human rights in other states as well.

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Marion Albers

Abstract

The article clarifies principles, provisions and shortcomings of regulating advance decisions with a view to current regulatory approaches in Germany. The legal framework of instructional directives has been fundamentally amended in 2009. But recent cases illustrate some of the difficulties that arise and several decisions of the highest courts have reopened controversial discussions. The article argues that both the making and the implementation of advance directives involve decisions made under conditions of uncertainty. Regulations must be and are already quite complex. Even so, problems are predictable if advance decisions are not embedded in a broader context of advance care planning.

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Renaud Bouvet

Abstract

In its promotion of an autonomy model of decision-making in medical matters, French law, after making patients’ consent to medical procedures compulsory by case law then by legislation, established the primacy of the expression of patients’ wishes. Lawmakers followed the principle of shared medical decision-making and, for situations in which subjects are not fit to express their wishes, created mechanisms to represent their wishes as expressed previously. Examination of comparable legal provisions in other countries raises questions about the pertinence of the French model, which has not fully incorporated the concept of decision-making capacity but limited itself to a binary appreciation of fitness to express one’s wishes.

Open Access

Joseph Dute

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Transplant Tourism

An International and National Law Model to Prohibit Travelling Abroad for Illegal Organ Transplants

Terry O. Adido

Transplant Tourism: An International and National Law Model to Prohibit Travelling Abroad for Illegal Organ Transplants explores the role that international and national laws must play in the prohibition and eradication of transplant tourism and proposes a three-stage legal model for the prohibition of the practices. Through the examination of international law norms, principles and instruments; laws and policies from several legal systems; and legal frameworks and models which currently prohibit a number of national, transnational and international offences, this publication focuses on the creation of a comprehensive soft law instrument on transplant tourism, a treaty on transplant tourism and unified national transplant tourism laws with extraterritorial application in accordance with the principles and spirit of the international law instruments.