Abstract
For the December 2024 edition of Medical Law International, we are pleased to conclude our first year as editors by sharing with readers an exciting collection of contributions.
The problematic subject of the COVID-19 pandemic is a key theme of this edition. First, an article by Mark Davies focuses on ‘Scientific debate, misinformation, and the COVID-19 pandemic – considerations from a medical regulatory perspective’. This contribution explores the involvement of doctors in conspiracy theory debates that emerged almost alongside the first media reports concerning the spread of COVID-19. The key question considered is, how the General Medical Council and the Medical Practitioner’s Tribunal Service should respond when people with professional standing engage in controversial debates that sit outside established and accepted forums for scientific and professional medical discourse. Davies explores the uncertain boundary between acceptable professional discussion and inappropriate commentary, which brings the profession into disrepute, during a time when the internet and social media have made it extremely easy for professionals to wade into provocative online debates. Key cases are examined, and the author highlights the Adil case, 1 which illustrates that discussion that conflicts with widely accepted medical opinion does not necessarily amount to misconduct. This is because, as knowledge of an uncertain scientific question grows, such participation in discussion might present an important contribution to the development of understanding. However, when a doctor advances baseless opinions which risk harming patient welfare it will amount to misconduct, as was evident in Adil. Importantly, when ethical guidance within Good Medical Practice appears to conflict with the right to freedom of expression protected by Article 10 of the European Convention on Human Rights, the exceptions under 10(2) are more difficult to determine when applied to such ethical guidance in comparison with traditional sources of law. Consequently, medical practitioners wishing to avoid disciplinary proceedings would be wise to hesitate before contributing to contentious conspiracy debates.
The second contribution to the broad topic of pandemic law within this edition comes from Andraž Zidar and Živa Cotič Zidar, with a commentary on the recently amended WHO International Health Regulations (IHR) for a better global pandemic governance. In addition to the devastating consequences of COVID-19, the authors suggest that other pandemics, such as the outbreak of Ebola in West Africa in 2014, have similarly exposed serious deficiencies within the IHR. They argue that past responses favoured economic and political considerations over scientific and legal categories in assessing risk to human health. In May 2024, at the 77th World Health Assembly, a package of amendments to the IHR was adopted to improve the pandemic response. The amendments change the concept of a public health emergency of international concern (PHEIC), to address the concern that the approach which emerged in the Ebola and COVID-19 outbreaks had been too slow to respond to the epidemiological evidence. A key development is that pandemic emergency is introduced as a subcategory of PHEIC. The authors explore the very significant challenges of global health governance, considering the approach in relation to effectiveness, transparency and accountability. Two principles – equity and solidarity, intended to improve governance – are also examined. The authors of this insightful commentary conclude that the inclusion of pandemic emergency as a category of PHEIC is a positive development. This, however, needs to be reinforced by better governance which embraces not only effective, transparent and accountable management of international public health emergencies, but also, crucially, health equity and solidarity must serve as mobilisings force for protecting global health.
Two book reviews complete the contributions for this edition. John Keown reviews Jonathan Herring’s The Right to Be Protected From Committing Suicide (Oxford, Hart, 2022). Herring’s thesis is that there is a human right to be protected by the state from taking one’s own life. Over 10 chapters, the book argues that society establishes the environment within which socio-economic and health inequality encourage suicide to flourish, and so the state has an obligation to protect people who might choose to die by suicide. Keown praises the book for presenting a thoughtful and well-researched contribution, which attempts to ‘recentre contemporary discussion of suicide and assisted suicide by putting the sad reality of suicide, and its causes, centre-stage’. Keown also, however, suggests that there are some unresolved tensions within the thesis that could have been avoided. In Keown’s opinion, the discussion about the value of autonomy on the issue of suicide, and the inclusion of any consideration of legalising assisted suicide weaken the potential impact of the central argument. The review alerts the reader to some well-established concerns over the vagaries of autonomy, the slippery dangers of legalising assisted dying and some definitional questions concerning the precise meaning of suicide. Ultimately, though, Keown compliments the book for being an ‘original, thought-provoking and valuable contribution to the literature on suicide’.
The second book reviewed – by Heather Swadley – is, The Disability Bioethics Reader, a collection of essays edited by Joel Michael Reynolds and Christine Wieseler (Routledge, 2022). This book presents an introduction to the field of bioethics through the lens of critical disability studies and the philosophy of disability. It brings together a diverse selection of scholars, and, over 10 sections and 36 chapters, a rich array of themes and topics are explored. Due to the breadth and scope of the collection, Swadley’s review focuses on core themes and strengths of this impressive volume. The identified strengths are ‘thought-provoking, engaging and provides prospective that will be useful for practitioners and scholars alike’. The critical comments are intended as suggestions for future research and further exploration, and these include, the need to engage more with lived experiences through qualitative study, and a plea for more engagement with eugenics as reproductive control. Notwithstanding these suggestions, Swadley finds that the collection ‘provides a vital synthesis of critical disability studies and bioethics’, that is both accessible for anyone new to the field and insightful for established scholars.