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The next Frontier in Health Law André den Exter What is Health Law? Current Issues in Health Law • • • • • • • • • • • Guaranteeing Equal Access Rationing Health Care (who decides based on what criteria?) Oviedo Convention and national law Emerging health technologies: – e-Health – Personalised medicine – Nanohealth technologies and human enhancement Palliative care and Euthanasia Public Health Threats Globalization and ‘Brain drain’ EU – Ukraine Association Agreement and Health Healthcare behind bars (Hungerstrike & forced feeding) Health Law education …. Access to Unapproved Treatment • • • • Mrs A. is a 60-years old widow afflicted with terminal cancer. She was admitted to a hospital, where she underwent extensive treatment for her cancer. Mrs A. had underdone expensive chemotherapy and availed herself of all the technology which would offer her the best hope for recovery, but her treatment was ineffectual in arresting or curing her cancer. Her condition has steadily deteriorated and her prognosis is poor; death is imminent. Due to the unsuccessful conventional treatment, Mrs A desires to receive an alternative medicine in an effort to cure or arrest the course of her cancer: This medicine is a experimental product based on garlic and has been, over the years, recommended for the treatment of cancer. This medicine is not generally recognised by qualified experts as a safe and effective medicine, but it has been claimed by its various proponents to cure the spread of cancer, or more moderately, to mitigate the symptoms of the disease without curing it. This medicine has not been approved by the National Medicines Authority of that country. It has not been proven to be an accepted method for the treatment of cancer. Clinical trials (testing efficacy and safety) are being scheduled, but will start at the end of this year. So far it has only be tested on animals. The first signs however appeared positive. Still, the hospital, in the exercise of its best medical judgment, refuses Mrs A or any other hospitalised patient therein to be treated with this alternative medicine. Can the Hospital refuse a treatment that the patient would like to receive? Informed Refusal • Jehovah’s Witnesses vs. Russia: “The Court recognises that the refusal of potentially lifesaving medical treatment on religious grounds is a problem of considerable legal complexity, involving as it does a conflict between the State’s interest in protecting the lives and health of its citizens and the individual’s right to personal autonomy in the sphere of physical integrity and religious beliefs. (…)…. • What would be the outcome of this dilemma? Reproductive Health Issues • Informed consent and forced sterilization • Access to universal, safe and affordable contraception • Infertility, assisted reproductive technologies, female sex determination by ultrasound, etc • Right to privacy and confidential doctor/patient relationships (adolescents) • HIV/AIDS epidemic and women • Defending sex workers Genetic Testing • DTC Genetic Testing – – – – Right to information/private life Non-discrimination Reliability and quality Genetic counselling e-Health • A wide range of information technology-based applications found in health care settings, including: HIS Patients portals PACS DSS ePs Labs eHealth Record patient summary Health Insurers GPs Home Care Telemedicine telemonitoring mHealth Case 4: Telemedicine • A healthy woman wants to manage her wellness, and contacts with Wellness Partners for remote monitoring and support. They offer: – A web based personal Health Record – Integration with a physician held electronic health record – biosignal collection – Remote advice and consultation, incl. lab services, Prescription, and ePharmacy • Her GP supports Wellness Partners and himself makes useof a remote second opinion service Provided by: L. Eijpe Skoop sollicitors 2009