Transcript International Health Law. Access to Health Care

The next Frontier in Health Law
André den Exter
What is Health Law?
Current Issues in Health Law
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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
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Access to Unapproved Treatment
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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
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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