Stopping the Vicious Cycle: Equitable Enforcement Strategies to Achieve Safe, Stable, and Accessible Housing for People with Disabilities.

Policy Points People with disabilities experience a vicious cycle of poverty, poor health, and marginalization partly because of the inequitable implementation and enforcement of laws, including underenforcement of civil rights and housing laws and overenforcement of punitive nuisance and criminal laws. Inequitable enforcement reflects policy choices that prioritize powerful entities (e.g., landlords, developers) to the detriment of people who experience intersectional structural discrimination based on, for example, race, disability, and income. Equitable enforcement, a process of ensuring compliance with the law while considering and minimizing harms to marginalized people, can promote health and disability justice by increasing access to safe, stable, and accessible housing.

Reforming Physician Licensure in the United States to Improve Access to Telehealth: State, Regional, and Federal Initiatives.

Policy Points The reinstitution of pre-COVID-19 pandemic licensure regulations has impeded interstate telehealth. This has disproportionately impacted patients who live near a state border; geographically mobile patients, such as college students; and patients with rare diseases who may need care from a specialist outside their state. Several promising and feasible reforms are available, at both state and federal levels, to facilitate interstate telehealth. For example, states can offer exemptions to licensure requirements for certain types of telehealth such as follow-up care or create licensure registries that impose little reduced paperwork and fees on physicians. On the federal level, congressional interventions that mimic the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 can waive provider licensing and geographic restrictions to telehealth within certain federal programs such as Medicare. Any discussion of medical licensure reform, however, must also consider the current political climate, one in which states are taking divergent stances on sensitive topics such as reproductive care, gender-affirming care, and substance use treatments.

Legal and regulatory instruments for NCD prevention: a scoping review and descriptive analysis of evaluations in OECD countries.

CONTEXT: Public health law is an important tool in non-communicable disease (NCD) prevention. There are different approaches available for achieving policy objectives, including government, co-, quasi- and self-regulation. However, it is often unclear what legal design features drive successes or failures in particular contexts. This scoping review undertakes a descriptive analysis, exploring the design characteristics of legal instruments that have been used for NCD prevention and implemented and evaluated in OECD countries. METHODS: A scoping review was conducted across four health and legal databases (Scopus, EMBASE, MEDLINE, HeinOnline), identifying study characteristics, legal characteristics and regulatory approaches, and reported outcomes. Included studies focused on regulation of tobacco, alcohol, unhealthy foods and beverages, and environmental pollutants. FINDINGS: We identified 111 relevant studies evaluating 126 legal instruments. Evaluation measures most commonly assessed implementation, compliance and changes to the built and lived environment. Few studies evaluated health or economic outcomes. When examining the design and governance mechanisms of the included legal instruments, government regulation was most commonly evaluated (n = 90) and most likely to be reported effective (64%). Self-regulation (n = 27) and quasi-regulation (n = 5) were almost always reported to be ineffective (93% and 100% respectively). There were few co-regulated instruments evaluated (n = 4) with mixed effectiveness. When examining public health risks, food and beverages including alcohol were more likely to be self- or quasi-regulated and reported as ineffective more often. In comparison, tobacco and environmental pollutants were more likely to have government mandated regulation. Many evaluations lacked critical information on regulatory design. Monitoring and enforcement of regulations was inconsistently reported, making it difficult to draw linkages to outcomes and reported effectiveness. CONCLUSIONS: Food and alcohol regulation has tended to be less successful in part due to the strong reliance on self- and quasi-regulation. More work should be done in understanding how government regulation can be extended to these areas. Public health law evaluations are important for supporting government decision-making but must provide more detail of the design and implementation features of the instruments being evaluated - critical information for policy-makers.

POLICY POINTS: Government regulation is reported as more effective than co-regulation, quasi-regulation or self-regulation. Voluntary approaches, including voluntary government regulation, are reported less effective due to low uptake and limited accountability. In public health law mandated government regulation should be strived for.Food and alcohol sectors are more likely to adopt self- or quasi-regulation and are frequently reported as ineffective. More work should be done to support government regulation in these areas.Many public health law evaluations are lacking critical design information for policy makers. This may make it difficult to learn from successes or failures and replicate interventions in other jurisdictions.

Do compulsory mental health patients have a right to receive a second opinion on their treatment under Australian mental health legislation?

We reviewed Australian mental health legislation to determine what obligations it places on psychiatrists to facilitate second opinions for compulsory patients who request them. Only four jurisdictions-Australian Capital Territory, Queensland, Victoria, and Western Australia-have legislated for 'patient-initiated' second opinions. Within these four regimes, there is variation in important aspects of the second opinion process, and there is a general absence of direction given to the second opinion providers. Based on research showing the variability of second opinion provision under New Zealand mental health legislation, we argue that this absence is likely to result in significant variation in the quality and depth of second opinions provided in Australia. We argue that New South Wales, the Northern Territory, South Australia, and Tasmania should consider formal provision for patient-initiated second opinions in their mental health legislation. We believe that such legislation ought to be aware of the barriers patients may face in accessing second opinions, and avoid exacerbating these barriers as Queensland's legislation appears to. Also, we argue that research on current practice in Australia should be conducted to better understand the effects of legislation on second opinions, and to help determine what amounts to best practice.

Personal responsibility for health in Bulgarian public health law and social legislation.

BACKGROUND: In the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation. METHODS: Through a search of national legal databases 7 documents were selected and subjected to content analysis. RESULTS: Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics. CONCLUSION: Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.

From principles to practice: Clarifying new obligations under Victoria's Mental Health and Wellbeing Act 2022.

OBJECTIVE: To explain the new test for complying with the mental health principles under the Mental Health and Wellbeing Act 2022 (Vic). CONCLUSION: The principles carry over limitations from the previous Mental Health Act 2014 (Vic) while also containing new features. The 'all reasonable efforts to comply' and 'proper consideration' tests resemble the existing test under section 38(1) of the Charter of Human Rights and Responsibilities Act 2006 (Vic) that also apply to public mental health services. Taking these duties together, public mental health services, including hospital and community mental health boards, clinical directors and clinical governance processes, will need to show concrete evidence of specific rights and/or principles being deliberated in their decisions.

Examining legal and ethical challenges in HIV/AIDS disclosure obligations and medical practices: a case study from China.

In accordance with China's regulations on the prevention and control of HIV/AIDS, individuals diagnosed with HIV are required to disclose their medical condition when soliciting medical care in Mainland China. Empirical field investigations, however, indicate that people living with HIV (PLHIV) predominantly comply with this mandate only under conditions of absolute necessity. The ensuing conundrum, juxtaposing the imperative of privacy against the duty of disclosure, has materialised into a recurrent vicious cycle in its practical application, intensifying the intrinsic trust disparities characterising doctor-patient interactions. A meticulous scrutiny of pertinent legal precedents, coupled with in-depth field studies, reveals that the genesis of these complications can be traced back to an unforeseen metamorphosis in the legislative intent underpinning HIV/AIDS prevention and therapeutic strategies. While the initial objective was risk mitigation, the effect of enactment in real-world scenarios has significantly decreased. Owing to factors including extensive media reporting as well as prevailing public discourse, PLHIV, rather than being perceived as rights-bearing entities in legal frameworks, are increasingly relegated to the restrictive and dehumanising labels of 'HIV/AIDS'. As these individuals navigate their rights through alternative non-regulatory channels, circumventing formal legal obligations, their efficacy in actualising these rights is concurrently undermined.

Banning Engineered Stone: A Landmark Australian Public Health Law Reform.

Union activism, medical lobbying and occupational health and safety prosecutions led to a major public health initiative in Australia - the banning from 1 July 2024 of work with engineered/artificial stone, including manufacturing, supplying, processing and installing it. This editorial contextualises within the history of regulation of workers' exposure to risks of contracting silicosis the growing international awareness of the dangers posed by working with engineered stone, particularly in relation to making and installing kitchen and bathroom benchtops made from engineered stone. It argues that the Australian initiative is an important public health decision that has a sound justification, is likely to save many lives and should be emulated internationally.

Whose experts? How federalism shaped psychiatry in the late Habsburg monarchy.

The late Habsburg period (1867-1918) created a constitutional dual monarchy of Austria-Hungary. This paper discusses the role of psychiatry in Cisleithania, both as a developing profession and as a distinct 'policy field'. Tension between psychiatry's academic professionalisation and the creation of public institutions as signature projects by individual crownlands created complex relationships between psychiatry and politics. In federalist Cisleithania, psychiatrists became very 'political': whether employed by the state or a crownland influenced their position on policy, despite claiming that their expert knowledge was 'scientific' and 'objective'. The conflicts between asylum-based and academic psychiatrists mirrored those between the central state and the crownlands. This led to intractable delays in mental health law reform, eventually resolved by Imperial decree in 1916.

Nigeria mental health law: Challenges and implications for mental health services.

Background: The Nigerian mental health law titled the Lunacy Act of 1958 has been under scrutiny for violating the human rights of people with mental illness. The call to reform the obsolete Lunacy Act has garnered attention from the government, as the law has been unamended for over 60 years. Aim: This study presents the challenges and implications of the new mental health law to the mental health services of Nigeria. Methods: ScienceDirect, PubMed, and Google Scholar were used to find pertinent material. The implications and difficulties facing the new mental health law examined from the literature were discussed. Recommendations were made following an exploratory search for literature on mental health legislation in Nigeria. Results: The new Law in Section 5(6) saw the introduction of mental health services in primary and secondary healthcare. It also addresses critical issues such as non-discrimination, fundamental human rights, standards of treatment, access to information, confidentiality and autonomy, and the employment rights of persons with mental health and substance abuse-related disorders. The Law failed to include mental health services in the country's health insurance system. Conclusion: There is a need for legislation to meet people's mental health needs and encourage them to seek treatments, such as regulations that protect against discrimination and harsh treatment of people with mental illness. Contribution: Nigerian mental health services would benefit from the new mental health law if the key issues raised in this review are addressed.

The potential unintended consequences of Mental Health Act reforms in England and Wales on people with intellectual disability and/or autism.

The draft Mental Health Bill, which amends the Mental Health Act 1983 for England and Wales, proposes protections for people with intellectual disability and/or autism (ID/A) to prevent detention in hospital in the absence of mental illness. This editorial critically appraises the positive impact and unintended consequences of the proposed reforms for people with ID/A.

The utilisation of legal instruments by United Nations actors to restrict the exposure of children to unhealthy food and beverage marketing: a qualitative content analysis of UN instruments.

INTRODUCTION: United Nations (UN) agencies are influential global health actors that can introduce legal instruments to call on Member States to act on pressing issues. This paper examines the deployment and strength of global health law instruments used by UN actors to call on Member States to restrict the exposure of children to unhealthy food and beverage marketing. METHODS: Global health law instruments were identified from a review of four UN agencies that have a mandate over children's exposure to marketing of unhealthy food and beverage products namely: the World Health Organization (WHO); the Food and Agriculture Organization (FAO); the United Nations General Assembly (UNGA) and the UN Office of the High Commissioner for Human Rights (OHCHR). Data on marketing restrictions were extracted and coded and descriptive qualitative content analysis was used to assess the strength of the instruments. RESULTS: A wide range of instruments have been used by the four agencies: seven by the WHO; two by the FAO; three by the UNGA; and eight by the UN human rights infrastructure. The UN human rights instruments used strong, consistent language and called for government regulations to be enacted in a directive manner. In contrast, the language calling for action by the WHO, FAO and UNGA was weaker, inconsistent, did not get stronger over time and varied according to the type of instrument used. CONCLUSION: This study suggests that a child rights-based approach to restricting unhealthy food and beverage marketing to children would be supported by strong human rights legal instruments and would allow for more directive recommendations to Member States than is currently provided by WHO, FAO and UNGA. Strengthening the directives in the instruments to clarify Member States' obligations using both WHO and child rights mandates would increase the utility of global health law and UN actors' influence.

COVID-19 and the law in Uganda: a case study on development and application of the public health act from 2020 to 2021.

BACKGROUND: Despite the discovery of vaccines, the control, and prevention of Coronavirus disease 2019 (COVID-19) relied on non-pharmaceutical interventions (NPIs). This article describes the development and application of the Public Health Act to implement NPIs for COVID-19 pandemic control in Uganda. METHODS: This is a case study of Uganda's experience with enacting COVID-19 Rules under the Public Health Act Cap. 281. The study assessed how and what Rules were developed, their influence on the outbreak progress, and litigation. The data sources reviewed were applicable laws and policies, Presidential speeches, Cabinet resolutions, statutory instruments, COVID-19 situation reports, and the registry of court cases that contributed to a triangulated analysis. RESULTS: Uganda applied four COVID-19 broad Rules for the period March 2020 to October 2021. The Minister of Health enacted the Rules, which response teams, enforcement agencies, and the general population followed. The Presidential speeches, their expiry period and progress of the pandemic curve led to amendment of the Rules twenty one (21) times. The Uganda Peoples Defense Forces Act No. 7 of 2005, the Public Finance Management Act No. 3 of 2015, and the National Policy for Disaster Preparedness and Management supplemented the enacted COVID-19 Rules. However, these Rules attracted specific litigation due to perceived infringement on certain human rights provisions. CONCLUSIONS: Countries can enact supportive legislation within the course of an outbreak. The balance of enforcing public health interventions and human rights infringements is an important consideration in future. We recommend public sensitization about legislative provisions and reforms to guide public health responses in future outbreaks or pandemics.

Undue Burdens: State Abortion Laws in the United States, 1994-2022.

State laws have influenced access to abortion in the 50 years since Roe v. Wade. The 2022 Dobbs decision returned questions about the legality of abortion to the states, which increased the importance of state laws for abortion access. The objective of this study is to illustrate trends in abortion-restrictive and abortion-supportive state laws using a unique longitudinal database of reproductive health laws across the United States from 1994 to 2022. This study offers a descriptive analysis of historical trends in state-level pre-viability abortion bans, abortion method bans, efforts to dissuade abortion, TRAP (targeted regulation of abortion providers) laws, other laws that restrict reproductive choice, and laws that expand abortion access and support reproductive health. Data sources include state statutes (from Nexis Uni) and secondary sources. The data reveal that pre-viability bans, including gestation-based bans and total bans, became significantly more prevalent over time. Other abortion-restrictive laws increased from 1994 to 2022, but states also passed a growing number of laws that support reproductive health. Increasing polarization into abortion-restrictive and abortion-supportive states characterized the 1994-2022 period. These trends have implications for maternal and infant health and for racial/ethnic and income disparities.

The COVID-19 vaccine patent: a right without rationale.

Since the approval of COVID-19 vaccines, international efforts have intensified on vaccination schemes perceived as the only light at the end of the tunnel. Governments are working tirelessly to scale up the number of vaccinated people, just as vaccine manufacturers are stretching their facilities to meet the increasing demand for doses. The international community is trying to help the poorest countries in the world by improving vaccine supplies and removing obstacles. In this regard, India and South Africa have applied to World Trade Organisation to waive vaccine-related intellectual property rights. The proposal has sparked off academic debates as to its merit. This article addresses the waiver controversy. Following a critical review of both dimensions of the controversy, the article concentrates on the extent to which the waiver application contradicts the theoretical justification of the patent system. It concludes that the concerns raised over the conflict between the waiver proposal and the patent right philosophy are indefensible.

Knowledge of mental health diagnosis among patients and their family members: an inpatient survey in China.

BACKGROUND: Patient-oriented information disclosure has been advocated by the National Mental Health Law (NMHL) in China since 2012; however, reporting on diagnostic disclosure to patients with mental disorders after the NMHL is limited. AMIS: This study aims to investigate and compare the knowledge of mental health diagnosis among patients and their family members in China. METHODS: An inpatient survey was conducted among 205 patients with mental disorders and their family members. Group differences of the correctness of self-reported mental health diagnosis were compared, and logistic regression was performed to investigate correlates among both patients and their family members. RESULTS: Overall, 76.7% patients and 80.6% of their family members reported a correct diagnosis. Only 46.2% patients with psychotic disorders correctly knew their diagnosis, significantly lower than their family members and patients with non-psychotic disorders. Multivariate regression analysis found that the diagnosis of psychotic disorders was a risk factor of patients' diagnostic knowledge (AOR = 0.137; 95% CI = 0.044-0.429), while family members' diagnostic knowledge was associated with their employment (AOR = 6.125, 95% CI = 1.942-19.323) and parent-child relationship with patients (AOR = 3.719; 95% CI = 1.057-13.086). CONCLUSIONS: The majority of patients with non-psychotic disorders know their diagnosis correctly and informing family members of patients' diagnosis remains a common practice in psychiatric setting after the implementation of China's NMHL.

The Legal Needs of People Living with a Sexually Transmissible Infection or Blood-Borne Virus: Perspectives From a Sample of the Australian Sexual Health and Blood Borne Virus Workforce.

Law and the legal environment are important factors in the epidemiology and prevention of sexually transmissible infections (STIs) and blood-borne viruses (BBVs). However, there has been no sustained effort to monitor the legal environment surrounding STIs and BBVs. This article presents the first data on the incidence and impacts of unmet legal needs for those affected by an STI or BBV in Australia using a survey administered to a sample of the Australian sexual health and BBV workforce. Migration, Housing, Money/Debt, Health (including complaints about health services), and Crime (accused/offender) were reported as the five most common legal need areas, with 60% of respondents describing these legal problems as generating a "severe" impact on health. These results indicate that unmet legal needs generate significant negative impacts in terms of individual health, on public health, and the ability to provide sustainable services such as testing and treatment to those facing unmet legal needs.

[Knowledge, use and opinion about written informed consent in primary healthcare nurses: CONOSER pilot project]. / Conocimiento, implementación y opinión acerca del consentimiento informado por escrito de las enfermeras de atención primaria: proyecto piloto CONOSER.

OBJECTIVE: To know the knowledge, implementation and opinion on informed consent of generalist nurses, specialists and primary care residents. DESIGN: Descriptive cross-sectional study using an online self-administered 'ad hoc' questionnaire. SETTING: Primary care nurses in Madrid, from November 2020 to March 2021. PARTICIPANTS: Sample of 114 nurses: 91 generalist, 20 specialists and 3 residents. MAIN MEASUREMENTS: Sociodemographics, knowledge, implementation and opinion. RESULTS: The response rate was 27.7%. As a general rule, 48.2% indicated that informed consent was collected verbally, as established by law, with differences being found between categories, this percentage being higher in specialists and residents (P=0.004), and within specialists in those who had obtained their speciality by internal resident nurse (IRN) (P<0.0001). In addition, specialists and residents were those who most identified the legal norm regulating informed consent (P<0.0001). In terms of implementation and opinion, all groups obtained similar results. DISCUSSION: There are no previous studies that have analysed these aspects of informed consent comparing the different categories. Studies from other healthcare and geographical areas show that nurses have greater knowledge, although the demand for specific training in bioethics and biolaw is greater in the nurses participating in this study. CONCLUSIONS: Nurses have adequate knowledge about informed consent, use it in clinical practice and have an appropriate conception of it, being higher in some items in specialist nurses IRN and in residents.

The legal relevance of a minor patient's wish to die: a temporality-related exploration of end-of-life decisions in pediatric care.

Decisions regarding the end-of-life of minor patients are amongst the most difficult areas of decision-making in pediatric health care. In this field of medicine, such decisions inevitably occur early in human life, which makes one aware of the fact that any life-young or old-cannot escape its temporal nature. Belgium and the Netherlands have adopted domestic regulations, which conditionally permit euthanasia and physician-assisted suicide in minors who experience hopeless and unbearable suffering. One of these conditions states that the minor involved must be legally competent and able to express an authentic and lasting wish to die. This contribution is different from other legal texts on end-of-life decisions in modern health care. Foremost, it deals with the role time-bound components play in our views on the permissibility of such decisions with regard to minor patients. While other disciplines provide profound reflections on this issue, from a legal point of view this side has hardly been explored, let alone examined with regard to its relevance for the legal permissibility of end-of-life decisions in pediatrics. Therefore, the manuscript inquires whether there are legal lessons to be learned if we look more closely to temporality-related aspects of these end-of-life decisions, particularly in connection to a minor patient's assumable ability to choose death over an agonizing existence.

What Domains of Belgian Euthanasia Practice are Governed and by Which Sources of Regulation: A Scoping Review.

BACKGROUND: Multiple sources of regulation seek to shape euthanasia practice in Belgium, including legislation and training. This study comprehensively mapped which of these sources govern which domains of euthanasia practice, such health professionals' obligations, or managing patient requests. METHOD: Scoping review methodology was used to search for scholarly records which discussed Belgian euthanasia regulation. Template analysis was used to generate themes describing the domains of euthanasia practice governed by sources of regulation. RESULTS: Of 1364 records screened, 107 records were included. Multiple sources of regulation govern each domain, which are: the permissible scope of euthanasia; the legal status of a euthanasia death; the euthanasia process; the rights, obligations, and roles of those involved; system workings; and support for health professionals who provide euthanasia. CONCLUSIONS: Domains with significant yet fragmented regulation may lead to inconsistent care provision. Policymakers should develop coherent guidance to support health professionals to navigate this regulatory landscape.