Reshaping EU Legislation for Air Pollution Control: Main Features of the Proposed Directive in Comparison with the US Legislation.

Abstract: In October 2022, the European Commission released a draft of a new Directive aimed at securing more effective control and prevention of outdoor air pollution in Europe through the recasting and update of previous European legislation. The proposal is intended to reshape the current regulations in the field within the EU and its implementation at the Member State level and achieve lower air pollution in light of the recent advancements in environmental health and novel indications in the field from the World Health Organization. In addition, the proposed Directive provides a legal framework for air pollution control that falls within the wider legal context of the EU Green Deal and NextGenerationEU initiatives. The new rules are also remarkably consistent with corresponding and updated US regulations, though stricter in terms of air pollution control and more open to interactions with local authorities. In sum, the proposed EU Directive appears to take better stock of the emerging scientific evidence on the adverse effects of air pollution and may provide an effective legal instrument for adequate public health protection.

Reorganizing Italy's Territorial Healthcare: the Ministerial Decree No. 77/2022 and its Comparative Significance.

Abstract: As approved by the European Commission in 2021, Italy's National Recovery and Resilience Plan encompasses a far-reaching reform in the governance and structure of the national health service (NHS) that should shift the focus of assistance from large, centralized hospitals to a tight network of numerous smaller health centers dislocated in the country. In this respect, the adoption of the Ministerial Decree no. 77 on May 23, 2022, represented a key step in the execution of the intended reform, to the extent that the Decree set forth the main terms of the primary care reorganization process. This review summarizes the key elements of the Decree, foreshadows its legal and public health implications, acknowledges the uncertainties about the economic feasibility of the reform, and highlights its possible comparative significance for health systems facing similar challenges, especially those - such as the UK NHS - that share a comparable type of funding system and organizational framework.

Protecting privacy in mandatory reporting of infectious diseases during the COVID-19 pandemic: perspectives from a developing country.

Mandatory reporting of infectious diseases (MRID) is an essential practice to prevent disease outbreaks. Disease notification is a mandatory procedure for most infectious diseases, even during non-pandemic periods in healthcare. The main rationale behind MRID is the protection of public health. The information and data provided by infectious disease reports are used for many purposes, such as preventing the spread and potential negative impact of infectious diseases, assessing the national and global situation regarding reported diseases, conducting scientific research and planning health policy. In this context, the relevant information benefits public health, health systems and scientific work. Additionally, the follow up and treatment of individuals with infectious diseases is a necessity in certain cases to protect those who cohabit with them. However, these benefits cannot be accepted as unrestricted justifications for MRID, since it is evident that reporting should be conducted within ethical and legal boundaries. MRID should only be devised and implemented with due regard to balancing potential benefits between all individuals, as well as between the individual and the rest of society. Disease notification systems that are not designed with a balancing and harm-reductionist approach may lead to stigmatisation and discrimination. This study aims to investigate the legal framework and ethical issues regarding the reporting of individuals diagnosed with COVID-19 in Turkey-which is a primary example of a developing country.

Constitutional Reform by Legal Transplantation: The United Kingdom Internal Market Act 2020.

This article develops the comparative law framework on legal transplantation to theorise the impact of the United Kingdom Internal Market Act 2020 (UKIMA) on the UK constitution across three registers of analysis-the territorial, the material and the conceptual. It arrives at three conclusions. First, in relation to the territorial constitution, this article argues that the UKIMA introduces something transformative: the concept of an internal market as a shared regulatory space that cuts across the respective competences of the UK and devolved legislatures. Secondly, the legal transplant framework points to the introduction of a powerful commitment to the principles of a liberal market economy as the basis of the UK's material constitution. Finally, regarding the conceptual constitution, this article concludes that the UKIMA effects a qualitative change to established patterns of judicial review through its co-opting of courts as agents to secure the foundations of the newly recast material constitution.

Future-Proof Regulation against the Test of Time: The Evolution of European Telecommunications Regulation.

Regulation is sometimes designed to be future-proof, so that it can adapt to changing economic and technological realities. The EU (and UK) Regulatory Framework for electronic communications was expressly crafted to be able to adjust to the evolution of the industry. This article considers how well the regime has stood the test of time and, based on this analysis, what lessons can be drawn for regulation more generally. It appears that, by and large, the Framework has effectively accompanied the transformation of telecommunications in Europe. On the other hand, the EU legislature's commitment to future-proof intervention has waned over time. Every new review of the regime has represented a move away from the philosophy and mechanisms conceived to ensure that regulation would adapt seamlessly to industry shifts. This experience suggests that the failure or success of future-proof intervention primarily hinges on the intertemporal consistency of legislatures.

Insurance-based inequities in emergency interhospital transfers: an argument for the prioritisation of patient care.

Currently there is an inequity in transfer rates of uninsured patients versus their insured counterparts. While this may vary by hospital system, studies indicate that this is a national trend, especially in emergency situations, and represents a prioritisation of profits over ethical obligations. This creates a variety of ethical issues for patients and society that generates a concordance between deontological and utilitarian viewpoints, two generally opposed schools of thought. The prioritisation of profit maximisation in order to provide better care for a select population is insufficient to justify deleterious health outcomes, stress and financial burden on patients. Current policy regarding patient transfers in the emergency department is insufficient to protect the uninsured and must be reevaluated.

Views of disability rights organisations on assisted dying legislation in England, Wales and Scotland: an analysis of position statements.

Assisted dying is a divisive and controversial topic and it is therefore desirable that a broad range of interests inform any proposed policy changes. The purpose of this study is to collect and synthesize the views of an important stakeholder group-namely people with disabilities (PwD)-as expressed by disability rights organisations (DROs) in Great Britain. Parliamentary consultations were reviewed, together with an examination of the contemporary positions of a wide range of DROs. Our analysis revealed that the vast majority do not have a clear public stance; those that do exhibit a significant diversity of opinion. DROs opposing legislation on assisted dying have argued that it would be premature, misguided, inequitable and culturally undesirable. Some specify conditions that would have to be satisfied before they could support legalisation, such as radical improvements in health and social care services (especially those relating to end of life care) and the elimination of discrimination against PwD. DROs supporting assisted dying maintain that a change in the law would promote autonomy, end intense suffering, can be delivered safely and is supported by the DRO's membership. The discussion considers the reasons why several DROs adopt a neutral stance and the argument is made that, whatever their overarching stance on the issue, DROs need to be involved in the policy debate so that the crucial perspectives of PwD are heard and addressed. This is an important message for countries around the world that permit, or are considering legalising, assisted dying.

Freedom of Information Act: scalpel or just a sharp knife?

The concluding statement of the Burns Commission, established to evaluate whether changes are needed to the Freedom of Information Act (FOIA), ruled no major legislative changes were required. As such Freedom of Information (FOI) legislation still enables anyone to obtain information from public authorities. In this brief report article we explore arguments regarding FOI as an instrument for healthcare research using an international research programme as a case study.

The BMA's guidance on conscientious objection may be contrary to human rights law.

It is argued that the current policy of the British Medical Association (BMA) on conscientious objection is not aligned with recent human rights developments. These grant a right to conscientious objection to doctors in many more circumstances than the very few recognised by the BMA. However, this wide-ranging right may be overridden if the refusal to accommodate the conscientious objection is proportionate. It is shown that it is very likely that it is lawful to refuse to accommodate conscientious objections that would result in discrimination of protected groups. It is still uncertain, however, in what particular circumstances the objection may be lawfully refused, if it poses risks to the health and safety of patients. The BMA's policy has not caught up with these human rights developments and ought to be changed.

Das 'politische Volontariat' des Arnold Clapmarius. Praktische Erfahrung und der Anschein praktischer Erfahrung als Qualifikation für die politischen Wissenschaften um 1600.

Arnold Clapmarius' 'Traineeship in politics'. Practical Experience and the Semblance of Practical Experience as a Qualification in the Field of Political Science around the Year 1600. In 1600, Arnold Clapmarius (1574-1604) was appointed the first professor for Public Law and Political Science in the Holy Roman Empire by the University of Altdorf (Nürnberg). He received this professorship though he had not yet published anything because he was a protégé of Landgrave Maurice the Learned of Hesse-Kassel. Two newly discovered letters which were written by Clapmarius to Maurice show that the young scholar did a traineeship at the Landgrave's court to gather practical experience in politics. This was probably the reason for his appointment in Altdorf. Nevertheless, he hushed up this traineeship because it did not comply to the kind of experience that were expected from a 'politicus' at that time, id est military service, educational journeys, foreign languages and regional studies. Thus, this paper fills a gap of Arnold Clapmarius' biography, and provides a new perspective on the value of practical experience in the field of political science in the Early Modern Period.

Court applications for withdrawal of artificial nutrition and hydration from patients in a permanent vegetative state: family experiences.

Withdrawal of artificially delivered nutrition and hydration (ANH) from patients in a permanent vegetative state (PVS) requires judicial approval in England and Wales, even when families and healthcare professionals agree that withdrawal is in the patient's best interests. Part of the rationale underpinning the original recommendation for such court approval was the reassurance of patients' families, but there has been no research as to whether or not family members are reassured by the requirement for court proceedings or how they experience the process. The research reported here draws on in-depth narrative interviews with 10 family members (from five different families) of PVS patients who have been the subject of court proceedings for ANH-withdrawal. We analyse the empirical evidence to understand how family members perceive and experience the process of applying to the courts for ANH-withdrawal and consider the ethical and practice implications of our findings. Our analysis of family experience supports arguments grounded in economic and legal analysis that court approval should no longer be required. We conclude with some suggestions for how we might develop other more efficient, just and humane mechanisms for reviewing best interests decisions about ANH-withdrawal from these patients.

Legislative and judicial responses to public health protection under eco-environmental damage relief in China.

Background: The group-type health damage caused by eco-environmental damage has been stated in the Environmental Protection Law and other laws in China. The first-ever Chinese Civil Code, which took effect in 2021, has explicitly defined eco-environmental damage relief and imposed affirmative duties on those who polluted the environment or destroyed the ecology. This study aims to describe the status quo of public health protection in eco-environmental damage relief and explore its progress and limits in protecting public health. Methods: By reviewing China's legislation on relief of eco-environmental damage and observing the implementation of these laws in judicial practice. All judicial cases of eco-environmental damage published by Chinese courts from January 2021 to May 2023 were selected and examined. From the perspective of the comparison of laws, the measurement of interests and the execution of cases, we discussed the issues of China's legislative and judicial responses to public health. Results: The relief system of eco-environmental damage in China has been formed initially, but there are still some deficiencies: In the application of law for relief of public health, there are many choices of means, resulting in the choice conflict of law application; the public health damage in the eco-environmental damage case has been ignored by courts, and it has not been a dominant consideration element; the objects of the execution of the cases are directed to the pure eco-environmental restoration, and the restoration plan does not cover public health protection measures, which does not have a preventive effect on public health. The root cause of problems is that the relief of eco-environmental damage in China follows the logic of traditional private law. Conclusion: The issues mentioned above merit consideration in China's future law revisions and judicial practice. Based on the dual nature of public and private law in environmental health, it is necessary to adjust the provisions of responsibility for eco-environmental restoration from the framework of public law, including the scope and mechanism, and then further suggestion includes the legal subject, the benefit element and the use of funds.

The role of statistical significance testing in public law and health risk assessment.

Following a fundamental statement made in 2016 by the American Statistical Associations and broad and consistent changes in data analysis and interpretation methodology in public health and other sciences, statistical significance/null hypothesis testing is being increasingly criticized and abandoned in the reporting and interpretation of the results of biomedical research. This shift in favor of a more comprehensive and non-dichotomous approach in the assessment of causal relationships may have a major impact on human health risk assessment. It is interesting to see, however, that authoritative opinions by the Supreme Court of the United States and European regulatory agencies have somehow anticipated this tide of criticism of statistical significance testing, thus providing additional support to its demise. Current methodological evidence further warrants abandoning this approach in both the biomedical and public law contexts, in favor of a more comprehensive and flexible method of assessing the effects of toxicological exposure on human and environmental health.

Updating the European Union's regulation on classification, labelling and packaging of substances and mixtures (CLP): A key opportunity for consumers, workers and stakeholders with interests in the legislation and toxicology of hazardous chemicals.

Recent advancements in toxicology and the European Union's Green Deal, with its Chemicals Strategy for Sustainability, have paved the way for major changes in EU legislation on the control of environmental chemicals for a cleaner and safer environment. Another substantial legislative advancement underway is the update of the "Regulation on Classification, Labelling and Packaging of Substances and Mixtures (CLP)," an ambitious piece of EU legislation with exceptional scientific toxicological background in identifying a hazard, aiming at better protecting its citizens and the environment from the risk of chemical substances and products, the occupational settings included. Update of CLP legislation additionally aims at facilitating the free exchange of chemicals in the European Internal Market, provided that proper labelling and packaging processes are implemented. Participation in the ongoing online public consultation on these issues, ending on November 15, 2021, is of key relevance to ensure a transparent and effective definition of such an important piece of legislation, fully compliant with current EU priorities in terms of human and environmental protection and animal welfare.

Portuguese Advance Directives-a twist against futility? A cross sectional study

ABSTRACT BACKGROUND: Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility. OBJECTIVES: To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions. DESIGN AND SETTING: This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool. METHODS: Sixty palliative patients and 60 caregivers (n = 120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments. RESULTS: In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts. CONCLUSION: The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase "Health Care to Receive / Not to Receive" with the sentence "Health Care to Accept / Refuse" so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05090072 URL: https://clinicaltrials.gov/ct2/show/NCT05090072.

Corrective Justice as A Principle of Criminal Law: A Prolegomenon.

This article argues that corrective justice is an adequate principle of criminalization. On my interpretation, corrective justice holds that, in order for an action to count as a crime, there needs to be a plausible normative story about an offender having violated the interests of a victim in a way that disturbs their relationship as equal persons and a subsequent story about responding to crime in a way that corrects this disturbance. More specifically, I claim that corrective justice is concerned with the protection of interests that persons have in owning private goods throughout standard interactions with other persons. The argument proceeds in three steps. First, I specify the subject-matter that principles of criminal law need to ground and provide an outline of the idea of corrective justice. Second, I show that corrective justice can account for the main cases of crime and the salient modes of criminal responsibility. I also argue that corrective justice can make sense of two prima facie recalcitrant types of cases (rape and inchoate offenses). Third, and finally, I address two objections to my corrective justice theory of criminal law. The first concerns the implications corrective justice has for locating criminal law along the private/public law divide. The second objection raises the putatively problematic consequences corrective justice has for understanding the separation between criminal and civil law.

Derecho Disciplinario en Colombia, desde la imposición de Sanciones ¿la pérdida de su vocación preventiva? / Disciplinary law in Colombia from the imposition of sanctions, is it the loss of its preventive vocation?

Resumen El aumento progresivo de las sanciones disciplinarias no es un hecho aislado o ajeno a las dinámicas sociales y políticas de Colombia, podemos decir, que tanto el desarrollo normativo en términos de creación de leyes así como las diferentes posturas jurisprudenciales respecto al tema influyen en la tendencia de crecimiento; también lo hacen las condiciones sociales y los eventos coyunturales que involucran responsabilidad de funcionarios del Estado y, específicamente, en el aumento de funcionarios públicos, se puede ver la relación entre la concentración de funcionarios en un territorio y las sanciones disciplinarias que se imponen en este.

Abstract The progressive increase in disciplinary sanctions is not an isolated or unrelated fact to the social and political dynamics of Colombia. It can be said that both regulatory development in terms of the creation of laws, as well as the different jurisprudential postures on the issue influence the growth trend, so do social conditions and contemporary events, which involve responsibility for State officials. Moreover, specifically, in the increase of public officials, the relationship between the concentration of civil servants in a territory and the disciplinary sanctions, which are imposed in it, can be appreciated.

Kidneys for transplantation.

A profound kidney shortage compromises the effective care of renal failure patients in the United States and other nations. This article discusses the need for kidneys, the procurement of live donor and cadaver organs, and strategies to increase organ donation. It suggests that the kidney shortage can be minimized and perhaps eliminated through the use of living related donors whenever appropriate, and through more efficient procurement of volunteered cadaver kidneys. Two other strategies to increase the supply of kidneys-the sale of organs and "contracting out" laws-are rejected. The first is unacceptable in the Western world. The second is fraught with constitutional and ethical problems, and may not lead to more kidney procurement.