What to Do in the Next Pandemic Outbreak: Natural Herd Immunity Versus Lockdown (Lessons Learned from COVID-19).

The purpose of this article is to analyse non-pharmaceutical approaches to control pandemics. Currently vaccines are our best hope to control the COVID-19 pandemic, but before the appearance of the first vaccines the available possibilities were much more limited. While most people worldwide were confined to their homes to slow the spread of the new coronavirus, some countries (most notably the United Kingdom) advocated infecting the majority of the community, aiming to achieve what has been called "herd immunity". This article focuses on two non-therapeutic strategies for dealing with deadly viruses and points out their respective problems: natural herd immunity and quarantines/lockdowns. It analyses these strategies from three perspectives: legal, ethical and social. The article concludes that in the absence of therapeutic alternatives (vaccines), short-term lockdowns are necessary, but long-term lockdowns are legally, ethically, socially and financially impossible to sustain.

A Room with a View (and with a Gene Therapy Drug): Gene Therapy Medicinal Products and Genetic Tourism in Europe.

In contrast to the extreme caution that has been imposed on genetic medical procedures, in European law genetic drugs, or medications, have found a legal loophole that allows flexible (perhaps too flexible) access to these drugs. In Europe, Gene Therapy Medicinal Products are a form of Advanced Therapy Medicinal Products and as such submitted to the marketing authorization procedure. However, there are legal mechanisms in place - such as compassionate use, named patient use, and hospital exception - that allow for their provision to patients without proper approval. This is not, de per se, problematic; the problem arises, though, because such mechanisms are neither properly regulated nor monitored, and their application differs substantially according to the jurisdiction. This disparity and lack of control have given rise to situations of genetic tourism, where patients in desperate need travel to so-called genetic paradises, looking for a miraculous, and extremely expensive cure. The outcome is sometimes tragic, endangering patients' safety and undermining confidence in genetic products.

The Use of Facial Recognition Technology by Law Enforcement in Europe: a Non-Orwellian Draft Proposal.

The European legal framework is not devoid of norms that are directly or indirectly applicable to facial recognition technology for identification purposes within law enforcement. However, these various norms, which have different targets and are from multiple sources, create a kind of legal patchwork that could undermine the lawful use of this technology in criminal investigations. This paper advocates the creation of a specific law on the use of facial recognition technology for identification in law enforcement, based on existing regulations, to specifically address the pressing issues arising in this domain. The ultimate aim is to allow its use under certain conditions and to protect the rights of the people involved, but also to provide law enforcement authorities with the necessary tools to combat serious crimes.

Pigs Don't Fly and You Cannot Expect Absolutely Safe COVID-19 Vaccines (But You Should Expect a Fair Compensation).

This paper focuses on the COVID-19 vaccines authorised for use in the European Union, and explores the mechanisms in place to control vaccine safety and to compensate injured patients, mainly in the context of European law. Based on these considerations, the paper concludes that the refusal by some potential vaccinees to take the vaccine based on safety concerns is ungrounded and an indication of unrealistic expectations, but that in order to build public trust proper compensation mechanisms should be in place.

Can China's 'standard of care' for COVID-19 be replicated in Europe?

The Director-General of the WHO has suggested that China's approach to the COVID-19 crisis could be the standard of care for global epidemics. However, as remarkable as the Chinese strategy might be, it cannot be replicated in other countries and certainly not in Europe. In Europe, there is a distribution of power between the European Union and its member states. In contrast, China's political power is concentrated in the central government. This enables it to take immediate measures that affect the entire country, such as massive quarantines or closing borders. Moreover, the Chinese legal framework includes restrictions on privacy and other human rights that are unknown in Europe. In addition, China has the technological power to easily impose such restrictions. In most European countries, that would be science fiction. These conditions have enabled China to combat epidemics like no other country can. However, the WHO might have been overoptimistic. The Chinese standard of care for treating COVID-19 also raises problematic issues for human rights, and the real consequences of these actions remain to be seen.

An ethical evaluation of the legal status of foetuses and embryos under Chinese law.

Under Chinese law, the juridical status of the embryo and the foetus is unclear, mainly because the existing legislation can be subject to diverse interpretations due to its ambiguous language. Lack of clarity with the law has led to different understandings amongst Chinese legal scholars. However, although there has been no consensus, there has been a clear tendency to deprive embryos and foetuses of legal status or personhood, thereby excluding them from entitlement to fundamental rights, an understanding reinforced by the Confucian view of the beginning of life. It is expected that in the near future the Chinese courts will face issues involving embryos and foetuses more often, such as disputes over in vitro embryos. The lack of legal precedent could result in contradictory resolutions, therefore, the law should clarify the legal status of embryos and foetuses and accord to prenatal life special respect and treatment.

International Access to Public Health Data: An Important Brazilian Legal Precedent.

Accurate, up-to-date data are the bedrock of effective public health responses, including in the context of the suffering caused by COVID-19. Any action to inhibit the compilation of such data has ramifications locally, nationally and internationally, and risks impairing the global capacity to respond to the virus. This article contextualises the decision of the government of President Bolsonaro of Brazil to reduce the accessibility of contemporary data about COVID-19 infections in Brazil within his views about, and responses to, the virus. It identifies the nature of actions taken to suppress such data by the Brazilian Ministry of Health and then scrutinises a decision by De Moraes J of Brazil's High Court in Sustainability Network v The President of the Republic of Brazil (ADPF 690 MC/DF, 8 June 2020), which quashed the attempted suppression of public health data. The article hails the decision as an important public health law precedent.

Wrongful genetic connection: neither blood of my blood, nor flesh of my flesh.

The use of reproductive techniques and the eventual reproductive negligence from the provider of reproductive services gave rise to situations in which the intended parents are deprived of raising a child genetically connected to them. Courts have been dealing with cases of those for years, but have systemically denied claimants (the prospective parents) compensation, failing to recognise as damage the loss of genetic connection. In 2017, for the first time, the Singapore High Court provided compensation for that damage, labelled "loss of genetic affinity" (ACB v Thomson Medical Pte Ltd and Others [2017] SGCA 20). This paper will argue that the damage in question is the loss of genetic connection (wrongful genetic connection) and results from a violation of reproductive rights (and eventually also the right to found a family) because a key element of reproductive rights is to have children with whom we keep a genetic bond and raise them. The paper will explain why the arguments classically argued against such compensation are unfounded and it will argue for a compensation covering both patrimonial and non-patrimonial damages.

Lost in 'Culturation': medical informed consent in China (from a Western perspective).

Although Chinese law imposes informed consent for medical treatments, the Chinese understanding of this requirement is very different from the European one, mostly due to the influence of Confucianism. Chinese doctors and relatives are primarily interested in protecting the patient, even from the truth; thus, patients are commonly uninformed of their medical conditions, often at the family's request. The family plays an important role in health care decisions, even substituting their decisions for the patient's. Accordingly, instead of personal informed consent, what actually exists is 'family informed consent'. From a Western perspective, these features of Chinese law and Chinese culture might seem strange, contradicting our understanding of doctor-patient relationship and even the very essence of self-determination and fundamental rights. However, we cannot forget the huge influence of cultural factors in these domains, and that 'Western' informed consent is grounded on the individualistic nature of Western culture. This article will underline the differences between the Western and the Chinese perspectives, clarifying how each of them must be understood in its own cultural environment. But, while still respecting Chinese particularities, this paper advocates that China adopt patient individual informed consent because this is the only solution compatible with human dignity and human rights.

Doctor's Criminal Liability and Medically Assisted Death - The Portuguese Case.

Recently, the Portuguese Parliament discussed four proposals aimed at allowing some forms of medically assisted death. However, all of them were rejected by the majority. Therefore, doctors who in some way accelerate a patient's death risk being convicted of the crime of homicide. Portuguese law provides some legal mechanisms that can exempt a doctor from criminal liability, such as causes excluding the conduct's wrongfulness, and causes excluding the doctor's culpability. Other elements to take into consideration are a proper interpretation of homicide crimes, thereby excluding conducts without the intent to kill; the relevance of patient consent; and the rejection of medical futility. This article explains how a doctor may not be held criminally accountable for medically assisted death, even in restrictive jurisdictions such as the Portuguese one.

CRISPR-Cas9 and the Promise of a Better Future.

Due to its simplicity, low cost and accuracy, CRISPR-Cas9 has become a promising new technique in the field of gene editing. However, despite its virtues, it is not yet immune to scientific hazards and ethical legal concerns. These concerns have been used to justify opposition to genetic manipulation, and have led to some regulations to ban or impose a moratorium based on the precautionary principle. In Europe, regulation mostly comes from the European Union and the Council of Europe, both very cautious towards gene editing. In this article, two arguments on the future legal framework of CRISPR-Cas9 are made. The first is that continued research will contribute to more scientific accuracy; thus, the precautionary principle should promote regulated research to achieve this aim. The second is that most of the legal and ethical concerns surrounding CRISPR-Cas9 are based on unfounded prejudice emanating from a mystical understanding of the human genome.

Defensive Medicine and the Imposition of a More Demanding Standard of Care.

"Defensive medicine" refers to the practice of medicine guided by the intention to avoid litigation, either by excluding scenarios with potential risks (negative defensive medicine) or by providing additional health care (positive defensive medicine). Positive defensive medicine is the topic of this article.Despite the criticism surrounding it, positive defensive medicine is increasing because doctors feel that they will be better protected from litigation if they provide more medical care. Courts, patients, and the community in general never seem to have enough medical care and are even willing to accept some negative outcomes if they feel that the doctor is doing a lot.There are, however, several negative consequences engendered by positive defensive medicine. This article focuses on a particularly pernicious one: the consolidation of an extremely demanding standard of care. If a significant number of doctors starts acting as imposed by defensive medicine, the rest will feel pressured to follow that behavior. Customary conduct will prevail over reasonable conduct.This article demonstrates that this new standard of care leads to bad medicine and eventually to medical malpractice, because it postpones necessary treatments, exposes patients to unnecessary risks, and results in ineffective medical care.

Macao Report: Informed Consent in a Multilingual and Multicultural Region, a Bioethical Challenge.

Complying with the requirements of informed consent for medical procedures can sometimes be problematic, even when the hospitals are located in countries that are uniform in their language and cultural values. However, when hospitals are located in countries with diverse linguistic and ethnic communities, it becomes particularly challenging. This article examines how Macao, with four predominant languages-Mandarin, Portuguese, Cantonese and English-and two very strong cultures, Western and Chinese, strives to meet the challenges of informed consent. The situation is made even more complicated by a healthcare delivery in Macao that is mostly guided by Chinese ethical and cultural perspectives, whereas its law is inspired by the Western model.

Legal aspects of post-mortem reproduction: a comparative perspective of French, Brazilian and Portuguese legal systems.

Death arrives always too soon, and most often unexpectedly, destroying our plans and the plans of the ones who love us. Medically assisted reproduction offers nowadays a technique that makes possible to have children from someone that recently passed away. Post mortem reproduction is not the satisfaction of a mere whim, but the continuity of strong love affections, and frequently provides some kind of fulfillment to the common aspiration of the couple in constituting a family. All around the world courts and law makers are profoundly divided in the legitimacy of this practice. The well being of the child to be and the respect for the dead person seem to be the strongest arguments against. But, as this study will show, none of them resist to a more careful scrutiny. Therefore, not only post mortem embryo transfer should be allowed, but post mortem insemination and fertilization should also be permitted.

From Public Eugenics to Private Eugenics: What Does the Future Hold?

Traditional public eugenics, which was ordered by the State, has been replaced by a kind of private eugenics conducted by parents using reproductive techniques, genetic testing and, eventually in the future, genetic engineering. While traditional eugenics strived to improve the species, the new model aims to satisfy parents' reproductive aspirations. The association between public and private eugenics is an ongoing issue, mostly due to its relation to nazi eugenics. This paper will state that both are eugenics; however, with different characteristics, and thus worthy of different legal and ethical assessments. The paper will contextualize private eugenics in the framework of reproductive rights (legal and ethical perspective) and in the development of genetics and reproductive techniques (scientific perspective). Finally, it will analyze some of the legal consequences of a broader acceptance of private eugenics, namely in terms of liability and tort law. Throughout the paper, the different legal solutions in place in Europe will contextualize its considerations.

The new Japanese regulation on human/non-human chimeras: should we worry?

In March 2019 Japan modified its norms regarding research with human/non-human chimeras. The amended rules allow the creation of chimeras with human brain cells, and the subsequent transfer of the resulting creature to an uterus, where it can develop for more than 14 days, eventually until term. At this moment, the real consequences of this new regulation in actual research are still uncertain. However, many concerning issues have already been identified. This paper will start by addressing traditional topics involving this practice: the use of non-human animals in research, the use of human stem cells in scientific experimentation and the creation of human/non-human chimeras. Subsequently, it will analyze the new concerning issues brought on by the 2019 amendment: the use of human brain cells, the transfer of the chimera to an uterus and its development for more than 14 days, and the possibility of using animals which present close similarities with humans. In the end, the paper will conclude that in spite of the legal and ethical hazards that this new regulation might carry, it should be allowed under strict scrutiny.

Access to Health Care by Migrants with Precarious Status During a Health Crisis: Some Insights from Portugal.

In March 2020, the Portuguese Government issued a remarkable regulation by which irregular migrants who had previously started the regularization procedure were temporarily regularized and thus allowed full access to all social benefits, including healthcare. The Portuguese constitutional and legal framework is particularly generous regarding the right to healthcare to irregular migrants. Nevertheless, until now, several practical barriers prevented full access to healthcare services provided by the national health service, even in situations in which it was legally granted. This decision is not only remarkable in light of the fulfilling of migrants' rights to health, as imposed by international commitments assumed by, but also in view of the fight against COVID-19. The decision is grounded both on human rights and in public health reasons. The paper is divided in two main parts. In the first one, it analyzes national State obligations with regard to healthcare provision to migrants in irregular situation. In the second part, it analyzes the Portuguese solution, using this case study to discuss the possible mechanisms to comply with such obligations.

International Efforts and Next Steps to Advance COVID-19 Vaccines Research and Production in Low- and Middle-Income Countries.

Equitable and efficient distribution of COVID-19 vaccines continues to be a key issue in global health, and a targeted approach is needed to meet the World Health Organization's world vaccination targets. Although some low- and middle-income countries (LMICs) are developing their own vaccines to address the distribution problem, legal and technical challenges have had a negative impact on productivity. This article explores relevant international legal instruments that can enable faster research and development of COVID-19 vaccines in LMICs, focusing on the role of biosafety standards, biological materials transfer, and key knowledge sharing. Our analysis has established that the potential of existing global health legal instruments has yet to be realized in order to close the productivity gap in LMICs and strengthen their vaccine manufacturing capacity. Additionally, mutual recognition of vaccine efficacy has become a new challenge for achieving global vaccination targets. We argue that the World Health Organization should continue its leading position by developing a more practical and targeted framework to help LMICs overcome challenges arising from technology transfer, knowledge sharing, and politics.

COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control.

As the world struggles with the new COVID-19 pandemic, contact tracing apps of various types have been adopted in many jurisdictions for combating the spread of the SARS-CoV-2 virus. However, even if they are successful in containing the virus within national borders, these apps are becoming ineffective as international travel is gradually resumed. The problem rests in the plurality of apps and their inability to operate in a synchronized manner, as well as the absence of an international entity with the power to coordinate and analyze the information collected by the disparate apps. The risk of creating a useless Tower of Babel of COVID-19 contact tracing apps is very real, endangering global health. This paper analyzes legal barriers for realizing the interoperability of contact tracing apps and emphasizes the need for developing coordinated solutions to promote safe international travel and global pandemic control.

Correction: COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control.

[This corrects the article DOI: 10.2196/23194.].