[Controversies between mental health and disability standards in Mexico]

There are controversies between the practice of psychiatry, current international standards and mental disorders or conditions with disabilities, framed in social care models. The objective of this work is to provide evidence and analyze the main gaps in mental health such as: the invisibility of some people with disabilities for the design of policies, legislation, or public programs; the predominance of the medical model, in which the substitution of decision-making in informed consent prevails, which violates the rights of legal personality, equality, freedom, security and respect for personal integrity, among others. This analysis highlights the importance of: a) integrating the legal provisions on health and disability to international standards, and complying with the Human Rights framework of the Political Constitution of the United States of Mexico, especially the pro personae principle and to the conforming interpretation clause; b) reform the General Health Law in matters of mental health and general health, in order to change the paradigm of asylum care to move towards that of community care with a focus on primary health care, adjacent to the services of the National System of Health; c) prohibit the institutionalization of people with mental disorders, as well as coercive measures as containment measures, and instead train and encourage verbal de-escalation techniques.

'THIS IS NO COUNTRY FOR OLD (WO)MEN'? AN EXAMINATION OF THE APPROACH TAKEN TO CARE HOME RESIDENTS DURING THE COVID-19 PANDEMIC

This article discusses the human rights of residents in care homes in England who were affected by restrictions that were imposed during the first months of the COVID-19 pandemic in order to safeguard health and life at a time of public health emergency. It focuses on the potentially adversarial relationship between the need to protect the health of these residents and the possible adverse interferences with their human rights in the initial phase of the pandemic. The scope and application of these rights to the healthcare context is not straightforward due to the exigencies of the pandemic. Consideration is given to whether their rights, as protected by the European Convention on Human Rights (ECHR) and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) are vindicated or breached by the actions taken in the context of the COVID-19 pandemic. The article questions whether the restrictions that were applied were justified, given the limitations that exist within some ECHR Articles. It deliberates upon what can be done to ensure that relevant bodies and care homes, themselves, are better enabled to respond to a public health emergency in an individualistic, rights-based manner, based upon both principlism and pragmatism.

Thinking like a Lawyer-Human Rights and Their Association with the Plastic Surgeon of Today

Plastic surgeons are trained to perform a wide repertoire of surgeries-ranging from standard local procedures to highly specialized operations. Therefore, plastic surgeons treat a plethora of clinical presentations and address multiple patient needs. Their daily workflow is increasingly entwined with legal topics. The concrete legal interpretation falls within the remit of legal experts. However, by understanding the legal basics of selected surgical procedures, plastic surgeons may generate synergies in patient care and clinical practice. The legal situation is to be elucidated based on the German Basic Law (GBL) and the European Convention on Human Rights (ECHR). LEVEL OF EVIDENCE V: "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

The United Nations convention on the rights of persons with disabilities, neuroscience, and criminal legal capacity

The United Nations Convention on the Rights of Persons with Disabilities requires states parties to 'recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life.' This mandate has sparked debate about the interpretation of legal capacity, including within the criminal context as applied to the retrogressively named 'insanity defense.' Yet, under-examined are two questions: First, what defenses should defendants with psychosocial disabilities be able to invoke during criminal prosecutions? Second, what kind of evidence is consistent with, on the one hand, determining a defendant's decision-making capacity to establish culpability and, on the other hand, the right to equal recognition before the law? Developments in neuroscience offer a unique prism to grapple with these issues. We argue that neuroscientific evidence of impaired decision-making, insofar as it presents valid and interpretable diagnostic information, can be a useful tool for influencing judicial decision-making and outcomes in criminal court. In doing so, we oppose the argument espoused by significant members of the global disability rights community that bioscientific evidence of psychosocial disability should be inadmissible to negate criminal responsibility. Such a position risks more defendants being punished harshly, sentenced to death, and placed in solitary confinement.

More Pain, More Gain! The Delivery of COVID-19 Vaccines and the Pharmaceutical Industry's Role in Widening the Access Gap

BACKGROUND

An effective response to the coronavirus disease 2019 (COVID-19) pandemic entails a comprehensive strategy that ensures equitable access to all COVID-19-fighting technologies. To achieve this goal, the international community has acknowledged immunization as a public good. However, a trend of grossly unequal dose distribution emerged, owing, among other factors, to pharmaceutical companies' profit-driven actions, jeopardizing the mechanisms built to increase vaccine access. The contradiction between public health interests and corporate discretion in determining vaccine dose distribution poses critical concerns about the health risks associated with lengthening the duration of the pandemic and the eventual liability of companies for violations of human rights.

METHODS

To evaluate the risks posed to the COVID-19 immunization program, data on vaccine allocation and delivery, vaccine dose application, immunized populations, and the volume of Advanced Purchase Agreements (APAs) between countries and pharmaceutical companies were compiled and assessed. A descriptive analysis was then conducted to analyze the role of pharmaceutical companies in providing equitable access to COVID-19 vaccines.

RESULTS

When the data is broken down by income (as of June 2021), it shows that high-income countries (HICs) have already crossed the COVID-19 Vaccine Global Access (COVAX) 20% immunization threshold. However, countries of all other income levels have yet to achieve this mark for fully vaccinated people. Upper-middle-income countries (UMICs) have approximately 3%, low- and middle-income countries (LMICs) have approximately 2% and low-income countries (LICs) have less than 0.1% of fully vaccinated people per hundred. The supply shortage is expected to last until the second half of 2021.

CONCLUSION

As a result of the COVAX failure, a health gap emerged with countries living in a pre-immunization period for an extended time. The existing conflict between the international response to tackle COVID-19 and corporate profit-driven behavior contributed to prolonging pandemic, especially in Africa. Accordingly, there is a need to approve an international treaty that targets the activities of all actors, including the pharmaceutical companies, in protecting human rights and the right to health realms.

Developmental Perspectives on Social Inequalities and Human Rights

Social inequalities and human rights are inevitably linked to children's and adolescents' healthy development. Children who experience structural and interpersonal inequalities in access to resources and opportunities based on their gender, race, ethnicity, or other group categories are denied the right to fair treatment. We assert that investigating the psychological perspectives that children hold regarding inequalities and human rights is necessary for creating fair and just societies. We take a constructivist approach to this topic which seeks to understand how individuals interpret and evaluate observed and experienced inequalities. Even young children think about these issues. Yet, throughout development, individuals must often weigh multiple, potentially conflicting considerations when interpreting, evaluating, and responding to social inequalities and rights violations. In these complex contexts, children and adolescents are neither fully "moral" nor fully "prejudiced." Rather, critical questions for research in this area concern when, why, and for whom young people reject inequalities and support rights, and, by contrast, when, why, and for whom they accept that inequalities and rights violations should be allowed to persist. This paper provides a brief overview of how different conceptions of social inequalities and rights are intrinsically linked together.

Thinking Politically About UN Political Declarations: A Recipe for Healthier Commitments-Free of Commercial Interests Comment on "Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases"

As evidence mounts that corporate actor engagement in United Nations (UN) policy-making processes leads to weaker and shallower public health commitments, greater attention is being paid to how to minimise undue interference and manage conflicts of interest (CoI). While we welcome efforts to develop normative guidance on managing such conflicts, we argue that there is the need to go further. In particular, we propose that an index be developed that would assess the health impacts of individual corporate actors, and those actors who fail to achieve a set benchmark would not have engagement privileges. We further propose the establishment of an independent panel of experts to advise on corporate actor engagement as well as on ambiguous and potentially health-harming commitments in text under negotiation in the UN. Recognising that the implementation of such measures will be contested, we recommend a number of practical steps to make their implementation more politically palatable.

Did U.S. Governments Violate Individual Human Rights? A Thomistic Response to COVID-19 Government Mandates

In response to the COVID-19 pandemic, some Americans have claimed that U.S. governments have superseded their jurisdiction and violated individuals' human rights in the use of government mandates. Many citizens and politicians have also claimed that governments are utilizing the pandemic as a smoke screen to take individual rights away from citizens to gain further power. In light of such claims, I provide a Thomistic response to argue that state and local political authorities' use of public health mandates were other-regarding in seeking to protect the common good in an unprecedented health crisis. Further, I argue that the characterization of individual rights atomized from community has led to an improper understanding of political authorities, individual rights, and our duties to our communities. Rejecting the reductive, skeptical, individualistic, and atomistic views that many Americans have engendered, I provide a Thomistic political orientation that more adequately helps us think about political authorities' and citizens' responsibilities within our political communities.

Criminal and financial penalties for clinicians in the ACT Mental Health Act weigh more heavily on senior doctors

OBJECTIVE

We sought to assess the attitudes of ACT public psychiatry doctors towards the financial and criminal penalties in the ACT Mental Health Act 2015.

METHOD

Baseline attitude was surveyed with an 11-item 5-point Likert scale. Education was then provided about the offences outlined in the Act and the associated penalties. The same initial survey was then repeated. Primary outcomes were changes in attitude pre- and post- information, and secondarily data was explored for differences related to gender and seniority.

RESULTS

Forty-nine percent of 89 eligible public mental health system doctors responded. The majority of the survey respondents were female (59%). Provision of information resulted in a significant improvement in understanding of liabilities (2.80 (SD 1.14) versus 3.58 (SD 0.93), t(39) = 4.06, p < 0.001). Gender had no significant impact on scores. Senior staff were less legally secure and less satisfied with the Mental Health Act pre-information being provided. With regards to notification penalties, with education, junior staff became more secure and seniors less so.

CONCLUSIONS

Information provision improves understanding of the penalties under the Mental Health Act 2015. Having a senior role predicts lower satisfaction with the penalties in the Act.

IMF's Surcharges as a Threat to the Right to Development

This article focuses on the implications of the IMF's surcharges policies, jointly with its de facto preferred creditor status, on the right to sustainable development of sovereign borrowers. The article argues that, while surcharges are not effective in limiting access to IMF credit, they inequitably distribute the IMF's operating costs, are disproportionate, pro-cyclical, very costly for developing countries, and non-transparent. Furthermore, if surcharges are theoretically a way to protect the IMF from potential risks of default, the article questions the IMF's de facto preferred creditor status, as it precisely denies the possibility of granting debt relief in case of insolvency, ultimately affecting the right to development of -mainly- middle-income borrowing countries.

COVID-19 Law Lab: Building Strong Legal Evidence

The COVID-19 Law Lab platform enables quantitative representation of epidemic law and policies in a given country for multiple years, enabling governments and researchers to compare countries, and learn about the impacts and drivers of policy choices. The Law Lab initiative is designed to address the urgent need for quality legal information to support the study of how law and policy can be used to effectively manage this, and future, pandemic(s).

Transcending the Gender Binary under International Law: Advancing Health-Related Human Rights for Trans* Populations

Despite a recent wave in global recognition of the rights of transgender and gender-diverse populations, referred to in this text by the umbrella label of trans*, international law continues to presume a cisgender binary definition of gender - dismissing the lived realities of trans* individuals throughout the world. This gap in international legal recognition and protection has fundamental implications for health, where trans* persons have been and continue to be subjected to widespread discrimination in health care, longstanding neglect of health needs, and significant violations of bodily autonomy.

Regulating Risk and Autonomy in Assisted Suicide: Conway V Secretary of State for Justice

Noel Conway appealed against the dismissal of his claim in the High Court, that section 2(1) Suicide Act 1961 is incompatible with his Article 8(1) ECHR right to respect for private and family life. Mr Conway's appeal concerned three main issues: first, the correct way the court should respond to Parliament's decision not to amend section 2(1) Suicide Act; secondly, the way the Divisional Court addressed Mr Conway's alternative scheme; and thirdly, the weight to be placed upon personal autonomy. The Court of Appeal held that Parliament is better placed for determining the purported legal rights relating to assisted suicide. The court also concludes that there is evidence for the potential of indirect coercion or undue influence if assisted suicide is permitted. The comment draws out the court's basic presumption in analysing the efficacy of Mr Conway's alternative scheme to protect the weak and vulnerable. The comment also argues the level of acceptable risk used by the court in assessing Mr Conway's scheme-a 100% success rate-is overly-cautious and inconsistent. Finally, the comment goes on to show that courts still have problems, in end-of-life cases, in understanding how ethical principles operate in determining true propositions of law.

Mental health and human rights: Challenges for health services and communities

The care of people with mental health problems requires health system and service reforms to build up proper mental health care. The challenges of the present moment continue to be immense. The viral pandemic that we are experiencing has exposed the fragility of our health and social services and certified the inequality and precariousness of the living conditions of many people. The collection of articles published in the journal Salud Colectiva as part of the open call for papers "Mental health and human rights: challenges for health services and communities," includes articles from Spain, Brazil, Mexico, and Chile. These papers present conceptual experiences and reflections on community action plans and programs, contributing toward better knowledge and development of mental health in the region.

[Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain]

Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.

[Public policies for people who use drugs: Strategies for the elimination of stigma and the promotion of human rights]

This paper aims to provide theoretically informed practical proposals for the improvement of current drug policies, which are based on a biological model of disease and the criminalization of people who use drugs. First, we present alternatives to a biologically-oriented scientific conception centered around neuroscientific postulates, which support the idea that the etiology of addiction materializes in the brain, in favor of models based on the social sciences where context plays a relevant role in the description and management approaches regarding different uses of psychoactive substances. Second, epistemological models and proposals are offered from a practical perspective to sustain or implement policies and programs in accordance with a more sustainable approach based on the elimination of stigma and the promotion of political participation of people who use drugs. In short, drug policies based on human rights.

Ethical principles, opportunities and constraints in clinical proteomics

Recent advances in MS-based proteomics have vastly increased the quality and scope of biological information that can be derived from human samples. These advances have rendered current workflows increasingly applicable in biomedical and clinical contexts. As proteomics is poised to take an important role in the clinic, associated ethical responsibilities increase in tandem with the impact on the health, privacy, and well-being of individuals. Here we conducted and report a systematic literature review of ethical issues in clinical proteomics. We add our perspectives from a background of bioethics, the results of our accompanying paper extracting individual-sensitive results from patient samples, and the literature addressing similar issues in genomics. The spectrum of potential issues ranges from patient re-identification to incidental findings of clinical significance. The latter can be divided into actionable and unactionable findings. Some of these have the potential to be employed in discriminatory or privacy-infringing ways. However, incidental findings may also have great positive potential. A plasma proteome profile, for instance, could inform on the general health or disease status of an individual regardless of the narrow diagnostic question that prompted it. We suggest that early discussion of ethical issues in clinical proteomics is important to ensure that eventual regulations reflect the considered judgment of the community as well as to anticipate opportunities and problems that may arise as the technology matures further.

Pharmaceutical Companies, Human Rights, and the Alien Tort Statute

On January 3, 2019, U.S. District Judge Theodore D. Chuang of the U.S. District Court of the District of Maryland took a crucial first step in redressing one of the worst human subjects research ethics violations in U.S. history.

Strengthening Human Rights in Global Health Law: Lessons from the COVID-19 Response

While human rights law has evolved to provide guidance to governments in realizing human rights in public health emergencies, the COVID-19 pandemic has challenged the foundations of human rights in global health governance. Public health responses to the pandemic have undermined international human rights obligations to realize (1) the rights to health and life, (2) human rights that underlie public health, and (3) international assistance and cooperation. As governments prepare for revisions of global health law, new opportunities are presented to harmonize global health law and human rights law, strengthening rights-based governance to respond to future threats.

Designing for and with People with Dementia using a Human Rights-Based Approach

User-centered design is typically framed around meeting the preferences and needs of populations involved in the design process. However, when designing technology for people with disabilities, in particular dementia, there is also a moral imperative to ensure that human rights of this segment of the population are consciously integrated into the process and respectfully included in the product. We introduce a human rights-based user-centered design process which is informed by the United Nations Convention on the Rights of Persons with Disabilities (CRPD). We conducted two editions of a three-day-long design workshop during which undergraduate students and dementia advocates came together to design technology for people with dementia. This case study demonstrates our novel approach to user-centered design that centers human rights through different stages of the workshop and actively involves people with dementia in the design process.

["No one seems ready to hear what I've seen:" Mental health care for refugees and asylum seekers in Chile]

This article analyzes the results of a descriptive, qualitative study carried out in 2018 on the mental healthcare needs of Latin American refugees and asylum seekers in Chile, through the perspectives of refugees and asylum applicants (n=8), healthcare professionals responsible for delivery of care (n=4), and members of civil society organisations involved in this area (n=2). Our findings indicate that despite Chile's commitment to international treaties in this regard, little has been achieved in safeguarding the right to access to mental health care, understood as part of the universal right to health care access. This article documents barriers to mental health care access for migrants applying for asylum and refugee status. Post-migration stress factors may also increase the risk of emotional disorders within this group of people. Mental healthcare providers and teams are often not equipped with the tools to deal with the psychological consequences arising from the situations of violence and persecution associated with forced migration. Our study discusses the need to strengthen the link between mental health care - as a fundamental human right - and the right to international protection.

COVID-19 and the Rise of Participatory SIGINT: An Examination of the Rise in Government Surveillance Through Mobile Applications

The COVID-19 pandemic has triggered a significant growth in government surveillance techniques globally, primarily through the use of cell phone applications. However, although these applications can have actionable effects on public health efforts to control pandemics, the participatory or voluntary nature of these measures is obscuring the relationship between health information and traditional government surveillance techniques, potentially preventing effective oversight. Public health measures have traditionally been resistant to the integration of government-led intelligence techniques, such as signals intelligence (SIGINT), because of ethical and legal issues arising from the nature of surveillance techniques.We explore this rise of participatory SIGINT and its nature as an extension of biosurveillance through 3 drivers: the rise of surveillance capitalism, the exploitation of a public health crisis to obscure state of exception politics with a moral imperative, and the historically enduring nature of emergency-implemented surveillance measures.We conclude that although mobile applications may indeed be useful in containing pandemics, they should be subject to similar oversight and regulation as other government intelligence collection techniques.