Laws governing access to sexual health services and information: contents, protections, and restrictions

Access to sexual health services and information is critical to achieving the highest attainable standard of sexual health, and enabling legal environments are key to advancing progress in this area. In determining overall alignment with human rights standards to respect, protect, and fulfil sexual health-related rights without discrimination, there are many aspects of laws, including their specificity and content, which impact which sexual health services and information are availed, which are restricted, and for whom. To understand the nature of existing legal provisions surrounding access to sexual health services and information, we analysed the content of 40 laws in English, French, and Spanish from 18 countries for the specific sexual health services and information to which access is ensured or prohibited, and the non-discrimination provisions within these laws. Overall, there was wide variation across countries in the types of laws covering these services and the types and number of services and information ensured. Some countries covered different services through multiple laws, and most of the laws dedicated specifically to sexual health addressed only a narrow aspect of sexual health and covered a small range of services. The protected characteristics in non-discrimination provisions and the specificity of these provisions with regard to sexual health services also varied. Findings may inform national legal and policy dialogues around sexual health to identify opportunities for positive change, as well as to guide further investigation to understand the relationship between such legal provisions, the implementation of these laws within countries, and relevant sexual health outcomes.

Revive and Refuse: Capacity, Autonomy, and Refusal of Care After Opioid Overdose

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation.

Angiotensin Receptor Blocker-Related Sprue-like Enteropathy: Review of Food and Drug Administration Adverse Event Reporting System

BACKGROUND

Sprue-like enteropathy (SE) related to olmesartan use was first reported in 2012. In 2017, the manufacturer of Benicar paid $300 million for 2300 claims for olmesartan-related SE.

OBJECTIVE

A study in 2019 suggested that SE was related to olmesartan and with the possibility of angiotensin receptor blocker (ARB) class effect. To further characterize this condition, our group examined reports of ARB-related SE to Food and Drug Administration Adverse Event Reporting System (FAERS).

METHODS

All reports of ARB-related SE from January 2017 to December 2021 were downloaded from the FAERS database. Gastrointestinal adverse events including SE were reviewed. Reporter categories included physicians, pharmacists, other health care professionals, consumers, and attorneys.

RESULTS

A total of 106 590 reports of ARB-related adverse effects were analyzed. Sprue-like enteropathy was identified in 4337 cases (4.1% of total reports). Of these, 4240 cases (98.0%) of ARB-related SE were reported in patients using products with olmesartan, and 97 cases of SE were reported for all other ARBs (eprosartan, losartan, telmisartan, irbesartan, valsartan, and candesartan). Reports of olmesartan-related SE increased rapidly in 2017, continued at a high rate in 2018 and 2019, and essentially stopped in 2020 and 2021.

CONCLUSIONS AND RELEVANCE

Reports to FAERS for ARB-related SE are mostly related to olmesartan. There was a steep decline in reports of olmesartan-related SE following the lawsuit with potential of lawyer interference. There are reports of SE related to ARBs other than olmesartan, with increased physician awareness and the potential to discover a class effect with future studies.

Law, Blood, and Custody: Sexual Minority Mothers and Heteronormativity

This article analyzes how couples made up of two mothers redefine their roles when they break up as well as how legal professionals frame the custodial arrangements of these former same-sex couples. To do so, we focus on the case of Quebec, Canada, where parentage equality between mothers was attained as early as in 2002. We rely on individual semi-structured interviews with mothers' (N = 17) and legal professionals' accounts (N = 23) as well as on court records regarding physical custody arrangements. We find that the legal recognition of both mothers favors coparenting practices, and especially joint physical custody. However, the heteronormative frame of custody arrangements lingers. Sexual minority mothers struggle with the valorization of birth motherhood and with the standard of gendered parental complementarity. Indeed, professionals can still fall back on heteronormative norms, notably by assigning to non-birth mothers a "paternal" role. In the end, the inexperience of many professionals on LGBTQ+ issues, the embeddedness of heteronormativity in day-to-day relations, as well as the permanence of heteronormative legal categories and professional practices are all factors that set these families apart.

Judicial hierarchy and discursive influence

We apply a dynamic influence model to the opinions of the US federal courts to examine the role of the US Supreme Court in influencing the direction of legal discourse in the federal courts. We propose two mechanisms for how the Court affects innovation in legal language: a selection mechanism where the Court's influence primarily derives from its discretionary jurisdiction, and an authorship mechanism in which the Court's influence derives directly from its own innovations. To test these alternative hypotheses, we develop a novel influence measure based on a dynamic topic model that separates the Court's own language innovations from those of the lower courts. Applying this measure to the US federal courts, we find that the Supreme Court primarily exercises influence through the selection mechanism, with modest additional influence attributable to the authorship mechanism. This article is part of the theme issue 'A complexity science approach to law and governance'.

Coalitions in international litigation: a network perspective

We apply network science principles to analyse the coalitions formed by European Union nations and institutions during litigation proceedings at the European Court of Justice. By constructing Friends and Foes networks, we explore their characteristics and dynamics through the application of cluster detection, motif analysis and duplex analysis. Our findings demonstrate that the Friends and Foes networks exhibit disassortative behaviour, highlighting the inclination of nodes to connect with dissimilar nodes. Furthermore, there is a correlation among centrality measures, indicating that member states and institutions with a larger number of connections play a prominent role in bridging the network. An examination of the modularity of the networks reveals that coalitions tend to align along regional and institutional lines, rather than national government divisions. Additionally, an analysis of triadic binary motifs uncovers a greater level of reciprocity within the Foes network compared to the Friends network. This article is part of the theme issue 'A complexity science approach to law and governance'.

A Systematic Review of State Office-Based Buprenorphine Treatment Laws Effective During 2022: Counseling, Dosage, and Visit Frequency Requirements

BACKGROUND

Buprenorphine is among the most effective treatments for opioid use disorder. Even though the federal government recently eliminated the waiver requirement and patient limits applicable to office-based buprenorphine treatment (OBBT), among other settings, some states may still have policies imposing requirements on OBBT providers not required by federal law.

METHODS

We collected statutes and regulations from 50 US states and the District of Columbia (ie, 51 jurisdictions) between August 11 and November 30, 2022 using the Nexis Uni legal database and search terms related to OBBT counseling, dosage, and/or frequency of visits. We then used template analysis, a mixed deductive-inductive qualitative method, to analyze legal content.

RESULTS

Ten jurisdictions (20%) in 2022 had an OBBT counseling, dosage, and/or visit frequency requirement. Four jurisdictions had at least one law in each OBBT policy category examined. One-fifth of jurisdictions have OBBT policies not required under federal law. Five of these jurisdictions are among those with the highest overdose death rates per capita, according to publicly available data from 2021. Some OBBT requirements could potentially limit clinician interest in offering buprenorphine treatment or result in inadequate care (eg, if dosage limitations are too low.).

CONCLUSIONS

Even though a federal waiver is no longer required for OBBT, our results suggests that at least some jurisdictions have other OBBT requirements, such as counseling, dosage, and/or frequency requirements. Given the severity of the ongoing opioid overdose crisis, policymakers should carefully consider the extent to which OBBT requirements are evidence based.

Examining the propensity and nature of criminal risk behaviours in frontotemporal dementia syndromes and Alzheimer's disease

INTRODUCTION

Some people with dementia develop changes in behaviour and cognition that may lead to interactions with police or the legal system. However, large, prospective case-control studies examining these behaviours are lacking.

METHODS

One hundred and forty-four people with dementia and 53 controls completed the Misdemeanours and Transgressions Screener.

RESULTS

Criminal risk behaviours were reported in: 65.6% of behavioural-variant frontotemporal dementia, 46.2% of right-lateralised semantic dementia, and 27.0% of Alzheimer's disease patients. In 19.1% of patients these behaviours led to contact with police or authority figures. Compared to controls, people with dementia showed higher rates of physical assault (p = 0.024), financial/professional recklessness (p = 0.009), and inappropriate behaviours (p  = 0.052).

DISCUSSION

Criminal risk behaviours are common across dementia subtypes and may be one of the first clinical signs of frontotemporal dementia. Further research to understand how to balance risk minimisation with an individual's liberties as well as the inappropriate criminalisation of people with dementia is needed.

Highlights

The Misdemeanours and Transgressions Screener is a new tool to assess criminal risk behaviours.Forty-seven percent of patients with dementia show criminal risk behaviour after dementia onset.Behaviours included verbal abuse, traffic violations, physical assault.New onset of criminal risk behaviours >50 years is a clinical sign for frontotemporal dementia.

The struggle for access - a qualitative document study of how people using wheeled mobility devices experience exclusion and discrimination

PURPOSE

The overall aim of this study was to describe experiences of discrimination due to inaccessibility among people using mobility devices.

MATERIAL AND METHODS

We conducted a thematic qualitative analysis of 88 complaints about wheeled mobility device use, inaccessibility, and discrimination submitted to the Swedish Equality Ombudsman (DO) during 2015 and 2016.

RESULTS

The analysis resulted in three themes: instigating change by invoking laws and regulations and highlighting lack of compliance; demanding to be recognised, understood, and listened to; and struggling for equal access and social participation. Regulations and treaties were invoked as the basis for complaints by people using mobility devices regarding their lack of access to physical environments and impediments to their enjoyment of their full right to participate in and contribute to society. The complaints described feelings of discrimination, the disadvantages and exclusion due to physical inaccessibility, and experiences of being prevented from living one's life as others do.

CONCLUSIONS

Complaints filed by people using mobility devices showed that they were denied access to a wide range of contexts, including offices, theatres, restaurants, schools, and public transportation, though they desired to live an active and social life outside their homes. Filing a complaint was a way to take action, highlight present inaccessibility, and express a hope for change.IMPLICATIONS FOR REHABILITATIONDifficulties experienced by people using wheeled mobility devices can reveal knowledge important for revising existing design and renovation standards for housing and public buildings.Documenting facilitators and barriers in different environments is important for giving voice to the needs of wheeled mobility device users and revealing standards that need to be strongly enforced or revised.People using wheeled mobility devices should be supported in finding solutions in inaccessible environments, both to fulfil their wishes and to enable their participation in society.

ChatGPT: Forensic, legal, and ethical issues

Artificial intelligence (AI) refers to a group of technologies that enable people to perform a variety of activities, including observing, comprehending, analysing and translating data, among other things. Nowadays, practically every school of thought is interested in AI. One such innovation, a chatbot by the name of ChatGPT (Chat Generative Pre-Trained Transformer), launched by OpenAI recently, has taken the internet by storm. It had one million users within 1 week of its launch. The present communication explores the practicability and versatility of the ChatGPT in forensic examinations and scenarios, and also addresses the ethical and legal issues surrounding its usage. The observations suggest that the said technology, in its current form, has limited relevance in the realm of forensic science and the law. Only human critical thinking, expertise, and practical experience can provide the information and competencies needed in the realms of forensics, research, clinical and legal practices. Thus, the ChatGPT should be used with utmost caution in the disciplines of medicine, forensic science and the law, irrespective of its many positive attributes.

The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice.

Discrepancy of the law on disaster emergency in Indonesia: In search of an integrated law

The emergency status is a critical factor in handling disasters in Indonesia, particularly for coronavirus disease 2019 (COVID-19). It provides adequate access for the Government to reduce legal bureaucracy and facilitate expenditure. However, it has faced difficulties in its application as it does not have an explicit reference to existing emergency-related disaster laws. This article investigates this discrepancy in terms of the meaning of emergency status within the legal framework in Indonesia. This study uses the doctrinal method to explore six various laws related to disaster emergencies and analyse their discrepancies that have adversely impacted the management of COVID-19. The article finds that the term 'disaster emergencies' in the Indonesian legal system has different legal interpretations and a lack of standardisation, making their execution difficult.

Contribution

This article significantly highlights the normative issues of determining disaster emergencies and their status in six different disaster-related laws. It provides an alternative approach to mainstream thinking by proposing amendments to the Infectious Disease Outbreak Law as an integrated law to ensure legal certainty, benefit, and fairness for the people in handling potential pandemics in Indonesia in the years to come.

Using digital technologies to diagnose in the home: recommendations from a Delphi panel

Rapid advances in digital technology have expanded the availability of diagnostic tools beyond traditional medical settings. Previously confined to clinical environments, these many diagnostic capabilities are now accessible outside the clinic. This study utilized the Delphi method, a consensus-building approach, to develop recommendations for the development and deployment of these innovative technologies. The study findings present the 29 consensus-based recommendations generated through the Delphi process, providing valuable insights and guidance for stakeholders involved in the implementation and utilization of these novel diagnostic solutions. These recommendations serve as a roadmap for navigating the complexities of integrating digital diagnostics into healthcare practice outside traditional settings like hospitals and clinics.

Factors Associated with Delta-8 THC Retail Availability in Fort Worth, Texas, 2021-2022

Background: Delta-8 THC is a federally unregulated psychoactive cannabis product rising in popularity. However, little is known regarding its retail availability. Method: We assessed Delta-8 THC retail by calling locations with alcohol, tobacco, and/or consumable hemp retail licenses in Fort Worth, Texas, before and after Texas announced ongoing litigation surrounding Delta-8 THC legality. We linked census block area deprivation index (ADI) scores (1-10; 10 = most disadvantaged) to locations. Logistic regression models examined associations between license type, ADI, ADI*license type interaction, and Delta-8 availability at each time. Results: Retail availability was 11% at Time 1 (n = 133/1,223) and 9% at Time 2 (n = 94/1,026). Alcohol (aORTime1 = 0.18, 95%CI = 0.12,0.28; aORTime2 = 0.14, 95%CI = 0.08,0.24), tobacco (aORTime1 = 15.13, 95%CI = 6.78,33.74; aORTime2 = 12.39, 95%CI = 4.97,30.91), and consumable hemp licenses (aORTime1 = 21.85, 95%CI = 7.91,60.39; aORTime2 = 22.93, 95%CI = 6.92,75.98) were associated with Delta-8 THC retail availability; ADI scores were borderline but not statistically significant. The multiplicative interaction at Time 2 indicated locations with both high ADI scores and alcohol retail licenses had higher odds of selling Delta-8 THC. Differential associations between ADI and Delta-8 THC availability were observed based on those with (b = 0.007) or without (b = -0.023) alcohol retail licenses. Conclusions: Both timepoints had similar proportions of Delta-8 THC retailers, indicating that despite the uncertain legal landscape in Texas, interest in Delta-8 did not appear to be declining. Geographic socioeconomic disparities were observed among locations with alcohol retail licenses. Future regulations may include minimum distances from specific locations (e.g., schools), particularly in more disadvantaged areas. Increasing the compliance of Texas Delta-8 THC retailers to have the required hemp license is important for surveillance and product safety.

Avortement au Maroc et virage au drame : femmes et professionnels de santé en parlent ! Une étude transversale mixte à Agadir

RésuméLes avortements à risque constituent une problématique majeure de santé publique, responsable de la mortalité et de la morbidité maternelles et absorbant les ressources des systèmes de santé publique à l'échelle mondiale. Malgré l'ampleur très probable du problème de l'avortement non sécurisé au Maroc, peu de données sont accessibles sur cette question. Cette recherche vise à analyser la situation de l'avortement du point de vue des femmes et des professionnels de santé dans la préfecture d'Agadir Idaoutanane au Sud du Maroc. Nous avons conduit une étude transversale mixte. De janvier à septembre 2018, 266 femmes ont été recrutées pour répondre à un questionnaire, et 45 entretiens avec les femmes et les professionnels de la santé impliqués dans la santé sexuelle et reproductive (SSR) ont été menés. Nous avons procédé à une analyse descriptive des données quantitatives et à une analyse de contenu thématique des données recueillies par les entretiens individuels. Les résultats de l'étude révèlent que les avortements sont la conjugaison de plusieurs facteurs multidimensionnels. Le manque d'informations en SSR et l'échec de la contraception sont les facteurs majeurs de grossesses non désirées. L'avortement provoqué est un sujet tabou, fortement stigmatisant, portant à l'image sociale de la personne. L'accessibilité aux services d'avortement est marquée de grandes disparités et de trajectoires différentes. Cette étude apporte une contribution à l'analyse du phénomène de l'avortement au Maroc et appelle à une action politique urgente sur plusieurs niveaux: l'accès aux programmes d'éducation sexuelle et à la contraception appropriée, l'élargissement des indications d'avortement préconisées dans le projet de loi, la mise en place des stratégies de lutte contre la stigmatisation de l'avortement par les professionnels de santé et l'accès à des soins post-avortement de haute qualité.

Online legal driving behavior monitoring for self-driving vehicles

Defined traffic laws must be respected by all vehicles when driving on the road, including self-driving vehicles without human drivers. Nevertheless, the ambiguity of human-oriented traffic laws, particularly compliance thresholds, poses a significant challenge to the implementation of regulations on self-driving vehicles, especially in detecting illegal driving behaviors. To address these challenges, here we present a trigger-based hierarchical online monitor for self-assessment of driving behavior, which aims to improve the rationality and real-time performance of the monitoring results. Furthermore, the general principle to determine the ambiguous compliance threshold based on real driving behaviors is proposed, and the specific outcomes and sensitivity of the compliance threshold selection are analyzed. In this work, the effectiveness and real-time capability of the online monitor were verified using both Chinese human driving behavior datasets and real vehicle field tests, indicating the potential for implementing regulations in self-driving vehicles for online monitoring.

Combining legal epidemiology and implementation science to improve global access to medicines: challenges and opportunities

Laws and policies affecting access to medicines have been in the global health spotlight for decades, yet our understanding of their effects remains substantially underdeveloped. The emerging field of legal epidemiology combined with the methods of implementation science presents an opportunity to help address this gap. Legal epidemiology refers to the scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease and injury in a population. Legal epidemiology studies consist of a systematic collection and coding of laws and policies relating to a particular topic. Quasi-experimental or observational research methods can then be applied to take advantage of natural experiments resulting from heterogenous adoption and/or implementation of laws and policies. Often legal epidemiology studies fail to account for heterogenous law implementation processes, presenting a need and opportunity to integrate implementation science methods. Researchers may face challenges in integrating these methods for access to medicines studies, including data access issues and a complex legal and implementation environment. Yet, the opportunities presented by increasingly transparent legal environments, improved monitoring of medicine availability, universal health coverage expansion, and electronic health and insurance records integration may facilitate overcoming these challenges. Improved collaboration and communication between researchers, health authorities, manufacturers, and health providers from public and private sectors will be critical. In spite of the challenges, combining the fields of legal epidemiology and implementation science may present an important strategy toward creating a legal and policy environment that supports global and equitable access to medicines.

A comprehensive dataset of U.S. federal laws (1789-2022)

U.S. federal laws figure importantly in many research projects in political science, law, sociology, economics, and other disciplines. Despite their prominence, there is no authoritative, current, and comprehensive dataset of U.S. federal laws. In part, this is because such laws have been enacted over hundreds of years, resulting in a complicated patchwork of documents published in numerous and inconsistent formats. As a simplification, many scholars have relied upon selective lists of major legislative enactments or complete lists of relatively recent enactments. Here, I report on an effort to transparently and reproducibly assemble a complete database of US laws and their revision histories by combining data from HeinOnline, the Governmental Printing Office, and the National Archives and Records Administration. The result is a database of 49,746 laws spanning 1789 to 2022.

Are regulations addressing farm animal welfare issues during live transportation fit for purpose? A multi-country jurisdictional check

Growing animal welfare concerns have pushed some jurisdictions to strengthen regulations addressing live farm animal transportation, but whether they provide satisfactory levels of protection for animals remains to be shown. Using the recent peer-reviewed literature, we identified four major risk factors associated with live animal transportation (fitness for transport, journey duration, climatic conditions and space allowances) and explored how regulations were structured to prevent animal welfare issues in five English-speaking Western jurisdictions (Australia, Canada, New Zealand, the EU and the USA). All legally binding federal regulations were systematically reviewed and compared. Whether these rules were fit for purpose was assessed using the relevant peer-reviewed scientific literature. Our findings indicate the majority of regulations in most jurisdictions are often insufficient or too vague to be deemed fit for purpose. All five jurisdictions fall short in guaranteeing adequate protection to livestock during transport. Using recent changes as well as future policy proposals under discussion, we identify future directions that could form the basis for regulatory changes that may significantly improve the welfare of farm animals during transportation.

U.S. Tax Credits to Promote Practical Proactive Preventative Care for Parkinson's Disease

Persons with Parkinson's disease (PD) and society at large can profit from a strategic investment into a forward leaning, practical, preventative, and proactive multidisciplinary care policy. The American healthcare system is not easily bent to accommodate this type of care, and thus a tax benefit is an attractive option. An individual federal income tax benefit of $6200 each year for every person residing in the US with a diagnosis of PD, could among other offerings provide monthly access to a licensed clinical social worker and access to mental health services. The implementation of more coordinated care has the potential reduce the burden of depression, anxiety, and demoralization. Personal training would also be covered and directed by physical and occupational therapists. The combination of home-based and telemedicine services would have the added benefit of improving access. The tax benefit would also provide access to a dietician. This type of care strategy could be designed to proactively identify early signs of aspiration and urinary tract infections to 'head off' significant morbidity. A $6200/year individual tax benefit for those diagnosed with PD will thus translate into more fall prevention, more care in the home setting, less hospitalizations, less depression, less anxiety, less demoralization, better diets, and less persons placed in nursing facilities. Additionally, this tax benefit will provide the potential for billions of dollars in savings to the healthcare system. A tax benefit for PD is a practical preventative and proactive strategy which can serve to advantage both this generation and the next.

An Overview of Ethical Issues Raised by Medicolegal Challenges to Death by Neurologic Criteria in the United Kingdom and a Comparison to Management of These Challenges in the USA

Although medicolegal challenges to the use of neurologic criteria to declare death in the USA have been well-described, the management of court cases in the United Kingdom about objections to the use of neurologic criteria to declare death has not been explored in the bioethics or medical literature. This article (1) reviews conceptual, medical and legal differences between death by neurologic criteria (DNC) in the United Kingdom and the rest of the world to contextualize medicolegal challenges to DNC; (2) summarizes highly publicized legal cases related to DNC in the United Kingdom, including the nuanced 2022 case of Archie Battersbee, who was transiently considered dead by neurologic criteria, but ultimately determined to be in a vegetative state/unresponsive-wakeful state; and (3) provides an overview of ethical issues raised by medicolegal challenges to DNC in the United Kingdom and a comparison to the management of these challenges in the USA.

[From psychiatric care to psychic care, for an ethic of restraint]

This analysis of the ethical issues raised by the relationship between caregiver and patient is based on the history of psychiatry and sensitivity to the ethical tensions that run through the field of psychiatry and mental health. Taking a step back from the injunction to treat well, not fetishizing it, adopting a holistic approach, equipping ourselves to counter the stigmatization and self-stigmatization that so often accompany psychic and/or psychosocial disability, and inviting reflection on proportionality in mental health are all ethical priorities that are insufficiently invested in psychiatric clinics.

Certificates of confidentiality: privileging research data

With the Supreme Court's decision in Dobbs, reproductive research now joins other sensitive research topics that present legal risks to research participants, underscoring the role of Certificates in protecting them. Yet, stakeholders question whether Certificates will hold up in court. In this article, we describe the essential arguments supporting Congress's regulation of biomedical research and, thus, Certificates, under its authority to regulate interstate commerce. Our analysis should reassure researchers and Institutional review boards who rely on Certificates to protect the confidentiality of research participants' data. We conclude with recommendations for stakeholders based on our analysis.

[Awaiting completion: Definitions missing in action]

Bevezetés

Egy, a sebészetben alkalmazott leggyakoribb fogalmaknak szentelt cikksorozat bevezető tanulmánya ez. A látszólag egyértelmű definíciók vizsgálatakor kiderül, hogy vagy egyáltalán nem is léteznek, annyira maguktól értetődők (pseudoaxiomák), vagy olyan sok van belőlük, hogy nincs igazi. A javasolt definíciók munkapéldányok, további javításra várnak. Az első két javaslatot tesszük közzé: a sebészet és a kompetencia kérdésében.

A sebészet fogalma

A sebészet a medicina azon válfaja, melynek megkülönböztető tulajdonsága, hogy szövetegyüttesi szintű sértés révén, azaz a testet alkotó strukturális elemeket eltávolító/átalakító módokat alkalmaz célja elérésében: a kórismézésben és a kezelés nyújtásában.

A sebészi kompetencia fogalma

A sebészeti kompetencia az állam mint közhatalom által hitelesített bizonyított cselekvőkész tudásösszesség birtoklása, kerete a szakvizsga.

Konklúzió

A tiszta, egyértelmű definíciók hiánya akadályozza a tudományos és szakmai diskurzust. Megalkotásuk, elfogadásuk közmegegyezés kérdése. További kísérletek következnek.

Beyond the Unitary State: Multi-Level Governance, Politics, and Cross-Cultural Perspectives on Animal Welfare

It is argued that extant cross-cultural research on animal welfare often overlooks or gives insufficient attention to new governance theory, civil society, politics, and the realities of devolved or (quasi-)federal, multi-level governance in the modern state. This paper synthesizes relevant social theory and draws on new empirical findings of civil society accounts of campaigning on animal welfare policies and law in the United Kingdom. It is presented as a corrective to arguably reductive, earlier unitary state-based analyses. Our core, evidence-based argument is that cognizance of civil society activism and the contrasting institutional governance structures and political cultures of constituent nations in unitary states-such as the UK-are providing opportunities for the territorialization of legally grounded animal welfare regimes, and culturally distinctive practices.

Towards understanding policy design through text-as-data approaches: The policy design annotations (POLIANNA) dataset

Despite the importance of ambitious policy action for addressing climate change, large and systematic assessments of public policies and their design are lacking as analysing text manually is labour-intensive and costly. POLIANNA is a dataset of policy texts from the European Union (EU) that are annotated based on theoretical concepts of policy design, which can be used to develop supervised machine learning approaches for scaling policy analysis. The dataset consists of 20,577 annotated spans, drawn from 18 EU climate change mitigation and renewable energy policies. We developed a novel coding scheme translating existing taxonomies of policy design elements to a method for annotating text spans that consist of one or several words. Here, we provide the coding scheme, a description of the annotated corpus, and an analysis of inter-annotator agreement, and discuss potential applications. As understanding policy texts is still difficult for current text-processing algorithms, we envision this database to be used for building tools that help with manual coding of policy texts by automatically proposing paragraphs containing relevant information.

Prior authorization restrictions on medications for opioid use disorder: trends in state laws from 2005 to 2019

RESEARCH OBJECTIVE

Medications for opioid use disorder (MOUDs) - including methadone, buprenorphine, and naltrexone - are the most effective treatments for opioid use disorder (OUD). Historically, insurers have required prior authorization for MOUD, but prior authorization is often reported as a key barrier to MOUD prescribing. Some states have passed laws prohibiting MOUD prior authorization requirements. We sought to identify the frequency of MOUD prior authorization prohibitions in state laws and to categorize types of prohibitions.

METHODS

We searched for regulations and statutes present in all U.S. states and Washington DC between 2005 and 2019 using MOUD-related terms in Westlaw legal software. In qualitative software, we coded laws discussing MOUD prior authorization using template analysis - a mixed deductive/inductive approach. Finally, we used coded laws to identify frequencies of states with prior authorization prohibitions, including changes over time.

RESULTS

No states had laws prohibiting MOUD prior authorization between 2005 and 2015, with the first prohibition appearing in 2016. By 2019, fifteen states had MOUD prior authorization prohibitions. States varied significantly in their approach to prohibiting MOUD prior authorization. In 2019, it was more common for states to have MOUD prior authorization prohibitions applying to all insurers (n = 10 states) than to only Medicaid (n = 7 states) or only non-Medicaid insurers (n = 1 state). In 2019, general prior authorization prohibitions (n = 10 states) were more common than prohibitions only applicable to medications on the formulary, prohibitions only applicable to medications on the preferred drug list, prohibitions only applicable during the first 5 days of treatment, and prohibitions only applicable during the first 30 days of treatment.

CONCLUSIONS

The number of states with an MOUD prior authorization law prohibition increased in recent years. Such laws could help expand access to life-saving OUD treatments by making it easier for clinicians to prescribe MOUD.KEY MESSAGESNo states had MOUD prior authorization prohibitions between 2005 and 2015 in state statutes or regulations, and only one state had such a prohibition in 2016.By 2019, fifteen states had an MOUD prior authorization prohibition law.States varied significantly in their approach to prohibiting MOUD prior authorization, including with respect to the insurer type, duration of the prohibition, and applicable medication.

Protect and Control: Coverture's Logics Across Welfare Policy and Abortion Law

In the aftermath of Dobbs v. Jackson Women's Health Organization, which overturned the federal constitutional right to abortion, states have begun to recriminalize the procedure. These abortion bans raise important questions about the political and social status of women and pregnant people in the United States. Moreover, restrictions in social welfare programs such as the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children and Temporary Assistance for Needy Families, which serve low-income pregnant people and parents, raise similar questions. The regulation and administration of all three are framed by race, class, and gender. To understand how these restrictions (a) claim to protect women but ultimately function to control, police, and surveil and (b) rely on imagined, stereotype-laden psychological states such as vulnerability, irresponsibility, or irrationality, we turn to the British Common Law doctrine of coverture, which subsumed a married woman's legal, financial, and political identities under her husband's. The American colonies, and later, states of the United States, drew from British Common Law to craft laws that regulated relationships between men and women. Taken together, this analysis can provide a more comprehensive accounting of the cumulative harms experienced by women, poor people, people of color, and pregnant people in today's health and social welfare landscape. We conclude with recommendations for psychologists and other mental health providers to address, in practice and advocacy, the ethical dilemmas and obligations raised by the reach of coverture's logics in people's lives.

[Legal aspects of alternative methods to animal testing]

While the total replacement of animal experimentation was the goal set by the European Directive of 22 September 2010 on the protection of animals used for scientific purposes, it has to be said that it is still far from being achieved. The number of animals is not decreasing and alternative methods are struggling to be used. Under pressure from the citizens, the European Commission has just made new commitments to define the stages and specific actions to be put in place to reduce animal testing, a prerequisite for the transition to an animal-free regulatory system. Given the shortcomings and lack of coherence in European policy, mobilising the public is an essential lever for speeding up the implementation of alternative methods.

Legal and ethical principles governing the use of artificial intelligence in radiology services in South Africa

Artificial intelligence (AI) will drastically change the healthcare system. Radiology is one speciality that is most affected as AI algorithms are increasingly used in diagnostic imaging. AI-enhanced health technologies will, inter alia, increase workflow efficiency, improve diagnostic accuracy, reduce healthcare-related costs, and help alleviate medical personnel shortages in under-resourced settings. However, the development of AI-enhanced technologies in healthcare is fraught with legal, ethical, and human rights concerns. Currently, the use of AI in South African healthcare is not governed by sui generis legislation or ethical guidance focused exclusively and specifically on AI, although various provisions and principles from law and ethics find application. This article outlines these normative principles and explains their relationship with the extant legal obligations and regulatory framework as applied to the use of AI in radiology services in South Africa. The article concludes with three key recommendations for radiology practitioners using AI in South Africa. These are the need for: vigilant monitoring of AI use in practice, reforms to the liability framework, and appropriate guidance from local regulators and the Health Professions Council of South Africa on the ethical use of AI.

Winter's Topography, Law, and the Colonial Legal Imaginary in British Columbia

This article examines how images of nature, weather, and topography disclose a politics of recognition (who is visible/invisible) invested in a burgeoning criminal justice milieu, where punishment of wrongdoing became increasingly racialized in British Columbia during the early confederation period of Canada's history. Drawing from archived court documents and colonial writing, it examines dominant environmental metaphors and tropes that structured this politics of recognition within the colonial legal imaginary. I argue that images and understandings of topography, nature, weather, and seasons shaped the background enactment of law in early Canadian lawmaking practices. By examining these natural tropes, this article seeks to understand the contours of a contextually specific colonial legal imaginary as a vital component for entry into the criminal justice system. This colonial legal imaginary predisposes certain groups, and particularly Indigenous peoples, as subject to the constraining power of law, thereby fueling the growth of crime control industries over the last 150 years.

Reparations for people living with dementia: Recognition, accountability, change, now!

There is a significant and longstanding problem of harm to people living with dementia in long term care institutions ('LTC institutions', referred to by others as 'care homes', 'nursing homes', 'long term care', 'residential aged care facilities'), along with a failure to redress the harm or hold people accountable for this harm. This article reports on an Australian project that found reparations must be a response to harm to people living with dementia in residential aged care. Using a disability human rights methodology, focus groups were conducted with people living with dementia, care partners and family members, advocates and lawyers to explore perspectives on why and how to redress harm to people living with dementia in Australian LTC institutions. Researchers found four key themes provide the basis for the necessity and design of a reparative approach to redress - recognition, accountability, change, now. The article calls for further attention to reparations in dementia scholarship, with a particular focus on the role that can be played in the delivery of reparations by the LTC industry, dementia practitioners, and dementia scholars. Ultimately, this article provides a new understanding of responses to violence, abuse, neglect and other harms experienced by people living with dementia in LTC institutions, which centres justice, rights, and transformative change.

Clinically Indicated Genomic Sequencing of Children in Foster Care: Legal and Ethical Issues

There are approximately 400 000 children in foster care in the US, approximately one-half of whom have chronic health problems and approximately 10% of whom have complex healthcare needs. Given the increasing relevance of genomic sequencing to guide clinical care for children with rare, chronic, and undiagnosed conditions, it may be an important component of diagnostic evaluation for children in foster care. Clinically indicated genomic sequencing may provide information that has health implications for children in foster care, as well as for their biological parents and other relatives. Whether and how genomic sequencing results impact legal decision making and family court outcomes is not yet well-understood. We describe scenarios that highlight legal, ethical, and policy issues surrounding genomic sequencing for children in foster care using 3 cases adapted from real-world events. Together, these cases highlight important yet underexplored issues that arise when genomic information has legal relevance in family court and ethical implications for child and family well-being. As genomic sequencing becomes more routine for the general pediatric population, additional research is needed to better understand its impacts on children and other stakeholders within the foster care system.

Impact of State Stroke Systems of Care Laws on Stroke Outcomes

Since 2003, 38 US states and Washington, DC have adopted legislation and/or regulations to strengthen stroke systems of care (SSOCs). This study estimated the impact of SSOC laws on stroke outcomes. We used a coded legal dataset of 50 states and DC SSOC laws (years 2003-2018), national stroke accreditation information (years 1997-2018), data from the Healthcare Cost and Utilization Project (years 2012-2018), and National Vital Statistics System (years 1979-2019). We applied a natural experimental design paired with longitudinal modeling to estimate the impact of having one or more SSOC policies in effect on outcomes. On average, states with one or more SSOC policies in effect achieved better access to primary stroke centers (PSCs) than expected without SSOC policies (ranging from 2.7 to 8.0 percentage points (PP) higher), lower inpatient hospital costs (USD 610-1724 less per hospital stay), lower age-adjusted stroke mortality (1.0-1.6 fewer annual deaths per 100,000), a higher proportion of stroke patients with brain imaging results within 45 min of emergency department arrival (3.6-5.0 PP higher), and, in some states, lower in-hospital stroke mortality (5 fewer deaths per 1000). Findings were mixed for some outcomes and there was limited evidence of model fit for others. No effect was observed in racial and/or rural disparities in stroke mortality.

Fairness of recommender systems in the recruitment domain: an analysis from technical and legal perspectives

Recommender systems (RSs) have become an integral part of the hiring process, be it via job advertisement ranking systems (job recommenders) for the potential employee or candidate ranking systems (candidate recommenders) for the employer. As seen in other domains, RSs are prone to harmful biases, unfair algorithmic behavior, and even discrimination in a legal sense. Some cases, such as salary equity in regards to gender (gender pay gap), stereotypical job perceptions along gendered lines, or biases toward other subgroups sharing specific characteristics in candidate recommenders, can have profound ethical and legal implications. In this survey, we discuss the current state of fairness research considering the fairness definitions (e.g., demographic parity and equal opportunity) used in recruitment-related RSs (RRSs). We investigate from a technical perspective the approaches to improve fairness, like synthetic data generation, adversarial training, protected subgroup distributional constraints, and post-hoc re-ranking. Thereafter, from a legal perspective, we contrast the fairness definitions and the effects of the aforementioned approaches with existing EU and US law requirements for employment and occupation, and second, we ascertain whether and to what extent EU and US law permits such approaches to improve fairness. We finally discuss the advances that RSs have made in terms of fairness in the recruitment domain, compare them with those made in other domains, and outline existing open challenges.

Legal and human rights issues in the use of electronic monitoring (using GPS 'tracking' technology) in forensic mental health settings in the UK

Electronic monitoring (EM) of individuals has been used by the criminal justice system for the past thirty years, and in the UK, use is on the increase. Its use has been justified as an alternative to prison to reduce recidivism and allowing early release of prisoners, however, the evidence base for this remains mixed. In 2010, it was employed for the first time in a forensic psychiatry setting. A study investigating the effects of EM on leave episodes concluded that EM may improve the speed of patient progress and reduce the length of admission, leading to reduced costs and increased public safety. However, the intervention generated considerable controversy and sparked discussion about ethical concerns. Here, we consider specifically legal and human rights issues that emerge from use of EM in forensic healthcare settings, scrutinising its use in the context of the Mental Health Act and the Human Rights Act. We conclude that EM is legal and justifiable, providing it is used judiciously and with due consideration of concerns for the individual and the given context.

Experts' assessments of migration scenarios between the Middle East & North Africa and Europe

We describe data collected among 138 migration experts about the repercussions of scenarios of social change on migration between the Middle East & North Africa and Europe, during the period 2021-2030. Scenarios include changes in the cultural, demographic, economic, and political determinants of migration in sending and receiving countries. Assessments focus on the change in the number of family, work, and return migrants, the number of refugees, and the likelihood of achieving safe, orderly, and regular migration. Experts were at the moment of the survey active in European research centers or European (supra-) national governmental or civil society organizations. The survey features a factorial design, which allows for identifying a causal relationship between the experts' assessments and the scenarios of social change. Our data may be used to estimate projection models of future migration flows, map out what experts consider as critical migration issues for the region, and identify areas of agreement or disagreement between them. As such, our dataset may illuminate decision-making regarding migration policies in Europe and beyond.

The status of surrogacy in China

China's birth rates hit a record low in 2021. The high demand for having children has spawned a massive market for surrogacy, which, however, is a dilemma in China involving a series of moral and legal issues under the current circumstances. First, special populations, including infertile patients, families who have lost their sole child, and homosexuals, wanted to have children, giving rise to surrogacy. Then, the development of and innovation in assisted reproductive technology allowed surrogacy to mature. A high return offsets a high risk, and consequently, an underground surrogacy market has emerged, causing various social issues for the Chinese Government, such as civil disputes, gender disproportion, crime, and the spread of disease. At the same time, surrogacy violates moral ethics, traditional Chinese culture, and the rights and interests of vulnerable groups.

Reflection on the Role of a Hospital Chaplain as a Resource for Ethical Concerns

As I take a legal approach to religion and spirituality, I reflect on how a chaplain can be beneficial as a resource to ethical concerns with which medical teams and patients/caregivers are confronted. This rather new approach can help medical professionals to understand the scope of a chaplain's work and to distinguish the work of a chaplain from that of clergy in organized religion.

[Organ donation is not a gift]

If the obligation to donate as defined by French law ("we are all donors") remains in the wake of sociologist Marcel Mauss's Essai sur le don (Essay on donation), there the similarity ends. How do you make a counter-donation to a deceased person? In the case of inter vivos organ donation, the act is more akin to mutualization than donation.

[Legal provisions governing organ and tissue donation in France]

As an expression of the general will, the law makes organ removal and transplantation a lawful activity. The legislator makes them conditional on the primacy of the person, the inviolability of the body and the need for consent.

Twitter Sentiment About the US Federal Tobacco 21 Law: Mixed Methods Analysis

BACKGROUND

On December 20, 2019, the US "Tobacco 21" law raised the minimum legal sales age of tobacco products to 21 years. Initial research suggests that misinformation about Tobacco 21 circulated via news sources on Twitter and that sentiment about the law was associated with particular types of tobacco products and included discussions about other age-related behaviors. However, underlying themes about this sentiment as well as temporal trends leading up to enactment of the law have not been explored.

OBJECTIVE

This study sought to examine (1) sentiment (pro-, anti-, and neutral policy) about Tobacco 21 on Twitter and (2) volume patterns (number of tweets) of Twitter discussions leading up to the enactment of the federal law.

METHODS

We collected tweets related to Tobacco 21 posted between September 4, 2019, and December 31, 2019. A 2% subsample of tweets (4628/231,447) was annotated by 2 experienced, trained coders for policy-related information and sentiment. To do this, a codebook was developed using an inductive procedure that outlined the operational definitions and examples for the human coders to annotate sentiment (pro-, anti-, and neutral policy). Following the annotation of the data, the researchers used a thematic analysis to determine emergent themes per sentiment category. The data were then annotated again to capture frequencies of emergent themes. Concurrently, we examined trends in the volume of Tobacco 21-related tweets (weekly rhythms and total number of tweets over the time data were collected) and analyzed the qualitative discussions occurring at those peak times.

RESULTS

The most prevalent category of tweets related to Tobacco 21 was neutral policy (514/1113, 46.2%), followed by antipolicy (432/1113, 38.8%); 167 of 1113 (15%) were propolicy or supportive of the law. Key themes identified among neutral tweets were news reports and discussion of political figures, parties, or government involvement in general. Most discussions were generated from news sources and surfaced in the final days before enactment. Tweets opposing Tobacco 21 mentioned that the law was unfair to young audiences who were addicted to nicotine and were skeptical of the law's efficacy and importance. Methods used to evade the law were found to be represented in both neutral and antipolicy tweets. Propolicy tweets focused on the protection of youth and described the law as a sensible regulatory approach rather than a complete ban of all products or flavored products. Four spikes in daily volume were noted, 2 of which corresponded with political speeches and 2 with the preparation and passage of the legislation.

CONCLUSIONS

Understanding themes of public sentiment-as well as when Twitter activity is most active-will help public health professionals to optimize health promotion activities to increase community readiness and respond to enforcement needs including education for retailers and the general public.

From the bathroom to a national discussion of LGBTQ+ rights: a case of discrimination in the Philippines

Despite the Philippines' progress in gender equality, contemporary evidence suggests that Filipinos continue to possess negative attitudes toward lesbian and gay individuals. Likewise, discrimination and violence toward bisexual, transgender, and queer Filipinos have been documented. Despite cases of sexual orientation and gender identity and expression (SOGIE) based discrimination, national-level anti-discrimination legislation remains unpassed in the Senate. This study explores the national discussions on the SOGIE Equality Bill triggered by a bathroom discrimination experienced by a Filipino transgender woman in 2019. Taking cues from Richardson's sexual citizenship framework, we investigate the diverse rights discourses among sectoral groups, such as local lesbian, gay, bisexual, transgender, queer, and other individuals of marginalized sexualities and genders (LGBTQ+) organizations and their allies, high-ranking Filipino politicians, and religious organizations. Analysis of local discourses showed that those supporting the SOGIE Equality Bill leverage identity-based rights discourses, while those opposed primarily navigate these debates using conduct-based rights discourses. Future policy and advocacy work must leverage the insights from these public proceedings to foster LGBTQ + solidarity in their campaigns for LGBTQ + rights in the country. Particularly, future work must (1) locate the middle ground between the LGBTQ + community and opposed legislators; (2) highlight essential values and common issues shared by all Filipinos; (3) surface how privilege can preclude and advance solidarity within the LGBTQ + community; (4) campaign for the passage of local anti-discrimination ordinances; (5) improve the SOGIE-related competencies of policy implementers; and (6) engage in research that explores public discourses and meanings assigned to sexual rights among Filipinos.

How AI can learn from the law: putting humans in the loop only on appeal

While the literature on putting a "human in the loop" in artificial intelligence (AI) and machine learning (ML) has grown significantly, limited attention has been paid to how human expertise ought to be combined with AI/ML judgments. This design question arises because of the ubiquity and quantity of algorithmic decisions being made today in the face of widespread public reluctance to forgo human expert judgment. To resolve this conflict, we propose that human expert judges be included via appeals processes for review of algorithmic decisions. Thus, the human intervenes only in a limited number of cases and only after an initial AI/ML judgment has been made. Based on an analogy with appellate processes in judiciary decision-making, we argue that this is, in many respects, a more efficient way to divide the labor between a human and a machine. Human reviewers can add more nuanced clinical, moral, or legal reasoning, and they can consider case-specific information that is not easily quantified and, as such, not available to the AI/ML at an initial stage. In doing so, the human can serve as a crucial error correction check on the AI/ML, while retaining much of the efficiency of AI/ML's use in the decision-making process. In this paper, we develop these widely applicable arguments while focusing primarily on examples from the use of AI/ML in medicine, including organ allocation, fertility care, and hospital readmission.

Frozen and forgotten: What are South African fertility clinics to do with surplus cryopreserved embryos once their patients lose interest?

As is the case around the globe, South African fertility clinics face an ever-expanding problem: what to do with the growing number of surplus cryopreserved embryos. Fertility clinics remain hesitant to destroy these abandoned embryos, partly because of concerns about the legal ramifications. This article clarifies the legal position in South Africa and offers practical recommendations to assist fertility clinics in managing abandoned embryos. In sum, fertility clinics cannot deem embryos as abandoned and discard them if fertility patients fail to respond to a notice that the embryo storage agreement is about to expire. However, if there is non-payment for embryo storage by fertility patients and the fertility clinic has informed the fertility patients of other options available to them with respect to their embryos, and there is still no response, the fertility clinic is legally entitled - and legally obliged - to discard the embryos.