Justice and equality in mental health law: the European experience

This is the text of a lecture delivered at the World Conference of the International Academy of Law and Mental Health in Sydney in September 2003 on the occasion of the award to the author of the Prix Philippe Pinel. Its theme is the potential of the European Convention on Human Rights to secure the human rights of people with mental disorders and disabilities, viewed in the context of the legislation on mental health and mental incapacity in England and Wales. Its conclusion is that the Convention is better at protecting them from unwanted or unnecessary treatment and care than it is at securing for them equal access to the treatment and care they want or need. The lecture has been updated to reflect developments in the United Kingdom since 2003.     

Obesity in Europe: the strategy of the European Union from a public health law perspective

In 2007 the European Commission published a White Paper on a "Strategy on nutrition, overweight and obesity", proposing measures to impede the current trend towards a steady gain in weight by Union citizens. In this article, these ideas are discussed critically in the light of the competences of the Union and from a public health law perspective, in order to scrutinise the effectiveness of the measures and to identify shortcomings in the White Paper. One focus of this article will be European food legislation, as food is one of the leading causes of people being overweight or obese.     

Age determination of unaccompanied asylum seeking minors in the European Union: a health law perspective

In the European Union, unaccompanied asylum seekers below 18 years of age are entitled to specific treatment. Age assessment practices to verify the age-statement by the asylum seeker differ between EU Member States. Medical methods in use raise questions about accuracy, reliability and safety. The medical, legal and ethical acceptability of invasive methods (notably X-rays) in particular is controversial. Human rights are at stake. The lack of common practices results in different levels of protection (discrimination). The absence ofstandardisation is an obstacle for the functioning of the Common European Asylum System. EU Best Practice Guidelines should remedy the situation; such guidelines should reflect the best interest of the child.     

Transparency of machine-learning in healthcare: The GDPR & European health law

Machine-learning (‘ML’) models are powerful tools which can support personalised clinical judgments, as well as patients’ choices about their healthcare. Concern has been raised, however, as to their ‘black box’ nature, in which calculations are so complex they are difficult to understand and independently verify. In considering the use of ML in healthcare, we divide the question of transparency into three different scenarios:

• 1)Solely automated decisions. We suggest these will be unusual in healthcare, as Article 22(4) of the General Data Protection Regulation presents a high bar. However, if solely automatic decisions are made (e.g. for inpatient triage), data subjects will have a right to ‘meaningful information’ about the logic involved.
• 2)Clinical decisions. These are decisions made ultimately by clinicians—such as diagnosis—and the standard of transparency under the GDPR is lower due to this human mediation.
• 3)Patient decisions. Decisions about treatment are ultimately taken by the patient or their representative, albeit in dialogue with clinicians. Here, the patient will require a personalised level of medical information, depending on the severity of the risk, and how much they wish to know.

In the final category of decisions made by patients, we suggest European healthcare law sets a more personalised standard of information requirement than the GDPR. Clinical information must be tailored to the individual patient according to their needs and priorities; there is no monolithic ‘explanation’ of risk under healthcare law. When giving advice based (even partly) on a ML model, clinicians must have a sufficient grasp of the medically-relevant factors involved in the model output to offer patients this personalised level of medical information. We use the UK, Ireland, Denmark, Norway and Sweden as examples of European health law jurisdictions which require this personalised transparency to support patients’ rights to make informed choices. This adds to the argument for post-hoc, rationale explanations of ML to support healthcare decisions in all three scenarios.     

The law and the public's health: a study of infectious disease law in the United States

Law plays crucial roles in the field of public health, from defining the power and jurisdiction of health agencies, to influencing the social norms that shape individual behavior. Despite its importance, public health law has been neglected. Over a decade ago, the Institute of Medicine issued a report lamenting the state of public health administration, generally, and calling, in particular, for a revision of public health statutes. The Article examines the current state of public health law. To help create the conditions in which people can be healthy, public health law must reflect an understanding of how public health agencies work to promote health, as well as the political and social contexts in which these agencies operate. The authors first discuss three prevailing ways in which the determinants of health are conceptualized, and the political and social problems each model tends to create for public health efforts. The analysis then turns to the core functions of public health, emphasizing how law furthers public health work. The Article reports the results of a fifty-state survey of communicable disease control law, revealing that few states have systematically reformed their laws to reflect contemporary medical and legal developments. The Article concludes with specific guidelines for law reform.     

How to build European private law: an economic analysis of the lawmaking and harmonization dimensions in European private law

In the process of building a European Private Law, the lawmaking and harmonization dimensions??the modes of harmonization and even more, the scope and reach of the harmonizing effect of the European rules- appear as crucial issues. We show how the harmonization strategy is as important a question as whether we should have European Private Law at all. We present an economic discussion of the different modes of harmonizing Private Law in the abstract, and how they are likely to differently affect outcomes. We also present in informal terms a simple economic model of how to build optimal harmonized rules and standards in a setting of pre-existing separate and diverse national ones, and we systematically explore how the different harmonization regimes (maximum harmonization, minimum harmonization, and pure co-existence of harmonized and national standards) affect the outcomes of the harmonization process.     

Keywords,case law and the Court of Justice: the need for legislative intervention in modernising European trade mark law

Recent preliminary references to the CJEU on online keyword advertising and registered trade mark infringement have exposed the challenges facing EU registered trade mark law in its response to new technologies. These cases and the challenges they pose provide a timely prism through which to examine the European trade mark law-making process and the role of the CJEU within that process. This article will employ an analysis of the way in which the CJEU has developed certain key new aspects of the law on ‘infringing use’ to explore concerns over the CJEU's role and approach. It will be argued that, driven by policy considerations, the CJEU has acted creatively to develop the law of infringement in ways that cannot be sustained by the TMD and CTMR and which are likely to cause increasing uncertainties going forward. With the European Commission currently considering reform of Trade Marks Directive 2008/95/EC and Community Trade Mark Regulation 207/2009/EC, this paper will argue that there is a need for more comprehensive and forward-looking legislative intervention than has yet been proposed and that such intervention will be essential to restoring balance in the European trade mark law-making process.     

Access to health care and equal protection of the law: the need for a new heightened scrutiny

Proposals to reduce national expenditures for health care under Medicare and other programs raise questions about the limits on legislative power to distribute health care benefits. The constitutional guarantee of equal protection has been a weak source of protection for the sick, largely because they fail to qualify for special scrutiny under traditional equal protection analysis. Recent decisions of the United States Supreme Court suggest that the Justices seek a newer, more flexible approach to reviewing claims of unequal protection. This Article examines the application of the equal protection guarantee to health-related claims. It argues that traditional equal protection analysis is too rigid and newer rationality review too imprecise to provide just eligibility determinations. The Article concludes that courts should subject claims of unequal protection in the health care context to heightened scrutiny, as health care plays a special role in assuring equality of opportunity.     

Modernization of European data protection law at a turning point

CLSR welcomes occasional comment pieces on issues of current importance in the law and technology field. In this note Dr Ulrich Wuermeling of Latham & Watkins LLP, Frankfurt offers a personal viewpoint on the EU data protection reform package.