Umbilical cord blood banking and the next generation of human tissue regulation: an agenda for research

The transformation of umbilical cord blood from being a waste product to being a valuable source of stem cells has led to the emergence of significant legal, ethical and social issues. This editorial proposes an agenda for research into the regulation of umbilical cord blood banking which focuses on issues of characterisation, consent, the interplay of public and private services, and the importance of applying property concepts. It concludes by stressing the need for reform to be based on well-informed public debate.     

Section 8 orders on the public-private law divide*

While section 9(2) of the Children Act 1989 prevents a Local Authority from applying for a child arrangements order directly, a case file study of residence and contact orders made in 2011 found that a significant number of applications for residence orders in the County Court were supported and sometimes even instigated by local authority children’s services (Harding & Newnham, 2015). The findings of the study demonstrate that residence orders often formed part of solutions offered to the family and can even operate as an alternative to formal public law remedies in situations where the parents are no longer able to provide care, and grandparents or other relatives take over. In these ‘hybrid cases’ private law orders are used to resolve situations on the fringes of public law action and, in some cases, divert cases from voluntary accommodation or formal care proceedings. This article raises questions about whether cases are being diverted to private law remedies in an appropriate manner and argues that closer scrutiny of the practice is required to ensure that the rights of parents, children and kinship carers are appropriately respected.     

Religious perspectives on umbilical cord blood banking

Umbilical cord blood is a valuable source of haematopoietic stem cells. There is little information about whether religious affiliations have any bearing on attitudes to and decisions about its collection, donation and storage. The authors provided information about umbilical cord blood banking to expert commentators from six major world religions (Catholicism, Anglicanism, Islam, Judaism, Hinduism and Buddhism) and asked them to address a specific set of questions in a commentary. The commentaries suggest there is considerable support for umbilical cord blood banking in these religions. Four commentaries provide moral grounds for favouring public donation over private storage. None attach any particular religious significance to the umbilical cord or to the blood within it, nor place restrictions on the ethnicity or religion of donors and recipients. Views on ownership of umbilical cord blood vary. The authors offer a series of general points for those who seek a better understanding of religious perspectives on umbilical cord blood banking.     

The ethical, legal and social implications of umbilical cord blood banking: learning important lessons from the protection of human genetic information

Internationally networked umbilical cord blood banks hold great promise for better clinical outcomes, but also raise a host of potential ethical and legal concerns. There is now significant accumulated experience in Australia and overseas with regard to the establishment of human genetic research databases and tissue collections, popularly known as "biobanks". For example, clear lessons emerge from the controversies that surrounded, stalled or derailed the establishment of some early biobanks, such as Iceland's deCODE, Autogen's Tonga database, a proposed biobank in Newfoundland, Canada, and the proposed Taiwan biobank. More recent efforts in the United Kingdom, Japan, Quebec and Tasmania have been relatively more successful in generating public support, recognising the critical need for openness and transparency, and ample public education and debate, in order to build community acceptance and legitimacy. Strong attention must be paid to ensuring that other concerns--about privacy, discrimination, informed consent, governance, security, commercial fairness and financial probity--are addressed in structural terms and monitored thereafter, in order to maintain public confidence and avoid a backlash that inevitably would imperil such research. Once lost, credibility is very difficult to restore.     

Racially conditional donation: the example of umbilical cord blood

While direction of donated tissue to family members has long been accepted, direction to members of specific racial groups has been opposed, on the basis that it is discriminatory and contrary to the ethos the institution of organ donation seeks to promote. It has, however, recently been proposed that racially conditional donation may provide a useful--and ethically acceptable--way to address the social inequalities and injustices experienced by certain cultural groups. This article examines the ethical, legal and cultural arguments for and against racially conditional donation, concluding that the practice is more likely to undermine the values of equity and justice than to promote them and that it may also lead to other unfavourable personal and social outcomes.     

Genomics and toxic torts: dismantling the risk-injury divide

Emerging genetic and molecular technologies are revolutionizing our understanding of the relationship between genes and the environment. This Article develops an innovative framework for understanding the implications of the genomic revolution for the law of toxic torts. Professor Grodsky demonstrates how new technologies are poised to challenge longstanding distinctions between legally inconsequential "risk" and remediable "injury," and how the U.S. legal system will need to adapt to this emerging reality. If the law remains wedded to conventional notions of injury, it will ignore the fruits of a scientific revolution and thus may forego new remedial opportunities as yet unimagined. This is particularly significant given that twenty-first century medicine strives to "go beyond the limitations of biology" and detect, prevent, and treat disease at the molecular level. The transformative and rapidly evolving technologies of the genomic era will present herculean challenges for the legal system. But opportunities to fashion new remedies and create new efficiencies must not be overlooked in the process. Professor Grodsky recommends legal approaches to balance the goals of deterrence and legal restraint in an age of accelerating scientific change.     

The Boston schoolyard initiative: a public-private partnership for rebuilding urban play spaces

The Boston Schoolyard Initiative (BSI) is a policy effort to rebuild school yards in Boston through innovative citywide public-private partnerships. At the center of the initiative is a commitment to engage multiple stakeholders and utilize a bottom-up planning process to encourage meaningful change. Based on a case study of BSI, this article develops a framework to understand and analyze how different school and neighborhood sectors can partner to benefit neighborhood communities and utilize the built environment to encourage more active living and active learning. The article contributes to a literature that focuses on the effects of school yards and the role of physically active environments on learning. It expands on this literature by looking at the school-yard initiative as a way to build and expand relationships between teachers, parents, and the community at large. Finally, the study shows that even older schools in inner-city neighborhoods, previously considered blights, can be turned into community, educational, and political assets.     

Tackling the health divide in europe: the role of the world health organization

Europe faces major health challenges in addition to its well-reported economic and financial difficulties. Despite the overall improvement in population health, significant inequalities remain, with a growing gap between rich and poor. WHO Europe, covering fifty-three member states, is committed to helping European governments meet the complex challenge posed by the "silent epidemic" of noncommunicable diseases. In September 2012 WHO launched Health 2020, an ambitious new health policy framework and strategy. Its success requires a whole-of-government and whole-of-society approach to improving health and well-being, informed by the latest evidence on cost-effective interventions. This review considers the prospects for success.     

Quality of health care and the role of relationships: bridging the medico-legal divide

This Article focuses on an often overlooked barrier to efforts to enhance the quality of health care: the relationship crisis that currently exists between physicians and patients. This state of affairs has resulted from the divide between the medical and legal worlds. The medical arena has understandably tended to view the doctor-patient relationship as a purely medical issue, ignoring the law's impact in generating and sustaining problematic relationship patterns. The legal world has yet to fully recognize this state of affairs, and the law's role in its evolution and persistence. We offer a relational approach to health-care law as a means of bridging the divide between the two disciplines. In the malpractice context, this would entail adopting a no-fault compensation scheme, which is committed to strengthening collaborative doctor-patient relations, enhancing patient safety and systemic learning, while providing adequate compensation.     

Russian banking since the crisis of 1998

Banking is one of the most difficult areas in the transition process. In Russia most reforms were less smooth than in the formerly socialist countries of central Europe and creation of a financial sector met with weak regulations and an opportunistic and weak government. The financial crisis of 1998 was therefore not the result of unforeseeable external events but one of limitless recklessness. The paper describes the major problems in building up a banking sector before 1998 and identifies the major reasons for the crisis. Crisis management also turned out to be atypical. Instead of seizing the opportunity to carry out necessary reforms, in particular a regulatory overhaul, not much happened. Now nearly ten years after the reform, the banking system has strengthened thanks to a very pronounced macroeconomics boom based on favourable terms of trade. The major weaknesses survive however under the cover of strong growth of the economy.     

Beyond the public and private divide: remapping transnational climate governance in the 21st century

This article provides a first step towards a better theoretical and empirical knowledge of the emerging arena of transnational climate governance. The need for such a re-conceptualization emerges from the increasing relevance of non-state and transnational approaches towards climate change mitigation at a time when the intergovernmental negotiation process has to overcome substantial stalemate and the international arena becomes increasingly fragmented. Based on a brief discussion of the increasing trend towards transnationalization and functional segmentation of the global climate governance arena, we argue that a remapping of climate governance is necessary and needs to take into account different spheres of authority beyond the public and international. Hence, we provide a brief analysis of how the public/private divide has been conceptualized in Political Science and International Relations. Subsequently, we analyse the emerging transnational climate governance arena. Analytically, we distinguish between different manifestations of transnational climate governance on a continuum ranging from delegated and shared public–private authority to fully non-state and private responses to the climate problem. We suggest that our remapping exercise presented in this article can be a useful starting point for future research on the role and relevance of transnational approaches to the global climate crisis.