End-of-life healthcare decisions, ethics and law: the debate in Spain

The debate on euthanasia in Spain has been ongoing from the beginning of the 20th century and remains extant. Three periods can be identified: prior to 1978, 1978-2002, and after 2002. The debate increased significantly after the Ramon Sampedro case (1995-1998), and was fuelled with new, although very different cases, such as those of Leganés (2005-2008), Jorge Leon (2006) or Inmaculada Echevarria (2006-2007). As a consequence of these cases in 2008 the Regional Government of Andalusia started a legal process to pass a law regulating end-of-life decisions, excluding euthanasia and assisted-suicide, which was finally enacted in 2010. Two other Spanish regions (Navarra and Aragón) passed similar laws. The central government also initiated a legal process to approve a national law, excluding euthanasia and assisted-suicide. The project failed because of the dissolution of the Parliament in June 2011. The new government will have to decide how to continue the process.     

Navigating the minefield: legal ethics and healthcare law

Practicing law in the healthcare field is a daunting task due to the highly-regulated nature of the field and the increasing scrutiny of the conduct of industry providers, payors, and vendors. Attorneys must provide difficult opinions regarding matters with civil, criminal, and reimbursement implications and often are asked to represent multiple parties in healthcare-related settings. This article discusses some legal ethics issues for the healthcare practitioner and touches on some of the recent changes to the Model Rules of Professional Conduct, which were adopted by the American Bar Association's House of Delegates at its mid-February 2002 meeting. The authors conduct their analysis by applying the model rules to a number of hypothetical fact situations typical of those encountered in the day-to-day practice of healthcare law.     

Barcelona 2002: law, ethics, and human rights. Using the law to improve access to treatments

The XIII International AIDS Conference in Durban, South Africa in July 2000 focused worldwide attention on the problem of accessing treatments in developing countries. In the interim, thanks to the work of activists - from demonstrations to court cases, and from acts of public courage by people living with HIV/AIDS to ongoing lobbying of politicians and trade negotiators - some very significant developments have occurred. But the reality is that the vast majority of people living with HIV/AIDS still lack access to affordable, quality medicines. This article, a summary of a paper presented at "Putting Third First: Vaccines, Access to Treatments and the Law," a satellite meeting held at Barcelona on 5 July 2002 and organized by the Canadian HIV/AIDS Legal Network, the AIDS Law Project, South Africa, and the Lawyers Collective HIV/AIDS Unit, India, explores three approaches for improving access. In the first part, Richard Elliott provides an overview of the state of the right to health as embodied in international human rights law; comments on the experience to date in litigating claims to the right to health; and identifies potential strategies activists can adopt to advance recognition of the right to health. In the second part, Sharan Parmar and Vivek Divan describe price-control and drug-financing mechanisms used by industrialized countries to increase the affordability of medicines; and discuss how some of these mechanisms could be adapted for use in developing countries. Finally, Jonathan Berger describes the use of litigation in the courts by the Treatment Action Campaign in South Africa.     

Why we need the independent sector: the behavior, law, and ethics of not-for-profit hospitals

Among the major forms of corporate ownership, the not-for-profit ownership form is distinct in its behavior, legal constraints, and moral obligations. A new empirical analysis of the American Hospital industry, using eleven years of data for all urban general hospitals in the country, shows that corporate form accounts for large differences in the provision of specific medical services. Not-for-profit hospitals systematically provide both private and public goods that are in the public interest, and that other forms fail to provide. Two hypotheses are proposed to account for the findings, one legal and one moral. While no causal claims are made, not-for-profit hospital behavior is consistent with the behavior required by law and morality. The moral argument, developed as a preliminary theory of not-for-profit ethics, also provides a potential reason to prefer not-for-profit hospitals. The findings provide a new justification for the not-for-profit tax exemption for hospitals, and also suggest new uses for ownership categories as regulatory tools.