Tipping the Scales for Public Health (Eric Ip Profiled in HKU Bulletin)

"Tipping the Scales for Public Health"
Eric Ip
HKU Bulletin
Published in November 2024

Pandemics, vaccination programmes and other public health measures cannot succeed without good legal regimes. Professor Eric Ip Chi-yeung presents the case.

In the early months of the COVID-19 pandemic, the UK government announced that it was “following the science” in implementing severe interventions. The approach sounded reasonable, but soon revealed serious limitations, particularly in regard to people’s freedoms and mental health. Similarly, in Hong Kong, stringent interventions, such as mandatory masking and quarantine, were initially appropriate, but over time, with vaccinations and community immunity, they seemed unduly restrictive.

Professor of Law and public health bioethicist Eric Ip Chi-yeung, who is Co-Director of the Centre for Medical Ethics and Law, argues that policymakers tend to forget that the rule of law is as important to public health as science, in his new book The Law and Regulation of Public Health: Global Perspectives on Hong Kong.

“My book has two general messages. The first is that all the incredible achievements in public health during the 20th century were made possible by law, whether it be criminal law to punish those who do not wear seatbelts or administrative law to empower certain public authorities to enforce sanitation policies, administer immunisation programmes, and so forth,” he said.

“The second message is that while we need the guidance of scientists in making public health decisions, to rely exclusively on them would be woefully inadequate. Science can’t answer the crucial questions that governments face such as the trade-offs in the social relationships between the individual, the population and the state. During a lockdown, an appropriate balance must be struck between respiratory health and other dimensions of human flourishing, such as familial love, friendship, mental well-being, and economic stability.”

The Hong Kong case

His book outlines why and how the rule of law should be given its due place in protecting mental and physical health. Professor Ip chose Hong Kong as a case study because...

Click here to read the full text.

New book by Eric Ip: The Law and Regulation of Public Health: Global Perspectives on Hong Kong (Routledge)

The Law and Regulation of Public Health: Global Perspectives on Hong Kong
Eric Ip
Routledge
Published in November 2023
264 pp.

Description: Public health law has been a subject of much controversy and contestation, especially since the COVID-19 pandemic broke out. This timely book inquires into the foundational principles of a form of public health law that takes seriously the inherent dignity of the human person. Written from a multidisciplinary perspective, this illuminating study makes the case that the rule of law, just as much as population health, is an essential determinant of human well-being. 

Choosing the case of the Hong Kong Special Administrative Region of the People’s Republic of China, where life expectancy is among the highest in the world, yet whose well-established rule of law tradition is oft perceived to be under strain, in describing the central dilemmas of public health law, it makes an original contribution to our knowledge of comparative public health law and public health ethics. Situating Hong Kong’s public health law in the context of global health, The Law and Regulation of Public Health should appeal across the world to students and scholars of public health, medical law, public law, comparative law, and international law. It accessibly explains the law to epidemiologists and public health policymakers, and public health to jurists and legal practitioners.

This book lucidly urges professionals of public health and law to reflect on how the myriad legal instruments and legal institutions should best be used to promote and protect public health in ways that are at once ethical and lawful. It is a must read for anyone who is interested in gaining insights into public health law and regulation in this highly internationalised Chinese Special Administrative Region.

Eric Ip on An Emergent Planetary Health Law (International & Comparative Law Quarterly)

"An Emergent Planetary Health Law"
Eric Ip
International & Comparative Law Quarterly, Volume 72, Issue 4, p. 1047 - 1067
Published online: October 2023

Abstract: The health of the planet and its life forms are under threat from anthropogenic climate change, pollution and biodiversity loss, and the extreme weather events, heatwaves and wildfires that accompany them. The burgeoning field of planetary health studies the interplay between humanity and the Earth's biosphere and ecosystems on which human health depends. Scholarship on law from a planetary health vantage point remains scarce. This article fills this gap by delineating the conceptual building blocks of a planetary health law, which, in its latent form, is dispersed across various hard and soft sources of international environmental law and global health law that converge on the right to a healthy environment, and, to a lesser extent, rights of nature emerging in various domestic jurisdictions. It elucidates how the fragmented regimes of international environmental and global health law could be developed in more coherent ways, driven by an overarching concern for the integrity of the planetary foundations of life.

Eric Ip on Harnessing Legal Structures of Virtue for Planetary Health (Journal of Medical Ethics)

"Harnessing legal structures of virtue for planetary health"
Eric Ip
Journal of Medical Ethics
Published online in March 2023
http://dx.doi.org/10.1136/jme-2022-108759

Abstract: Humans and other species depend on the planet’s well-being to survive and flourish. The health of the planet and its ecosystems is under threat from anthropogenic climate change, pollution and biodiversity loss. The promotion of planetary health against entrenched degradation of nature urgently requires ethical guidance. Using an ecocentric virtue jurisprudence approach, this article argues that the highest end of safeguarding planetary health is to secure the flourishing of the Earth community, of which the flourishing of humanity is but one component. The article demonstrates how law, despite its historic role in facilitating our present planetary crisis, has an untapped potential to redeem itself by promoting planetary flourishing through the creation of conditions conducive to the practice of moral virtues, which can help meet the challenges of the Anthropocene. Once given an ecocentric interpretation, the cardinal virtues of prudence, justice, courage and moderation, as well as their subvirtues, can justify or produce legal structures that address everything from the human right to a healthy environment to the rights of nature.

Ryan Whalen on Continuing Hong Kong’s Health ‘Emergency’ Risks Public Trust (SCMP: Letter)

Letters | "Continuing Hong Kong’s health ‘emergency’ risks public trust"
Whalen Ryan
SCMP
8 February 2023

Introduction: The government is to be commended for reopening Hong Kong, rolling back most pandemic-related restrictions, and welcoming the world to come and visit again. However, there is one major legal omission in our return to normalcy. Hong Kong legally remains in a state of public health emergency. This state of emergency provides the government with a variety of powers under the Prevention and Control of Disease Ordinance (Cap 599).

     Despite our current legal state of emergency, it is clear to most observers that the emergency has passed. This is true whether one takes a layperson’s definition, or that provided in Cap 599.
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New Book edited by Daisy Cheung & Michael Dunn: Advance Directives Across Asia (Cambridge University Press)

Advance Directives Across Asia
Edited by Daisy Cheung & Michael Dunn
Cambridge University Press

Published in February 2023
342 pp.

DOI: https://doi.org/10.1017/9781009152631

Book Description: This book is the first to consider comprehensively and systematically the law and practice of advance directives across Asia. It will thus be important not only as a reference volume that documents how advance directives are regulated and used throughout Asia, but also as an exploration of the concept of the advance directive itself, in context. By examining how advance directives operate in Asian countries, we will also shed light on the principle of personal autonomy in this context, alongside other values and religious and socio-cultural factors that shape health and care decision-making. As such, this book will have broad appeal not only to Asian scholars, students, policymakers and practitioners in the fields of health law and ethics and end-of-life care more generally, but will also be of wider interest to an international academic audience in the fields of law, ethics and health and social care research. This title is also available as open access on Cambridge Core.
Book Review by Alex RK on 25 February 2023: 

It is always a joy when a book not only lives up to what it promises in its title, but goes substantially further. This book is just such a one. Daisy Cheung, Assistant Professor at the Centre for Medical Ethics and Law at the University of Hong Kong, and Michael Dunn, Associate Professor at the Centre for Biomedical Ethics, National University of Singapore, have gathered a wide range of contributors to analyse the very different places of advance directives in end of life decision-making in 14 jurisdictions across Asia.[1] Crucially, they have also done the necessary heavy-lifting behind the scenes and on the page to pull together the threads to pose fascinating and important questions both about advance directives specifically but also about the interaction between international consensuses and localised traditions and expectations.

     Of particular interest, and importance, is that the editors deliberately sought to cast their net widely in terms of defining ‘Asia,’ the book taking in countries as diverse as Israel, Saudi Arabia and the Philippines. This has the huge advantage of making clear that it is just as reductionist to talk about an ‘Asian’ approach to issues around advance directives as it is to talk about a ‘Western’ approach: and one only needs to compare the chapters about Saudi Arabia and Pakistan to understand that it is equally reductionistic to talk about an Islamic approach to such issues. Further, as it is impossible to talk about advance directives without talking about the framework within which they sit, the book also serves as a fascinating tour d’horizon of end of life decision-making more broadly in each of the jurisdictions.

     In the discussion that I did with the editors for my website, they (rightly) squirmed when asked to highlight jurisdictions which they found particularly interesting; they also (and equally rightly) wanted to emphasise that they wanted the book to stand alone, rather than continually to refer back or across to jurisdictions such as England & Wales. So whilst knowing it is perhaps wrong, I cannot help resist highlighting some of the points that particularly struck me in different chapters and some of the reflections that this Anglo-author had in response):The discussion in Ilhak Lee’s chapter on South Korea of the Boromae Hospital case (page 58), in which the Korean Supreme Court found surgeons guilty as accomplices to murder in a case where a wife obtained the discharge of her husband from hospital because she could not continue to pay for his care, [2] the Supreme Court considering that his wife’s decision could not be regarded as an authoritative proxy decision, and that the surgeons had not taken proper measures to prevent an anticipated harm;

     Daniel Fu-Chang Tsai’s discussion (in the chapter on Taiwan, pages 88-89) of the 2019 Taipei Declaration of Advance Care Planning, which expressly recognises that family members and other care givers have needs that should be attended to as part of the patient’s care;

       The observation in Kelly Amal Dhru and Ravindra B Ghooi’s chapter on India (pages 116-120) that the introduction of advance directives in the end of life context has been accompanied by far more controversy than their introduction in the psychiatric context by the Mental Healthcare Act 2017 (in complete contrast, it might be noted, to the situation in jurisdictions such as England & Wales). The same chapter also contains a fascinating discussion of the way in which the courts in India appear to view the family as part of the problem, rather than (potentially) as part of the solution, in decision-making;

      The detailed analysis of what Islamic law requires, or is considered to require in Saudi Arabia (by Z. Abbas Syed, E. Shamshi-Gookshi and A. Parsapoor) and Pakistan (by Mohammed Asim Beg, Erfan Hussain, Noshin Khan, Asma Hamid and Muhammad Atif Waqar), albeit that this is one area where it would have been very interesting had the authors of the respective chapters expressly commented on the interpretations advanced in the other, as this would have been a conversation I would very much liked to have been privy to;

       The relevance of resignation to uncertainty within Filipino culture analysed by L.D. de Castro, R.B. Manaloto, and A.A.L. Lopez (pages 192-5), a cultural phenomenon which it might be thought is more widely spread than just within the Philippines (and the Filipino diaspora), and might well be thought to play at least some part in the universally low uptake of advance decisions in every jurisdiction;

       The (tantalisingly brief) discussion in Bo Chen’s chapter (at pages 240-1) of the role of voluntary guardianship amongst the LGBT community in mainland China as a way in which to seek to secure recognition of the place of a partner within decision-making;

      The emphasis placed in Japan (discussed by Reina Ozei-Hayashi, Futoshi Iwata, Satoshi Kodama and Miho Tanaka, at pages 248-249) on consensus in healthcare decision-making, including the family as part of the consensus group. Whilst this might be thought to sit at odds with the focus on the patient in ‘Western’ systems, one might ask how often decisions to honour advance decisions to refuse treatment are honoured where (at the point that the decision is ‘active’) there is a mismatch between any indications that the patient may be able to give, the view of the family and the view of the medical team.

      What is set out above are but a few of the points at which I found myself reaching for a Post-It note to put on the (curiously shiny) pages of the hardback, but hopefully serve to indicate just how many different directions it would be possible to jump from the springboard of the book’s chapters.

      Structurally, the editors have divided the jurisdictions that are covered into three categories: (1) well-regulated; (2) semi-regulated; and (3) non-regulated. However, as the editors make clear (page 13), “well-regulated” simply means that there is a clear set of rules, rather than that those rules actually work effectively. Miriam Ethel Bentwich (for instance) making a powerful case in relation to Israel (a supposedly “well-regulated” jurisdiction) that “the restrictive nature and supposed strict regulation of Israeli advance directives have actually led to their under-regulation” (page 19). As developed in the final chapter, the differences in approach represent different aspects of “generative accommodation” to “an emerging international consensus in healthcare practice and regulation regarding the value of an AD and its underlying ethical principle of respect for patient autonomy” (page 332). Cheung and Dunn’s view, one which appears amply borne out on the evidence in the preceding pages, is that this a better way to explain the growing place of advance directives in different shapes in the jurisdictions they examine than indigenous development. The concept of generative accommodation, with its requirement for acute sensitivity to local traditions, is a helpful explanatory and descriptive tool for other areas where change is afoot: an obvious one being in relation to the Convention on the Rights of Persons with Disabilities. It is also one which is helpful in prompting reflection as to whether a failure to respond to the asserted consensus in the ‘required’ fashion simply because of wrong-headedness or bias, or is it because the accommodation reached actually represents the ‘right’ result for that particular jurisdiction at that point in time.

      The only, minor, reservation that I have about this book is that, whilst the editors are at pains (page 14) to make clear that they did not seek to encourage their contributors to advance a case that advance directives are ‘a good thing,’[3] the tenor of each of the chapters suggests that the contributors did, in fact, appear to consider this to be the case. It would have been interesting, if only to give shade to the light, to have had a chapter written by a contributor who appeared to have reservations about them, as it is clear that many people, in many of the jurisdictions covered, do indeed have reservations. However, I anticipate that it might well have proven challenging to find contributors with such views to take part in such a project, and even those contributors who are clearly most concerned to advance the cause of advance directives within their own jurisdiction give more than enough material relating to that jurisdiction to enable the reader to gain what appears to be a rounded picture of the position.

     Overall, therefore, this book comes highly recommended, and, as a real bonus, it is open access in its electronic form, thereby making its insights readily available to all.

      [Full disclosure: I was involved in the conference in 2020 from which the book took its genesis; I was also provided with a review copy by the publishers. I am always happy to review books in the fields of mental capacity, mental health and healthcare ethics and law (broadly defined)]

Eric Ip on From the Right to a Healthy Planet to the Planetary Right to Health" (The Lancet: Planetary Health)

"From the right to a healthy planet to the planetary right to health"
Eric C Ip

The Lancet: Planetary Health, Volume 7, Issue 2
Published online in February 2023

Introduction: The rich potential of legal rights in advancing planetary health is no longer untapped. In July, 2022, the UN General Assembly adopted Resolution A/76/L.75, which recognised “the right to a clean, healthy and sustainable environment as a human right”, by a landslide of 161 votes. This historic resolution stands on the shoulders of a long line of UN initiatives, such as the Human Rights Council's Resolution 48/13, which was enacted in October, 2021, and recognised the right to a healthy environment as “important for the enjoyment of human rights”. This occurred 6 months after UN Environment, WHO, and 13 other UN entities issued a statement that described the failure to recognise the right to a healthy environment as detrimental to the attainment of the UN Sustainable Development Goals. Earlier, the Stockholm Declaration on the Human Environment 1972 affirmed that humans have “the fundamental right to freedom, equality and adequate conditions of life, in an environment of a quality that permits a life of dignity and well-being”. Two decades later, the Rio Declaration on Environment and Development 1992 demanded that states “conserve, protect and restore the health and integrity of the Earth's ecosystem”.

Select List of Covid Restriction Offences in Hong Kong (Updated: 24 February 2022)

This blog post aims to help persons in Hong Kong navigate the various Covid-19 restrictions and offences imposed under the law.  Click here for the lists of premises in Hong Kong specified for compulsory testing (Centre for Health Protection). As from 24 February 2022, the Chief Secretary for Administration has a power to grant an exemption in writing from any requirement under any enactment for purposes of preventing, protecting against, delaying or otherwise controlling the incidence or transmission of COVID-19 or treating patients with COVID-19.  Last Updated: 24 February 2022.

A. Complying with Vaccine Pass Direction (Cap 599L) (expiry date)

• A person must not (a) enter or remain on any specified premises unless the person has been vaccinated in the specified manner for the purposes of a vaccine pass direction in relation to the premises; or (b) board or remain on any specified public transport carrier unless the person has been vaccinated in the specified manner for the purposes of a vaccine pass direction in relation to the carrier.  Secretrary's direction.  Maximum punishment: $10,000 fine.  Does not apply to these persons.  Specified medical exemption certificate.  
• The person in charge of any specified premises or specified public transport carrier must comply with any requirement made in a vaccine pass direction in relation to the premises or carrier.  Secretary's direction. Maximum punishment: $50,000 fine and 6 months imprisonment. Defence available. 
• A responsible person for a vulnerable person must use the responsible person's best endeavours to ensure that the vulnerable person complies with section 5(1) (prohibition on entering or remaining on specified premises unless vaccinated, etc).  Maximum punishment: $10,000 fine. Defences available.  

B. Prohibition on Group Gatherings (Cap 599G) (expiry date)

• Group gatherings of more than 2 persons at a public place are prohibited during a specified period (24 February to 9 March 2022).  Offences to participate in gathering, organise the gathering, and to knowingly allow the taking place of the gathering as one who owns, controls or operates the place/premises at which the gathering takes place.  Maximum punishment: $25,000 fine and 6 months imprisonment. Defences available. List of exemptions. Chief Secretary's permission.

C. Prohibition on Multi-Household Gatherings (Cap 599G) (expiry date)

• Multi-household gatherings (i.e. a gathering of persons ordinarily living in more than 2 households) at any private premises are prohibited during a specified period (24 February to 9 March 2022).  Offences to participate in gathering, organise the gathering, and to knowingly allow the taking place of the gathering as one who owns, controls or operates the premises at which the gathering takes place.  Those solely providing care and support to any other participant of the gathering ordinarily living in another household who has particular needs are not counted when counting households.  Maximum punishment: $25,000 fine and 6 months imprisonment. Defences available. Exemptions available. Chief Secretary's permission.

D. Requirements and Directions in Relation to Catering Businesses (Cap 599F)  (expiry date)

• Person responsible for carrying on a catering business contravening requirement to cease selling food or drink or close premises as directed by the Secretary for Food and Health for a specified period (24 February to 9 March 2022).  Secretary's direction.  Does not apply to certain premises.  Maximum punishment: $50,000 fine and 6 months imprisonment.  Defences available. 
• Person responsible for carrying on a catering business contravening requirement to comply with direction issued by the Secretary for Food and Health for a specified period (24 February to 9 March 2022).  Secretary's direction.  Maximum punishment: $50,000 fine and 6 months' imprisonment. Defences available. 
• Person who enters, or is present on, any catering business premises contravening requirement to comply with direction issued by the Secretary for Food and Health for a specified period (24 February to 9 March 2022). Secretary's direction. Maximum punishment: $10,000 fine. Defences available. 

E. Directions in Relation to Scheduled Premises and Specified Events (Cap 599F)  (expiry date)

• Manager of any scheduled premises (other than event premises), or the organizer of a specified event held on event premises, contravening requirement to comply with a direction issued by the Secretary for Food and Health for a specified period (24 February to 9 March 2022).  Secretary's direction. Maximum punishment: $50,000 fine and 6 months imprisonment.  List of scheduled premises.  Defences available. 
• Person who enters, or is present on, any scheduled premises contravening requirement to comply with direction issued by the Secretary for Food and Health for a specified period (24 February to 9 March 2022). Secretary's direction.  List of scheduled premises.  Maximum punishment: $10,000 fine.  Defences available. 

F. Wearing of Mask (Cap 599I) (expiry date)

• On public transport carrier/MTR paid area. Person contravening requirement to wear a mask at all times, during a specified period (24 February to 9 March 2022), when the person is (a) boarding or on board a public transport carrier; or (b) entering or present in an MTR paid area.  Exceptions and defences.  Maximum punishment: $10,000 fine. 
• In a specified public place. Person contravening requirement to wear a mask at all times, during a specified period (24 February to 9 March 2022), when the person is entering or present in a specified public place.  Exceptions and defences.  Maximum punishment: $10,000 fine.

G. Compulsory Testing for Certain Persons (Cap 599J) (expiry date)

• A person who fails to comply with a requirement under a compulsory testing direction commits an offence.  Maximum punishment: $10,000 fine. Power of specified medical practitioner to issue written direction requiring a person to undergo a specified test.  Defences available.
• A specified person who fails to comply with a requirement under a compulsory testing notice commits an offence.  Maximum punishment: $10,000 fine. Latest testing notices.  Power of Secretary to issue testing notices.  Defences available.
• A person who fails to comply with a requirement under a compulsory testing order commits an offence.  Maximum punishment: $25,000 fine and 6 months imprisonment.  Power of prescribed officer to order testing for non-compliance with testing direction or notice. Defences available.

H. Premises Subject to Restriction-Testing Declaration (Cap 599J) (expiry date)

• A restricted person leaving any restricted premises commits an offence.  Maximum punishment: $25,000 fine and 6 months imprisonment. Power of Secretary to make restriction-testing declaration.  Prohibition does not apply in certain circumstances.
• A person, other than a prescribed officer or person specified under section 19M(3), entering any restricted premises commits an offence. Maximum punishment: $25,000 fine and 6 months imprisonment.  Power of Secretary to make restriction-testing declaration.  Prohibition does not apply in certain circumstances.

I. Restrictions During Quarantine (Cap 559C) (expiry date)

• A person must not leave the place of quarantine in which the person is placed under quarantine without permission given by an authorized officer. A person who, without reasonable excuse, contravenes this prohibition commits an offence. Maximum punishment: $25,000 fine and 6 months imprisonment. Compulsory quarantine of certain persons arriving at Hong Kong. 
• A person must not, without permission given by an authorized officer, knowingly enter an assigned place of quarantine in which another person is placed under quarantine unless (a) the person is an authorized officer or a health officer; or (b) the person is to be placed under quarantine in the place.  A person who, without reasonable excuse, contravenes this prohibition commits an offence. Maximum punishment: $25,000 fine and 6 months imprisonment. Compulsory quarantine of certain persons arriving at Hong Kong.  Written permission of an authorized officer.
• A person against whom a quarantine order is made must not contravene the terms of quarantine specified in the order. A person who, without reasonable excuse, contravenes this prohibition commits an offence. Maximum punishment: $25,000 fine and 6 months imprisonment. 

Annual Review of Hong Kong Health Law (CMEL Zoom Event)

Annual Review of Hong Kong Health Law in 2021 

23 February 2022 (Wednesday)
6:30 pm – 8:00 pm (Hong Kong Time)
Live Zoom Session

This workshop provides an analysis of important regulatory and case law developments that relate to health and healthcare in Hong Kong in 2021. The coverage is not intended to be comprehensive, but the intent is to promote professional deliberation and discussion on developments that are likely to be far-reaching. Accordingly, the aims (all pertaining to the jurisdiction of Hong Kong) are as follows: (1) review selected decisions of the Inquiry Panel of the Medical Council of Hong Kong; (2) review the state of the law on gross negligence manslaughter as applicable to medical practitioners and draw the attention of the audience to the new regime introduced by the Private Healthcare Facilities Ordinance (Cap. 633); (3) review the state of the law on medical negligence; (4) provide an update on alternative dispute resolution in healthcare from a legal and regulatory perspective; and (5) provide an analysis of regulatory developments that pertain to digital health. 

Programme, Abstracts & Biographies: click here

Chairs
Calvin HO
Associate Professor of Law & Co-Director of the Centre for Medical Ethics and Law, The University of Hong Kong

Philip BEH
Principal Clinical Practitioner of the Department of Pathology & Co-Director of the Centre for Medical Ethics and Law, The University of Hong Kong

Presentations & Speakers
David KAN
Partner at Howse Williams & Solicitor Advocate
Title: Recent MCHK Inquiry Judgment

Jane OR
Centre Manager of the Centre for Medical Ethics and Law, The University of Hong Kong
Title: Updates on Medical Negligence and Gross Negligence Manslaughter

Albert LEE
Clinical Professor of Public Health and Primary Care and Founding Director of Centre for Health Education and Health Promotion, The Chinese University of Hong Kong & Honorary Professor, Department of Rehabilitation Science, Hong Kong Polytechnic University
Title: Alternative Dispute Resolution for Medical Mishaps: Role of Arbitration

Calvin HO
Associate Professor of Law & Co-Director of the Centre for Medical Ethics and Law, The University of Hong Kong
Title: Recent Advances in Data Governance and Healthcare Digitalisation

Prior registration is required.

For CME/CPD Accreditation, registration and other details, please visit https://www.cmel.hku.hk/events-detail.php?id=87.

This event is free of charge.

All are welcome!

Calvin Ho & Karel Caals on The International Pandemic Preparedness Treaty and An Emerging Digital Divide (Asia Global Online)

“The International Pandemic Preparedness Treaty and An Emerging Digital Divide”
Dr Calvin Ho & Karel Caals
Asia Global Online
5 January 2022 

Introduction: The persistent Covid-19 pandemic has uncovered various inequities, from access to crucial supplies and income inequality to the digital divide. As the World Health Organization begins work on a new international treaty on pandemic preparedness and response, Calvin Ho Wai Loon of The University of Hong Kong and Karel Caals of the National University of Singapore examine digital inequalities that have arisen from different health systems, arguing that pandemic preparedness should include a range of digital health capabilities with a view to minimizing the digital divide. ... Click here to read the full text. 

Calvin Ho et al on GA4GH: International Policies and Standards for Data Sharing across Genomic Research and Healthcare (Cell Genomics)

"GA4GH: International policies and standards for data sharing across genomic research and healthcare"

Heidi L. Rehm, Angela J.H. Page, Lindsay Smith, Jeremy B. Adams, Gil Alterovitz, Lawrence, J. Babb, Maxmillian P. Barkley, Michael Baudis, Michael J.S. Beauvais, Tim Beck, Jacques, S. Beckmann, Sergi Beltran, David Bernick, Alexander Bernier, James K. Bonfield, Tiffany F. Boughtwood, Guillaume Bourque, Sarion R. Bowers, Anthony J. Brookes, Michael Brudno, Matthew H. Brush, David Bujold, Tony Burdett, Orion J. Buske, Moran N. Cabili, Daniel L. Cameron, Robert J. Carroll, Esmeralda Casas-Silva, Debyani Chakravarty, Bimal P. Chaudhari, Shu Hui Chen,  J Michael Cherry, Justina Chung, Melissa Cline. Hayley L. Clissold, Robert M. Cook-Deegan, Mélanie Courtot, Fiona Cunningham, Miro Cupak, Robert M. Davies, Danielle Denisko, Megan J.Doerr, Lena I. Dolman, Edward S. Dove, L. Jonathan Dursi, Stephanie O.M. Dyke, James A. Eddy, Karen Eilbeck, Kyle P. Ellrott, Susan Fairley, Khalid A. Fakhro, Helen V. Firth, Michael S. Fitzsimons, Marc Fiume, Paul Flicek, Ian M.Fore, Mallory A.F reeberg, Robert R.Freimuth, Lauren A.Fromont, JonathanFuerth, Clara L.Gaff, Weiniu Gan, Elena M. Ghanaim, David Glazer, Robert C. Green, Malachi Griffith, Obi L.Griffith, Robert L. Grossman, Tudor Groza, Jaime M.Guidry Auvil, Roderic Guigó, Dipayan Gupta, Melissa A. Haendel, Ada Hamosh, David P .Hansen, Reece K.Hart, Dean Mitchell Hartley, David Haussler, Rachele M. Hendricks-Sturrup, Calvin W.L.Ho, Ashley E.Hobb, Michael M. Hoffmanm, Oliver M.Hofmann, PetrHolub, Jacob ShujuiHsu, Jean-Pierre Hubaux, Sarah E.Hunt, Ammar Husami, Julius O.J acobsen, Saumya S. Jamuar, Elizabeth L. Janes, Francis Jeanson, Aina Jeném Amber L. Johns, Yann Joly, Steven J.M. Jones, Alexander Kanitz, Kazuto Kato, Thomas M.Keane, Kristina Kekesi-Lafrance, Jerome Kelleher, Giselle Kerry, Seik-SoonKhor, Bartha M. Knoppers, Melissa A. Konopko, Kenjiro Kosaki, Martin Kuba, Jonathan Lawson, Rasko Leinonen, Stephanie Li, Michael F. Lin, Mikael Linden, Xianglin Liu, Isuru Udara Liyanage, Javier Lopez, Anneke M. Lucassen, Michael Lukowski, Alice L.Mann, John Marshall, Michele Mattioni, Alejandro Metke-Jimenez, Anna Middleton, Richard J. Milne, Fruzsina Molnár-Gábor, Nicola Mulder, Monica C.Munoz-Torres, RishiNag, Hidewaki Nakagawa, Jamal Nasir, Arcadi Navarro, Tristan H. Nelson, Ania Niewielska, Amy Nisselle, Jeffrey Niu, Tommi H.Nyrönen, Brian D. O’Connor, Sabine Oesterle, Soichi Ogishima, VivianOta Wang, Laura A.D.Paglione, Emilio Palumbo, Helen E. Parkinson, Anthony A. Philippakis, Angel D.Pizarro, Andreas Prlic, Jordi Rambla, Augusto Rendon, Renee A.Rider, Peter N.Robinson, Kurt W.Rodarmer, Laura Lyman Rodriguez, Alan F.Rubin, Manuel Rueda, Gregory A.Rushton, Rosalyn S.Ryan, Gary I. Saunders, Helen Schuilenburg, Torsten Schwede, Serena Scollen, Alexander Senf, Nathan C.Sheffield, Neerjah Skantharajah, Albert V. Smith, Heidi J. Sofia, Dylan Spalding, Amanda B.Spurdle, Zornitza Stark, Lincoln D.Stein, Makoto Suematsu, Patrick Tan, Jonathan A. Tedds, Alastair A. Thomson, Adrian Thorogood, Timothy L.Tickle1 Katsushi Tokunaga, Juha Törnroos, David Torrents, Sean Upchurch, Alfonso Valencia, Roman Valls Guimera ,Jessica Vamathevan, Susheel Varma, Danya F. Vears, Coby Viner, Craig Voisin, Alex H. Wagner, Susan E. Wallace, Brian P.Walsh, Marc S.Williams, Eva C.Winkler, Barbara J.Wold, Grant M. Wood, J. Patrick Woolley, Chisato Yamasaki, Andrew D.Yates, Christina K.Yung, Lyndon J.Zass, Ksenia Zaytseva, Junjun Zhang, Peter Goodhand, Kathryn North1, Ewan Birney

Cell Genomics
Published in Nov 2021

Summary: The Global Alliance for Genomics and Health (GA4GH) aims to accelerate biomedical advances by enabling the responsible sharing of clinical and genomic data through both harmonized data aggregation and federated approaches. The decreasing cost of genomic sequencing (along with other genome-wide molecular assays) and increasing evidence of its clinical utility will soon drive the generation of sequence data from tens of millions of humans, with increasing levels of diversity. In this perspective, we present the GA4GH strategies for addressing the major challenges of this data revolution. We describe the GA4GH organization, which is fueled by the development efforts of eight Work Streams and informed by the needs of 24 Driver Projects and other key stakeholders. We present the GA4GH suite of secure, interoperable technical standards and policy frameworks and review the current status of standards, their relevance to key domains of research and clinical care, and future plans of GA4GH. Broad international participation in building, adopting, and deploying GA4GH standards and frameworks will catalyze an unprecedented effort in data sharing that will be critical to advancing genomic medicine and ensuring that all populations can access its benefits.

"Disunity of Purpose" (Calvin Ho Profiled in HKU Bulletin)

"Disunity of Purpose"
Calvin Ho
HKU Bulletin
Published in November 2021
Governance and laws relating to human, animal and ecological health are divided across the world, making it difficult to coordinate responses to emerging health threats. Dr Calvin Ho has been analysing the problem.

     In 2007, the Indonesian government announced it would stop sending samples of the H5N1 avian influenza virus detected in its country to the World Health Organization’s (WHO) reference laboratories. Its worry was that these samples, provided freely, would be used by pharmaceutical companies to develop vaccines the country could not afford. The situation prompted the establishment of a new international framework for data and pathogen sharing – but only for H5N1 and other influenza viruses with human pandemic potential.

     Despite other circulating threats to human health, such as antimicrobial resistance (AMR) and emerging zoonotic diseases like the Middle East Respiratory Syndrome (MERS) coronavirus, there is as yet no comprehensive international framework for sharing biological materials and related data to address these concerns. Even the COVID-19 global pandemic has yet to motivate any change.

     Dr Calvin Ho of the Faculty of Law, and Co-Director of the Centre for Medical Ethics and Law, has been looking at ethical and legal means to facilitate data and pathogen sharing for AMR and One Health research, and the development of appropriate countermeasures. 

     AMR, which arises mainly from misuse and overuse of antibiotics and other antimicrobials, is a major concern because drug-resistant pathogens circulate among humans, animals and the environment and are projected to lead to 10 million additional deaths each year globally by 2050. Its growing threat prompted the WHO to endorse the One Health concept in 2010 and recognise that protecting and promoting human health is closely interconnected to animal and environmental health. …Click here to read the full text. 

Eric Ip on Courts, Proportionality and COVID-19 Lockdowns (IACL-AIDC Blog)

"Courts, Proportionality and COVID-19 Lockdowns" 

Eric Ip

IACL-AIDC Blog
September 23, 2021

The COVID-19 pandemic and domestic legal responses to it have inflicted widespread suffering across the globe. States, democratic and authoritarian, most of them signatories of international human rights instruments, including the International Covenant on Civil and Political Rights (ICCPR), the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the United Nations Convention on the Rights of Persons with Disabilities (CRPD), have imposed drastic emergency responses that include quarantines of entire towns, cities, provinces, even nations unprecedented in the modern era.

    Mass quarantine, called ‘lockdown’, can be said to be an invention of the Chinese authorities who shut down transport systems in Wuhan, the first known epicentre of the COVID-19 outbreak, in January 2020. Though differing from state to state, such measures generally feature significant restrictions on citizens’ personal liberty, freedom of movement, work, family life, education, and ironically even health due to the delay in treating other diseases. Displacing individuals, families, and social networks may very well prove, in retrospect, to have caused a devastating public mental health crisis. The economic slump, mass unemployment, domestic violence, and other repercussions that ensued on lockdowns that disproportionately hit the less well-off may ramify in more long-run health issues and early deaths than the pandemic itself.

     It has become commonplace in public debate that a public health emergency is a legitimate justification for suspending fundamental rights and freedoms at all costs. In fact, to adopt an ‘all-or-nothing’ approach to combat a public health emergency using non-pharmaceutical Interventions is incompatible with most international human rights treaties, especially the ICCPR. Article 4 of the ICCPR explicitly forbids such restrictions, even during a ‘public emergency which threatens the life of the nation’, if it should involve ‘discrimination solely on the ground of race, colour, sex, language, religion or social origin’; or derogations from the right to life, freedom of thought, conscience and religion; or from the prohibition of torture, cruel, inhuman or degrading punishment, medical or scientific experimentation without consent, slavery, slave-trade, servitude, imprisonment due to inability to fulfil a contractual obligation; or from recognition of everyone as a person before the law and the principles of legality in criminal law. What is more, the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, approved in 1984 by the United Nations’ Commission on Human Rights, states that the ‘severity, duration, and geographic scope’ of any emergency response that derogates from the rights guaranteed by the ICCPR must be ‘strictly necessary’ and ‘proportionate’ to the threat defended-against... Click here to read the full post.

Eric Ip on The Political Determinants of China’s New Health Constitution (Medical Law Review)

"The Political Determinants of China’s New Health Constitution"

Eric Ip
Medical Law Review
Published on 13 March 2021

Abstract: The Basic Healthcare and Health Promotion Law 2019 became the new constitution of China’s health system in June 2020, giving legal effect to ambitious health reform programmes like Healthy China 2030. The concurrent outbreak of coronavirus disease 2019 must not distract us from appreciating the fact that this Law will comprehensively overhaul the health regulatory framework of the world’s most populous country during the coming decade, if not beyond. This article offers an original evaluation of the Law in its political context. The Law commendably promises to safeguard the right to health, assist citizens to live a ‘complete cycle of life’, and promote health using the resources of the public health system. However, it is also deeply politicised, guaranteeing extensive and penetrative political control in health campaigns, digitalised health data, the governance of health institutions, and the resolution of medical disputes. This can be explained by the consequential roles played by epidemics in China’s historical dynastic cycles, but even more so by powerful tendencies of centralisation on the part of the Leninist Party-state. The Law’s potential is thus subject to the overriding caveat that the Party-state’s existence and influence over law and public health must be secured.

Cedric Tang (PCLL 2021, JD 2020) on Liability for Dispensing Errors in Hong Kong (Asian Bioethics Review)

"Liability for Dispensing Errors in Hong Kong"

Cedric Tang (PCLL 2021, JD 2020)

Asian Bioethics Review

Published on 28 May 2021

Abstract: The United Kingdom (UK) case R v Lee (2010) EWCA Crim 1404 resulted in a pharmacist being convicted for an inadvertent dispensing error and paved way for the decriminalisation of such errors by way of a due diligence defence enacted in 2018. In relation to Hong Kong (HK), what is its legal position for dispensing errors, and can it follow the decriminalising steps of UK? The primary objective of this paper is to explore whether and how HK can reach the normative position for a dispensing error legal regime: (1) I posit that the normative position for healthcare professional (HCP) liability for dispensing errors should prioritise the public interest of minimisation of future dispensing errors over the retribution of past wrongs; (2) I illustrate HK’s current position for the liabilities of HCPs on dispensing errors, focusing analysis on the relatively controversial aspects of HK’s criminal liability, referencing the landmark cases Hin Lin Yee v HKSAR (2009) 13 HKCFAR 142 and Kulemesin v HKSAR (2013) 16 HKCFAR 195 to assist my analysis of the requisite mental element for relevant statutory offences; (3) through comparison with UK’s development post-R v Lee and application of Rule of Law principles, HK’s current position is critiqued, coming to the conclusion that while there are compelling reasons for the decriminalisation of dispensing errors in HK, the prerequisite for this to happen is an overhaul of regulatory frameworks by significantly increasing levels of accountability.

Eric Ip & S.F. Lee on The Constitutional Determinants of Planetary Health (The Lancet Planetary Health)

"The Constitutional Determinants of Planetary Health"
Eric Ip & S.F. Lee
The Lancet Planetary Health, Volume 5, Issue 6
Published in June 2021

Abstract: We need to understand the constitutional determinants of planetary health. We define the constitutional determinants of planetary health as the constitutional structures within which human impacts on the Earth's natural systems affect human health. Supported by more rigorous evidence in relation to the effects of constitutional determinants of planetary health, we might be able to generate concrete advice on how constitutional institutions that are not conducive to planetary health can be suppressed, and how those that are favourable to planetary health can be reinforced.

Calvin Ho et al on Immunity Certification for COVID-19: Ethical Considerations (Bulletin of the WHO)

"Immunity certification for COVID-19: ethical considerations"
By Teck Chuan Voo, Andreas A Reis, Beatriz Thomé, Calvin WL Ho, Clarence C Tam, Cassandra Kelly-Cirino, Ezekiel Emanuel, Juan P Beca, Katherine Littler, Maxwell J Smith, Michael Parker, Nancy Kass, Nina Gobat, Ruipeng Lei, Ross Upshur, Samia Hurst & Sody Munsaka
Bulletin of the World Health Organization (2021) 99(2): 155–161.

Abstract: Restrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonly called an immunity passport. This document certifies them as having protective immunity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus that causes COVID-19. The World Health Organization has advised against the implementation of immunity certification at present because of uncertainty about whether long-term immunity truly exists for those who have recovered from COVID-19 and concerns over the reliability of the proposed serological test method for determining immunity. Immunity certification can only be considered if scientific thresholds for assuring immunity are met, whether based on antibodies or other criteria. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process. We examine the main considerations for the ethical acceptability of immunity certification to exempt individuals from restrictive measures during the COVID-19 pandemic. As well as needing to meet robust scientific criteria, the ethical acceptability of immunity certification depends on its uses and policy objectives and the measures in place to reduce potential harms, and prevent disproportionate burdens on non-certified individuals and violation of individual liberties and rights.

Daisy Cheung & Eric Ip on COVID-19 Lockdowns: a Public Mental Health Ethics Perspective (Asian Bioethics Review)

"COVID-19 Lockdowns: a Public Mental Health Ethics Perspective"

Daisy Cheung & Eric Ip

Asian Bioethics Review
Published in August 2020

Abstract: States all over the world have reacted to COVID-19 with quarantines of entire cities, provinces, and even nations. Previous studies and preliminary evidence from current lockdowns suggest that emergency measures protecting the public’s physical health by dislocating individuals, families, and social networks could well be causing a devastating public health crisis of mental ill-health in the months and years to come. This article is the first to take a public mental health ethics perspective in examining these lockdowns, the lodestar of which is the right to mental health, rooted in the concept of human dignity. Even the strictest lockdowns are not necessarily unethical but are prone to damage mental health disproportionately, with vulnerable and disadvantaged populations being at particular risk.  Click here to read the full article.

Stephen Thomson & Eric Ip on COVID-19 Emergency Measures Hurting Democracy Globally (American J of Public Health)

"COVID-19 Emergency Measures Are Hurting Democracy Globally"

Stephen Thomson & Eric Ip

American Journal of Public Health

Issue 110, Volume 9, p 1356

Published online in August 2020

Abstract: As necessary as effective COVID-19 emergency measures are, governments around the world must never lose sight of the need that a proportionate balance ought to be struck between population health goals on the one hand, and “the fundamental rights and freedoms that are the lifeblood of transparent, accountable, and democratic government”, on the other.

Eric Ip & SF Lee on Preparing for the Coming Transnational Cancer Crisis Amid the COVID-19 Pandemic (Cancer Causes & Control)

"Preparing for the coming transnational cancer crisis amid the COVID-19 pandemic"

Eric Ip & Shing Fung Lee 

Cancer Causes & Control

Published in May 2020

https://doi.org/10.1007/s10552-020-01310-3

Abstract: The continuing outbreak of the coronavirus disease 2019 (COVID-19) caused by the novel coronavirus SARS-CoV-2 has inflicted considerable burdens onto the health system of China, the world's most populous country. Remarkably, among spectrum of potential mitigation strategies, the Chinese government has implemented all-out lockdowns on large geographical areas, unprecedented in the modern era. This inevitably undermined the right to healthcare of many who now faced great difficulty in getting treatment, especially those with cancer or other life-threatening issues. We elaborate and discuss the medico-legal and human rights consideration triggered by the lockdowns, the unprecedented mass quarantine of Hubei province in China, and the suspension of normal healthcare services. We argue that the same challenge will now be faced by other countries, particularly the USA, Italy, Spain, and France, as the epicentres of COVID-19 has shifted to Europe and the Americas.

     It has been estimated that by 2020, China will have over 4.5 million cancer patients and in consequence some 3 million cancer deaths [1]. That number may surge in consequence of the 2019 coronavirus (COVID-19) outbreak, which has been declared a public health emergency of international concern and then a global pandemic by the WHO, as cancer patients have been found to suffer poorer outcomes from COVID-19 than those without cancer [2]. Alarmingly, Wuhan, the epicentre of the pandemic, has exhibited mass neglect of treatment of all other patients not infected with COVID-19, including those suffering from cancer. The shortage of medical care for these patients stems from the all-out campaign of the Chinese health authorities to contain COVID-19 with drastic lockdown measures at significant social and economic cost. The suspension of care occurs in spite of the mobilization of extra equipment and manpower to Hubei province and its capital Wuhan, and building of makeshift healthcare camps to monitor and care for the 67,794 (as at 15 March 2020) confirmed cases infected with coronavirus, and others suspected to have been infected [3].

     The problematic consequences of China’s COVID-19 strategy, which has been adopted to varying degrees by many countries, upon the broader healthcare system are beginning to emerge. Many hospitals in Hubei have been designated for and converted to the exclusive care of COVID-19 patients, with previous treatment plans for other patients being postponed or suspended. Additionally, due to fears of COVID-19 cross-infection, hospital wards have not been permitted to admit cancer patients and operating theatres have had to be closed. Chemotherapy has been suspended indefinitely. Clinical trials have been similarly affected: participants have been unable to return for follow-up; data collection are no longer timely; many protocols have been violated. Notwithstanding effective measures coping with the needs of cancer patients during the pandemic reportedly adopted by a hospital in Beijing, the nation’s capital [5], there is much evidence pointing to a systemic coming crisis in cancer treatment in the world’s most populous country, whose magnitude cannot be easily quantified.

     People in China with other diseases, even life-threatening ones, are struggling to even get diagnosed, let alone treated. The exclusive public health focus on COVID-19 at the expense of even special classes of patients implies that the health system in Hubei, if not elsewhere, is in all likelihood being strained to the breaking point in delivering the usual care while coping with the pandemic, and will remain so for quite some time. Delays in the delivery of oncological care could yield long-lasting, devastating effects at both individual and population levels. Lessons may be learned from the recent history of the Chinese special administrative region of Hong Kong. The former British dependency was one of the jurisdictions most heavily afflicted by the severe acute respiratory syndrome (SARS) outbreak of 2003, suffering almost 40% of the global death toll [5]. The Hong Kong Cancer Registry recorded a dip in crude cancer incidence to 20,763 during 2003 (the only year to break the uptrend) and a significant rebound the next year [6]. It may have been that the anxiety prevailing in the general public about seeking medical attention caused delayed diagnosis, or the administrative burdens inflicted by the epidemic hampered normal registration processes and then the non-registered cases were carried over to the next year. Note that this happened even though no radical cuts were made to cancer treatment in Hong Kong, as there have been in Hubei this time. When resources become as heavily skewed toward COVID-19 patients as they have in Hubei and elsewhere, the cancer patients currently ignored will face delays in diagnosis and treatment, which will adversely affect oncological outcomes. This very same challenge to healthcare service will be faced by other countries heavily afflicted by the virus such as USA, Italy, Spain, and France as the epicentres of COVID-19 has now shifted to Europe and the Americas.

     The Chinese government, as with governments elsewhere, should therefore take steps to prepare for a massive resurgence of cancer patients hitting the healthcare system once the COVID-19 pandemic has been contained. It is understandable that the authorities are under pressure to accord top priority to this containment, especially given the media furore and public anxiety. But it is both ethically and pragmatically dubious that this should be done to the detriment of all other patients. Considerations of justice and of equable resource allocation must not be neglected in national preparedness for cancer incidence [7]. The urgency to reassign priorities so as to give due weight to the needs of cancer patients and ontological research is acute even from a law and policy perspective. China’s landmark Basic Healthcare and Health Promotion Law, which codifies a decade of healthcare reforms and is set to enter into force on 1 June 2020, will for the first time guarantee to the Chinese people a positive “right to health”, which will in turn obligate the State to enhance citizens’ ability to live a “full life cycle” (Article 4), echoing the promises of Article 12 of the International Covenant on Economic, Social and Cultural Rights, signed and ratified by most countries of the world.