Eric Ip and Trevor Wan et al on Harnessing the power of constitutional rights and legal frameworks to scale up public mental health implementation (The Lancet Psychiatry)

"Harnessing the power of constitutional rights and legal frameworks to scale up public mental health implementation"
Michael Ni, Candi Leung, Trevor Wan, Jonathan Campion, Neeraj Gill, Sandro Galea, Eric Ip
The Lancet Psychiatry
Published online: February 2026

Summary: Despite the existence of effective public mental health interventions, global coverage remains low. Only a minority of people with mental disorders receive treatment, far fewer receive interventions to address or prevent the associated impacts of mental disorders, and there is negligible coverage of interventions to prevent mental disorders or promote mental wellbeing and resilience. This implementation failure breaches the right to health and statutory legislation in some countries and results in population-scale preventable suffering, broad societal and individual impacts, and associated economic costs. Various reasons account for public mental health implementation failure, including insufficient policy and implementation according to population needs, and insufficient knowledge, resource, political will, and legal protection regarding the right to mental health. This Health Policy highlights a further reason for implementation failure is that only 12% of constitutions covering 3·5% of the world's population explicitly recognise a constitutional right to mental health, compared with 70% of constitutions recognising a constitutional right to health or physical health. A legal framework that includes explicit constitutional protection for mental health would mean the right to mental health would supersede all other laws. This would thereby provide a basis for legislation and support legal opportunities to challenge, advocate, and improve effective public mental health implementation by different sectors. This framework and associated opportunities would support the scale-up of implementation of cross-sector policy based on the public mental health needs of a population. Such a holistic, coordinated legal approach would support scaled-up coverage of public mental health interventions to treat and prevent mental disorders and promote mental wellbeing and resilience, as well as action to address inequities and protect the rights of those with mental disorders. Improved implementation would result in broad impacts across different sectors and associated economic benefits.

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.

Kelvin Kwok, Eric Ip and Shing Fung Lee on The Conundrums of the Reasonable Patient Standard in English Medical Law (BMC Medical Ethics)

"The conundrums of the reasonable patient standard in English medical law"
Kelvin Hiu Fai Kwok, Eric C. Ip & Shing Fung Lee
BMC Medical Ethics
Published on 23 February 2023
Abstract:

Background

In its 2015 decision in Montgomery v. Lanarkshire Health Board, the Supreme Court of the United Kingdom overruled the long-standing, paternalistic prudent doctor standard of care in favour of a new reasonable patient standard which obligates doctors to make their patients aware of all material risks of the recommended treatment and of any reasonable alternative treatment. This landmark judgment has been of interest to the rest of the common law world. A judicial trend of invoking Montgomery to impose more stringent requirements on doctors is discernible in subsequent decisions since then.

Main body

In this narrative review, without questioning the idea that properly informed patients should play a more active role in procedures affecting their own health in furtherance of their autonomy, safety, and consumer rights, we identify and analyse, with the aid of realistic clinical thought experiments, three practical conundrums that the Montgomery standard may inflict on the daily work of doctors, unfairly exposing them to arbitrary legal risks.

Conclusions

These conundrums pertain to the ascertainment of the risks that must be disclosed to the patient under the test of ‘materiality’; the legal uncertainty as to the scope of the exceptions; and the actual ability of doctors to cope with the pressures of time. These conundrums offer ripe opportunities to rethink the proper role of judicially developed medical law in modern health care practice.

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)]

Minsung Kim on Governance of Genetic Scissors CRISPR-Cas9 for Research on Embryos and Researchers' Responsibility (Korean Society of Law and Medicine)

"A Study on How Governance of Genetic Scissors CRISPR-Cas9 for Research on Embryos Can Encourage a Researcher to Have a Sense of Responsibility: Focus on the Bioethics and Safety Act Article 47"
Minsung Kim
The Korean Society of Law and Medicine
2022

Abstract: CRISPR-Cas9 is one of the gene-editing technologies that infinite potential. It may provide human beings with many benefits or cause unanticipated challenges. The governance as standards setting or regulation of gene-editing technologies can contribute to keeping a balance between scientific value and ethical commitments. Guaranteeing public participation provides an additional opportunity to think about ethical and moral considerations: For whose benefit the internationally discussed governance of gene-editing technologies is directed at? There is a doubt regarding whether the governance justifies scientific researchers’ gene-editing research. Suppose that governance promotes the advancement of CRISPR-Cas9, it should also encourage greater research responsibility. If not, there may be tragedies brought about by the misconduct of researchers. Thus, the essential matter on the governance for the research of CRISPR-Cas9 is the researchers’ responsibility. 

Calvin Ho on Taking an Ethics+ Approach to Conceptualising Laws in Research Governance (new book chapter)

"Breathing Life into Law: What it means to take an Ethics+ Approach to Conceptualising Laws in Research Governance"

Calvin Ho

in E. Dove & N. Nic Shuibhne (Eds.), Law and Legacy in Medical Jurisprudence: Essays in Honour of Graeme Laurie (Cambridge: Cambridge University Press), pp. 149-166

Published online on 23 December 2021

Summary: The lived experience of law in medical practice and research is typified by intricate, sometimes complex and often mundane (perhaps even ritualistic) procedural requirements. While some scholars have been content thus to limit the normativity of law, Graeme reminds us that law is interconnected with ethics and that its distinctiveness may be better understood as process, particularly in boundary or liminal spaces where the roles of ethics and law are blurred. This processual conception of law is in turn a component of governance regimes that he depicts as ‘Ethics+’. He argues that ethics is always a necessary component of a robust and defensible regime of health research that is rooted in the core values and principles at stake while concurrently enabling adaptation and accommodation. Law as an ‘Ethics+’ governance regime embraces uncertainty and the liminal nature of the health research journey, while admitting value-based objectives that can act as foci for stakeholders. The chapter shows the bright beacon dimension of Graeme’s legacy, which points the way to a rich, non-formalistic account of law – not simply as law in action or law on the books but as law subsisting in-between.

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.

Eric Ip on The Virtuous Epidemiologist (Journal of Public Health)

"The virtuous epidemiologist"
Eric Ip

Journal of Public Health

Published online: 5 November 2018

Abstract: This article addresses the scholarly gap in the ethics of epidemiology by exploring what virtue ethics, one of the oldest ethical traditions in moral philosophy, has to say about ‘the virtuous epidemiologist’. It expounds comparatively the content and merits of a virtue ethics approach against more popular contemporary schools of thought such as consequentialism and deontology. Without necessarily dismissing the value of principles and standards, it presents a vision that a virtuous epidemiologist should cultivate wisdom in making prudential judgments in conditions of uncertainty; fortitude in dealing with powerful politicians and administrators which does not sacrifice truth; temperance and self-restraint in keeping one’s ideological views from compromising one’s scientific credibility; and justice in giving due weight to individual rights and the public interest when doing research and giving advice on public health interventions.  Click here to read the full article.

HKU Law Welcomes Biomedical Legal Scholar, Dr Calvin Ho

Welcome to Dr Calvin Ho who joins the Department of Law as Associate Professor, working closely with HKU's Centre for Medical Ethics and Law (CMEL).  Dr Ho will contribute to the Faculty of Law's interdisciplinary research with his expertise in Biomedical Law & Ethics, Regulatory Governance, Artificial Intelligence & Data Science and Comparative Law.  He will also teach the course entitled 'The Regulation of Biomedical Research' (LLW6250).

    Dr Ho holds a doctorate in juridical science from Cornell University, and was also trained in law at the National University of Singapore (NUS) and the University of Cambridge. In addition, he read sociology and economics at the London School of Economics and Political Science, and at the School of Oriental and African Studies (University of London). Dr Ho is qualified as Advocate & Solicitor of the Supreme Court of Singapore, and as Solicitor of the Senior Courts of England and Wales. He has practiced law in London and Singapore with Messrs Linklaters Allen & Gledhill, and has served as a medicolegal expert advisor to the Medical Protection Society (MPS). Dr Ho is currently an Ethics Board member of Médecins Sans Frontières (Doctors Without Borders), Co-Head of the Accountability Policy Task Team of the Global Alliance for Genomics & Health; and a research affiliate with the Ethox Centre, University of Oxford. 

     Prior to joining HKU, Dr Ho was Assistant Professor at the Centre for Biomedical Ethics at the Yong Loo Lin School of Medicine, NUS; Co-Head of the WHO Collaborating Centre on Bioethics in Singapore; and Editor-in-Chief of the Asian Bioethics Review. Additionally, he has served as a statutory board member of the Singapore Nursing Board, the Legal Aid Bureau of the Ministry of Law of Singapore, as well as on national advisory committees on transplantation and on genetic testing of the Ministry of Health of Singapore.

     Dr Ho's research focuses on the explication of the normative (i.e. legal and ethical) and social implications of health and biotechnologies, as well as the responses to these concerns through policy and regulatory governance. His research also includes medical law and ethics, and the normative aspects of health systems (especially on health insurance and access to health) and global health.

Eric Ip on Anorexia Nervosa, Advance Directives and the Law (Bioethics)

"Anorexia Nervosa, Advance Directives, and the Law: A British Perspective"

Eric C. Ip

Bioethics
Early View: 29 April 2019

Abstract: This article will explore whether the law should allow people with anorexia nervosa to refuse nutrition and hydration with special reference to the English decision in Re E (Medical Treatment: Anorexia). It argues that the judge in that case made the correct decision in holding that the patient, who suffered from severe anorexia nervosa, lacked capacity to make valid advance directives under the Mental Capacity Act 2005 of the United Kingdom, and that medical procedures that are apparently against her wishes should be carried out for the sake of preserving her life. The law should generally not permit patients with anorexia nervosa to decline nutrition and hydration, precisely because their autonomous ability to make such decisions has been substantially circumscribed by this psychiatric condition.

Ryan Whalen on the Office of Alternative Medicine and the Endorsement Effects Innovation Policy (Science and Public Policy)

"Research funding’s ‘endorsement effect’ on scientific boundary work and research production: government legitimization of alternative medicine"

Ryan Whalen
Science and Public Policy
Published on 24 April 2018

Abstract: This article demonstrates how science and technology policy can have an ‘endorsement effect’ that legitimizes and increases the salience of scientific research areas. The validation and increased attention provided by state funding policies can support the discursive boundary work of interested parties as they seek to situate research fields within mainstream science. Increased validity and attention can subsequently lead to increased research activity, above and beyond that funded by the state. This article demonstrates the endorsement effect by examining how the founding of the NIH’s Office of Alternative Medicine affected both the discourse surrounding the legitimacy of alternative medicine, and the production of alternative medicine-related patents. The existence of this endorsement effect suggests that policymakers should consider both the direct effects that innovation policy might have on researchers’ incentives as well as the endorsement effects it can have on the research system.

Terry Kaan Urges Caution on Launching Opt-Out Organ Donation Scheme in Hong Kong (SCMP)

"Hong Kong urged to clarify legal issues before launching opt-out organ donation scheme"
Elizabeth Cheung
South China Morning Post
9 April 2017

Hong Kong is not yet ready for an opt-out organ donation scheme as legal issues and further medical matters need to clarified, an expert in the field says.

     Terry Kaan Sheung-hung, co-director of the University of Hong Kong’s Centre for Medical Ethics and Law, issued the caution as health minister Dr Ko Wing-man revealed that the government was thinking about introducing an opt-out scheme to increase the transplant rate.

     Under such a system a person would be considered a willing donor upon their death unless stating an objection in advance.

     The organ donation rate in Hong Kong is among the lowest in the world, with only 5.8 in every million people donating in 2015, compared with 39.7 in Spain. By the end of March more than 248,000 people had registered at the centralised organ donation register.

     Kaan said the city should first legislate the definition of brain death, a condition in which a person’s brain no longer functioned but the heart might continue to beat with the support of a ventilator... Click here to read the full article.

Daisy Cheung on the Constitutionality of Hong Kong's Compulsory Psychiatric Regime (Int'l J Law & Psychiatry)

"The compulsory psychiatric regime in Hong Kong: Constitutional and ethical perspectives"
Daisy Cheung
International Journal of Law and Psychiatry
Jan-Feb 2017, Vol. 50, pp. 24-30

Abstract: This article examines the compulsory psychiatric regime in Hong Kong. Under section 36 of the Mental Health Ordinance, which authorises long-term detention of psychiatric patients, a District Judge is required to countersign the form filled out by the registered medical practitioners in order for the detention to be valid. Case law, however, has shown that the role of the District Judge is merely administrative. This article suggests that, as it currently stands, the compulsory psychiatric regime in Hong Kong is unconstitutional because it fails the proportionality test. In light of this conclusion, the author proposes two solutions to deal with the issue, by common law or by legislative reform. The former would see an exercise of discretion by the courts read into section 36, while the latter would involve piecemeal reform of the relevant provisions to give the courts an explicit discretion to consider substantive issues when reviewing compulsory detention applications. The author argues that these solutions would introduce effective judicial supervision into the compulsory psychiatric regime and safeguard against abuse of process.

Precision Medicine: Legal and Ethical Challenges (Report on HKU-Cambridge Conference)

HKU-Cambridge Conference on Implications of Precision Medicine

In recent years, the cost of sequencing the entire genome of an individual (a procedure known as whole genome sequencing, or WGS) has dropped to a point that its routine use in some clinical applications has become a reality in some areas of medicine in developed countries. The information gained from the WGS procedure is analyzed with a view to gaining insights into potential vulnerabilities to disease for that particular individual, on the basis that some kinds of genetic sequences are known to be, or are suspected to be associated with particular kinds of disease, or predict for vulnerability to genetically-associated conditions. The basis of an entire new arm of medicine, generally referred to as either personalized medicine or precision medicine, rests on the notion that the specific clinical information about a given individual (including but not limited to WGS information) may be harnessed to refine or tailor treatment choices and regimes for that individual, instead of taking every adult patient as a ‘standard’ patient for whom standard interventions and standard doses and methodologies are to be offered.

     While the science and methodology of genomic sequencing has now been mastered, the full significance of the information gained through the WGS of any given individual is much less well understood. Even less well explored are the legal and ethical implications of personalised medicine or precision medicine. With WGS, for example, a physician will have as part of the patient’s medical records the patient’s entire genome. But in the current state of medical science, we can only draw limited conclusions about its likely impact on a very limited number of genetically linked conditions. Much is uncertain, and must (except in certain very rare conditions) be couched not in terms of certainties, but in terms of probabilities of varying degrees of confidence. Analysing a patient’s genome for specific conditions cost money, time and resources. What kind of analyses should be offered to the patient, or be carried out? What are the duties of clinicians to their patients in respect of such decisions? By definition, genetic information is familial: the information about health vulnerabilities gained from a given patient is relevant not only just for the patient, but for the patient’s family and relations. What issues of privacy and consent are raised by such familial implications?

     On April 7-8 2016, the Centre for Medical Ethics & Law of the University of Hong Kong (http://www.cmel.hku.hk) and the Centre for Law, Medicine and Life Sciences of the University of Cambridge (http://www.lml.law.cam.ac.uk) were the joint hosts and organizers of an international conference on ‘Legal and Ethical Implications of Precision Medicine’ held at the premises of Faculty of Law of the University of Hong Kong to explore these and related issues. Over two days, 29 speakers drawn from the USA, Canada, UK, Australia, Japan, South Korea, Taiwan, Singapore and Hong Hong delivered presentations. Opening each of the four keynote sessions were particularly distinguished scholars in the field, including Dr Ron Zimmern of the PHG Foundation; Professor Henry T. Greely of the Center for Law and the Biosciences, Stanford University; Professor I. Glenn Cohen of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics of Harvard; Professor Donald Chalmers of the Centre for Law & Genetics of the University of Tasmania, and Professor Bartha Maria Knoppers of the Center of Genomics and Policy of McGill University. Abstracts and the slide presentations for each of the presentations are available at from the conference micro-site at http://www.cmel.hku.hk/conference/pmconference/.'

Report on Asia Launch of Global Health Risk Framework Recommendations

In order to cope with the risk of major outbreak of infectious diseases around the globe, the Commission on a Global Health Risk Framework for the Future of the U.S. National Academy of Medicine released a report and recommended an investment of $4.5 billion per year to strengthen national public health systems, improve global response coordination and capabilities, and accelerate R&D. Professor Gabriel Leung, Commissioner and Dean of Li Ka Shing Faculty of Medicine, The University of Hong Kong (HKU), said, “Hong Kong and neighbouring Asian countries have experienced epidemics of infectious diseases, such as SARS, H1N1, H3N2, H7N9, etc. With the recent outbreak of seasonal influenza, both public and private medical services were overwhelmed due to the excessive demand for medical care, revealing deficiencies in global defenses against potential pandemics. It is most timely that we can have an in-depth discussion at this important occasion and offer recommendations to combat infectious diseases.”

     In collaboration with the Centre for Medical Ethics and Law of HKU, the U.S. National Academy of Medicine and Bauhinia Foundation Research Centre, the WHO Collaborating Centre for Infectious Disease Epidemiology and Control at the School of Public Health, Li Ka Shing Faculty of Medicine of HKU hosted the Asia Launch cum Seminar of the Report Recommendations of the Commission on a Global Health Risk Framework for the Future at HKU today (March 13, 2016) and presented the report in Asia for the first time... Click here to read the entire press release.