Tracey Evans Chan

Evolving legal responses to dependence on families in New Zealand and Singapore healthcare

Healthcare decision-making has traditionally focused on individual autonomy, but there is now a change occurring in which the involvement of families is gaining prominence. This appears to stem from an increasing emphasis on relational aspects of autonomy which recognises the individuals connectedness to their family, and also state reliance upon families to share the burdens and costs of caring for elderly and disabled dependents. Such a reorientation calls for similar legal emphasis on patient autonomy as understood in relational terms, and one that offers more adequate conceptions of independence, confidentiality and decision-making authority in the light of this change. This paper outlines how two common law jurisdictions, New Zealand and Singapore, have accommodated, or are responding to, these changes.

REGULATING THE PLACEBO EFFECT IN CLINICAL PRACTICE

Recent research and ethical analysis have forced a clinical and ethical reappraisal of the utility of placebos in medical practice. The main concern of ethics and law is that using placebos in health care involves deception, which is antithetical to patient autonomy and trust in the physician-patient relationship. This article reviews the various, more nuanced scientific conceptions of the placebo effect, and evaluates the ethical and legal objections to deploying placebos in clinical practice. It argues that the placebo effect may be legitimately accommodated on the basis that it does not engage the requirement for material or quasi-fiduciary disclosures of information, and may also be justified by therapeutic privilege. In addition, this reconceptualisation of the placebo effect offers a new justification for therapeutic privilege in these contexts. Notwithstanding this, using the placebo effect in clinical practice raises regulatory issues that will require special regulatory supervision.

LEGAL AND REGULATORY RESPONSES TO INNOVATIVE TREATMENT

Developments in medical technology, healthcare delivery, and commercial interests in medicine have increased both the potential for conflicts of interest on the part of physicians, and doubts over the sufficiency of patient autonomy as a justification for administering innovative therapy. The legal and regulatory treatment of innovative therapy is therefore an important question, on which there is a current lack of consensus on a number of issues. This paper discusses recent developments in Singapore and uses them as a springboard to flesh out basic regulatory issues that arise from the deployment of innovative treatment: the distinction between innovative treatment and clinical research, the adequacy of the current post hoc scrutiny of innovative therapy under existing legal principles and the need for further specialised regulatory oversight.

The regulatory challenges of international transplant medicine Developments in Singapore

Transplant tourism is spurred by the global shortage of organs and the potential for regulatory arbitrage in purchasing an organ in jurisdictions that do not prohibit sale or lack effective regulatory mechanisms to enforce prohibition. Various nations once identified as transplant tourism hotspots have since enacted legislation prohibiting organ sales and emplaced regulatory oversight. However, concerns persist that the legitimization of altruistic unrelated living donor transplants conceals underlying commercialism and unethical practices. These concerns are heightened when transplant candidates travel across borders in search of international transplant medicine. This article examines the regulatory challenges associated with differentiating international transplant medicine from transplant tourism, and various regulatory mechanisms that have been developed to address them from the domestic perspective – in particular, those recently implemented in the Singapore. It seeks to identify the strengths and weaknesses of the Singapore system and what lessons this has for international standards and practices.