Government public health policy: three cautionary tales from Malaysia, South Africa and the United States.

Three authors describe problematic scenarios of health policy in their respective countries. These examples illustrate the role of government influences in determining resource allocation, legislation, health provision and health outcomes in very different situations. These outcomes are affected not only by attitudes to public health, but also by the legal systems in the countries which are the subjects of this study. The authors draw conclusions about the use and abuse of public health regulation.

Balancing individual rights versus collective good in public health enforcement.

This paper explores the balance between common good and individual liberty in the context of public health regulation. The issues are explored in reference to two areas of regulation, isolation and quarantine in the case of SARS, and the rights of parents to refuse mandatory childhood immunizations. In the case of SARS, the analysis explores the age old practice of isolation and quarantine, an important preventive measure with clear civil liberty implications. In reference to childhood immunization the paper considers the American controversy involving the refusal of parents to have their children vaccinated, fearing that mercury in vaccines will lead to autism. The analysis explores the US Supreme Court case of Jacobson v. Massachusetts which 100 years ago established a four part test for evaluating claims of individuals that government public health authorities were infringing on their liberty interests. The paper endorses the four elements of necessity, reasonableness, proportionality, and harm avoidance identified in Jacobson, but calls for a more rigorous scientific evaluation to accompany this traditional test.

Rights of patients: comparative perspectives from five countries.

Recognition and articulation of patient rights are core issues in the medical jurisprudence of most nations. While the nature of rights in medical care may vary from country to country, reflecting the idiosyncrasies of domestic law and health delivery, there are commonalities in this area of law that cut across borders. This paper presents five case studies in the patient rights area from Malaysia, Ireland, South Africa, Indonesia and the United States, respectively. The case discussions range from ongoing and fundamental concerns over broad patient rights issues, such as access to health care and informed consent, to rights concerns of those suffering from HIV/AIDS, to a novel consideration over ethical and legal issues concerning ownership of infant organs. It is the hope of the authors that individually, and collectively, the cases will provide helpful insights into this core area of medical law.