Legal values as tools for promoting harmony.

The doctrine of informed consent has the effect of allowing the mentally competent adult patient to exercise individual choice in any proposed medical treatment. The ethical principles primarily inherent in this doctrine would be the principles of autonomy and beneficence. However, it is argued in this essay that the concept and meaning of autonomy might be vastly different between western and eastern communities. Consequently the doctrine of informed consent will lead to a different meaning in these different societies. The essay also raises the implication of transplanting legal doctrines into societies which might not be fully prepared to implement the ideal contained in the doctrine of informed consent.

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.

Dilemmas surrounding passive euthanasia--a Malaysian perspective.

In western societies where the principle of autonomy is jealously guarded, perhaps active euthanasia is more often the focus of public concern and debates rather than any other forms of euthanasia. However due to the advance in technology and its corresponding ability in prolonging life, in Malaysia passive euthanasia presents more of a dilemma. For those concerned and involved with end of life decision-making, it is generally agreed that this is an area fraught with not only medical but legal and ethical issues. In Malaysia where the society is not homogenous but is multi-cultural and multi-religious, in addition to medical, legal and ethical issues, religious principles and cultural norms further impact and play significant roles in end of life decision-making. This paper seeks to identify the issues surrounding the practice of passive euthanasia in Malaysia. It will be shown that despite applicable legal provisions, current practice of the medical profession combined with religious and cultural values together affect decision-making which involves the withholding and/or withdrawing of life-saving treatment.

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.