Navigating equity in global access to genome therapy expanding access to potentially transformative therapies and benefiting those in need requires global policy changes.

In December 2023, the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency granted the first regulatory approval for genome therapy for sickle cell disease. This approval brings hope to those suffering from this debilitating genetic disease. However, several barriers may hinder global patient access, including high treatment costs, obtaining informed consent for minors, inadequate public health infrastructure, and insufficient regulatory oversight. These barriers reflect the structural inequalities inherent in global health governance, where patient access often depends on social and institutional arrangements. This article addresses concerns around informed consent, treatment costs, and patient access, and proposes corresponding policy reforms. We argue that these discussions should be framed within a broader global context that considers social and institutional structures, global research priorities, and a commitment to health equity.

OPCAT: How an international treaty regarding torture is relevant to the Australian mental health system.

The United Nations Subcommittee on the Prevention of Torture visits signatory nations to the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT). Its role is to monitor and support signatory nations in implementing and complying with the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). In October 2022, the United Nations Subcommittee on the Prevention of Torture visited Australia but was barred from visiting mental health wards in Queensland and all detention facilities in New South Wales leading to the termination of its visit. This breach of Australia's obligations under the OPCAT presents a significant setback for the rights of people with mental illness and other involuntarily detained populations. This piece sets out to demonstrate the relevance of OPCAT to the mental health system in Australia. Individuals who are detained for compulsory treatment in locked facilities such as acute psychiatric inpatient wards and forensic mental health facilities are deprived of their liberty, often out of public view. Thus, it highlights the ethical and professional obligations of all mental health professionals, especially psychiatrists, to safeguard the human rights of individuals being detained in mental health facilities as enshrined in Australia's international legal obligations under the OPCAT. Adhering to these obligations diminishes the risk of future human rights violations of people with mental illness.

Eight Strategies to Engineer Acceptance of Human Germline Modifications.

Until recently, scientific consensus held firm that genetically manipulated embryos created through methods including Mitochondrial Replacement Therapy or human germline genome editing should not be used to initiate a pregnancy. In countries that have relevant laws pertaining to heritable human germline modifications, the vast majority prohibit or restrict this practice. In the last several years, scholars have observed a transformation of scientific and policy restrictions with insistent calls for creating a regulatory pathway. Multiple stakeholders highlight the role of social consensus and public engagement for governance of heritable human germline modifications. However, in the drive to gain public acceptance and lift restrictions, some proponents provide distorted or misleading narratives designed to influence public perception and incrementally shift the consensus. This article describes eight discrete strategies that proponents employ to influence framing, sway public opinion, and revise policymaking of human germline modifications in a manner that undermines honest engagement.

Parsing human rights, promoting health equity: reflections on Colombia's response to Venezuelan migration.

Over the last 7 years, a multidimensional crisis in Venezuela has resulted in massive emigration. Over 7 million have fled the country, with more than 2.4 million seeking to settle in Colombia. Of these, as of 2021, more than 1 million were undocumented, but the situation has started to change with the implementation of an ambitious migrant regularisation scheme. Regularisation promises access to comprehensive healthcare, full educational opportunities and the formal labour market. Securing these social determinants of health is critical because social inequalities produce health inequalities-that is, systematic health differences that are preventable and thus unjust. Social medicine, social epidemiology and international human rights law agree on this, yet law-focused studies of health equity initiatives remain rare. Aiming to reverse this, we examine Colombia's response to Venezuelan migration, including its recent migrant regularisation initiative, which was introduced in part to comply with the country's obligations under international human rights law. The examination foregrounds what we are calling 'legal literacy', testing the hypothesis that advancing health equity involves asking more and better questions about international human rights law.

The Right to Construct Yourself and Your Identity: The Current Human Rights Law Framework Falls Short in Practice in the Face of Illegitimate Interference to the Mind.

Propaganda and manipulation have long been employed to influence and shape individuals' thoughts and identities. In the advent of the digital era, these techniques have become more sophisticated and invasive, and are utilized to further various causes. This article investigates the extent to which international human rights law affords protection against manipulation techniques such as microtargeting and behavioral reading, which can negatively impact individuals' mental health and autonomy by threatening their right to construct their own identity. The right to freedom of thought in the Universal Declaration of Human Rights (Article 18), the International Covenant on Civil and Political Rights (Article 18), and the European Convention on Human Rights (Article 9) offers absolute protection to individuals' inner selves and covers the protection against manipulation on paper. However, in practice, the right has not received much attention and has not reached its full potential due to its abstract and ambiguous nature. This Article analyzes the preparatory works of these human rights law instruments, with a particular focus on the right to freedom of thought, to clarify its origins and the intention behind its creation. The Article contends that the historical origins of the right do not provide sufficient answers to the current issue and contribute to the ineffective application of the right against emerging manipulative practices. The Article also proposes potential ways to clarify and strengthen the legal framework related to the right to freedom of thought.

Human Rights Law and the Defence of Mental Impairment.

This article provides an overview of recent scholarship calling for the defence of mental impairment to be abolished on the grounds that it breaches international human rights law. It outlines how differing interpretations of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) suggest that arguments for abolition will continue to be contested. On a practical level, no Australasian law reform body has called for the abolition of the defence and it seems unlikely that government policy will shift towards this in the absence of such a recommendation from these bodies. However, highlighting the obligations on States Parties to the CRPD to ensure the right to equal treatment before the law necessitates a careful consideration of whether the defence of mental impairment is still fit for purpose.

'Conversion Therapy' As Degrading Treatment.

This article responds to the widespread uncertainty in UK and international human rights law over the legality of 'conversion therapy', a set of practices that aim to eradicate LGBTIQ+ sexualities and gender identities. The article pursues two main arguments. First, it is argued that all forms of 'conversion therapy' are disrespectful of the equal moral value of LGBTIQ+ people and violate specific protected areas of liberty and equality that are inherent in the idea of human dignity. Secondly, the article develops a theoretical account of degrading treatment under article 3 of the European Convention on Human Rights that illuminates the relationship between the prohibition of degrading treatment, human dignity and antidiscrimination. It is then argued that 'conversion therapy', in all its different forms, spawns the specific kind of degradation that UK and international human rights law prohibit. The article ends by analysing the positive state obligations that arise in this context.

Regulating private medical institutions: a case study of China.

The expansion of privatisation in health care has been discussed extensively in most European countries and remains a hot topic nowadays. In China, privatisation results in considerable changes in its health care system, especially accelerating the ever-growing private medical institutions (PMIs). The rapid growth of PMIs raises the question of regulation for the Chinese government. Given the fact that few studies are available on the regulation of PMIs in China, I attempted to fill that gap by discussing the development of PMIs with a special focus on legal-regulatory strategies. After assessing current legal-regulatory strategies concerning PMIs, the paper identifies three major concerns regarding effective legal rules (i.e. weak coherence, inconsistency and legislative vacancy) and three difficult issues regarding government capacity (i.e. the negative effects of decentralised political structure, the low professionalism of bureaucrats and lack of reliability) that impede the well-functioning of regulatory agencies in China. As a plausible response, the paper recommends that the newly drafted basic health law should assign a separate chapter to regulate PMIs and also an independent regulatory body should be established to manage the issues of PMIs in China. Detailed recommendations are the practical implications of ICESCR General Comment No. 14.

Disorder within the humanitarian sector: the old versus new humanitarianism debate.

A debate is continuing between old humanitarianism, based on neutrality and short-term, relief-based assistance, and new humanitarianism, centring on advocacy and development. This paper views this deliberation as the humanitarian equivalent of the legal discussion between international humanitarian law and international human rights law. It tries to regulate it using the lex specialis and the belt and suspenders approach. Whether or not to be neutral is the key issue. Analysis of this point makes it possible to reveal the limited functionality of the lex specialis: it does not determine which approach should and should not be employed; there is no superior methodology. In conclusion, the belt and suspenders approach helps one to comprehend that 'what is the right method for humanitarian actors?' is not the right question to ask; both positions are valid, or simply the two approaches apply. It is important, therefore, to clarify and combine old and new humanitarianism.

Las compañías militares de seguridad privada: ¿los nuevos mercenarios? / Private Military Security Companies: The new mercenaries? / As companhias militares de segurança privada: os novos mercenários?

Resumen El objetivo es comparar las figuras del mercenarismo y de las Compañías Militares y de Seguridad Privadas (CMSP), para de ahí contemplar la opción de una potencial tipificación jurídica para estas últimas. Para este fin, se recurre a una metodología en un doble sentido. Por un lado, se realiza una representación histórica del mercenarismo, en la que se contrastan las visiones sobre lo que esta figura simboliza y de cómo desde la literatura académica esas representaciones contradictorias también permean el debate sobre las CMSP. Por el otro lado, se propone un análisis de contenido de los instrumentos convencionales, jurisprudenciales y doctrinales del derecho internacional, para entender las dinámicas jurídicas y políticas que afectan en mayor medida el intento de regulación de las CMSP. La conclusión a la que se llegará apunta a que la importancia de adelantar un debate teórico-conceptual sobre el mercenarismo y las CMSP resulta estéril en la medida en que ninguna de las dos figuras cuenta con un sistema de regulación adecuado.

Abstract The objective of this study is to compare the concepts of mercenarism and the Private Military Security Companies (abbreviated in Spanish CMSP) to considering the possibility of a potential juridical classification for the PMSCs. A double methodology is implemented to reach this aim. On the one hand, a mercenarism historical representation is developed.The views upon what mercenarism symbolizes are compared in this representation, and how these contradictory representations have permeated the debate on the PMSCs from the academic literature. On the other hand, an analysis is conducted with regard to the conventional, legal and doctrinal instruments of the international law to understanding the juridical dynamics and policies, which affect in great measure the intention of regulating the PMSCs. The conclusión emphasizes in the unproductiveness of developing a conceptual-theoretical debate on mercenarism and the PMSCs, since these two concepts do not have a correct regulatory system.

Resumo O objetivo é comparar as figuras do mercenarismo e das Companhias Militares e de Segurança Privadas (CMSP), para daí considerar a opção de uma potencial tipificação jurídica para essas últimas. Para esse propósito, se recorre a uma metodologia em um sentido duplo. Por um lado, se realiza a representação histórica do mercenarismo, na qual se contrastam as visões sobre o que essa figura simboliza e como a partir da literatura académica essas representações contraditórias também permeiam o debate sobre as CMSP. Por outro lado, propõe-se uma análise do conteúdo dos instrumentos convencionais, jurisprudenciais e doutrinais do direito internacional, para entender as dinâmicas jurídicas e políticas que afeitam em maior medida o intento de regulação das CMSP. A conclusão a que se chegará aponta que a importância de desenvolver um debate teórico-conceptual sobre o mercenarismo e as CMSP é estéril na medida em que nenhuma das duas figuras conta com um sistema de regulação adequado.

Global frameworks, local strategies: Women's rights, health, and the tobacco control movement in Argentina.

The article examines how civil society organisations in Argentina used the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to frame the country's failure to enact strong national tobacco control legislation as a violation of women's rights in the late 2000s. We analyze this case study through the politics of scale, namely the social processes that produce, reproduce, and contest the boundaries of policies and socio-economic relations. This approach understands how multiple scales overlap and connect to obstruct or enhance the right to health in Latin America. In Argentina, the global organisation of tobacco companies, the reach of international financial institutions and the national dynamics of economic austerity and export-orientation promoted the local production and use of tobacco (leaf and cigarettes) and reproduced health inequalities in the country throughout the 1990s and the early 2000s. Yet, the visible legacy of local and national human rights struggles in the adoption of international human rights treaties into Argentina's national constitution allowed the tobacco control movement to link the scale of women's bodies to the right to health through the use of CEDAW to change national legislation, tackling the social determinants of the tobacco epidemic.

The human rights impact of gender stereotyping in the context of reproductive health care.

Gender stereotypes surrounding women's reproductive health impede women's access to essential reproductive healthcare and contribute to inequality more generally. Stereotyping in healthcare settings impedes women's access to contraceptive information, services, and induced abortion, and lead to involuntary interventions in the context of sterilization. Decisions by human rights monitoring bodies, such as the Inter-American Court of Human Rights' case, IV v. Bolivia, which was a case concerned with the involuntary sterilization of a woman during childbirth, highlight how stereotypes in the context of providing health care can operate to strip women of their agency and decision-making authority, deny them their right to informed consent, reinforce gender hierarchies and violate their reproductive rights. In the present article, IV v. Bolivia is examined as a case study with the objective being to highlight how, in the context of coercive sterilization, human rights law has been used to advance legal and ethical guidelines, including the International Federation of Gynecology and Obstetrics' (FIGO) own guidelines, on gender stereotyping and reproductive healthcare. The Inter-American Court's judgment in IV v. Bolivia illustrates the important role FIGO's guidance can play in shaping human rights standards and provides guidance on the service provider's role and responsibility in eliminating gender stereotypes and upholding and fulfilling human rights.

Implementing international human rights recommendations to improve obstetric care in Brazil.

In 2011, the UN Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) issued a groundbreaking decision in the case of Alyne da Silva Pimentel Teixeira versus Brazil involving the maternal death of a young Afro-Brazilian woman. The CEDAW addressed systemic failures in the Brazilian health system that combined to violate Alyne's rights to life, health, and access to maternal health services. Almost 5 years later, after significant back and forth between the concerned parties, a technical follow-up commission was created with the support of the Center for Reproductive Rights, and was welcomed by the government of Brazil. The technical follow-up commission was precedent-setting, seeking to move beyond identifying gaps in "compliance" and concentrate instead on issues that might catalyze re-engagement by national level stakeholders, both governmental and non-governmental, with the aim of advancing CEDAW's recommendations through not only the creation, but also the effective implementation, of policies and programs that promote women's sexual and reproductive rights in practice, including their rights to safe motherhood. Here, the human-rights-based framework of the technical follow-up commission is described, in addition to their findings related to legal and policy frameworks, evidence-based programing, and monitoring and oversight of providers.

Legal duties, professional obligations or notional guidelines? Screening, treatment and referral of domestic violence cases in primary health care settings in South Africa.

BACKGROUND: Since 2013, approximately 4400 women have been murdered by their partners in South Africa. This is five times higher than the per capita global average. Domestic violence is known to be cyclical, endemic and frequently involves multiple victims. It also becomes progressively more dangerous over time and may lead to fatalities. In 2012, the Health Professions Council of South Africa released a domestic violence protocol for emergency service providers. This protocol, or screening guidelines, includes assessing future risk to domestic violence, providing physical and psychosocial care, documentation of evidence of abuse and informing patients of their rights and the services available to them. The extent to which these guidelines have been circulated and implemented, particularly by general health care practitioners (HCPs), is unknown. AIM: We review international treaties to which South Africa is a signatory, as well as national legislation and policies that reinforce the right to care for victims of domestic violence, to delineate the implication of these laws and policies for HCPs. METHOD: We reviewed literature and analysed national and international legislation and policies. RESULTS: The 'norms' contained in existing guidelines and currently practiced in an ad hoc manner are not only compatible with existing statutory duties of HCPs but are in fact a natural extension of them. CONCLUSION: Proactive interventions such as the use of guidelines for working with victims of domestic violence enable suspected cases of domestic violence to be systematically identified, appropriately managed, properly referred, and should be adopted by all South African HCPs.

The law on artificial insemination: an italian anomaly.

The law on medically assisted procreation in Italy, from its entering into force, has undergone numerous amendments. This has been due to the fact that those citizens, directly affected by its imposed prohibitions, have not given in, bringing their requests before the courts, both nationally and internationally. Over the years, the courts through numerous rulings have significantly changed a law clearly incapable of protecting the rights of those involved. Currently Italy has an acceptable law on M.A.P. which is the result of the strong willing of citizens affected by problems of sterility or infertility. The aim of this paper is to present an historical summary of the troubled path which the issue, from every perspective, has faced and is still facing today. As well, it will document how, in Italy, the case-law and, therefore, the law's interpretation and application by the judges have contributed, in the end, to shaping a positive legislation.

La Sentencia Rol N.° 9.031-2013 de la Corte Suprema de Chile. ¿Una aplicación del control de convencionalidad en el análisis de la extradición pasiva por el delito de transporte de estupefacientes? / Judgment Rol N.° 9.031-2013 of The Supreme Court of Chile. Is it an appliation of conventionality control in the analysis of passive extradition for the crime of narcotics transportation? / A Sentênça Rol N.° 9.031-2013 do Tribunal Supremo do Chile. Uma aplicação do controle da convencionalidade na análise da extradição passiva pelo crime do transporte de estupefacientes?

Resumen El trabajo presenta analíticamente los significados atribuibles al concepto de "control de convencionalidad", a partir del análisis de la jurisprudencia emanada de la Corte Interamericana. Asimismo, busca establecer si en los casos de extradición pasiva la Corte Suprema chilena aplica el control de convencionalidad, y examinar cuál es el significado y alcances que el máximo tribunal nacional le atribuye al mencionado examen, contrastándolo con los sentidos propuestos pretorianamente por la Corte Interamericana. Lo anterior, en el contexto del único fallo en que la Corte Suprema de Chile afirma haber ejercido el control de convencionalidad, esto es, en la resolución de un caso de extradición pasiva de un ciudadano boliviano, a quien se le atribuyó participación como autor en el delito de transporte de estupefacientes, Rol N.° 9.031-2013. La conclusión a la que se llega es que el máximo tribunal no ejerció propiamente el control de convencionalidad, ni siguió el significado y efectos asignados por la Corte Interamericana de Derechos Humanos en su jurisprudencia dominante, que lo concibe fundamentalmente como control normativo entre las normas internas y el corpus iuris interamericano. Todo lo anterior en el marco de un análisis conforme al método crítico de casos.

Abstract This work offers in an analytical manner the meanings attributable to the "conventionality control" from the study of the jurisprudence emanating from the Inter-American Court. Likewise, it attempts to establish whether or not in passive extradition cases the Chilean Supreme Court applies this "conventionality control", while examining what are the meaning and scope that the highest national court attributes to the above-mentioned exam in contrast with the senses suggested in a praetorian manner by the Inter-American Court. The above, in the context of the only judgment where the Supreme Court of Chile affirms having exercised this conventionality control, i.e. in the resolution of the passive extradition of a Bolivian citizen charged with taking part as an author in the crime of narcotics trafficking, Rol N.° 9.031-2013. The conclusión reached is that it was not exercised properly by the highest court which, in addition, did not follow the meaning and effects assigned by the Inter-American Court of Human Rights in its did not exercise in a proper manner that control in its prevailing jurisprudence that fundamentally conceives it as a normative control between internal rules and the inter-American corpus iuris, all the foregoing within the framework of an analysis of cases made according to the critical method.

Resumo O trabalho apresenta analíticamente significados atribuíveis ao conceito do "controle da convencionalidade", da análise da jurisprudencia emanda da corte interamericana. Também, procura estabelecer se nos casos da extradicão passiva a corte suprema chilena aplica o controle da convencionalidade, e examinar qual é o significado e os alcances que o máximo tribunal nacional atribuí ao exame mencionado, fazendo um contraste com os sentidos propostos pretorianamente pela corte interamericana. A coisa precedente, no contexto da única sentença em que a corte suprema do chile, afirma ter exercido o controle da convencionalidade, ou seja, na resolução de um caso de extradição passiva de um cidadão boliviano, quem foi atribuída a participação como o autor no crime de transporte de estupefacientes, Rol N.° 9.031-2013. A conclusão é que o máximo tribunal não exerceu adequadamente o controle da convencionalidade, nem seguiu o significado e os efeitos atribuídos pela Corte Interamericana de Direitos Humanos em sua jurisprudencia dominante, que concebê-lo fundamentalmente como o controle normativo entre as normas internas e o corpus iuris interamericano. Todo o anterior dentro do marco de uma análise de acordo com o método crítico dos casos.

Human rights and correctional health policy: a view from Europe.

Purpose Correctional healthcare should promote the protection of human rights. The purpose of this paper is to bring a discussion of human rights into debates on how such policy should be best organized. Design/methodology/approach The paper achieves its aim by providing an analysis of European prison law and policy in the area of prison health, through assessing decisions of the European Court of Human Rights, as well as policies created by the European Committee for the Prevention of Torture. Findings The paper describes the position of the European Court of Human Rights on the topics of access to healthcare, ill health and release from prison, mental illness in prison, and the duty to provide rehabilitative programming for those seeking to reduce their level of "risk." It also argues that human rights law can be a source of practical reform, and that legal frameworks have much to offer healthcare leaders seeking to uphold the dignity of those in their care. Originality/value This paper will provide a rare example of the engagement of human rights law with correctional health policy. It provides practical recommendations arising out of an analysis of European human rights law in the area of prisons.

Human rights and proactive displacement: determining the appropriate balance between the duty to protect and the right to remain.

The proactive displacement by public authorities of populations from areas perceived to be exposed to a high risk of disaster presents complex human rights challenges. Provided that no ulterior motive is at play, the use of compulsory evacuations and relocations as policy responses to such risk is mandated by the duty to protect the right to life. However, proactive displacement in the interest of saving lives can be problematic as such measures can lead to the limitation of other human rights, resulting in an intricate assessment of whether compulsory evacuation or permanent relocation is proportional in any given circumstance. Such an analysis demands critical attention by public authorities to the perception of the disaster risk in question and problematises claims to objectivity of official risk assessments. Furthermore, it poses the question as to whether measures designed to address the disaster risk in question that are less intrusive than relocation may be available to public authorities.

Fatal Foetal Abnormality, Irish Constitutional Law, and Mellet v Ireland

Under the Irish Constitution abortion is allowed only where the life of the pregnant woman is at risk. The provision in question, Article 40.3.3 (or the 8th Amendment) has long been criticised for failing to respect women's autonomy, and in Mellet v Ireland, the UN Human Rights Committee found that Amanda Jane Mellet, who travelled to Liverpool to access abortion following a finding that her foetus suffered a fatal abnormality, had suffered a violation of her rights under the International Covenant on Civil and Political Rights (ICCPR). In this commentary I demonstrate the value of Mellet when compared to the possible legal findings in such circumstances under both the Constitution and the European Convention on Human Rights, and argue that the findings are not restricted to cases of fatal foetal abnormality. Rather, the Committee's decision illustrates the suffering that all women in Ireland who travel to access abortion experience, arguably constituting a violation of their right to be free from cruel, inhuman, and degrading treatment. On that reading, Mellet signifies the need to implement a comprehensive rethink of Irish abortion law including, but going beyond, access to abortion in cases of fatal foetal abnormality.