When should precaution prevail? : interests in (public) health, the risk of harm and xenotransplantation.

Xenotransplantation is an example of a developing biotechnology which highlights three differing interests in the health of the public; a specific interest in enhancing the health of individuals who require a particular procedure or treatment, a wider interest in protecting the health of us all by avoiding introducing biotechnologies which risk the health of the public, and a public interest in advancing medical knowledge and treatment. Here we explore how matters of private benefit and public risk can be appropriately reconciled and consider whether ideas of public health should take a more central role when deciding whether clinical xenotransplantation should proceed. The risks of xenotransplantation are not certain but the nature of the harm to individual and public health could be severe. The concept of risk is central to our analysis as xenotransplantation threatens potential future harm as well as possible benefit. We argue that it is sometimes legally and ethically necessary for the state to act in advance to protect the health of the public, and that xenotransplantation is such a case. In reaching this conclusion we adopt a precautionary approach; an approach which we modify by Mill’s harm principle

The De-medicalisation of assisted dying : is a less medicalised model the way forward?

Although assisted dying has been most commonly presented within a medicalised framework, the notion of de-medicalisation is employed in this paper to suggest that there are emerging models of assisted dying in which some medical aspects assumed to be an integral part of the phenomenon are both challenged and diminished. The paper considers cases where relatives have facilitated a loved one's assisted suicide abroad, cases of assisted death in which the assistor in the actual suicide act is a non-medic, and the growing debate surrounding non-medical grounds for desiring death. In evaluating the potential impact of partial de-medicalisation on the assisted dying debate, the argument presented is that whilst a de-medicalised model could well contribute to a richer understanding of assisted dying and a better death for the person who is assisted, there are cogent reasons to retain some aspects of the medicalised model and that a completely de-medicalised model of assisted dying is unrealistic

Voices carry?:the voice of bioethics in the courtroom and voice of law in bioethics

This paper explores the interaction between bioethics and law in the theatre of the courtroom, with particular reference to English law. No matter what some judges say, the courtroom has long been a location in which law and bioethics interact, not least in seminal health care law cases such as Re A (Minors) (Conjoined Twins: Separation [2000] and R v Arthur [1981]. Judge-made law has made some positive contributions to the shaping of bioethics as a discipline, providing a real-world testing ground for moral arguments, issuing the judicial ‘products’ with which bioethics engages, and emphasising the importance of observing due process. At the same time, the courtroom is an adversarial arena, not always ideally suited to the resolution of ethical conflict, and its concern with actions that satisfy attainable standards can fall short of the aspirations set in philosophical ethics. Indeed, sometimes the judges misinterpret or wholly neglect the ethical dimensions of the case at hand. So much of what judges do involves orchestrated framing, the manipulation of legal concepts, interpretation (of the facts of the case, the story of legal precedent and of the particular ethical dilemma) and translation (of ethical issues into law's discourse). Whether they like it or not, the judges are interpreting and responding to the voice of bioethics alongside the voice of the law in their attempts to reach the 'right' judgment and in the face of the theatre surrounding cases involving bioethical controversy. The end result may be distorting because bioethical theory is misinterpreted or the voice of bioethics becomes obscured because of the drama of the case. But this is not to claim that bioethics has some access to the ‘right’ or ‘true’ response to the case at hand. Indeed, neither bioethics nor law can necessarily claim superiority or access to the ‘truth’ of the matter. We nevertheless argue that each will be likely to gain greater insight by opening a dialogue with the other, telling and re-telling the story, so that the voices of one forum can carry over into the other

A new paradigm of reparation for victims of child pornography

This paper sets out the distinctive harm caused and wrong done to child pornography victims. It presents a paradigm of reparation within a restorative justice framework that explains the significance of material reparation for these victims. The paper demonstrates that because of the particular nature of child pornography offences and the harms and wrongs occasioned, existing avenues for legal redress in England and Wales and the United States are generally inadequate and ill-fitting and that a new mechanism for effecting suitable reparation is required. It concludes by sketching a new mode of restorative justice for victims of child pornography, emphasising significant matters that must be addressed alongside financial redress in order to facilitate victims’ restoration

Breaching the sexual boundaries in the doctor-patient relationship:should English law recognise fiduciary duties?

In this paper I argue that sexual exploitation in the doctor-patient relationship would be dealt with more appropriately by the law in England and Wales on the basis of a breach of fiduciary duty. Three different types of sexual boundary breaches are discussed and the particular focus is on breaches where the patient’s consent is obtained through inducement. I contend that current avenues of redress do not clearly catch this behaviour and, moreover, they fail to capture the essence of the wrong committed by the doctor – the knowing breach of trust for self-gain - and the calculated way in which consent is induced. Finally, I demonstrate that the fiduciary approach is compatible with the contemporary pro-patient autonomy model of the doctor-patient relationship

The "higher" age of consent and the concept of sexual exploitation

Whilst it is often said that the age of consent in England & Wales is 16 this is not always true. In some situations it is 18. This chapter considers the extent to which this higher age is justified and whether it would be better to create a new, stand-alone offence to tackle abuses of a position of trust

To know or not to know:should crimes regarding photographs of their child sexual abuse be disclosed to now-adult, unknowing victims?

This paper considers the unexplored question of whether unaware crime victims have rights or interests in knowing and not knowing information pertaining to the crime(s) committed against them. Our specific focus is on whether crimes regarding abusive images (AI) should be disclosed to now-adult victims of child sexual abuse who feature in them. Because these issues have not been addressed in the victimology or criminological literature, we utilise literature in another discipline - health care ethics and law - to inform our analysis. Through engaging with the debate on the right to know and not to know information concerning one’s genetic status, we develop a conceptualisation of the issues regarding unknowing AI victims. A rights-based conceptualisation proves to be largely inappropriate; we contend that, instead, it would be more productive to look to unknowing AI victims’ interests. We argue that the interests at stake are grounded in autonomy and/or spatial privacy, and that in order to find a way to resolve the disclosure dilemma, these interests must be considered alongside consequentialist concerns; disclosing information regarding AI could empower now-adult victims but could well cause them (further) harm. Finally, we consider the implications of our analysis for victimology

Breaching the stalemate on assisted dying:it’s time to move beyond a medicalised approach

Despite growing legal and medical support for assisted dying, many healthcare professionals do not want to be directly involved. Could a de-medicalised approach help to overcome this? Nancy Preston, Sheila Payne, and Suzanne Ost discuss

Germline variation at 8q24 and prostate cancer risk in men of European ancestry

Chromosome 8q24 is a susceptibility locus for multiple cancers, including prostate cancer. Here we combine genetic data across the 8q24 susceptibility region from 71,535 prostate cancer cases and 52,935 controls of European ancestry to define the overall contribution of germline variation at 8q24 to prostate cancer risk. We identify 12 independent risk signals for prostate cancer (p < 4.28 × 10−15), including three risk variants that have yet to be reported. From a polygenic risk score (PRS) model, derived to assess the cumulative effect of risk variants at 8q24, men in the top 1% of the PRS have a 4-fold (95%CI = 3.62–4.40) greater risk compared to the population average. These 12 variants account for ~25% of what can be currently explained of the familial risk of prostate cancer by known genetic risk factors. These findings highlight the overwhelming contribution of germline variation at 8q24 on prostate cancer risk which has implications for population risk stratification

Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction.

Prostate cancer is a highly heritable disease with large disparities in incidence rates across ancestry populations. We conducted a multiancestry meta-analysis of prostate cancer genome-wide association studies (107,247 cases and 127,006 controls) and identified 86 new genetic risk variants independently associated with prostate cancer risk, bringing the total to 269 known risk variants. The top genetic risk score (GRS) decile was associated with odds ratios that ranged from 5.06 (95% confidence interval (CI), 4.84-5.29) for men of European ancestry to 3.74 (95% CI, 3.36-4.17) for men of African ancestry. Men of African ancestry were estimated to have a mean GRS that was 2.18-times higher (95% CI, 2.14-2.22), and men of East Asian ancestry 0.73-times lower (95% CI, 0.71-0.76), than men of European ancestry. These findings support the role of germline variation contributing to population differences in prostate cancer risk, with the GRS offering an approach for personalized risk prediction