Medical Law International

The Dutch political discussion concerning euthanasia has concentrated on whether there are situations in which euthanasia should be legalised and how these should be defined. An equally important question has been largely ignored: under what conditions is legal regulation of euthanasia likely to be effective?

Looked at from this perspective of effective control, the available empirical data lead to a rather different interpretation and to rather different concerns from those that so far have played a role in the political discussion. Euthanasia does not seem to deserve the attention that has been lavished on it. Neither in terms of its frequency nor in terms of the procedural safeguards with which it is surrounded does it seem to pose a substantial problem of control.

On the other hand, other medical procedures which, like euthanasia, intentionally shorten a patient's life surely warrant more attention than they have received. These other procedures are much more frequent than euthanasia and, because they are deemed ‘normal medical practice’, are attended by more limited procedural safeguards. Furthermore, because a given procedure can often be constructed either as ‘euthanasia’ or as one of the related procedures, effective regulation of euthanasia in isolation from the others is not possible.

Given an encompassing regulation of all medical procedures that shorten life, control can best be entrusted, at least in the first instance, to the medical profession itself and the substantive norms that govern euthanasia can perhaps largely be left to the patient and his or her family and doctor.

This article seeks to highlight some of the more important ethical and legal issues raised by the Human Genome Project. It is recognized that hithertofore ethical control over the pace and scope of scientific progress has been only partly successful, due largely to the resistance of the professionals involved to outside interference and to the ineffectiveness of self-monitoring. The Human Genome Project has the potential to alter the lives of individuals and the structure of human society as a whole. It is essential therefore that individuals be empowered through the application and development of existing heads of liability in constitutional and private law to effect at least some of the necessary control. The transnational aspects of the project and the ethical and legal issues which it raises are also stressed.

The Australian High Court's rejection in Rogers v Whitaker of the doctor-oriented standard of information to patients in negligence cases (the Bolam approach) is consistent with certain British dicta and international common law authority, and may persuade British courts to move beyond the Bolam approach and develop a patient-oriented standard of disclosure.

This article compares the impact of recent legislation on health care in Britain and France. It examines the contrasts between the British aim of introducing an internal market into health care with French efforts to improve planning systems. It is contended that there are serious problems with both reform proposals, but that aspects of the French planning reforms may provide potential solutions to the flaws in the NHS internal market.