INTRODUCTION

TO HEALTHCARE
LAW AND ETHICS
OVERVIEW AND
SCOPE OF STUDY
2 possible ways to divide the
area of study

Healthcare Law/Health
Law/Medical Law/

Bioethics/Medical Ethics
Health Law/Medical Law

Essentially the laws that

regulate relationships within
the health care
environment.

Very varied and range from

public laws (constitutional,
administrative, criminal) to
private laws (family,
contract, tort)
Health Law/Medical Law - Types of
relationships
Patient - health care personnel (physician, nurse,
pharmacist, dentist, therapist, …)

• Typically - tort, contract, criminal law

State and citizen

• Public health laws - e.g. control of infectious diseases, occupational

safety and health, sanitation, …
• Areas of law relating to individual rights vs state powers -
administrative law, constitutional law, human rights instruments.
• Fundamental questions relating to right to health care - consitutional
laws, human rights instruments

State - health care system/providers (hospitals,

professional bodies)

• Regulatory Laws - Medical Act, etc..

Methods in Health Law/
Medical Law
◦ Consider the law/s that impact on these
relationships
◦ Underlying philosophical/ethical principles
that inform/should inform legal standards
◦ Appropriateness of the legal regime/legal
standards
◦ Purpose
◦ Effectiveness
◦ Repercussions on individual, society, political
climate, etc..
◦ Jurisdiction specific – but the approach and tools
used to discuss and analyse are similar
Medical Ethics / Bioethics

Ethical (& legal) issues raised by

medical and biological technology

For eg - Assisted reproduction, Euthanasia,

Abortion, AI, Big Data, Cloning
Methods in Medical Ethics /
Bioethics
◦ Recognise and understand the
technology/science involved.
◦ Identify the issues raised by the
technology/science
◦ Ethical/legal
◦ Social/economic/cultural/religious/political
◦ Short term vs long term
◦ Impact on individual vs community/society
◦ Appropriate response
◦ Legal? Ethical? Limitations and appropriateness of
either.
 Overview of LQA7010
◦ Week 1 – Introduction and Overview [Divide into 2 groups for Healthcare Equity
Policy Briefs & Groups for Presentations )
◦ Week 2 – Watch Bending the Arc (Netflix) & write reflective essay (Assessed - 10%)
◦ Week 3 - Bioethics history, moral and legal theories
◦ Week 4 – Consent – Adults with capacity, incapacity & minors
◦ Week 5 – Presentation of Health Equity Policy Briefs [Assessed – 10%]
◦ Week 6 – The practice of medicine : professionalism, MMC and clinical ethics (Dr
Mark Tan)
◦ Week 7 – Legal and ethical Issues at the end of life (Dr Mark Tan)
◦ Week 8 –Negligence
◦ Week 9 – Confidentiality & Presentation Preview Studies [Assessed – 5%]
◦ Week 10 – Independent work on Case Comment Case comment due end of the
week Assessed 30%]
◦ Week 11 – Independent work on Presentations
◦ Week 12 – Presentations [Assessed – 15%]
◦ Week 13 – Presentations
◦ Week 14 – Summative Assessment [Assessed 30%]
 Reflective Essay (10%) Week 2
◦ Watch the film
documentary “Bending
the Arc” on Netflix.
◦ Write a reflective essay on
Bending the Arc as per
the instructions on
Spectrum
 Healthcare Equity Policy Briefs
(10%) (Week 5)
◦ Students divided into 2 groups.
◦ Group A
◦ Group B
◦ Each group will be given a
specific problem/case study
◦ Prepare a short written policy
brief which will be handed in
as well as presented to the
class for discussion.
◦ The groups will comment and
provide feedback on their
classmates briefs
 Health Equity
◦ Equity is the absence of unfair, avoidable or remediable differences among
groups of people, whether those groups are defined socially, economically,
demographically, or geographically or by other dimensions of inequality (e.g.
sex, gender, ethnicity, disability, or sexual orientation). Health is a fundamental
human right. Health equity is achieved when everyone can attain their full
potential for health and well-being.
◦ Health and health equity are determined by the conditions in which people are
born, grow, live, work, play and age, as well as biological
determinants. Structural determinants (political, legal, and economic) with
social norms and institutional processes shape the distribution of power and
resources determined by the conditions in which people are born, grow, live,
work, play and age..
◦ People’s living conditions are often made worse by discrimination,
stereotyping, and prejudice based on sex, gender, age, race, ethnicity, or
disability, among other factors. Discriminatory practices are often embedded in
institutional and systems processes, leading to groups being under-
represented in decision-making at all levels or underserved.
◦ Progressively realizing the right to health means systematically identifying and
eliminating inequities resulting from differences in health and in overall living
conditions.
Healthcare Equity Policy Briefs
There are two parts to this assessment
The written policy brief
• The written brief should not exceed 1,500 words
• The brief should be submitted on Spectrum by midnight 12
November 2022
• The written brief will account for 80% of the total assessment
Presentation and discussion – this will be held on 14 November
during the class.
• 10-minute presentation made to the Ministry of Health
• Questions from the floor (20 mins)
• Feedback and discussion of the brief. ALL students are
expected to have the policy briefs presented by the other
group. (30 mins)
• Internal discussion and submission of peer assessment (15
minutes)
Groups A & B
Access to Healthcare – Undocumented
Migrants and Refugees in Malaysia Health Equity – young people living with HIV in
Malaysia
A 35- year- old foreigner without any legal
documents, presents at a private clinic with a Mia is a 17 year old girl who is starting as a first
history of fever, abdominal pain, and vomiting year matriculation student at a local college.

A B
for the past three days. He was accompanied She is has been living with HIV since birth and is
by his friend and he relied on his friend to currently under the care of Dr Kim, a
answer most of the questions regarding his paediatrician who has taken care of her and
condition, as he could not understand and manages her condition.
speak Malay. The local college requires that she undergoes a
On examination, he looked lethargic and medical examination, which includes a HIV test.
dehydrated with guarding abdomen. Several The local college has a policy that it will not
blood investigations were carried out. Initial enrol a student who is HIV positive. Mia
treatment was given accordingly despite not approaches Dr Kim with the medical
being able to pay the treatment fee. The examination form. Both Dr Kim and Mia do not
condition and diagnosis were explained want to disclose Mia’s HIV status.
thoroughly to his friend, as was the need for
further treatment at the hospital.
Unfortunately, the patient was not keen on
being referred to the hospital as he might be
arrested and taken to a detention centre after
getting treatment at the hospital once he was
in full recovery. The attending doctor explained
the risks and complications of his decision to his
friend. He understood and decided not to
pursue any treatment.
Case Comment – 30% (Week 10)

Read the case Dr Kok Choong Seng & Anor v Soo Cheng Lin and
Another Appeal [2018] 1 MLJ 685 and write a case comment.

Instructions and guidance provided on Spectrum

 Presentations (20%)
Students will be assigned to the 10 presentation
areas below (2/3 in a group depending on size
of class)
1.Genetics/Genome Editing
2.Reproductive Ethics
3.Maternal/Foetal Conflict
4.Paediatric ethics
5.Mental health law and ethics
6.Medical Devices & health wearables
7.Big data/Personal Data Protection
8.AI / Emerging Technology in Healthcare
9.Neuroethics
10.Ethics of ageing
 For your presentations
◦ Each group should think about a specific research question/issue based
on the broad thematic area you have been given.
◦ When designing your presentation, do not try to cover all the arguments
relating to the topic. Pick 2 or at the most 3 points/arguments that you
want to talk about.
1. Genetics/Genome Editing
The genetic revolution is changing the very nature of medicine. Advances in
genetics and genomics have opened the possibility for the increased
effectiveness and affordability of medicine through the prospects of
personalized or precision medicine. Such advances have led to the altering of
genes through gene therapies and other genetic interventions for the
treatment of disease, but also raise concerns about potential future use of
such interventions that move beyond mere therapeutic goals toward human
enhancement ends.
Genetic medicine is changing how we view behaviour and personal
responsibility, the gift of children, and the identity and nature of human
beings. Developments in genetics and genomics offer exciting new modalities
for medicine, they also raise a host of ethical, legal, and social
considerations that include among others adverse diagnosis and genetic
counselling, the rise of reprogenetics, do-it-yourself (DIY) genetic testing,
gene patenting, biobanking, the prospects of big data and their application
for personalized or precision medicine, as well as concerns regarding privacy
and data security and the potential for genetic discrimination. Furthermore,
evolving technological innovations in genetic interventions such as the
development of CRISPR continue to demonstrate the importance of moral
considerations and societal discourse regarding the proper limits of these
technologies, particularly within the realm of human germline interventions.
https://cbhd.org/category/issues/genetics
2. Reproductive Ethics
◦ Reproductive ethics is concerned with the ethics surrounding
human reproduction and beginning-of-life issues such as
contraception, assisted reproductive technologies (e.g., in vitro
fertilization, zygote intrafallopian transfer (ZIFT),
intracytoplasmic sperm injection (ISCI), etc.), surrogacy, and
preimplantation genetic diagnosis. Ethical issues specific to
this field include among other concerns the introduction of
technology into the reproductive process, distinctions between
reproduction and procreation, the potential for abortifacient
effects through the use of certain contraceptives, embryo &
oocyte cryopreservation, embryo adoption & donation, uterus
transplants, mitochondrial replacement/donation interventions;
synthetic gametes, the exploitation and commodification of
women for reproductive services (i.e., egg donation and
surrogacy), and sex selection of embryos or fetuses.
(https://cbhd.org/category/issues/reproductive-ethics )
3. Maternal-Foetal Conflicts
Examples of issues
• What happens when medical therapy is indicated for one patient, yet
contraindicated for the other?
• When does a foetus or a new-born become a person?
• People have rights. Does a foetus have rights?
• What if maternal decisions seem to be based on unusual beliefs?
• What about obtaining court orders to force pregnant women to
comply?
4. Paediatric Ethics
◦ Neonates are babies within their first twenty-eight days of life. Neonatal
intensive care often caters for babies in one of three groups –
premature babies with low birth weight, full-term babies born with acute
conditions or babies born with congenital anomalies. Ethical issues
mostly surround decision making on behalf of neonates. Decisions
involve the weighing up of treatment that is beneficial or futile,
considering the individual’s short-term and long-term prognosis.
◦ Treatment of paediatric patients - Today, we can save children’s lives,
but the survivors are left with complex, chronic conditions. Premature
babies have chronic lung disease, visual impairment or cerebral palsy.
Cancer survivors have heart disease or hormone deficiencies. Babies
born with congenital anomalies or inborn errors of metabolism must take
multiple medications for the rest of their lives. In difficult situations,
emotions often run high as pediatricians, children, and parents may
disagree about what is best for a child.
https://www.childrensmercy.org/health-care-providers/bioethics-center/
5. Mental health law and ethics
Issues in mental health, such as
◦ involuntary confinement,
◦ adolescent disorders and decision-making,
◦ deinstitutionalization,
◦ the right to treatment and the right to refuse treatment,
◦ criminalization,
◦ substance use disorders,
◦ medicalization and the meaning of mental illness,
◦ forced treatments, discrimination, confidentiality,
◦ research
6. Medical Devices & health
wearables
Wearable devices capture workouts, calorie intake, and
medication adherence. In 2018, 485 million wearable devices are
expected to be sold; 52% of smartphone owners have looked up
health or medical information on their smartphone, and 19% have
downloaded a health-related app. This technology promises to
revolutionize healthcare, making it more broadly available and
fostering self-management and patient empowerment.
Examination of the ethical issues involved in mHealth, as well as its
promises and challenges.
The adoption of technologically advanced medical devices
assisted healthcare providers to examine and treat diseases.
However, technological advancements could increase the threats
to safety, security, and reliability of the devices from complications
associated with manufacturing, functionality, and the clinical
application of the devices.
7. Big data in Health

When data from all aspects of our lives can be relevant to our
health - from our habits at the grocery store and our Google
searches to our FitBit data and our medical records - can we really
differentiate between big data and health big data?
Will health big data be used for good, such as to improve drug
safety, or ill, as in insurance discrimination? Will it disrupt health care
(and the health care system) as we know it?
Will it be possible to protect our health privacy? What barriers will
there be to collecting and utilizing health big data? What role
should law play, and what ethical concerns may arise?
8. AI / Emerging Technology in
Healthcare
The uses of augmented intelligence (AI) in healthcare grow daily.
Many envision that AI will help individualize treatment plans, prevent
illness and expedite discovery, to name just a few applications.
History reminds us that healthcare innovation brings new social,
cultural, professional and often moral challenges. AI has already
pushed the boundaries of privacy and confidentiality and raised
important concerns related to the doctor-patient relationship, the
role of clinicians and the potential for group harms, not to mention
the myriad of unknown unknowns that have yet to surface.
They have raised fundamental questions about what we should do
with these systems, what the systems themselves should do, what
risks they involve, and how we can control these.
 9. Neuroethics
Neuroethics is a field of inquiry that is very broad in scope and is closely related to both
cognitive neuroscience and bioethics, though it is now formally recognised as a
discipline in its own right. Neuroethics can be roughly divided into two streams.
One stream concerns the more direct or proximal implications of cognitive
neuroscience, which can be referred to as the “ethics of neuroscience”. It deals with the
ethical implications of neuroscientific knowledge and technology such as enhancing
neurological function through novel neuro-pharmacological, neuro-stimulation and
neurogenetic engineering techniques. The implications of brain imaging technology,
which is now commonly used in both research and medical practice, raises issues
concerning mental privacy, diagnostics and predicting behaviour. Furthermore,
knowledge gained through neuroscience, along with brain imaging technology, may one
day allow us to probe the human mind to observe even ones thoughts and
predilections.
The second stream of neuroethics, can be referred to as the “neuroscience of ethics”.
This stream of neuroethics lies at the border between philosophy, metaethics and
normative ethics. One of the central issues concerns moral agency. How we impute
moral responsibility given that cognitive neuroscience may shed new light on the way
humans make their decisions as well as the nature of our underlying motivations to act
in certain ways. How can we trust our moral beliefs if it turns out that one’s belief was
not the product of rational contemplation but a post hoc rationalisation of an emotive
judgement, an attitude of disapprobation or a pre-reflective moral intuition that is
distinct, impenetrable and encapsulated from rational contemplation.
10. Ethics of Ageing
Ethical issues related to the elderly, including
◦ ethical decision-making in relation to life-sustaining treatment
for elderly patients,
◦ age-based rationing of health care,
◦ ethical issues in relation to research with elderly subjects,
◦ paternalism with regard to the elderly,
◦ and the responsibilities of adult children toward frail elderly
parents.
Useful resources - Journals
◦BMC Medical Ethics
◦Asian Bioethics Review
◦Hastings Center Report
◦Developing World Bioethics
◦Journal of Medical Ethics (JME)
◦Kennedy Institute of Ethics Journal
◦Bioethics
◦Medical Law Review
Useful Resources - webpages
◦ Bioethics.com
◦ https://bioethics.com
◦ US National Institutes of Health - Bioethics Resources on the
Web
◦ https://www.niehs.nih.gov/research/resources/bioethics/r
esources/index.cfm
◦ Bioethics Research Library at Georgetown
◦ https://bioethics.georgetown.edu
◦ Nuffield Council on Bioethics
◦ https://www.nuffieldbioethics.org
◦ WHO Bioethics Topics
◦ Global Health https://www.who.int/health-topics/ethics-
and-health#tab=tab_1