The Global Health Security Agenda (GHSA) provides a foundation in global health law to support legal preparedness across nations. This column examines the legal authorities necessary to meet the objectives of the GHSA Legal Preparedness Action Package and advance national law reforms to prevent, detect, and respond to public health emergencies.

Recent literature describes the controversy relating to brain death/death by neurological criteria (DNC), which some have referred to as “widely accepted, but not universally supported.” This article provides an overview of differences in state laws relating to DNC and describes recent proposals to reform the definition of brain death. In 2023, the American Academy of Neurology (AAN) issued clinical guidelines stating that clinicians may declare a patient DNC despite evidence of neuroendocrine function — a position that directly conflicts with state law requirements for determining death. This article offers a critical analysis of AAN guidelines, an update on proposals to reform the Uniform Determination of Death Act, and explains why policy discussions should include how DNC exams occur in practice. Research suggests there are flaws with current clinical testing methods, which contributes to two separate problems: (1) false positives from insufficient testing, and (2) inadvertent misdiagnosis from unintentional errors. Together, this has produced confusion and reduced public trust in the concept of brain death. This article provides recommendations to clarify and retain the current legal standard for brain death, explains the ethical importance of accurate standards for determining DNC, and offers practical solutions to reduce errors.

As surrogacy grows, many states and countries are enacting or considering relevant regulations, while others oppose it. Ethical, legal and policy questions arise: how to balance the rights of various kinds of parents (e.g., heterosexual and same-sex couples and single individuals) against the rights and well-being of surrogates. Concerns include risks of exploitation, autonomy, benefits of enabling prospective parents to create loving families, and mitigating possible harms through regulations. Though a few instances of abuse have been reported in developing countries, these do not appear to have occurred in developed countries, where robust regulations exist. The limited data available on surrogates in general (i.e., including traditional and non-commercial surrogacy) do not suggest exploitation or trafficking. In 2021, New York State enacted robust regulations allowing commercial surrogacy. Subsequent competing bills have sought to loosen or enhance certain restrictions. These regulations may be a model for commercial surrogacy regulations elsewhere, but certain ethical, legal and policy questions remain (e.g., where to draw the line to prevent trafficking). Additional data and exploration of these challenges are crucial

This paper considers whether assisted suicide and euthanasia (AS/E) is an area for medical regulation or whether there is a better alternative regulatory mechanism to govern it. Drawing from empirical evidence across a range of jurisdictions where it is legalized, the paper argues that there are at least four good reasons to consider demedicalizing AS/E: (1) pragmatic ethical issues of infrastructural weakness in AS/E service provision in already overstretched healthcare systems globally; (2) challenges of medicalization; (3) regulatory complexities concerning medical law (including pharmaceutical law) and criminal law; (4) the risk that AS/E becomes more easily susceptible to healthcare economics. The paper suggests several recommendations concerning a possible “demedicalized model.”

Climate change-related environmental harms have been observed to negatively affect mental health. While policymakers and courts around the world widely recognise the impacts of climate change on physical heath as potentially endangering human rights, the implications of climate change for mental health have received significantly less attention. This paper analyzed five cases that challenged national response to climate change and the resulting impacts on mental health before four different international human rights protection bodies. Four out of these five cases were dismissed either because the petitioners did not seek prior action before the national authorities, or because their claims were deemed unsubstantiated. Despite these outcomes, the protection bodies’ treatment of these petitions as well as various other ongoing developments show that the human rights approach to climate change and mental health is gradually emerging at the international and domestic levels, but it is still in its early days and there are various challenges to it.

Ongoing efforts among federal agencies to expunge public health data from websites and other media in line with Trump administration directives on “gender ideology” and other themes has led to widespread confusion, angst, and concern among health officials, medical practitioners, and patients. It has also generated legal claims seeking to reverse and stop public health data purges. Framed within statutory or constitutional limits, legal strategies countering these data policies help assure access to core public health information essential to specific services, care, and outcomes.

The risk of losing access to crucial means-tested programs — like Medicaid, Supplemental Security Income (SSI), the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF) — poses a barrier to the enrollment of low-income Americans in clinical trials. This burden likely disproportionately affects members of racial and ethnic minority groups, people with disabilities, elderly individuals, and rural populations, and may frustrate efforts to reflect the US population in clinical trial enrollment. To help achieve representative clinical trials for myriad conditions, Congress should pass legislation excluding payments to clinical trial participants from gross income and expand the clinical trial compensation exclusions for means-tested programs established in the Ensuring Access to Clinical Trials Act of 2015.