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.

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.

We present a training module in AI ethics designed to prepare a broad group of professionals to recognize and address potential ethical challenges of AI applications in healthcare. Training materials include a two-page checklist, a brief glossary, and three practical case studies. While we have developed and applied this framework for training Research Ethics Committee members in France and South Africa, it can also be helpful in university courses ranging from public health and healthcare law to biomedical engineering and applied ethics.

The United Kingdom was the first country to legalize the refusal to provide health care in the name of “conscientious objection”, allowing doctors to refuse to provide abortions based on personal or religious beliefs.

A historical review into the origins and motivation behind the “conscientious objection” clause in the 1967 Abortion Act found that Parliamentarians and the medical profession wanted to preserve doctors’ authority over patients, protect objecting doctors from liability, and appease religious anti-abortion beliefs.

These factors point to an unprincipled basis for the introduction of “conscientious objection” into healthcare, which ultimately came at the expense of patients’ rights and health. The “conscience clause” also represented a negation of basic ethical directives in medical practice including patient autonomy and physicians’ fiduciary duty to patients. The term “conscientious objection”— borrowed from the military but misapplied to healthcare — helped mask the practice as a moral “right” of doctors, even while it disregarded patients’ health and dignity.

Refusing to provide treatment on the basis of “conscience” is harmful and discriminatory, and should be phased out gradually using disincentives and other measures to encourage objectors to choose other fields.

Scientific advances to fight infectious diseases have been remarkable. International law and global governance have sought, and often failed, to keep pace, secure equity, and stop outbreaks. We trace the law and governance model emerging from early failure in the AIDS response and identify four elements: use of law by national governments to compel sharing; decentralized generic manufacturing; mechanisms for voluntary sharing of patents and technology transfer; international funding. In combination, these created a remarkable new ecosystem. We find that when COVID-19 hit and mRNA vaccines were rapidly developed, global North governments opposed mobilizing this synergistic model. Instead, equity efforts focused on financing purchase of vaccines from originator companies with little use of law. Amidst monopolies and scarcity of doses, vaccine nationalism fatally undermined this effort. Whether more synergistic law and governance emerges from rapidly changing global health law will likely dictate the efficacy of future global infectious disease response.

Trust in the validity of published work is of fundamental importance to scientists. Confirmation of validity is more readily attained than addressing the question of whether fraud was involved. Suggestions are made for key stakeholders - institutions and companies, journals, and funders as to how they might enhance trust in science, both by accelerating the assessment of data validity and by segregating that effort from investigation of allegations of fraud.

I write in tribute to my friend Larry Gostin, who has long emphasized that accountability and governance are central to global health policy.

The discipline of public health has begun to recognize the structural inequities of the carceral system as drivers of poor individual and population health. The number of people incarcerated and the length of their incarceration determine the scope and gravity of their exposure to these individual and public health effects. Plea bargains all but guarantee a period of incarceration, often for many years, because prosecutors have significant bargaining power against defendants who often do not fully understand their rights or the likelihood of receiving the sentences that prosecutors would be seeking in trial. I propose and analyze several pathways through which to eliminate or severely restrict the practice of plea bargaining to minimize the health effects associated with incarceration. I conclude that state legislation would be most feasible and effective at eliminating plea bargains but, without concurrent interventions addressing mandatory minima and/or bail, would not fundamentally address the primary concerns of sentence length and overcrowding.

In response to “Origin of ‘Conscientious Objection’ in Health Care: How Care Denials Became Enshrined into Law Because of Abortion,” in which Christian Fiala, Joyce Arthur, and Amelia Martzke trace the origins of “conscientious objection” (CO) policy, this commentary looks at the implications of their arguments for large religious health systems where CO disingenuously constrains care. Within such health institutions, the constraints on standard obstetric care reflect the conscience of bishops who write religious policy, not the beliefs of providers who must implement them, or the patients subject to them.

I have been investigating and reporting on image manipulation in the bioscience literature since 2011. During this time, several new tools have emerged to streamline the processes of image analysis and reporting. When presenting and discussing examples of scientific image manipulation, a common question is “how do you find this stuff?” Herein, I outline common software and other utilities — a toolbox for discovery and reporting of problematic scientific images and other data. This may serve as a useful reference for those seeking to enhance the effective removal of problematic papers from the bioscience literature.

Human rights offer to ground global health law in equity and justice. Human rights norms, advocacy, and strategies have proven successes in challenging private and public inequities and in realizing more equitable domestic and global health governance. However, mobilizing human rights within global health law faces enormous political, economic, technological, and epidemiological challenges, including from the corrosive health impacts of power, politics, and commerce. This article focuses on what human rights could bring to three major global health law challenges — health systems strengthening and universal health coverage, the commercial and economic determinants of health, and pandemic disease threats. We argue that human rights offer potentially powerful norms and strategies for achieving equity and justice in these and other key global health domains. The challenge for those working in human rights and global health law is to work nimbly, creatively, and courageously to strengthen the contribution of these instruments to health justice.

Over the past ten years, global health lawyers have actively engaged with noncommunicable diseases (NCDs). A pivotal instrument in this regard is the Framework Convention on Tobacco Control, adopted by the World Health Organization (WHO) in 2003. Despite its open-ended wording, it has significantly influenced domestic tobacco regulation. For instance, thanks to this treaty, the Dutch government no longer engages with the tobacco industry and has (independent from the tobacco industry) implemented various tobacco control measures, resulting in a significant reduction in smoking. The treaty also serves as an exemplary model for the adoption of similar treaties to regulate other behavioral risk factors such as unhealthy diets and alcohol use, as well as broader environmental determinants.

It has been ten years since the publication of Professor Larry Gostin’s pathbreaking contribution to law, medicine, and public health, Global Health Law (Harvard University Press, 2014). As Professor Sofia Gruskin’s review in The Lancet noted, the book “brings attention to critical aspects of law that anyone interested in global health needs to be concerned about…” This sentiment was echoed throughout the academy, civil society, among non-governmental organizations, legislative bodies, and even courts.

Professor Gostin’s legacy fits among those who harnessed their wisdom, expertise, and voices for the betterment of others and who recognized that chief among the worst harms for any people to endure is the denial of healthcare. This year, one decade after the publication of this of Global Health Law and numerous articles, commentaries, and books, it is clear that Professor Lawrence O. Gostin refuses to be silent on matters that concern the health of the most vulnerable in our world. Our planet is better for his very presence and commitment to what is just, kind, and compassionate.

From its beginnings in the 1978 Declaration of Alma-Ata, universal health coverage (UHC) has been constantly evolving, notably so within the last ten years. Although the 2015 Sustainable Development Goals, which identify both UHC and social protection among its targets, represent an important juncture in this evolution, several States are unlikely to meet the 2030 target deadline. This article traces the history of UHC and social (health) protection in global health law, focusing on their development over the past ten years. It concludes by reflecting on what the future of UHC and social (health) protection should look like and what is needed to fully realize their potential to achieve equity and to meaningfully contribute to the betterment of people and planet, highlighting human rights, One Health, legal and financial considerations as key for the future.

The tenth anniversary of the publication of Lawrence Gostin’s seminal treatise Global Health Law affords us the opportunity to reflect on his enduring legacy as a preeminent scholar, and one of the field’s founding thought leaders.