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05/19/2020 - 3:00am

I have read dozens of legislative reports and hundreds of articles on medical aid in dying. But this report from the Campaign for Dignity in Dying is especially compelling, because it does far beyond dry evidence and data.

This report has many mo...

05/19/2020 - 3:00am

I have read dozens of legislative reports and hundreds of articles on medical aid in dying. But this report from the Campaign for Dignity in Dying is especially compelling, because it does far beyond dry evidence and data.

05/19/2020 - 3:00am

I have read dozens of legislative reports and hundreds of articles on medical aid in dying. But this report from the Campaign for Dignity in Dying is especially compelling, because it does far beyond dry evidence and data.

This report has many mo...

06/01/2020 - 11:04pm

Why AIs will never fully replace humans.

05/18/2020 - 3:01pm

Some bioethicists support age-related rationing of ventilators during the Covid-19 pandemic as a way to save the most lives. But that goal might be better realized without strict age cutoffs.

The post Why I Don’t Support Age-Related Rationing During the Covid Pandemic appeared first on The Hastings Center.

05/18/2020 - 1:49pm

STUDENT VOICES | CHYNN PRIZE FIRST-PLACE WINNER By Ray Tischio In light of completing my International Studies thesis on nation-state cyber conflict this semester, I have given a lot of thought to the ethical component of this subject throughout the last few months. Although ethics was not something my thesis particularly addressed, I often found […]

05/18/2020 - 1:00pm

By Sara Gerke

Many countries are looking these days to Germany’s approach to combating COVID-19. Although Germany initially experienced a high case rate, the country has been able to slow the spread of the virus and appears to have the situation better “under control” than other countries.

There may be various reasons for Germany’s successful handling of the pandemic so far, ranging from early testing for COVID-19 to high public outreach and transparency to increasing the number of ICU beds and ventilators.

Restrictions of Basic Rights

However, various measures have also been taken at the federal and state levels that restrict the basic rights of citizens. For example, social distancing and contact restrictions in public spaces have been introduced nationwide. In all federal states, individuals are required to wear a mask in certain public areas, such as supermarkets and public transport. In some states, such as Saxony or Bavaria, stay-at-home orders were temporarily imposed; individuals could leave their homes only in certain circumstances. Daily life came to a standstill.

These restrictive measures caused anger and frustration among some citizens, and protests have taken place in several cities since March.

Moreover, the German Federal Constitutional Court (BVerfG) is receiving many applications against COVID-19 measures; some have been lifted, others have not. For example, on April 15, the BVerfG ruled, by means of an accelerated procedure, that the Gießen assembly authority had incorrectly assessed the ordinance of the Hessian State Government to combat the coronavirus. The authority’s interpretation surmised a blanket ban on assemblies of more than two people who do not belong to the same household. On this basis, the authority banned the applicant’s assemblies, and thereby, the court ruled, violated the applicant’s basic right to freedom of assembly under Article 8 of the Basic Law for the Federal Republic of Germany (GG). One of the assemblies was carried out on April 17 in Gießen, but with conditions such as safe distancing and mouth protection.

Some citizens also filed constitutional complaints against temporary stay-at-home-orders imposed by some federal states. For example, the Bavarian Constitutional Court refused on March 26 to repeal the Bavarian Ordinance on a temporary stay-at-home order due to the COVID-19 pandemic. On April 24, the same court also rejected the repeal of the Second Bavarian Infection Protection Measures Ordinance on the stay-at-home order due to the COVID-19 pandemic. In contrast, the stay-at-home order in Saarland was lifted by the Saarland constitutional court with immediate effect on April 28.

Easing of Measures

The country now has fewer numbers of confirmed daily COVID-19 cases than at the beginning of the crisis, and chancellor Angela Merkel has said in a press conference on May 6 that “we have achieved the goal of slowing the spread of the virus.”

But the complete shutdown has left its mark, such as through corporate insolvencies and rising unemployment.

Germany is thus easing the measures step-by-step, for example, gradually reopening shops, restaurants, schools, and museums. Contact restrictions initially remain until June 5. The federal states mainly decide independently on the successive loosening of restrictions. However, a spike in new infections (50 per 100,000 inhabitants per week) would trigger the reintroduction of restrictive measures to stop the further spread of the virus in affected regions. The corona warning app planned for June could also help to interrupt chains of infection. The use of the app will be voluntary and comply with European and German data protection rules.

Despite the easing of measures, protests are ongoing. On May 13, Merkel made an appeal for perseverance: “It would be depressing if we had to go back to the restrictions we all want to leave behind because we want too much too quickly.” On May 12 and 13, the BVerfG confirmed the current political course by not accepting two opposing constitutional complaints, one against the easing of COVID-19 measures and one against the continuing restrictions.

It remains to be seen in the coming weeks how the new step-by-step plan will play out, but Germany is proceeding with caution and safeguards in place, and continuing to focus on scientific development as a means to combat the pandemic. In particular, testing for COVID-19, antibody tests, and the development of vaccines remain a high priority.

Testing for COVID-19

The first patient with COVID-19 was diagnosed in Germany at the end of January. At that time, Germany was already well prepared and had started to produce and store test kits. Christian Drosten and his team at the Charité in Berlin developed and made available the world’s first diagnostic test in mid-January. Germany not only tested for the virus early on but has also increasingly expanded its testing capacity: According to the Robert Koch Institute, over 3.1 million people have been tested so far. The widespread testing could also be one reason why the coronavirus mortality rate is lower than in other countries.

Antibody Testing

Antibody testing is carried out with blood samples and can help to identify individuals who may have been previously infected with the virus and may have developed COVID-19 immunity. According to the current state of knowledge, further studies, however, are needed to better understand the level of antibodies required for individuals to be immune and the length of protection they offer.

Many countries around the world are currently also considering to implement so-called “immunity passports” to allow people with COVID-19 immunity to return to work and everyday life. Such passports, however, raise several ethical concerns. The formulation aid for a draft of the Second Civil Protection Act to be introduced in the German Bundestag initially included the introduction of immunity passports. After fierce criticism, however, the relevant passages were deleted, and the bill of May 5 does not include such passports.

The Federal Minister of Health, Jens Spahn, said that the opinion of the German Ethics Council should first be awaited before legal regulations on immunity passports are considered.

The pharmaceutical company Roche has recently made headlines, as the company is scheduled to deliver three million antibody tests to health care facilities in Germany in May, and five million tests each month over the coming months. The new test seems to be highly promising, reportedly having a sensitivity of 100 percent and a specificity of 99.8 percent.

Additionally, in April, the Robert Koch Institute announced the start of nationwide antibody studies.

Antibody testing can also help to identify potential donors of convalescent plasma that could be used to treat seriously ill patients with COVID-19. The Paul Ehrlich Institute approved the first COVID-19 clinical trial with convalescent plasma in Germany in April.

Vaccine Development

Germany is also working to develop a vaccine against COVID-19. The Paul Ehrlich Institute approved the first clinical trial of a vaccine in April and anticipates that further clinical trials of vaccines against COVID-19 will be approved in the coming months. These studies should be conducted with a robust ethical framework in place.

There have been some recent rumors of compulsory vaccination against COVID-19 in Germany, but the grand coalition has rejected such speculations. Spahn is optimistic that the vast majority of citizens would want to be vaccinated immediately as soon as there is a vaccine against COVID-19 available, and affirmed that “where voluntariness leads to the goal, there is no legal obligation.” From a constitutional point of view, a general obligation to vaccinate also could hardly be justified with the basic rights of physical integrity or occupational freedom.

 

Sara Gerke is a Research Fellow in Medicine, Artificial Intelligence, and Law at the Petrie-Flom Center.

The post Germany’s Response to the COVID-19 Pandemic appeared first on Bill of Health.

05/18/2020 - 12:48pm

[00:00:09] Hello and welcome to Reopening the Nation Hastings Center, a conversation about the next steps forward in the coveted 19 pandemic. We’re so pleased to have with us today. Ryan, Kalo, Ed Felten and Mildred Solomon. We’re hoping for strong audience participation. So please do us questions by typing them into the Q&A box… Read more

The post Transcript: Re-Opening the Nation: Privacy, Surveillance and Digital Tools for Contact Tracing appeared first on The Hastings Center.

05/18/2020 - 10:00am

By Hrefna D.  Gunnarsdóttir

Response and Restrictions

In the response to the COVID-19 pandemic, Iceland rolled out an extensive strategy of testing, isolating, contact tracing, quarantining, and social distancing, which has helped the country avoid the most drastic rights restrictions.

Diagnostic testing of those with symptoms started almost a month before the first case was identified in late February. By early March, hospitals and nursing homes closed to visitors, and public health authorities teamed up with a private company, deCODE genetics, to collect samples from symptom-free/mildly symptomatic residents. The collaboration (while controversial) provided valuable information on the prevalence of COVID-19 to tailor Iceland’s response.

Consequently, legal measures have not gone as far as placing curfews. However, Iceland has employed the following strategies to contain the virus: isolation, quarantine, limitations on group gatherings (first limited to less than 100, and later reduced to 20) and distancing requirements of 2 meters (with associated fines if violated). These measures have affected the autonomy of Iceland’s residents and severely impacted businesses.

Essential institutions, such as the Parliament and the Courts continued to run adapting their schedules and procedures in line with the measures. Stress on the right to education gradually progressed and higher education institutes ultimately closed their doors and moved teaching online. Kindergartens (ages 1-5) and elementary schools (ages 6-16) mostly stayed open with modified operations.  As of 4 May, these restrictions are, little by little, being withdrawn.

Iceland also participated in temporary restrictions on non-essential travel to the Schengen Area, and enacted internal border control including 14-day quarantine upon arrival, both of which are currently set to be in place until 15 May 2020. Iceland expects to reopen to international arrivals by mid-June. While the details of the reopening are currently being finalized, the government has announced that it might entail testing and tracing measures for arriving passengers.

Respecting the Rule of Law

In the absence of a specific emergency legislation, Iceland has relied on passing executive instruments based on statutory law. The travel restrictions were set by the Minister of Justice, enacting a Regulation, as authorized in the Act on Foreign Nationals.

Other measures (on quarantine and isolation, gatherings, and schools) have been introduced by the Minister of Health’s (MoH) Rules and Advertisements seeking basis in the Act on Health Security and Communicable Diseases. The Act allows the MoH to adopt measures in response to communicable diseases based on recommendations from Iceland’s Chief Epidemiologist. The associated fines for violating the measures rely on the same legislation, while prison sentences for more severe violations were already stipulated in the Penal Code.

The judiciary has not yet had to evaluate the legality of the enacted measures but local newspapers have reported that those might be on the horizon. Before the Courts, the measures, and their legal basis, might be tested against the provisions of the Constitution and the European Convention of Human Rights,  as Iceland has neither relied on the Constitution’s unwritten necessity principle nor the European Convention of Human Rights’ derogation.

While the Health Security and Communicable Diseases Act could certainly be clearer, it explicitly stipulates isolation, quarantine, closing of schools, and gathering bans as possible measures against communicable diseases. The specific legal basis for not permitting visitors to hospitals and nursing homes has not been precisely stated. However, according to the Patients’ Rights Act, health care services and nursing homes have an obvious duty to apply measures to protect patients, and provide best health service available. Additionally, the Act on Civil Protection provides the legal basis for the national pandemic response plan, stating the protection of those responsible for indispensable services as one of the key objectives.

Trust, but Rising Tensions

In addition to legal measures, the frontline in Iceland’s response (the Director of Health, the Chief Superintendent of Police and the Chief Epidemiologist) has held daily press conferences in Icelandic.

The trio of experts has used the platform to discuss the pandemic in wide context, introduce foreseeable restrictions and advise on issues ranging from hygiene to privacy concerns of the contact tracing application (developed in cooperation with the Data Protection Authority). Maybe due to this transparency, recent polls have shown that up to 96% of residents trust Iceland’s response. Other polls demonstrate that 85% consider Iceland’s response appropriate.

While the legal measures directly linked to the response seem to have been positively perceived, the crisis has magnified longstanding inequity issues in society, demonstrated, for example, in a delay issuing guidelines for people with disabilities using personal assistance services. Despite great efforts to translate the main website on COVID-19 into 8 different languages, it is currently not known whether non-Icelandic speaking communities had sufficient access to necessary information.

The secondary impact of the restrictions, such as potential increases in domestic violence and child abuse, has also been high on the national agenda. More controversial has been the follow-up compensation scheme, introduced by Iceland’s government to tackle the restrictions’ impact on aviation, tourism, and merchants, and the associated unemployment rate. In light of this controversy, the measures and their impact on civil rights are likely to be dissected as the dust settles.

 

Hrefna D. Gunnarsdóttir holds a BA and Mag. Juris in Law from the University of Iceland and MA in Disaster Management from School of Global Health, University of Copenhagen, Denmark (UCPH). Gunnarsdóttir was a practicing Attorney at Réttur – Aðalsteinsson & Partners in Reykjavik, Iceland, before commencing her PhD at Center for Advanced studies in Biomedical Innovation Law (CeBIL) at UCPH. In her PhD study, Gunnarsdóttir explores the intersection between communicable diseases, data ethics and law from a patient governance perspective.

The post COVID-19, Civil Rights, and the Rule of Law: The Case of Iceland appeared first on Bill of Health.

05/18/2020 - 7:00am

By Anand Grover

With only four hours’ notice, the Government of India imposed a nationwide lockdown to combat COVID-19, which began on March 24th, 2020 and is scheduled to end on May 17th, 2020.

The lockdown was implemented through executive orders, beginning March 24th, 2020, together with guidelines under the Disaster Management Act (DMA).

Only essential services, such as those related to security, government, food, medical supplies, and municipal cleaning, were permitted to continue operations, albeit sometimes in a curtailed manner. Inter-state and district borders were sealed. All persons, except those engaged in essential services, were mandated to stay at home and observe social distancing. Testing, quarantine and contact tracing were employed to detect and prevent further transmission of the virus. Breach of orders was criminally punishable.

In addition, state (provincial) governments issued regulations under the Epidemic Diseases Act of 1897 to further enforce the lockdown measures, including for testing, quarantine/isolation of individuals, and sealing off areas. Interestingly, the Delhi COVID-19 Regulations under the 1897 Act even provide that no information would disseminated “without prior permission of the … Government.”

Legal challenges

Invasive technology was employed to create lists of persons suspected to be infected with COVID-19. Drones were deployed to monitor compliance by quarantined individuals. Smartphone applications are being used for detection and contact-tracing. One particular application, Aarogya Setu, is now required to be downloaded by all persons employed in workplaces, which itself is open to legal challenge.

In the Puttaswamy (Privacy) judgment of 2017, it was held that to sustain a privacy restricting action the State had to show that, a) the restrictions were sanctioned by law; b) were made pursuant to a legitimate state aim; c) there exists a rational relationship between the purpose and the restriction; and d) that the State has chosen the “least restrictive” measure available to achieve its objective, all of which are absent in Aarogya Setu. The Puttaswamy (Aadhar) judgment of 2018 had also mandated that there should be a data protection law, which is also missing in the case of Aarogya Setu.

Other legal challenges include a Supreme Court ruling on health care workers’ (HCWs) lack of personal protective equipment (PPE). The Supreme Court directed the Government to provide PPE to HCWs, but did not provide for any form of compliance monitoring of its own orders.

And the Supreme Court ruled in Parmanad Katara that private hospitals must also admit non-COVID-19 emergency patients. In practice, however, private hospitals have not been admitting non-COVID-19 emergency patients.

Disparate impacts

The lockdown, with one stroke, resulted in the closure of all establishments and transport. Millions of migrant workers, dependent on daily earnings, were left with no money due to the loss their livelihoods. With no arrangements to pay for rent for their make-shift shelters, millions were forced to start marching home on foot, undertaking journeys of hundreds of miles from the major metros to their homes. Some died on the way. Some state governments directed workers to be charged criminally, returned back, or put up in temporary jails.

The central government had to issue an order dated March 29th, 2020 under the DMA directing the state governments to accommodate migrant workers and provide them food. However, the vast majority of the migrants were sheltered and fed by NGOs. In a petition to pay minimum wages, the Supreme Court directed the central government to “take such steps as it finds fit to resolve the issues raised in the petition.”

In a number of cities, migrant workers revolted. These revolts were quelled by police action. For Indian tourists, business people, and students abroad ⁠— mostly upper class individuals ⁠— planes were sent to repatriate them, all at the government’s expense. Migrant workers had no such solace. Just before the lockdown was partially lifted on May 1st, 2020, the government arranged for special trains to return migrant workers home. Initially the workers were made to pay for the train fare, but later the government stated that they would pay the fare. However, some states cancelled the trains.

These actions violate the migrant workers’ constitutional right to equality and the right to life and to move freely throughout India. In response to a petition, the Supreme Court only directed the government to place on record the proposed protocol, if any, for movement of migrant workers between states.

COVID-19 was also used to whip up communal hysteria. The press portrayed a sect of Muslims, Tablighi Jamaat, being responsible for the virus’s spread. The Government added fuel to the fire.

Domestic violence and sexual abuse of children also increased in the COVID-19 period, with no practical remedies for the survivors.

 

Anand Grover is a designated Senior Advocate practicing in the Supreme Court of India, the Director of the HIV/AIDS Unit of Lawyer’s Collective (India), and the former United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (2008-2014).

The post COVID-19 in India: Lockdown, Legal Challenges, and Disparate Impacts appeared first on Bill of Health.