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
A 35- year- old foreigner without any legal with HIV in Malaysia  
documents, presents at a private clinic with a
Mia is a 17 year old girl who is starting
history of fever, abdominal pain, and vomiting for
as a first year matriculation student at a

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