Bioethics and Human Rights in the Constitutional Formation of Global Health
Abstract
:1. Introduction
2. Conceptual Quandaries over the Global Health Law System
2.1. Institutional and Normative Fragmentation of the Global Health System
2.2. Responses to Fragmentation of the Global Health System
2.3. Global Health through the Lens of Global Pluralism and Transnational Constitutionalism
3. The Constitutional Development of Global Health Law
3.1. Constitutional Moments in the Development of Global Health Law
3.1.1. The Post-War Constitutional Foundations of International Health
3.1.2. The HIV/AIDS Crisis and the Emergence of the Global Health Paradigm
3.1.3. Biomedical Revolution and Global Health Law—An Unlikely Connection?
3.2. Reflexive Mechanism in Global Health Constitution
4. Conclusions
Conflicts of Interest
References and Notes
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- 2Global governance for health is understood as “the collection of rules, norms, institutions, and processes that shape the health of the world’s population”. See: [12].
- 3The distinction between “health care systems” and “global health” adopted in this paper follows the differentiation made by Daniels between the right to health care and the right to health. According to Daniels “the right to health care” includes both the right medical services and public health measures, whereas “the right to health” is defined more broadly as a way to characterise functionally the relevant, socially controllable actions that affect population health and its distribution. See: [13]. Due to the fact that the field of global health clearly exceeds health care services which are predominantly delivered at the national level, this papers refers to health care systems at the national level and global health system at the international/global level.
- 4UN General Assembly Resolution A/70/L.1, Transforming our world: the 2030 Agenda for Sustainable Development, 25 September 2015, A/RES/70/1.
- 6For the purposes of this paper, the terms global and transnational will be used interchangeably for the following reasons. On the one had, global law has been defined by Teubner as a new body of law that emerges from various globalization processes in multiple sectors of civil society independently of the laws of the nation states. See: [20]. As such it is focused on non-state, private systems of governance. Furthermore, according to Kingsbury the term “global” (in Global Administrative Law) includes informal institutional arrangements and other normative practices and sources that are not encompassed within standard conceptions of “international law”, but can be conceptually derived from national administrative (i.e., public) law principles (see: [21]). At the same time, the term “transnational law” was defined by Jessup as “all law, which regulates actions or events that transcend national frontiers. Both public and private international law are included, as are other rules, which do not wholly fit into such standard categories”. See: [22]. Today, transnational law is often seen ‘as a myriad web and “assemblage” of intertwining, both public and private, that is hybrid, forms of regulation that can no longer be easily associated with one particular country or, for that matter, one officially mandated rule making authority’. Those who subscribe to this view treat transnational law as conceptually distinct from national and international law because its primary sources and addressees are neither nation state agencies nor international institutions founded on treaties or conventions, but private actors involved in transnational relations. In this latter sense transnational law clearly overlaps and can be seen as tantamount to global law. See: [23]. See also [24].
- 7See [29]. The distinction between public health law and medical law will be examined at a later point in this paper.
- 8The term “biomedicine” here is neutral and carries no pejorative connotation to a specific model of health care. Rather, it describes the branch of medicine that uses and develops new technologies in medicine, and stands at the intersection of health and science.
- 9The concept of “constitutionalisation” describes the emergence of constitutional law within a given legal order. It implies that a constitution or constitutional law can come into being in a process extended through time. It may be, in short, a constitution-in-the-making.
- 11Art. 2 (a) of the Constitution of the World Health Organization as adopted by the International Health Conference, New York (19–22 June 1946) (Official Records of the World Health Organization, no. 2, p. 100), entered into force on 7 April 1948.
- 12See ([3], p. 30) and see the system as frequently ineffective, increasingly chaotic, and highly dysfunctional.
- 13“Juridification” is a term used by Teubner (2012) and it seems to be tantamount to “legalisation” used by Klabbers (2009) and Krisch (2010) to describe proliferation of treaties and the creation of ever more courts and tribunals. Despite subtle differences they will both be used interchangeably.
- 14See [43]. It is worth mentioning that it was UNESCO and not WHO, who adopted the three human rights instruments in the area of genetics and bioethics.
- 15Optional Protocol to the International Covenant of Social, Economic, and Cultural Rights 1966, UN General Assembly Resolution 63/117, 10 December 2008.
- 16It was also the Committee on Economic, Social and Cultural Rights that issued the General Comment No. 14: [49].
- 17This proliferation is well illustrated, for instance, on the WHO website enumerating guidelines and codes of practices issued by the organization on different subjects. The most famous one issued recently is the WHO Global Code of Practice on the International Recruitment of Health Personnel, at [50].
- 18The ILC preferred the term ‘special regime’ over ‘self-contained regime’, since no evidence is found supporting a full exclusion from general international law. However, as the latter notion has been adopted in case law and scholarship it will be used here. For detailed definition see: [58].
- 19That conceptual frame constituting a starting point for the ILC’s Report was provided by the Vienna Convention on the Law of Treaties of 1969 (VCLT) (23 May 1969), entered into force on 27 January 1980, United Nations, Treaty Series, 1155: 331.
- 20See [70]. The issue of enforceability of Art. 7 arises in this respect, but it constitutes a problem of the whole human rights regime.
- 21The recognition of the role of the judiciary (especially domestic constitutional courts and regional human rights courts) in the process of constitutionalisation may cast some doubt over the whole concept of societal constitutionalism, because it acknowledges that transnational law and sectorial constitutions are developing through the expansion of the public rather than the private sphere. An alternative interpretation would be that transnational constitutions are established through a dialectic involvement of both, public and private law. These issues exceed the scope of this paper and will be discussed elsewhere.
- 22See [90]. In making this point, Thornhill comes close to acknowledging the observations made by Teubner. The slow yet gradual recognition of the right to health at international and national level in a way which strengthens not only the global health system, but also the political power of the state might undermine Teubner’s claims about the complete separation of the political sphere from other global societal constitutions.
- 23e.g., Human Genome Project, HapMap Project, 1000 Genomes Project, European Genotype Archive.
- 24The term ‘biobank’ is controversial because it may imply commercial nature of the database or a repository. However, it is used here as it seems the most commonly employed by regulators and legal scholars. See: [103].
- 25Those companies use genotyping and sequencing of the human genome. U.S. National Library of Medicine. See [105].
- 26For analysis see: [106].
- 27A synthetic “protocell” is an artificial cell-like particle presenting membrane receptors in a biomimetic manner. See also: [107].
- 28These acts, especially the UNESCO Declaration on Human Genome and Human Rights (1997) and the UN Declaration on Reproductive Cloning (2005) are sometimes seen as emerging international customary law, although, these claims seem controversial. Despite common practice of state actors, there still seem to be little evidence that either of the declarations has actually affected the opinion juris of the international community.
- 29e.g., German Act for Protection of Embryos (Embryonenschutzgesetz—ESchG) of 13th December 1990 (BGBl. I S. 2746, as amended in 2001, BGBl. I S. 2702, 2705); English Human Fertilisation and Embryology Act 1990 (amended by the HFEAct 2008); Spanish Law 14/2006 of 26 May 2006 on Techniques of Assisted Reproduction (BOE, 282, 24 November 2006 and BOE 284, 26 November 2006) and Law 14/2007 of 3 July 2007 on Biomedical Research (BOE 4 July 2007), etc. For comparative analysis of laws in the EU see: [115].
- 30For a list of guidelines issued by ESHRE, see [116].
- 31K.L. v Peru, CCPR/C/85/D/1153/2003 (3 November 2005) (HRC).
- 32L.C. v. Peru, UN Doc. CEDAW/C/50/D/22/2009 (4 November 2011).
- 33VDA (on behalf of LMR) v Argentina, Merits, Communication No 1608/2007, UN Doc CCPR/C/101/D/1608/2007, IHRL 157 (UNHRC 2011), (29 March 2011), Human Rights Committee [UNHRC].
- 34Paulina del Carmen Ramírez Jacinto v. Mexico, Case 161-02, Report No. 21/07, Inter-Am. C.H.R., OEA/Ser.L/V/II.130 Doc. 22, rev. 1 (2007).
- 36Artavia Murillo et al. v. Costa Rica, Judgment, Inter-Am. Ct. H. R. (ser. C) No. 257 (November 28 2012). María Mamérita Mestanza Chávez v. Perú is a precedent for identifying discrimination as being a basis for women’s reproductive rights violations.
- 37Classifying the norm prohibiting human reproductive cloning as constitutional does not contradict the earlier statement that such a ban does not fulfil the criteria of customary international law.
- 38Art. 28 Convention on Human Rights and Biomedicine 4 April 1997 (ETS 164).
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Krajewska, A. Bioethics and Human Rights in the Constitutional Formation of Global Health. Laws 2015, 4, 771-802. https://doi.org/10.3390/laws4040771
Krajewska A. Bioethics and Human Rights in the Constitutional Formation of Global Health. Laws. 2015; 4(4):771-802. https://doi.org/10.3390/laws4040771
Chicago/Turabian StyleKrajewska, Atina. 2015. "Bioethics and Human Rights in the Constitutional Formation of Global Health" Laws 4, no. 4: 771-802. https://doi.org/10.3390/laws4040771