American Society of Law, Medicine and Ethics

Charity Scott was a professor of health law at Georgia State University College of Law, the founding director of the College of Law's Center for Law, Health, and Society, and co-founder of the Health Law Partnership (HeLP) at Georgia State. She is an iconic figure in her adopted hometown of Atlanta and certainly one of the most important scholars in the history of the health law field, justly celebrated for her teaching, her innovation, her commitment to interdisciplinary work, and for her compassion and love for others. She was also a dear friend of mine. In this short essay I will reflect on my friendship with Charity and her involvement with the American Society of Law, Medicine & Ethics, the publisher of this journal.

In two cases decided on October 18, 2022, the European Court of Human Rights issued judgments for the first time in complaints alleging racial profiling in police identity checks. The applicants in both cases alleged that the police had selected them for a check due to racial discrimination, and both argued that the state had failed to conduct an effective investigation in response to their complaints. In one case, a unanimous court found a violation of the European Convention on Human Rights, but in the other case, a sharply divided court decided 4–3 that there was no violation. The cases raise serious questions about proof and evidence in racial profiling cases, as well as what policies and procedures would meet the state obligation to ensure an adequate legal framework to protect against racial discrimination.

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56 Harvard International Law Journal 297 (2015)When crime reaches across borders to threaten human security or undermine democracy, states often respond by adopting multilateral treaties that obligate each of them to suppress the transnational crime at home. These treaties help, but only to the extent that parties comply with them. Because states generally cannot enforce their laws outside their own territory, transnational criminals can evade prosecution as long as some states are unable or unwilling to meet these treaty commitments. One solution for improving compliance with these treaties may be, counterintuitively, more unilateralism. Using case studies on transnational bribery and drug trafficking, as well as thick descriptions of several more transnational criminal regimes, this Article develops a theory of “channeled unilateralism” to explain how multilateralism and unilateralism can reinforce one another to the same ends. Treaties that channel unilateralism are structured to help motivated states apply their laws to crimes that reach beyond their borders. Specifically, the treaties endorse extraterritorial application of prescriptive jurisdiction and encourage the use of bilateral agreements for enforcement cooperation. These treaty provisions lower reputational and transaction costs for motivated states to expand their enforcement efforts as long as those efforts remain within the framework set by the treaty. Over time, these expanded unilateral efforts may promote broader compliance with the treaty regime by improving information, peer-to-peer contacts, and technical capacity. When channeled effectively, strong unilateral policies may strengthen rather than weaken multilateral regimes.

Informed consent has historically been described as critical in theory, but incapable of realization in practice, a superficial charade rather than an autonomous choice. This observation should help inspire us to reform our practice to make sure that informed choice actually upholds patient dignity, promotes rational decisionmaking, and protects self-determination.

A culture of health can be seen as a social norm that values health as the nation's priority or as an appeal to improve the social determinants of health. Better population health will require changing social and economic policies. Effective changes are unlikely unless health advocates can leverage a framework broader than health to mobilize political action in collaboration with non-health sector advocates. We suggest that human rights-the dominant international source of norms for government responsibilities-provides this broader framework. Human rights, as expressed in the Universal Declaration of Human Rights and enforceable treaties, require governments to assure their populations nondiscriminatory access to food, water, education, work, social security, and a standard of living adequate for health and well-being. The policies needed to realize human rights also improve population health, well-being, and equity. Aspirations for human rights are strong enough to endure beyond inevitable setbacks to specific causes.

Hospital ethics committees originated with concerns about legal liability, but today they educate, develop and implement policies, and review cases.