This thesis contends that the traditional legal and ethical approach to healthcare decision-making for children in mid-childhood is insufficient to meet the needs of those children, their families and the professionals that care for them. To address this failing I present a normative framework based on the Ethics of Care to aid in decision-making. My unique contribution to knowledge is first, to focus on children in mid-childhood (age 8 -14 years old); a neglected group in the jurisprudence, and contend that the current interpretation of Gillick competence and best interests fail to fully appreciate the child’s capabilities or accommodate the families views. Secondly, I assert that the Ethics of Care is well placed to address the needs of children in this age group, whilst fostering child participation. To this end I develop a novel Ethic of Care framework, based upon the work of Jo Bridgeman. Thirdly, I undertake a systematic review of the case law, spanning a 26-year period, and chart patterns and trends in judicial thinking. Finally, I test the utility of the framework by applying it to three areas on the legal fringes: end of life care, living organ donation and treatment for gender dysphoria.

This thesis assesses the new ASEAN Comprehensive Investment Agreement (ACIA) in the light of international practice. Investment protection is at the heart of this investment regime. Considering the ACIA as a tool of regional integration, its structure and contents demonstrate its ultimate objective of attracting intra-ASEAN investment flows for the realisation of a single market and production base under the ASEAN Economic Community (AEC). Analysis focuses on the specific elements of the ACIA and how they balance two contradictory interests, i.e. the protection of ASEAN investors and the sovereignty of ASEAN Member States to regulate investments in their territory. Tracking the solutions and innovations of substantial and procedural provisions introduced by the ACIA, it is found that the “ASEAN Way” of consensus and flexibility remains, even though ASEAN has become the AEC with rules and institutions. This general ASEAN Way is specifically reflected in the “ASEAN Way of Investment Protection”. Given the ASEAN-specific context, the ACIA shows a unique balance of States’ and investors’ interests which differs from that of international investment agreements of other regional integration initiatives. While the ACIA aims to protect ASEAN investors, it attempts to respect the sovereignty of ASEAN Member States, by giving more policy space to regulate for public purposes. From these findings, recommendations are offered to improve the ASEAN investment regime. The understanding of the “ASEAN Way of investment protection” may help interpretation and application of investment protection standards of the ACIA, as well as the other existing investment agreements. The ACIA may also serve as a platform for negotiations of future ASEAN investment agreements.

‘Climate change inundation’ — the process whereby climate change-related harms such as rising sea levels, higher storm surges and changing rainfall patterns interact with existing vulnerabilities like poverty, resource scarcity and inadequate infrastructure — will eventually leave low-lying coral atoll island states uninhabitable. Climate change inundation demands our attention because of the unique challenge it presents to the state, which provides the international legal personality and political infrastructure through which individual and collective human rights are protected, treaties are negotiated and so on. While recognising the positive features of proposals for the planned migration of individual islanders, this thesis is concerned with what they fail to capture: the threat posed by climate change inundation to the collective autonomy and independence of atoll island populations. It explores this threat from the perspective of self-determination, a legal principle whose relevance in this context has been widely acknowledged but not yet explored in detail. The thesis identifies the populations of atoll island states as self-determining peoples, argues for the recognition of climate change inundation as a grave, foreseeable, external threat to their self-determination, and examines the reasons other states may have for acting (or not acting) to address this threat. It then proposes a collective decision-making framework for atoll island peoples, drawing inspiration from the Declaration on Friendly Relations. The first option in this decision-making framework is the ‘[re-]establishment of a sovereign and independent State’ with jurisdiction over a defined territory; the second is ‘the emergence into any other political status freely determined by a people’, including a so-called ‘deterritorialized state’; and the third is to enter into ‘free association or integration with an independent State’, a choice that would protect the collective political status of a people but abandon any claim to statehood or exclusive territorial jurisdiction.

This thesis examines the laws and regulations created in the 1980s and 1990s in the U.S. to hasten development, evaluation, and approval of drugs to treat serious and lifethreatening diseases, and to allow access of seriously ill patients to investigational drugs on a pre-market approval basis. Using detailed historical exposition in tandem with the social-theoretic tools of the sociology of scientific knowledge (SSK), and particularly Barnes’s account of meaning finitism, this thesis examines the social origin, definition, and case-by-case application of conceptual categories in the regulatory oversight of drug development and approval. With this approach, rules and standards for drug approval are shown not to be fossilised machinery for decision-making, but rather living, socially produced and maintained, inherently revisable resources for action. Key conclusions from this study are that: the regulatory actions taken to confront AIDS in the 1980s, often considered to be a radical break with previous practice, had their conceptual origins in the 1960s and 1970s; rule-making is often constitutionally related to a creative process of rule-‘breaking’; tacit processes of consensus outside of, and prior to, formal consensus mechanisms for rule-making are often fundamental to the rule-making process, resulting in de facto ‘rules’ on which later, formal rule-writing can be based; as predicted by finitism, newly created categories of action in drug development and approval require reinterpretation of underlying concepts in related existing categories. The thesis also demonstrates the flexibility and revisable nature of existing conceptual resources for application to current circumstances, consistent with a finitist view of knowledge. While the conclusions of this research are based on only one area of regulation, they are suggestive for more general descriptions of regulatory action. Contemporary theories of regulation are typically designed as economic models or are viewed through traditional categories of law and political science. As a result, they tend to abstract reality, ignoring day-to-day administrative practice, idealizing the nature of rule-following and rulemaking, and ignoring tacit processes of consensus. This thesis brings an interdisciplinary perspective to the theory of regulation, suggesting the outlines of a ‘social’ theory of regulation more fully sensitive to the empirical reality of the social process of rule-making and rule-breaking in contemporary regulation.

Advance decisions to refuse medical treatment (“ADRTs”) have been recognised in English law through a series of cases which arose at the end of the Twentieth Century and subsequently by the Mental Capacity Act 2005. ADRTs allow adults, with the requisite mental capacity, to refuse forms of medical treatment that they anticipate being provided with at a time when they have lost mental capacity in respect of the anticipated treatment. The most frequently advanced argument for the recognition of these instruments is to respect and extend personal autonomy and/or self-determination. However, this thesis treats that particular normative ground as but one among a number of factors which have been crucial to the emergence of ADRTs. It is argued that the advancement in medical capabilities for prolonging life in its final stages is a sine qua non of ADRTs in practical terms. The demographic and financial pressures in which end-of-life care is provided add impetus to the argument for the recognition of ADRTs. However, it is suggested that the political environment in which ADRTs have emerged has also been of fundamental significance to their recognition in law. Using Michel Foucault’s theory of governmentality it will be shown ADRTs have been developed within advanced liberal programmes of government, in response to the inability of the traditional approaches of those forms of government to govern individuals who lack capacity at the end of life. The employment of this theory provides a novel perspective on the debates which have raged in this area of law and bioethics, allowing for a focus on the population, as well as the individual, and a focus on practices rather than on the outcomes.

This thesis examines the emergence of the concept of dangerous and severe personality disorder (DSPD) in England and Wales and its subsequent interactions with criminal justice and health policy, mental health law and the law of sentencing. It also presents a normative critique of the promise of rehabilitation as a limit on the preventive detention of offenders perceived to be dangerous and personality disordered. In the first part of the thesis it is argued that the DSPD initiative was a compromise between the objectives of the Home Office and Department of Health intended to provide a solution to the long-standing problems personality disordered offenders presented for the prison and secure hospital systems. The plans also sought to strike a “balance” between the recognised rights of the offender to liberty and the more contested and nebulous “right” of the public to protection against harm. In essence, the bargain struck meant that, in exchange for their detention to protect the public, dangerous offenders with severe personality disorders would be offered tailored treatments aimed at alleviating their personal distress and reducing the risks they posed to the public so that they could eventually be released. Problematically, however, the effectiveness of the treatments on offer in reducing risk has not yet been proven. In the second part of the thesis, it emerges that the domestic and European legal framework governing the DSPD group takes a similar approach to “balancing” competing rights. In the final analysis, however, the legal and policy framework prioritises the pursuit of public security over the rights of the offender and risk subjecting the latter to disproportionate punishment. In this context, it is argued that the promise of rehabilitation may be more accurately characterised as means of rendering the coercive practice of preventive detention more palatable for liberal governments than as a true safeguard against the violation of prisoners’ rights. Finally, some suggestions for a new normative framework that is more responsive to the risks of disproportionate punishment presented by the current system are put forward.

In this thesis, I critically investigate how issues of sexual justice, sexual politics and normative heterosexuality are interpreted, constructed, and discussed in several salient emancipatory or critical legal and political projects on sexuality and gender, especially in the areas of family relations. Subordination feminism, men and masculinity studies, queer theories, and liberal theories of sexual justice are the major theories I engage with. After critically reviewing the strengths and weaknesses of these theories, I argue that it is worth incorporating a combined approach of queer humanist men and masculinities studies in thinking about gender oppression, normative heterosexuality, law and sexual justice. The combined approach, I argue, is an approach that draws on queer theories, liberal theories of sexual justice, some feminist theories, and humanist men and masculinities studies. I contend that one of the core insights of queer humanist men and masculinities studies is the rejection of an oversimplified and unidimensional concept of gender oppression and gender power relations; a concept that is frequently assumed by subordination feminism. Queer humanist men and masculinities studies view the power relations of gender and the gender oppression in the family as multi-layered and complex, not just about male domination and female subordination. I argue that we will be able to see more realities and previously hidden or marginalised sexuality and gender oppression by incorporating perspectives inspired by queer humanist men and masculinities studies. I further contend that we cannot effectively subvert normative heterosexuality by only seeing and addressing gender normativity in one gender. I discuss the implications of queer humanist men’s studies in equality law, family law and gay men’s studies. In conclusion, I argue that queer humanist men and masculinity studies can broaden our base of concerns and knowledge of sexual injustices and sexual oppression in sexual justice projects. It is an approach worth considering and an area of sexual justice study worth further exploration and research.

This thesis considers the social stigmatisation of involuntary childlessness in Sub-Saharan Africa. It explores the socio-legal issues that arise when involuntary childlessness is given a gendered meaning and how this contributes to the social stigmatisation of involuntarily childless women in this developing region. The social stigmatisation of involuntarily childless women in Sub-Saharan Africa has been widely documented in the social science literature. This body of literature on the gendered meaning of infertility and its impact on involuntary childless women has helped to change attitudes and perspectives on involuntary childlessness in the international public health framework. The World Health Organisation (WHO) recently designated infertility as a global public health concern and has canvassed for wider access to assisted reproductive technologies (ARTs) in the developing world. The case for wider access to ARTs in the developing world has been made on a number of grounds, including those of human rights and social justice. International public health policy makers have also canvassed for wider access of affordable ARTS based on the notion of universal access to reproductive health care. This thesis queries why the law, unlike medicine and other disciplines, has been slow to respond to the gendered social stigmatisation of involuntary childlessness in developing regions of the world such as Sub Saharan Africa. It explores whether the law can facilitate wider access to affordable ARTs based on the notion of universal access to reproductive health care as canvassed by international public health policy makers. It also considers whether law in its regulatory function can be used as an agent of change to combat and curb the social stigmatisation of infertility and involuntary childless women in Sub-Saharan Africa.

The aim of the thesis is to examine the implications of the internationalisation of regulation in China as a developing country. To achieve this, variations in different Chinese food regulatory regimes are compared, ranging from those for domestic consumption to export. In particular, the three control components of a regulatory regime, namely standard-setting, information-gathering and behaviour-modification are analysed. This study finds a pattern of changes in the Chinese food regulatory regimes. At the initial stage, Chinese national food standards were less stringent than international standards, and the gap between established national standards and local enforcement was significantly high. In recent years, it is observed that Chinese national food standards have witnessed an upward movement to converge with international food standards. In the meantime, regulatory enforcement in the localities has undergone continual adjustment to strengthen enforcement force towards areas under public concern. This thesis aims to explain this trend of changes in terms of the internationalisation of regulation. It argues that while coercive international pressure is mainly exerted on the Chinese exported food regulatory regime, the domestic food regulatory regime in China has also been increasingly influenced by global forces over the past decade, in terms of policy transfer from developed countries and policy learning from the transnational professional networks. Regarding domestic food standard-setting, normative influence from the international community has induced a generally higher level of Chinese national food standards. With respect to regulatory enforcement, while enforcement work has been constrained by the incapacity of regulators and the inextricably linked interests in the localities, these domestic factors are becoming less influential under the context of internationalisation of regulation. In particular, food safety crises prompt the Chinese government to push forward regulatory changes in spite of strong resistance in the localities. This has been attributed to the aim of the Chinese government to safeguard the reputation of products ‘Made in China’ under the context of internationalisation of regulation, and build up an international image that China is a committed and responsible trading partner and world leader.

The pursuit of healthcare quality is a global trend as countries attempt to maximise the usage of resources amidst concerns about increasing costs and patient safety. The incentives for high quality care were traditionally provided by the tort system of medical negligence; however, modifications to this system saw it replaced in the UK in 1990 with a fault-based enterprise liability system (NHS Indemnity) - NHS trusts were now indemnified for clinical negligence claims in return for the payment of insurance premiums to the NHSLA which assumed responsibility for claims management. The incentives for quality care in this system evolved to a system of risk management standards in the 2002-2009 period – such standards offered reputational and financial benefits to trusts who achieved higher risk management levels (the attainment of such higher levels is proposed to be dependent on the trust governance structure and financial health), and the impact of this system on the clinical negligence outcomes of NHS trusts is the particular focus of this study. A lack of suitable data restricted previous studies of the effectiveness of risk management standards; however, the availability of such data permitted an empirical analysis of a unique panel database. This analysis initially found that the adoption of a new governance structure (i.e. foundation trust) is significantly associated with higher risk management levels, while efficient risk management processes are found to be significantly associated with lower numbers of clinical negligence claims. Finally, foundation trusts were found to be associated with higher closed claim values i.e. such trusts are willing to offer higher amounts to settle claims early. Overall, this study supports the proposition that more efficient risk management processes will lead to improved clinical negligence outcomes for NHS trusts, and recommendations are offered to assist trusts to become more efficient at risk management.