Many countries in Latin America, for cultural, religious and regulatory reasons, have struggled and failed to appear as competent players in the global bio-economy of emerging technologies in the biosciences field. This investigation takes Mexico as a country case study to map out the factors hampering the development of the governance of emergent biomedical biotechnologies in this context, particularly that applied to stem cell science. This research aims to contextualise and portray prevailing ethical, legal, political and religious concerns regarding stem cell research in this context. Exploring the debates in these arenas, it seeks to elucidate the perceptions of key stakeholders and to appraise critically the divergences and convergences among the actors who currently shape the debate and who may have significant influence on the creation of any legislative framework in the area. It explores whether it is feasible to draw on the approach taken to stem cell science and tissue regulation in the United Kingdom, in order to illuminate the way forward for governing stem cell research and its clinical applications in Mexico. It also aims to evaluate the risks posed by the persistent lack of regulation in this scientific field, since Mexico appears to be an ideal destination for stem cell tourism among Latin American countries. Drawing on empirical data gathered from prominent Mexican stakeholders in the stem cell issue, this research elucidates the key themes influencing the debate which need to be addressed in detail in order to prepare the ground for the effective governance of stem cell science and its clinical applications. By detailing the emergent themes and providing reflexive explanations of the elements influencing the views of all the actors in this arena, this thesis aims to provide ethical, empirical and normative proposals to be translated by policymakers into purposive regulation of biomedical innovations. Thus, it delineates two main features of the debate over stem cell science regulation in Mexico and shows the urgent need to create a legal framework to deal with problematic situations provoked by the legal vacuum in this area: a) the legal inertia preponderant in the Federal Congress, which is mainly caused by the constant lobbying of politicians by the Roman Catholic hierarchy to endorse prohibitive policies in sensitive areas, such as sexual matters, reproduction and stem cell science; b) the increasing phenomenon of stem cell tourism in the country, requiring the adoption of ethical and legal measures to avoid potential physical and financial harm to desperate patients who seek stem cell treatments.In conclusion, I argue that it is plausible to advance a permissive model of governance for the area of stem cell science. This thesis is supported by the evidence gathered from stakeholders’ opinions, added to the data emanating from the analysis of the country case study. As a result, it is possible to propose as an initial strategy the adoption of significant regulatory features of the paradigmatic system of governance which applies in the United Kingdom. The law is up to date as of 19 June 2012.

Independent Homicide Inquiries (IHIs) investigate homicides committed by persons in receipt of mental health services. They explore the potential causes of these events in order to learn lessons and improve the future provision of mental health services. IHIs decipher complex mental health care histories that, on further inspection, appear resistant to linear causal theories about what actually happened. IHIs are thus constantly open to indeterminacy in their findings regarding what caused the homicide, whether it was predictable and whether it could have been prevented. This is important because IHIs use these findings as a platform for changing the way mental health services are provided. The present thesis implements a theoretical framework, based on Niklas Luhmann’s systems theory, which explains why this problem occurs. Luhmann argued that reality is constructed by distinctly meaningful social systems of communication based around specific social codes. He furthermore posits that decisions are open to continual objection, disagreement and regret. Not only can decisions be decided otherwise by virtue of being decisions, but that social systems will observe decisions in different ways. Decisions can always be observed to be objectionable, incorrect and regrettable after they have been taken. Using this framework, this thesis asks how IHIs retrospectively understand the provision of mental health services in the cases that appear before them. It argues that IHIs construct their investigation and findings using specific social communications that give their observations specific meaning. In light of an expanding, interconnected decision making edifice that comprises mental health services however, the link between identifiable decisions and acts of homicide is obfuscated by ‘systems and processes’. This, in turn, obfuscates individual agency. The thesis consequently calls for a revision of what it means to hold mental health professionals to account in the aftermath of homicide.

In the medical context, it is an accepted (yet controversial) fact that doctors may sometimes legitimately hasten death when providing palliative care to dying patients. Or even, in relation to treatment decisions leading to withdrawal or omission, some doctors may choose death over life for certain patients and yet we seldom hear of doctors in the dock for intentional killing. Where complicity in suicide is concerned, it seems that the compassionate lay person has little reason to be fearful of criminal reprisal. The question, however, of whether a person suspected of complicity in suicide, or a doctor suspected of intentionally causing the death of a patient, will be greeted by sympathy or condemnation is a legal minefield. A range of diverse legal, moral and circumstantial factors will determine firstly, whether one is prosecuted and secondly, whether one will be subject to juridical disapproval and possible incarceration. This thesis sets out to explore whether continued obfuscation, together with turning a blind eye to possible breaches of the law, is the best approach to the moral dilemma over what should be permitted in assisted dying and end-of-life law. This is not a rhetorical question with a trite answer. Such obfuscation may be viewed as having certain advantages. This thesis explores the legal and ethical issues in the context of recent developments, societal concerns and international influences in order to examine whether the current legal position in respect of homicide and complicity in suicide is tenable. The analysis invites the conclusion that whilst some legal change is both desirable and necessary, any legal reform should seek to facilitate a cautious compromise that reflects the legitimate concerns of those opposed to legal change.

The protection of human health and the environment are two major goals of international environmental law. However, there has been little coherent scrutiny of their scope or implementation at international and domestic levels in developing countries and Africa in particular. This thesis shows that international environmental law regimes with a health protection objective have not maximized opportunities to reinforce the promotion and protection of public health in Africa. Through inter alia a study of sustainable management of shared freshwaters, trans-boundary movement of hazardous wastes and their disposal and international climate law, the thesis shows that a range of legal frameworks comprised of substantive, institutional and procedural law mandates States to advance the health objective in international environmental law. However, the thesis demonstrates the limits of these regimes and suggests options to enhance their potential in promoting and protecting public health. An enhanced framework of adaptive governance is proposed to improve environmental health governance. The thesis illustrates how the discourse on health in international environmental law can strengthen international environmental health governance to improve environmental and public health outcomes. It contains seven publications that analyse the strengths and weaknesses and options for reform of the international environmental law regime for health. The implications of these findings for theory, practice and public policy are discussed.

My hypothesis is that social contract theory does not satisfactorily explain why we owe a serious concern or respect to profoundly mentally disabled individuals (PMD). This is a problem for social contract theories if we assume, like I do in this dissertation, that the PMD possess a robust moral status (RMS). My dissertation will explore the main strategies deployed by contractarian and contractualist theorists to bring the PMD within the purview of the social contract, in order to clarify why some aspects of their claims are promising but why they nonetheless fail to fully explain the robust moral status of the PMD. I notably find that they leave morally important dimensions of human relations out of the contractual frame, which means that they exclude the PMD from the scope of justice and morality when they claim that this contractual frame offers the only valid explanation to be a subject of justice and a moral patient. I do not conclude that this requires us to reject social contract theory altogether, nor do I count it as a reason to question whether the PMD have a robust moral status. In my concluding chapter, I will rather suggest a theoretical frame that has the potential of incorporating both contractual and non-contractual relations within the spheres of morality and justice, because both kinds of relation vehicle important intuitions about what is of value in human life. This dissertation will contribute to orientate future research on the moral and political grounds for the rights of profoundly mentally disabled people, as well as question or curtail the breadth of certain key assumptions of social contract theories.

Eastern and southern Africa, a region that is home to a twentieth of the world’s population, accounts for half the number of people living with HIV globally, including an increasingly drug resistant Tuberculosis epidemic. The high mortality and untold human suffering associated with HIV in the region during the late 1990s and early 2000s has mostly been mitigated by a rapid scale up of national HIV treatment programmes over the past decade, largely made possible by generic competition from Indian pharmaceutical manufacturers. The sustainability of treatment programmes in the region depends on various factors. National HIV treatment programmes are largely financed by multilateral donor mechanisms which are facing a decline in funding for the first time in the history of the AIDS response. Indian pharmaceutical manufacturers are increasingly encountering patent barriers stemming from the country’s implementation of its intellectual property obligations under the World Trade Organisation’s TRIPS Agreement. As eastern and southern African countries increasingly focus on local pharmaceutical production and south-south co-operation as vehicles for treatment sustainability, this thesis examines the extent to which public health related flexibilities present in the TRIPS Agreement can be used to as enablers of affordable treatment, both in domestic intellectual property legislation, and relevant regional platforms. The thesis undertakes case studies of the policy and legislative environment in two countries with very different profiles: The United Republic of Tanzania as a least developed country with a nascent local pharmaceutical manufacturing industry and South Africa, as the country with the largest pharmaceutical industry on the continent present the full range of country profiles in the region. Conclusions are drawn regarding the optimization of legislative and policy frameworks to facilitate both the importation and local production of health technologies. Finally, the thesis explores challenges and opportunities facing various south-south co-operation initiatives in the region.

Veterinary negligence within the United Kingdom is under-litigated and under-theorised. Further, the owner-property dyadic means those who have suffered emotional harm cannot claim whilst veterinarians lack external guidance on evolving expectations. To address this tension, this thesis aims to provide guidance to veterinarians on their legal obligations stemming from the triangular relationship between veterinarian, owner, and animal, and to advance the position of the animal within this relationship by advocating a best interests approach. At the damage stage, a sentient constitutive property model, in which the reciprocal relationship between owner and animal is central, will be advocated. The veterinarian’s duty will similarly shift from one which protects the claimant’s financial interest, to one protecting the integrity of the reciprocal relationship. Where the animal’s best interests are at risk, veterinarians may be protected from liability where they have acted to protect this interest. Looking to breach, the importance of expert testimony necessitates profession-wide support of these ideas. To achieve this, new professional guidance developed by a representative council who embrace the aims of this thesis is advocated. Grounding these ideas is the position that courts should be alive to doctrinal aspects of vulnerability and reason decisions based on compassion and fairness.

The main aim of this thesis is to advocate a more scientifically informed approach towards epidemiological evidence in disease litigation. It analyses the judicial scepticism about epidemiology in UK tort law, and finds that the myth of scientific certainty lies at the heart of the devaluation of epidemiology as proof of specific causation. It traces misconceptions about epidemiology to broader misconceptions about science as a whole (including medical science and disease), and confused legal approaches to causation. To explain why legal objections to epidemiology are erroneous, the thesis clarifies fundamental aspects of science and disease causation that lawyers need to better grasp. Scientific reasoning is inherently probabilistic. Further, medical research indicates that disease causation is usually multifactorial and stochastic. Rigid and deterministic ‘but for’ questions are thus fundamentally unsuited for assessing disease causation. The mismatch between legal and medical causal models makes courts resort to normative, ‘backwards’ causal reasoning or haphazard exceptional approaches to disease causation, where the most difficult dilemmas around causation arise. This thesis argues that courts need a better test for causation for disease that can take account of probabilistic scientific and epidemiological evidence, and suggests one such principled approach. Epidemiology can be invaluable in such an assessment of disease causation.

Organ donation is traditionally based on the notion of making a gift based on altruism. An important aspect of ‘altruistic gifting’ is commitment to a solidaristic approach to meeting transplant needs. In line with this, people are encouraged to donate their organs at death to a common pool for collective provision, or donate a live organ to another freely. Given a chronic organ shortage, proposals have been made to change this system to increase donation. Proposals include introducing some organ market or payment in the form of a reward to incentivise live or deceased donation. However, these proposals have been opposed because of the grip of ‘altruistic gift’ as the only ethically acceptable way to procure and distribute organs. To support the ethical acceptability of other systems, ‘altruistic gift’ has been subject to various criticisms. One criticism is the moral relevance of altruism: people may donate on other motives other than altruism; or, altruism is not the motive that underpins most deceased organ donations. Another criticism is the moral value of altruism: even if deceased organ donations are in general altruistic, altruism does not express communal virtues like generosity that support solidarity. A third criticism is the value of the concept of altruism when understood in the pure sense: ‘pure altruism’ fashions an unnecessary or false dichotomy – gift versus sale – in the way people can ethically relate and help each other. Consistent with or following this criticism, it has been argued that use of a financial reward to incentivise donation can be compatible with preserving donation as altruistic albeit in a ‘non-pure’ sense. ‘Altruism’ and reward can co-exist as motives for donation. This thesis concerns itself centrally with the third criticism. It argues that the concept of altruism delineates a distinctive moral ‘perspective’ of a common humanity that engenders a devotion to others’ interests. Accordingly, as I argue, ‘non-pure’ definitions of altruism are misleading as to how a financial reward can be compatible with altruism. From this, the thesis argues that introduction of a financial reward for organ donation would not preserve donation as altruistic. Based on an understanding of altruism as also a motive for ‘creative’ relationships, the thesis counters criticisms of its relevance and value to deceased organ donation under a gift model. As part of its legal analysis, the thesis considers the antithesis of ‘altruistic gift’: the idea of organs as property which places individual control on their disposition at its moral centre. It has been argued that organs should be owned as property so that individuals can sell them, or transmit them to relatives so that relatives can claim payment from donation. To provoke thought on whether organs should be owned as private property like any other, the thesis proposes an inheritance regime for organs with family as default successor.

S'allier à autrui par des liens de confiance ou par le jeu d'obligations juridiques, pour faire face à l'incertitude et à la complexité, est l'affaire de l'homme depuis qu'il a besoin d'un autre pour sa survie et son mieux-Être. La juridicisation des relations sociales a envahi plus récemment le monde de la santé, remettant en question le lien de confiance dans la relation de soin. Il semble nécessaire d'aller au-Delà de ce présupposé opposant relation de confiance et relation contractuelle. Car le droit contraint notre liberté mais protège aussi le plus vulnérable et si la confiance oblige, elle engage de ce fait notre responsabilité.Phénomène pluridimensionnel particulièrement riche dans ses expressions et ses usages, la confiance permet l'engagement dans la relation, elle en est à la fois la cause, le moyen et l'effet. La relation de soin, où technicité et subjectivités se rencontrent, met en évidence une dynamique complexe de la confiance, entre nos attentes, nos contradictions et nos craintes. Aux moments charnières, encadrée par des textes récents, du parcours de soin: l'engagement dans la relation, l'information, la décision partagée, l'épreuve de l'obstination ou du refus, nous retrouvons la nécessité de la confiance entrecroisée à celle des droits du patient. Nous voyons s'inventer aujourd'hui, non sans déstabilisation, de nouvelles figures de la relation de soin.Au terme de cette double exploration émerge la question de la reconnaissance, celle des droits et celle de la personne dans le bouleversement de la maladie. Une reconnaissance mutuelle entre soigné et soignant qui se conjugue à une confiance réciproque comme fondement éthique de la relation de soin. / Dependency on others for one's survival or well-Being has always meant allying oneself with others. In this way, relationships founded on trust or legal obligation can make it easier to manage the inevitable problems and insecurity. The juridicisation of social relations which has emerged recently in health care is undermining the bond of trust in the health care relationship. It therefore seems necessary to explore this presupposition in which the trust relationship has come to be viewed in direct opposition to the contractual relationship. And if the law is there to restrain, it is likewise there to protect the weakest; confidence in somebody creates moral obligations, thus requiring commitment.Trust, a multi-Faceted phenomenon with many forms of expression and uses, is what makes a commitment to others possible. In the health care relationship, where technology and subjectivities come together, the complex dynamics of trust, between our expectations, contradictions and fears, are vividly exposed. At pivotal moments on the care pathway, we find the need for trust bisecting the patients' rights: commitment, information, shared decision-Making, the tug of war between obstinacy and refusal. This is where we see new features cropping up in the patient-Carer relationship.From this double investigation emerges the idea of acknowledgement of patients' rights and of the person struggling with the disease. A mutual acknowledgement between patient and carer combined with a reciprocal trust as an ethical basis for the health care relationship.