Criminal liability for fatal errors made by healthcare professionals, medical manslaughter (MM), has prompted much academic and professional debate. There is concern that doctors are increasingly vulnerable to this offence when they make inadvertent clinical errors in complex healthcare systems where mistakes are common and often arise from systemic causes. Yet, these discussions have been dominated by a few appellate court cases and focused on doctors, not victims. This highlights a key data gap and suggests that there may be patterns in MM cases not fully understood. This article analyses 192 MM cases that constitute all known investigations referred to the Crown Prosecution Service between 2007 and 2018. The analysis shows that MM prosecutions are extremely rare but also reveals previously unexplored trends, including high levels of individual advertent faults and deeper structural concerns beyond systemic faults. Although MM remains a contentious offence, attention must also shift to this wider body of cases, which demand approaches extending beyond criminal law and capable of addressing cross-cutting forms of culpability including structural violence. By situating these cases within a broader regulatory context, I demonstrate that MM cases constitute a vital yet underutilized resource for learning and accountability.
This article examines the acute ambiguity in the law governing the deprivation of liberty of children in England and Wales, where protective interventions often rely on judicial direction and on unclear statutory safeguards. It is argued that the current framework is reactive, welfare-driven, and lacking in procedural coherence. Drawing upon Fineman's theory of vulnerability, Fraser's parity of participation, and Lundy's analysis of children's agency in relation to the participatory guarantees of Article 12 of the United Nations Convention on the Rights of the Child, the article reconceptualizes vulnerability and rejects the paternalistic protection ethos of the status quo. The article exposes structural gaps in the light of a shifting legal landscape. This backdrop includes the Supreme Court's recent 2026 move away from the rigid, single-determinant tests for confinement towards contextual, multifactorial assessments. It proposes an original statutory architecture: the Children's Liberty Protection Framework (CLPF) that establishes statutory mechanisms of advocacy, review, and oversight at Tribunal level. The CLPF transforms vulnerability from being a control-based condition into a procedural right to participate. As such, it offers a coherent legal pathway for reconciling the challenges posed by the right to liberty and the need to protect children within a supportive and responsive state.
Maternity care in the UK continues to confront profound and systemic failings, despite decades of legal and ethical commitments to patient-centred care. This article demonstrates that these failings are not simply operational or episodic but stem from an entrenched institutional culture of paternalism that routinely suppresses women's autonomy. Drawing on major maternity inquiries alongside empirical studies documenting women's experiences of pregnancy and childbirth, the paper illustrates how women's voices are silenced, alternatives withheld, and concerns minimized-particularly for those from racialized or otherwise marginalized groups. These patterns reveal that autonomy, as currently conceived and practiced, remains largely procedural and illusory. The article argues that the dominant 'individualistic' model of autonomy cannot withstand the relational, emotional, and structural realities of pregnancy and childbirth, nor counter the gendered and hierarchical assumptions embedded within NHS practice. It proposes instead a shift towards a relational understanding of autonomy-one that recognizes vulnerability, prioritizes communication and trust, and situates decision-making within wider social and institutional contexts. Only by transforming the cultural foundations of maternity care can the promise of genuine autonomy and safe, respectful care be realized.
It has been a decade since the decision in Montgomery v Lanarkshire Health Board [2015] UKSC 11 was delivered, which definitively established a patient-focused test for deciding whether a healthcare professional (HCP) is under a duty to warn their patient of inherent risks. Given the significant cadre of cases since, it is an appropriate juncture to assess Montgomery's implications for HCPs and for their advisers in two important respects, so as to develop a 'Montgomery map' or guide. First, in the 'consultation phase' between diagnosis and treatment-and in which the duty to warn is nestled-the Bolam test (as modified by the Bolitho 'gloss') remains the governing test of breach to a much greater extent than may have been anticipated when Montgomery's patient-centric approach was affirmed, courtesy of McCulloch v Forth Valley Health Board [2023] UKSC 26. It is argued that Montgomery and McCulloch are entirely reconcilable within the nuanced landscape that the 'consultation phase' entails. Secondly, after a decade's worth of case law, it is now possible to provide a detailed multi-factorial framework as to what, really, renders a risk so 'material' that it ought to be disclosed in order to comply with the Montgomery duty.
This article argues that the lack of an explicit and systematic role for the restoration of P's decision-making capacity within the Mental Capacity Act 2005 (MCA) framework is problematic, in particular in light of the significant developments being made in neurointerventions that have the potential to restore, or at least repair, the abilities required to demonstrate decision-making capacity under the MCA. The article first demonstrates where the challenge lies, through an examination of the current legal framework. It then explores three points in the MCA framework at which the consideration of whether capacity can and should be restored might be incorporated, including the 'practicable steps' requirement, the best interests assessment, and a potential additional stage between the assessment of capacity and the best interests assessment. It is argued that there are significant challenges with all three of these possibilities, and some directions for the way forward are suggested.
This article explores the status of single women's rights to access in vitro fertilization (IVF) in the Western Balkans, with a particular focus on Kosovo. Despite adopting a constitutional framework aligned with the highest standards of Western democracies, Kosovo has for years failed to regulate this issue. In a predominantly Muslim and socially conservative society, resistance to recognizing such rights is often justified on the grounds that children cannot be properly raised without a father figure and that restrictions on access to genetic origins risk undermining the healthy development of children conceived through IVF. This article does not dismiss these concerns outright. Rather, it argues that such objections lack empirical support. Studies indicate that children raised without a father figure can experience full well-being and healthy psychosocial development. This article advances a dual interwoven perspective: legally, it situates Kosovo's obligations within its constitutional and international human rights commitments; psychologically, it challenges conservative narratives by highlighting research on child outcomes in single-mother families. It concludes that, instead of limiting single women's reproductive rights, Kosovo should provide access to IVF while ensuring that children are granted the opportunity, at an appropriate age, to obtain information about their biological fathers.
This article examines how European consent systems for deceased organ donation are evolving, arguing that the focus on opt-in versus opt-out consent systems overshadows the governance structures determining how consent is obtained at the bedside. Through legal analysis, it shows that the impact of opt-out schemes-often described as presumed consent schemes-depends on the usability of organ donation registers, evidence of the deceased's wishes, family influence, and documentation accuracy. While opt-out regimes are widespread and often operationally 'soft' (family-centred at the bedside), they generate a number of issues from a human rights perspective. The article introduces a medico-legal taxonomy connecting legal default rules, the design of organ donor registers, and family decisions about donation, suggesting a practical model for 'soft harmonisation' that respects national constitutional choices. Central to this is a European Consent Status Summary and six governance pillars to improve transparency, interoperability, and traceability without forcing a single consent model. This approach aims to reduce litigation, support cross-border organ exchanges, and build public trust by ensuring that, wherever they exist, the deceased's recorded or reliably reconstructed wishes are identified and given primacy in the transplantation process, regardless of the applicable consent default.
Government-led repurposing programmes are reshaping the division of labour in pharmaceutical innovation. A new power drafted into the European Union pharmaceutical reform package will allow the European Medicines Agency (EMA) to add new therapeutic indications to marketed medicines without the marketing authorization holder's consent. Companies oppose this power, but in weighing up enacting the power, society has a poor understanding of its potential to help patients. This study offers the first empirical assessment of the promise of the power. It analyses 198 medicines from 12 years, comparing EMA-authorized labels with those authorized by the US Food and Drug Administration and a leading reference for off-label uses. Sixty-seven per cent of the medicines have at least one additional use supported by clinical evidence, yielding 320 potential new uses. Of these, 39 per cent are for new diseases and 61 per cent for new patient cohorts, a third of the latter concerning paediatric populations. Commentators generally omit discussing repurposing for new patient cohorts, even though it is a focus of the European Commission. The study's results suggest that the power could be used to authorize a meaningful number of evidence-based uses, especially those already authorized in the USA, while also revealing a policy synergy for neglected populations.
Antibiotics are fundamental to modern medicine, enabling routine surgery, chemotherapy, and treatment of common infections. However, innovation has stagnated, largely targeting known classes that are vulnerable to resistance. Antimicrobial resistance (AMR)-the ability of pathogens to withstand treatment-erodes therapeutic effectiveness and poses substantial health and economic burdens. Addressing AMR requires an integrated strategy that preserves existing agents and rebuilds the pipeline. Traditional incentives, like patents and regulatory exclusivities, do not mitigate the risks associated with development or guarantee returns in a market where antimicrobial R&D often has negative net value. What is needed is a tailored package across the lifecycle: push incentives to finance high-risk early discovery and preclinical work, and pull incentives like market entry rewards, subscription models, and, where appropriate, exclusivity vouchers, to support late-stage development, secure predictable revenues, and ensure timely access. Experiences from the UK and Sweden show that subscription payments can stabilize supply and even deliver innovation incentives by decoupling revenues from volume. One-off rewards, including transferable exclusivity vouchers (TEVs), can decouple sales from use, but raise concerns around predictability and conditionality. Ultimately, economic tools must be coupled with stewardship and equitable access, alongside a shift from pay-by-volume to pay-for-provision/access.
Since 2019, numerous reports (both official and charity-led) have been published detailing patient care and safety failings in areas of women's healthcare in hospitals across the UK. A common theme that has emerged from these reports is a sense that the voices of women and people seeking maternity care and/or treatment for female health conditions are frequently dismissed and silenced. While many of the examples detailed in these reports have been appropriately recognized as both individual and systemic failings in patient care, here we apply Miranda Fricker's epistemic injustice framework to these issues. We argue that testimonial injustice (a form of discriminatory epistemic injustice) forms a core part of the experience of some of these patients' care resulting in a compounding of their experience of harm. Despite various exhortations within the reports that women should be listened to, the evidence demonstrates that women's testimonial knowledge is systematically devalued. We thus contend that a fundamental reframing of the issue is required and that understanding how and why epistemic injustice occurs is critical to developing a better understanding of how to avoid it, both in the provision of women's healthcare and in its regulation.
