Empty hospital bed.

The Inevitability of Error in Health Care

By John Tingle

A recent publication by the World Health Organization (WHO), a first draft of a global patient safety action plan 2021-2030, seems to have rekindled conversations about the “inevitability of error” in the field of patient safety.

The “inevitability of error” argument indicates that mistakes in health care do inevitably happen; that they are the consequences of the complex nature of health care treatment. Nursing and medicine depend on people, and nobody is infallible — we all make mistakes.

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NHS building

COVID-19 and the State of Health and Social Care in England

By John Tingle

The COVID-19 pandemic has exacerbated challenges facing the provision of health and social care in England, a recent report from the Care Quality Commission (CQC) finds.

The CQC is the independent regulator of health and social care in England. Every year they produce an assessment of the state of the country’s health and social care. The yearly lookbacks include information on trends, challenges, successes, failures and opportunities.

The most recent report analyzes service provision both pre- and post COVID-19, and draws key conclusions from this information. From a patient safety perspective, the report contains important lessons about issues the COVID-19 pandemic has brought into sharp focus. The report also highlights trailing patient safety problems that existed before the pandemic, and are still present as England grapples with the pandemic’s second wave.

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Supreme Court of Mexico.

How Does the Mexican Constitution Regulate Crisis?

By David García Sarubbi

When the Mexican Constitution was issued in 1917, one of its main concerns was to regulate how democracy must deal with crisis, that is, with exceptional situations that demand the exercise of powers outside the Constitution’s regular limits to suppress potential dangers.

There is not an “off switch” available for political powers to put the Constitution to rest while solving urgent issues. Instead, there are complex rules to govern decisions in extraordinary circumstances.

The Constitution’s Article 29 has a Suspension Clause, which contains a detailed regulation for such cases. Moreover, in Article 73, Section XVI, there is another regulation relating to pandemics like the one we are experiencing currently.

Thus, from the founding era, the Mexican constitution has upheld the value of the rule of law, even in extraordinary circumstances.

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Medicine doctor and stethoscope in hand touching icon medical network connection with modern virtual screen interface, medical technology network concept

Regulation of Access to Clinical Data in Chile’s New Constitution

By Gabriela Y. Novoa and Alexis M. Kalergis

As Chileans prepare to vote on whether or not to create a new Constitution, an issue worth considering relative to this reform concerns access to clinical data.

The Political Constitution of the Republic of Chile dates back to 1980, and, in the past decades, has undergone several amendments, including key reforms in August 1989, August 2005, and August 2019. As part of this last modification, it was agreed to organize a plebiscite to democratically decide whether or not to elaborate an entirely new constitutional text. If the alternative of generating a new constitution is adopted, it will consist of a constitution written from square one, rather than a modification to the existing text.

As part of the public discussion relative to the potential approval of the need for a new constitution, an open debate has taken place about which issues should or should not be incorporated into this new text.

Among several important themes, the need to regulate the access to clinical data of patients, also called “interoperability,” arises as a major one. Such an issue is linked to the rights to life, to health and privacy protection, individual honor and personal data and property, which are currently established as constitutional guarantees by Article 19 of the current Constitution. Further, the legal framework dealing with this issue is currently mainly found in Law No. 20,584, which regulates the Rights and Duties of individuals in connection with actions associated to their health care, and in Law No. 19,628 (on the protection of the privacy of individuals).

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Vaccine.

The Ethics of COVID-19 Vaccine Trials in Developing Countries

By Sunnie Ning

As more COVID-19 vaccine candidates enter clinical trials, many developing countries are being tapped to participate.

But the history of clinical trials in developing countries is fraught with ethics violations and discrimination. In June, several protests broke out in South Africa over the University of Oxford’s COVID-19 vaccine trial. Demonstrators held signs that said: “We are not guinea pigs.”

In this post, I explore some of the ethics issues of clinical trials conducted by groups in developed countries but carried out in developing countries.

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Santiago, Chile - Crosswalk in long-exposure.

Chile’s New Constitution, the Right to Health, and Health System Reforms

By Marco Antonio Nuñez

During these months of the COVID-19 pandemic in Chile, the need to align the constitutional process with long-postponed structural reforms to the health system has become evident among public health experts.

Capitalizing on this moment might avoid the possibility of a constitutional right to health becoming a dead letter or being reduced only to the prosecution of particular cases, postponing again the aspirations of the majority of Chileans.

Although the Chilean Constitution promulgated under the dictatorship in 1980 and subsequently reformed in several of its chapters recognizes “The right to the protection of health,” it has been tainted by authoritarianism from its origin, and promotes a subsidiary role of the state in health.

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gavel and stethoscope on white background

The Right to Health in the Upcoming Constitutional Debate in Chile

By Veronica Vargas

At this unprecedented COVID moment, health has been revealed as one of our most precious possessions and protecting it has become imperative. The right to health was articulated by the WHO in the Declaration of Alma-Ata of 1978. The upcoming constitutional debate in Chile is an opportunity to re-examine this concept.

The Chilean constitution specifies the right to “free and egalitarian access” to health care. Simultaneously, the constitution guarantees that “each person has the right to choose the health system they wish to join, either public or private.”

These provisions have championed a prospering private health sector, with corporate clinics and a private insurance system that represents almost half of total health spending.

However, this private sector serves less than 20 percent of the population. Nearly 80 percent of the population utilizes public sector insurance. Although the public sector has been expanding its coverage of health services, and health indicators for those with public insurance have been improving, the public sector is chronically underfunded. Public sector health care spending represents only 4% of the GDP.

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Santiago, Chile.

Pragmatism and the Chilean Constitutional Moment

By Sebastián Soto

Chile is heading into a constitutional change.

After 40 years, the Chilean 1980 Constitution, enacted under Pinochet’s rule, but subsequently amended over fifty times, will probably be replaced. On October 25th, a referendum will decide whether or not to call a constitutional convention to change the Constitution.

If the referendum passes, in April 2021 the convention will be called and will have nine months (extendable for three more, if needed) to write a new constitution. If the convention reaches an agreement on a new constitution by 2/3 of its members, a new referendum to approve it will be called during the first semester of 2022.

Social rights are expected to be one of the most contested topics discussed during the process.

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Buenos Aires, Argentina.

Concerns Mount About Rule of Law in Argentina During COVID-19

By Roberto Gargarella

From the first time that I wrote about the COVID-19 situation in Argentina, June 8, until the date I am writing this, September 7, things have changed significantly.

First, the number of people who have died of COVID-19 in Argentina has risen to nearly 10,000; the 16th highest death toll in the world. The total number of cases is 500,000; which places Argentina among the top 10 countries for infections worldwide.

These alarming statistics are particularly worrying in Argentina, given a number of additional facts mentioned in my original blog.

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Protest against Brazil's President Jair Bolsonaro.

Between Gross Negligence and Genocide: Brazil’s Failed Response to COVID-19

By Octávio Luiz Motta Ferraz

When my first piece in this series was published on May 12th, Brazil counted 11,000 deaths caused by COVID-19. A new health secretary had just been appointed to replace Dr. Luiz Henrique Mandetta, who was sacked for disagreeing with President Jair Bolsonaro’s views that the pandemic (which he infamously called a “little flu”) was a conspiracy of the media and that public health measures should be immediately lifted to avoid damage to the economy.

Fast forward to September 10th and the situation, predictably, has gotten significantly worse. Brazil now counts 128,539 deaths, the second highest number in absolute terms (after the U.S., where the death toll is 190,872), and the sixth in per capita terms, with just over 60 deaths per 100,000 population. When Brazil reached the 100,000 deaths mark in early August, the president thought it more appropriate to use his Twitter account to celebrate his football team’s win at the local tournament than to make any statement on the health crisis.

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