Embryo research and human rights: An overview of developments in Europe

European Journal of Health Law

Volumn 4, Issue 1, 1997, Pages 43-67

  Kriari Catranis, Ismini ^a,b  

^a PANTEION UNIVERSITY   (Greece)

^b NONE   (Germany)

Author keywords

Embryo; In vitro fertilization; Pre implantation diagnosis; Research

Indexed keywords

EMBRYO; ETHICS; EUROPE; HUMAN; HUMAN RIGHTS; LAW; MEDICAL RESEARCH; REVIEW;

EID: 0030964863     PISSN: 09290273     EISSN: None     Source Type: Journal    
DOI: 10.1163/15718099720521869     Document Type: Article

References (128)

1. See Council of Europe, Human Artificial Procreation , 1993, Strasbourg;
2. Council of Europe, The Draft Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the application of Biology and Medicine, Draft Explanatory Report, Doc. 7124 / 1994;
3. Council of Europe Convention on Human Rights and Biomedicine, 1996.
4. See in Current Law Statutes Annotated c. 37, the remarks of Lord Flowers during the Parliamentary Debates on Human Fertilisation and Embryology Act 1990, 1990, (hereinafter HUFEA) , at p. 3;
5. also The Ethics Committee of the American Fertility Society, Ethical Considerations of Assisted Reproductive Technologies, 1994, Birmingham, Alabama, pp. 78-79.
6. See in extenso The Ethics Committee of the American Fertility Society, 1994, Ethical Considerations of Assisted Reproductive Technologies, op.cit. pp. 29-31.
7. Eser, Albin, Neuartige Bedrohungen ungeborenen Lebens, 1990, Heidelberg, p. 28: "Damit aber sind wir an dem Punkt angekommen, wo die Grenzen reiner Deskription überschritten sind und die normative Evaluation beginnt".
8. Also Hermitte, Marie-Angèle, L'embryon aléatoire, pp. 327-367 at 331 in: J. Testart (ed.), Le Magasin des enfants, 1990, Paris, Gallimard;
9. Testart, J., Le désir du gène, chapter 4, 1992, Paris: Bourin.
10. See the Spanish Law in International Digest on Health Legislation (hereinafter IDHL) 1989, p. 82 et seq.: art. 12 para 1 and art. 12 para 2. The following laws use the term "embryo" before and after implantation: The British HUFEA of 1990, art. 1; the French Law No. 94-654 of 1994, J.O. No. 175/1994, Art. 152-3 et seq.;
11. the German Embryo Protection Law of 1990 (IDHL 1991, p. 60-64);
12. Law no. 18 of 1990 of the Swiss City of Basel (IDHL 1993, p. 256-257);
13. Regulations Concerning the Conditions Governing the Practice of In Vitro Fertilization and Embryo Transfer in Private Medical Establishments in the Canton of Geneva of 1986: see Stepan, Jan (ed.) (1990) International Survey of Laws of Assisted Procreation, Publications of the Swiss Institute of Comparative Law, pp. 174-176;
14. Directives Concerning the Artificial Insemination by Donor and the In Vitro Fertilization of the Canton of Neuchâtel of 1990 in Stepan, International Survey of Laws of Assisted Procreation, op. cit. p. 176;
15. The Decree Amending the General Administrative Regulations... on Hospital Facilities of The Netherlands of 1988, in Stepan, International Survey of Laws of Assisted Procreation, op. cit. p. 130;
16. The Swiss Constitution, art. 24 novies, para. 2, as well as Recommendations 1046/1986 and 1100/1989 of the Council of Europe, the CAHBI Report on Human Artificial Procreation and the Draft Bioethics Convention, art. 15.- The Norwegian Law No. 68 of 1987 on Artificial Fertilization (IDHL 1987, p. 782 et seq.)
17. in art 3 para. 4 as well as the Swedish Law No. 711 of 1988 (IDHL 1989, p. 93) and the Swedish Law No. 115 of 1991 refer to fertilized eggs;
18. the Austrian Reproductive Medicine Law no. 275 of 1992 (IDHL 1993, p. 247-248 ) defines as "viable cells" the fertilized oocytes and cells that have developed from such oocytes;
19. the Danish Law 353/1987 on the Establishment of an Ethical Council and the Regulation of Certain Forms of Bioethical Research distiguishes between "the fertilized human egg, the living embryo and the fetus" ( art. 4).- The Public Health Regulations of Israel of 1987 use the term " fertilized ovum" IDHL 1987, p. 779 et seq.
20. Art 40.3.3. of the Irish Constitution ( Eighth Amendment, enacted after a referendum in 1983) .
21. See Eser, Albin, "Abortion law reform in Germany in international comparative perspective", European Journal of Health Law 1, 1994: 15-34;
22. Peukert, Wolfgang, "Human Rights in International Law and the Protection of Unborn Human Beings", pp. 511-519, in: Matscher/Petzold (eds.), Protecting Human Rights: The European Dimension, 1988, Köln/ Berlin/ Bonn/ München: Carl Heymanns.
23. Tribunal de Grande Instance Rennes, 1re Ch. Civ., 30 Juin 1993: Mme O...c./ Centre d'Etude et de Conservation des Oeufs et du Sperme Humains (CECOS) de l'Ouest (La Semaine Juridique, JCP, 1994, 22250, pp. 169-170).
24. The decision has been criticised for not stating explicitly if the extracorporeal embryo is a thing or a person, see Neirinck, Claire (1994), Note, Mme O...c./ Centre d'Etude et de Conservation des Oeufs et du Sperme Humains (CECOS) de l'Ouest op. cit. pp.170-174.
25. See 15 Fam. L. Rep. ( ENA) 2097 (Tenn. Ch. App. 1989), quoted in: Note "Medical Technology and Law", Harvard Law Review 103,1990: 1518-1676, p. 1542 note 111.
26. Note "Medical Technology and the Law",1990, Harvard Law Review op. cit. p. 1543.
27. Ethics Committee of the American Fertility Society, Ethical Considerations of the new Reproductive Technologies, 1990, Birmingham, Alabama, pp. 34-35. The same views are expressed in the recent edition of the American Fertility Society, 1994, pp. 32-33.
28. Devis v. Davis Supreme Court of Tennessee 1992, 842 South Western Reporter, 2d Series, p. 588 et seq.
29. Ethical Considerations of the New Reproductive Technologies Op. cit. at 600-603.
30. See mainly Robertson, J.A., "Embryo Research", The University Of Western Ontario Law Review 24, 1986, 15 at 20-25.
31. Current Law Statutes Annotated, sect. 37 p. 30.
32. See also the Warnock Report (Report of the Committee of Inquiry into Human Fertilization and Embryology), 1984, London, (points 11.17 and 11.18).
33. For the discussion in Germany see Lanz-Zumstein, Moni, "Embryonenschutz-juristische und rechtspolitische Überlegungen" in: Lanz-Zumstein (Ed.) Embryonenschutz und Befruchtungstechnik, pp. 93-114, 1986, München: Schweitzer Verlag.
34. About Austria see: Bernat, Erwin, "Zivilrechtliche Fragen um die künstliche Humanreproduktion" in: Bernat (Ed.), Lebensbeginn durch Menschenhand, 1985, pp. 125-172, Graz: Leykam Verlag;
35. Posch, Willibald, Rechtsprobleme der medizinischen assistierten Fortpflanzung und Gentechnologie , Gutachten, Verhandlungen des Zehnten Österreichischen Juristentages, 1988, pp. 73-79, Wien: Manzsche Verlags-und Universitätsbuchhandlung;
36. Schlag, Martin, Verfassungsrechtliche Aspekte der künstlichen Fortpflanzung - insbesondere das Lebensrecht des in vitro gezeugten Embryos, Wien: Braumüller.
37. Law on the Establishment of an Ethical Council and the Regulation of Certain Forms of Bioethical Research No. 353 of 3. June 1987 in: Stepan,Jan, 1990, Verfassungsrechtliche Aspekte der künstlichen Fortpflanzung - insbesondere das Lebensrecht des in vitro gezeugten Embryos, op. cit., p. 104.
38. Loi no. 94-653/29.7.1994 relative au respect du corps humain, J.O. 175/30.7.1994, Art. 16.
39. Edelman, Bernard, "Le Conseil Constitutionnel et l' embryon", Recueil Dalloz Sirey 27, 1995: 205-210 at 207.
40. Conseil Constitutionnel, Dec. No. 94-343-344, I.O. 29. 7. 1994, p. 11025.
41. Luchaire, Francois, "Le Conseil Constitutionnel et l' assistance médicale à la procreation" in: Revue du Droit Public 6, 1994: pp. 1647-1658 at 1653.
42. See the Law 964/1986 in: Stepan, Jan Revue du Droit Public op. cit.p. 196 et seq. The destruction of extracorporeal embryos is prohibited and embryos whose intended parents renounce their parental rights are available only for 'adoptive implantation', Paras. 129-130 of the same law.
43. See Brüggemann and Scheuten v. the Federal Republic of Germany, Application No. 6959/75, DR 10, 100 et seq.; X. v. United Kingdom, Application No. 8416/79, DR 19, 244 et seq.; Council of Europe, Human Artificial Procreation, p 31.
44. See in extenso Eriksson, Maria Kirilova, "The Legal Position of the Unborn Child in International Law", German Yearbook of International Law 36, 1993: 86-130, at 105.
45. See Eser, Albin, "Legal Aspects of Bioethics", p. 41-52 in: Council of Europe, Europe and Bioethics, 1985, at 49;
46. Schirmer, G. Status und Schutz des frühen Embryos bei der "In-vitro"-Fertilisation/Rechtslage und Diskussionsstand in Deutschland im Vergleich zu den Ländern des angloamerikanischen Rechtskreises, 1987, Frankfurt am Main: Peter Lang.
47. An overview of the ethical positions surrounding the human embryo see in Walters, LeRoy, "Ethical issues in human in vitro fertilization and embryo transfer" in: Milunsky/ Annas (Eds.) Genetics and the Law III, 1985, pp. 215-225 at 219 et seq.
48. The positions of the Churches see in: Gott ist ein Freund des Lebens: Herausforderungen und Aufgaben beim Schutz des Lebens; gemeinsame Erklärung des Rates der Evangelischen Kirche in Deutschland und der Deutschen Bischofskonferenz, 1989, hrsg. vom Kirchenamt der Evangelischen Kirche in Deutschland u. dem Sekretariat der Deutschen Bischofskonferenz, Gütersloh: Gütersloher Verlag-Haus Mohn.
49. See the German Benda Commission Report, (Bericht der interministeriellen Arbeitsgruppe: In-Vitro-Fertilisation, Genomanalyse und Gentherapie = Benda Bericht), 1985, section 1.3.
50. Also the Swiss Amstad Report (:Bericht erstattet an Eidgenossisches Department des Innern und Eidgenossisches Justiz- und Polizeidepartment), 1986, Bern, para. 534;
51. Council of Europe, Human Artificial Procreation Report, p. 11; also Council of Europe, Recommendation 1046/1986, point 10.
52. See the discussions on HUFEA in the House of Lords, Current Law Statutes Annotated (1990), sect 37, p. 5.
53. "Recent Advances in Medically Assisted Conception: Legal, Ethical and Social Issues" in American Journal of Law and Medicine , vol. XVII, 1991: 329-361 at 336-337;
54. the same opinion is reflected in the Review of the Guidance on the Research Use of Fetuses and Fetal Material, 1989, Polinghorne Report, United Kingdom, quoted in: McLean & Elliston, "Bioethics, the Council of Europe and the Draft Convention" in: European Journal of Health Law 2, 1995: pp. 5-13 at 9.
55. Parliamentary Assembly of the Council of Europe, Recommendation 934/1982, p. 1.
56. In the UNESCO'S Recommendation on the Status of Scientific Researchers, research is indirectly considered as the pre-requisite of science.
57. Art. 5 para. 3.
58. Art. 17 para. 1 StGG (Staatsgrundgesetz vom 21. 12. 1867) is about freedom of science, which is considered as equivalent to freedom of research. See Bernat, Erwin, "Die Genomanalyse im Österreichischen Recht-Eine Bestandaufnahme" in: Genom Analysis-Legal Rules-Practical Applications, 1994, Coimbra, pp. 1-24 at 3 et seq.
59. Art. 16, para. 1.
60. See the Decision of the Swiss Federal Court "BGer/15/3/1989" in: EuGRZ, 1989, pp. 370-384 at 381.
61. This position is clearly reflected in the German Federal Constitutional Court decision BVerGE 47, 327, 369; especially for embryo research see Starck, Christian, Die künstliche Befruchtung beim Menschen - Zulässigkeit und zivilrechtliche Folgen, Verfassungsrechtliche Probleme, Gutachten für den 56. Deutschen Juristentag, 1986, München: C.H.Beck;
62. Losch, Bernhard Wissenschaftsfreiheit, Wissenschaftsschranken, Wissenschaftsverantwortung, 1993, Berlin: Duncker und Humblot.
63. Eser, Albin, "Genetik, Gen-Ethik, Gen-Recht?" in: Flöhl, Rainer (Hrsg.), Genforschung- Fluch oder Segen?, 1985, p. 248 et seq. (250).
64. United Nations, Economic and Social Council, Human Rights and Scientific and Technological Developments, 1994, p.5.
65. Knoppers/LeBris, Human Rights and Scientific and Technological Developments, op. cit., p. 339.
66. See European Parliament (Rapporteur W. Rothley), Working Document on the ethical and legal problems of genetic engineering, 1987, sect. 1.5.2, p. 20;
67. Council of Europe, Human Artificial Procreation, p. 31; Recommendation 1046/1986, Appendix, A i.
68. The Ethics Committee of the American Fertility Society in: Ethical Considerations of Assisted Reproductive Technologies 1994 (78-79).
69. About embryo experimentation in general see Sicilianos, L.A., Expérimentation biomédicale et droits de l' homme - Textes intenationaux et pratiques étatiques in: Fondation Marangopoulos pour les Droits de l' Homme (Eds.) Expérimentation biomédicale et Droits de l' Homme,1988, pp.217-300 at 271 et seq.;
70. also Ismini Kriari-Catranis, Biomedical Developments and Constitutional Law, 1994, Sakkoulas: Thessaloniki, pp. 153-175 (in Greek) .
71. Robertson, J.A., "Ethical and legal issues in preimplantation genetic screening", Fertility and Sterility 57, 1992: 1-11 at 1.
72. See i. e. Capron, A. M. "Which Ills to bear?: Reevaluating the 'Threat" of Modern Genetics" in: Emory Law Journal 39, 1990: 665-696 at 684 et seq.;
73. Testart, Jacques, Le désir du gène, 1992, ch. 5 and 6, Paris: Bourin.;
74. also Rothley, Le désir du gène, op. cit. sect. 1.5.1., p. 19.
75. Robertson, J.A. "Ethical and legal issues in preimplantation genetic screening", Fertility and Sterility 57, 1992: pp. 1-11 at 9.
76. Robertson, Fertility and Sterility op. cit., p. 9.
77. See the Conseil Constitutionnel Dec. No. 94-343-344, Fertility and Sterility op cit. p. 11025. In the Recommendation of the Council of Europe's Parliamentary Assembly on genetic engineering of 1982 the inherent dignity of the human person was linked to the notion of a right to inherit a genetic pattern which had not been artificially changed (except for therapeutic purposes and according to a list of serious diseases). The Parliamentary Assembly of 1982 considered that the rights to life and to human integrity protected under articles 2 and 3 of the European Convention on Human Rights implied such a right of genetic inheritance.
78. See Kiss, Alexander, "La notion de patrimoine commun de l'humanité", in: Recueil des cours de la Haye, (RCADI), pp. 99-256;
79. Knoppers, Bartha Maria, "Genetic Heritage: The International Debate" in: Knoppers & Laberge (Eds.) Genetic Screening from newborns to DNA typing, 1990, pp. 257-277 at 259 et seq., Excerpta Medica: Amsterdam-New York-Oxford.
80. Edelmann, Genetic Screening from newborns to DNA typing, op. cit., p. 298.
81. Luchaire, Genetic Screening from newborns to DNA typing, op. cit. p. 1653.
82. Warberg, Lasse, "Biotechnology, law and ethics. The new Norwegian Act on Medical Use of Biotechnology (Act no. 56 of 5 August 1994)" in European Journal of Health Law,3,1996: 189-195.
83. See Bernat, Erwin, 1994, European Journal of Health Law, op. cit. pp. 1-24 at 23.
84. See Hausheer, Heinz, "DNS-Analyse: Länderbericht Schweiz" in: Genome Analysis. Legal Rules-Practical Applications, 1994: 169-200 at 195.
85. It is stated that any intervention into the genome of human gametes and embryos is forbidden.
86. Art. 5 para. 1 of the Embryo Protection Law. Art. 5 para. 3 foresees that even attempts are punishable.
87. See European Commission, The ethical aspects of gene therapy. Press Dossier relative to the opinion from the Group of Advisers on Ethical Implications of Biotechnology, 13th December 1994.
88. This opinion was adopted by the Swiss Amstad Commission (sect. 642) and is based on the Council of Europe Recommendation 934/1982.
89. See the German Benda Report, sect. 4.2.2.1.1. and the German Enquete Commission, Catenhusen/Neumeister (Eds.) Chancen und Risiken der Gentechnologie, 1987 Muenchen: Schweitzer Verlag, sect. 6.3.3., pp. 184-190.
90. Loi no 94-653/29 juillet 1994, J.O. 175/30 juillet 1994, art. 16-4.
91. McGleenan, Tony, Legal Regulation of Genetic Technology in the United Kingdom: Hard or Soft Options? Unpublished Report at the Lueneburg- Symposium on Interdisciplinary Approaches to Gene Therapy, 25th-27th March 1996.
92. Zacherl, N., Legal Aspects of Gene Therapy - The Austrian Regulation Model, Unpublished Report at the a.m. Lueneburg - Symposium of 1996.
93. In the German Basic Law, art. 1 para. 1; the elaboration of the human dignity doctrine is indebted to Dürig, first commentator of the Basic Law in: Maunz/Dürig/Herzog (Hrsg.) Kommentar zum Bonner Grundgesetz, Art. 1.; in the Greek Constitution art. 2 para. 1;
94. see Raikos, Kommentar zum Bonner Grundgesetz, op. cit., tome B'b, p. 7 et seq.
95. "A penalty of up to three years' imprisonment or a fine shall be imposed on any person who...attempts to fertilize artificially an egg cell for any purpose other than bringing about a pregnancy of the woman from whom the egg cell originated...". Art. 1 para. 6 of the law foresees the same sanctions in case one removes an embryo from a woman before completion of implantation in the uterus, with a view to using it for another purpose that is not conducive to its preservation.
96. "Viable cells may not be used for any purpose other than medically assisted procreation...".
97. New article 511-18 of the penal Code foresees as penal sanctions seven years of imprisonment and 700,000 F as fine.
98. Art. 12 of the Law states that fertilization outside the body may only be carried out if the woman is sterile.
99. See art. 1 paras 2 and 3 of the law. The fertilization of human ovules for any purpose other than human procreation is considered as a very serious offence (art. 20 Bb of the same law).
100. The majority of the Warnock Committee in the United Kingdom concluded that the deliberate creation of extracorporeal embryos for research purposes is clinically acceptable: they underlined, however, that the deliberate creation of embryos may lead to a weakening of their importance, (sect 11.17-11.29). About the dissenting opinions to the report see Priest,Jaqueline, "Assisted Reproduction - Developments in England", in: International and Comparative Law Quarterly, 1988, pp. 535-550, at 549-550.
101. See, for instance, the South Australian Reproductive Technology Act, art. 10 para. 3(d) in Stepan, International and Comparative Law Quarterly, op. cit. p. 43.
102. Ethical Considerations of Assisted Reproductive Technologies, 1994, p. 80.
103. McLean & Elliston, Ethical Considerations of Assisted Reproductive Technologies, op. cit., p. 9.
104. See the Report in the newspaper Süddeutsche Zeitung 2.6.1995, about the permission, granted by the respective Ethics-Committee of the Clinic Grosshadern, in Germany, to use aborted embryos for the Parkinson-therapy research.
105. Robertson, J.A., "Embryo Research", The University of Western Ontario Law Review, 1986; p. 33.
106. American Fertility Society, 1994, Ethical Considerations..., p. 87.
107. About research in America in general see Baron, Charles, "Legislative Regulation of Fetal Experimentation - On Negotiating Compromise in Situations of Ethical Pluralism" in Milunsky/Annas (Eds.), Genetics and the Law III, 1985, pp. 431-445.
108. Stern, Kristina, "The regulation of assisted conception in England", European Journal of Health Law 1994, 1: 53-79 at 55, note 12.
109. Scedule 2 to the Act, art. 3 para . 2 and para.4.
110. Greek newspapers reported on July 31, 1996.
111. Romeo-Casabona, Carlos M, "Some implications of human genome analysis and research in Spanish law", in: Genome Analysis- Legal Rules, Practical Applications, 1994, Coimbra 1994, pp. 245-264 at 262.-
112. United Nations, Economic and Social Council, Human Rights and Scientific and Technological Developments - Report of the Secretary General, 1994, p. 23.
113. New art. 152-8 of the Code de la Santé.
114. See Warberg, Lasse, 1996, Human Rights and Scientific and Technological Developments - Report of the Secretary General op. cit. pp. 189-195 at 193.
115. The law further foresees a penalty of up to three years' imprisonment or a fine, in case its regulations are not respected. The Law penalizes all research on human embryos, in contrast to the early recommendations of the German Benda Report, which allowed research on "spare embryos", under certain conditions (sect. 2.4.2.1.1. ). The German law is praised as offering total protection to the embryo, see Andorno, Roberto, "Les droits nationaux européens face à la procréation médicalement assistée: Primauté da la technique ou primauté de la personne?" in: Revue Internationale de Droit Comparé, 1994: 141-152.
116. Losch Bernhard, 1993, Revue Internationale de Droit Comparé, op. cit. p. 311;
117. Günther, Hans-Ludwig, in: Keller/Günther/Kaiser (Hrsg.) Embryonenschutzgesetz, 1992, Kohlhammer, p. 199, Randnummer 23.
118. Spanish Law 35/1988, art. 15 para, 1c; HUFEA sect. 9 and 16; art. 184-3 of the French Code de la Santé; Danish Law 353/1987, art. 4 and 5; Council of Europe Human Artificial Procreation Report, para. 17.2.
119. Spanish Law 35/1988, art. 18, 19; HUFEA Schedule 2 to the Act; art. 184-3 and art. 162-16 of the French Code de la Santé; Council of Europe Recommendation 1046 and 1100; See also the South Australian Reproductive Technology Act para. 14 (1).
120. Danish Law 353/1987 para. 12; Spanish Law 35/1988 art.20; HUFEA sect.4; Art. 511-19 of the French Code Penal foresees penal sanctions if studies on embryo violate the regulations of art. 152-8 of the Code de la Santé and art. 162-20 of the Code de la Santé foresees penalties if prerequisites for preimplantation diagnosis are not followed; Council of Europe Recommendation 1100 para. 11; also South Australian Repr. Technology Act para. 14 (4).
121. One prominent representative of this opinion is Ernst Benda, Professor of Law and former President of the German Federal Constitutional Court. See his article "Die Erprobung der Menschenwürde am Beispiel der Humangenetik", in Flöhl (Ed.) Genforschung- Fluch oder Segen? 1985, p. 205-231.
122. It can be authorized to use the hamster test to evaluate the capacity of fertilization of human spermatozoa until the phase of binary fission of the fertilized hamster ovule, at which time the test will be interrupted (art. 14 para. 4). The law leaves open the possibility to allow the fertilization between human and animal gametes with permission of the competent public authority or the National Multidisciplinary Commission (art. 14 para. 4 sect. 2).
123. There is no explicit prohibition, but art. 9 states that : "Viable cells may not be used for any purpose other than medically assisted procreation".
124. Art 6 , prohibiting the creation of clones, states that not only the experiment but also the attempt thereof shall be punishable. Art. 7 prohibits the creation of chimeras and hybrids. Foreseen penalties in both articles comprise imprisonment up to five years or fine.
125. Article 3 para. 3d prohibits replacing of a nucleus of a cell of an embryo with a nucleus taken from a cell of any person. embryo or subsequent development of an embryo. Article 3 para. 2 foresees that: "No person shall place in a woman: a. a live embryo other than a human embryo; b.any live gametes other than human gametes. Article 4 para. 1c permits mixing of gametes of humans with other species only in pursuance of a licence. This regulation is intended to cover a test such as a hamster test, for the examination of male subfertility.
126. So the Recommendation No. R (92)3 of the Council of Europe On Genetic Testing and Screening for Health Care Purposes , principle 2c.
127. See Rees v. UK, ECHR Judgement of 17 october 1986, Ser. A 106, para. 47.
128. Carmi, Amnon (President of the World Association of Medical Law), "Health law towards the 21st Century", in European Journal of Health Law 1, 1994: 225.