Nasri Antoine Diab, a prominent figure in Lebanon’s health law arena, has recently unveiled his latest legal opus, “Éthique et droit de la santé” (Health Law and Ethics), spanning an impressive 315 pages. The preface is penned by Prof. Roland Tomb, former Dean of the USJ Faculty of Medicine. This marks Diab’s sixth legal publication.

With a robust background, Diab stands as one of Lebanon’s foremost experts in health law. As a law professor and a member of both the Beirut and Paris Bars, he has played a pivotal role in various capacities. Since 2011, he has been an esteemed member of the Medical Ethics Committee of the Hôtel-Dieu de France Hospital (HDF), alongside serving on the Lebanese National Consultative Committee on Ethics (LNCCE) for Life and Health Sciences.

Bringing over twenty-five years of consulting experience to the table, Diab has advised hospitals, laboratories, healthcare management companies, and physicians. His wealth of knowledge has been shared through lectures and seminars at esteemed institutions such as the former Institute of Health and Welfare Management (now Higher Institute of Public Health), the USJ Faculty of Medicine, and the Faculty of Medicine and Medical Sciences at the University of Balamand.

Diab’s influence extends to his prolific contributions in reputable journals, including the Revue du barreau de Beyrouth “Al Adl,” Travaux et Jours (USJ Journal), Proche-Orient études juridiques (the USJ Faculty of Law Journal), Alcinoé (philosophy journal), Revue libanaise de médecine d’urgence, Cap Santé (the HDF Journal), and the French psychiatric reference journal L’Encéphale. His editorial role includes serving as the Review Editor on the Editorial Board of Social Psychiatry and Psychiatric Rehabilitation (a special section of the journal Frontiers in Psychiatry). Notably, he was also a distinguished member of the Scientific Board of the Revue libanaise de médecine d’urgence.

This book delves into the dual themes of health law and ethics. In examining the legal dimension, it focuses on two pivotal Lebanese texts: the Code of Medical Ethics, initially promulgated by law no. 288 on February 22, 1994, and subsequently recast by law no. 240 on October 22, 2012; and law no. 574, which addresses patient rights and informed consent and was enacted on February 11, 2004. Diab’s comparative law research underscores the exemplary nature of these legislations, drawing parallels with French and American legal frameworks. Demonstrating a high standard, they effectively address a broad spectrum of inquiries that may arise for healthcare professionals and their patients.

As revealed in Diab’s research, healthcare law operates at the crossroads of public law, notably administrative law, and private law encompassing contracts and liability. The incorporation of fundamental rights, such as civil liberties and respect for the individual, further complicates the landscape. This amalgamation presents a compelling challenge for the inquisitive legal mind.

Exploring health ethics was a new venture for the author, stepping into uncharted territory. As someone rooted in a school of thought that prioritizes “hard” law over “soft” law, the author found himself navigating a realm where actions (or abstentions) are guided not by binding rules but by what Kant termed “the intrinsic goodness of action.” In this context, the obligation extends to actions rather than intentions.

For law practitioners, the fusion of law and morality defines ethics. When a law practitioner delves into medical ethics, they must depart from the instinctive application of the law in a strict and systematic fashion, aiming to transcend the text and to capture its essence. Man’s life in society is governed by various normative systems, with law, morality, and ethics all playing integral roles. Nevertheless, moral rules often exist beyond the realm of legal statutes, leading them to, in the colorful words of Georges Ripert, former Dean of the Faculty of Law of Paris, “wander at the frontiers of the law.”

Physicians, in their understanding of medical ethics, perceive it as “the demand for a certain form of medical behavior in the service of the patient.” This stands in contrast to bioethics, which involves “the shaping of a questioning of the conflicts of values raised by techno-scientific development in the field of the living.” In essence, medical ethics serves as a guide for specific medical conduct dedicated to the well-being of the patient, distinct from the broader exploration of conflicts in values presented by technological and scientific advancements in the realm of the living in bioethics.

Understanding and distinguishing right from wrong lies at the heart of ethics, presenting a challenge that encompasses various dimensions. Within the intricate fabric of ethical considerations, one encounters established positive legal norms, deontological rules mandating strict adherence, internal protocols within hospital institutions, and more. The pertinent question arises: where does this novel layer of norms—ethics—fit into this weighty corpus of regulations?

Navigating the ever-evolving landscape of medicine further complicates the delineation between right and wrong. In 1973, Professor Jean Bernard embarked on an insightful exploration in his book “Grandeur et tentations de la médecine.” He posed a series of hypothetical scenarios, envisioning a doctor from 1900 awakening in 1930, followed by a doctor from 1930 awakening in 1960, and a doctor from 1960 awakening in 1990. This exercise emphasized the rapid and substantial progress in medicine, suggesting that ethical inquiries must keep pace, growing in complexity, with legal frameworks following suit.

In essence, the chronological sequence unfolds as follows: advancements in medical knowledge provoke inquiries; ethics endeavors to provide answers; and eventually, the law codifies and preserves these answers.

For instance, the Lebanese Penal Code and the Code of Medical Ethics cover voluntary interruption of pregnancy, also known as “elective abortion.” However, these concise texts lack consideration for the diverse cases practitioners encounter daily. Questions arise, such as whether to approve the termination of pregnancy for a rape victim or for a woman whose fetus faces debilitating malformations leading to inevitable death upon birth. It’s worth noting that, even within the realm of health ethics, the complexity extends far beyond these dilemmas. Ethical considerations in healthcare encompass a myriad of situations, and there’s a growing trend towards formalizing and consolidating these principles at the international level. This is particularly evident in the areas of clinical trials and research involving human subjects.

The COVID-19 pandemic has functioned as a real legal-ethical testing ground, challenging established benchmarks, and aligning with Susan Neiman’s counsel to question the potential flaws of the “obvious truths” that we have widely accepted [adapted citation]. Diab further emphasizes this perspective. He cited the range of measures undertaken during the pandemic, such as border closures, travel bans, surveillance, individual “monitoring,” curfews, vaccine passports, lockdown and isolation, compulsory vaccination, and dismissal for refuseniks (as in, insurgents), patient triage, and hospitalization priorities. The global adoption of laws and regulations during this period has subjected even the most advanced and democratic legal systems to rigorous testing.

This comprehensive book addresses a range of subjects that are of utmost importance to various stakeholders, including legal practitioners (such as lawyers, judges, and law instructors), healthcare professionals (including doctors, nurses, and psychologists), and patients. The topics covered span a wide spectrum, encompassing medical malpractice, emergency medicine, hospital infections, the patient’s right to information, medical confidentiality, occupational health law, regulation of the psychology profession, ethics of the nursing profession, and the functioning of the hospital ethics committee. The book provides an extensive reference apparatus with over a thousand footnotes, empowering readers to delve deeper into their research and contemplation.