Digital Commons Network^™

End-Of-Life Care: Doctors' Complaints And Legal Restraints, Robert L. Schwartz

Faculty Scholarship

Health lawyers and policymakers cannot always see the same shadows of the laws that are visible to health care providers, and sometimes those shadows have penumbras and emanations that are not visible to those outside of a narrow medical practice. Sometimes those shadows, whether real or imagined, cause doctors to act inconsistently with the intent of the law, and inconsistently with the requirements of good medical practice. Doctors may misread or misunderstand a law. Still, if the law as misread or misunderstood actually affects medical practice, we should not be blind to the fact of the misunderstanding. Listen to doctors' …

The Role And Legal Status Of Health Care Ethics Committees In The United States, Diane E. Hoffmann, Anita J. Tarzian

Faculty Scholarship

Over a quarter of a century has passed since health care ethics committees (HCECs) in the United States received legal recognition as alternatives to the courts in resolving conflicts related to patient end-of-life care. By the mid to late 1980s HCECs had been established in over half of U.S. hospitals and had received a certain legitimacy in the health care system. Given their age and growth one could characterize them developmentally as emerging from adolescence and establishing themselves in young adult-hood. As a result, we might expect that they would have resolved the identify crisis characterizing the adolescent years. Yet, …

Achieving Quality And Responding To Consumers - The Medicare Beneficiary Complaint Process: Who Should Respond?, Diane E. Hoffmann, Virginia Rowthorn

Faculty Scholarship

No abstract provided.

The Architecture Of Charities’ Commercial Activities - Structural Reactions: Basic Structures, Stephen Schwarz

Faculty Scholarship

No abstract provided.

Involuntary Passive Euthanasia In U.S. Courts: Reassessing The Judicial Treatment Of Medical Futility Cases, Thaddeus Mason Pope

Faculty Scholarship

Over the past twenty-five years, a significant number of surrogate decision makers have demanded that a health care provider use medical technology to prolong a patient's life beyond the point thought medically appropriate. These surrogates want to continue life-sustaining medical treatment (LSMT) that providers want to stop. While most of these futility disputes are resolved informally inside the hospital, dozens have now been litigated in U.S. courts. Because the judicial treatment of these disputes casts a long, dark shadow on the informal resolution of all the others, it is important to ascertain exactly what guidance these court cases provide.

In …

Bizarre Love Triangle: The Spending Clause, Section 1983, And Medicaid Entitlements, Nicole Huberfeld

Faculty Scholarship

The first two terms of the Roberts Court signal a willingness to revisit precedent, and the Court appears poised to reinterpret another area of jurisprudence: the private enforcement of conditions on federal spending against states through actions under 42 U.S.C. § 1983. The most recent pre-Roberts Court precedent is Gonzaga University v. Doe. Federal courts have inconsistently and confusingly applied the Gonzaga framework, but the Rehnquist Court would not revisit the rule. Last term, the Roberts Court granted a petition for certiorari that would have required reconsidering Gonzaga. Before it could be heard on the merits, the respondents mooted the …

Reflections Of A Community Lawyer, Luz E. Herrera

Faculty Scholarship

In May 2002, I opened a law office in one of the most underserved communities in Los Angeles County. Many questioned the sanity of such a career path when evaluating my financial stability and the personal toll that such a career path can exact. Given that I graduated from some of the best universities in the country, my friends, family, and strangers were even more perplexed at my choice. I cannot say that my decision to build a law practice in Compton, California, has been easy. However, time and time again, I found myself rejecting more secure and prestigious job …

Collateral Damage: The Aftermath Of The Political Culture Wars In Schiavo, Kathy L. Cerminara

Faculty Scholarship

Kathy Cerminara, Collateral Damage: The Aftermath of the Political Culture Wars in Schiavo, 29 Western New England Law Review 279 (2007). Theresa Marie Schiavo died a celebrity at the age of 42 in Pinellas Park, Florida, in early 2005. She never sought the public spotlight; she never even knew she was a celebrity. She became a celebrity, one of the best-known figures in bioethics, because of politics. This Article examines the politics surrounding her death and draws some conclusions about the aftermath for those left behind in the America Ms. Schiavo departed. The lessons of Schiavo are mixed. It …

Pharma On The Hot Seat, Nicole Huberfeld

Faculty Scholarship

The pharmaceutical industry has been receiving greater scrutiny lately due in large part to the many public and private legal enforcement actions taken against pharmaceutical manufacturers. These enforcement actions, along with legal developments such as the OIG Compliance Guidance for Pharmaceutical Manufacturers, the Sarbanes-Oxley Act’s statutory guidelines for public corporations, the HIPAA privacy regulations, and the Medicare Modernization Act, have the potential to encourage the pharmaceutical industry to self-regulate beyond the bounds currently required by the law. After a brief overview of enforcement actions and compliance programs directed toward the pharmaceutical industry, this Article reviews a similar situation the hospital …

Foreword: The Politics Of Health Law: Any Tipping Points In View?, Frances H. Miller

Faculty Scholarship

Malcolm Gladwell explored the way certain ideas and behaviors can proliferate "just like viruses do" once they achieve a critical mass in The Tipping Point,' his best-seller about the sorts of widespread and rapidly adopted social phenomena he labels epidemics. Gladwell's subtitle, "How Little Things Can Make a Big Difference," indicates that he thinks it need not take much to get one of these social epidemics rolling. He does believe, however, that three factors are essential: getting "people with a particular and rare set of social gifts" involved,² packaging the ideas so they are "irresistible" under the circumstances, ^{3 …}

Critical Essay: Musings On The Need To Convince Some People With Disabilities That End-Of-Life-Decision-Making-Advocates Are Not Out To Get Them, Kathy L. Cerminara

Faculty Scholarship

Kathy Cerminara, Critical Essay: Musings on the Need to Convince Some People with Disabilities That End-of-Life-Decision-Making Advocates are Not Out to Get Them, 37 Loyola University of Chicago Law Journal 343 (2006). As others have noted, the importance of the Terri Schiavo case is not legal; the various Schiavo opinions broke no new legal ground other than the constitutional questions raised when legislatures began intervening to attempt to change the outcome of the end-of-life decision-making rulings. Rather, it was activism by certain disability rights and vitalist groups that so caught the attention of the public, the politicians and the …

Clinical Legal Education In Hong Kong: A Time To Move Forward, Stacy Caplow

Faculty Scholarship

No abstract provided.

The Role Of Religion In The Schiavo Controversy, Barbara A. Noah

Faculty Scholarship

The brief life of Theresa Marie Schiavo and the dispute over her end-of-life care captured public awareness in a way that few such cases have done. The reasons for the nearly unprecedented public attention to her case are two-fold. The decision by various religious groups and governmental entities to intervene in the dispute surrounding her care in order to promote conservative causes (some of them only tenuously related to her particular medical circumstances) prompted unusually intense media coverage. In addition, the ensuing publicity surrounding Theresa's tragic condition--an unexpected cardiac arrest left her in a permanent vegetative state at the age …

Dying In America - An Examination Of Policies That Deter Adequate End-Of-Life Care In Nursing Homes, Diane E. Hoffmann, Anita J. Tarzian

Faculty Scholarship

This article examines current health care policies and government practices that deter appropriate end-of-life care, focusing on the use of hospice services for dying nursing home patients. The authors conclude that hospice and nursing home regulations, reimbursement for hospice and nursing homes, and enforcement of the fraud and abuse rules collude to “chill” utilization of hospice by nursing homes and result in inadequate end-of-life care for many nursing home patients. They argue that these policies and practices have at their roots a number of questionable assumptions and call for a shift in existing paradigms affecting care to this group and …

Thou Shalt Not Kill As Defeasible Heuristic: Law And Economics And The Debate Over Assisted Suicide, Daniel J. Gilman

Faculty Scholarship

Although the literature addressing medical decisions at the end of life is vast, surprisingly little of it has come from the perspective of law and economics. This article begins with a critical account of one of the very few law and economics-based discussions of physician-assisted suicide (PAS), that developed by Judge Richard Posner in his book, Aging and Old Age. Central to Judge Posner's account is a model of PAS as a sort of technological innovation. What this particular innovation is supposed to bring is a radical reduction in certain critical information costs attending end-of-life decision making. It is …

“Culture Of Life” Politics At The Bedside: The Case Of Terri Schiavo, George J. Annas

Faculty Scholarship

For the first time in the history of the United States, Congress met in a special emergency session on Sunday, March 20, to pass legislation aimed at the medical care of one patient — Terri Schiavo. President George W. Bush encouraged the legislation and flew back to Washington, D.C., from his vacation in Crawford, Texas, so that he could be on hand to sign it immediately. In a statement issued three days earlier, he said: “The case of Terri Schiavo raises complex issues. . . . Those who live at the mercy of others deserve our special care and concern. …

I Want To Live: Medicine Betrayed By Ideology In The Political Debate Over Terri Schaivo, George J. Annas

Faculty Scholarship

The public's view of the political intrusion into the medical care of Theresa Marie Schiavo is well illustrated by two political cartoons. The first, by Tony Auth, reprinted in the Boston Globe shortly after Congress passed a law authorizing intervention by the federal courts, pictures a horde of congressmen charging mindlessly out of the Capitol, all dressed as physicians-one carrying a saw, another an I.V. pole-with the caption, "Coming Soon to a Sickbed Near You . .. [tihe United States Congress." The second, by Tom Toles, published in the Washington Post shortly after the results of the autopsy report were …

Behind The Process Remembering John Ely's Compassion, Clark Freshman

Faculty Scholarship

No abstract provided.

Politicizing The End Of Life: Lessons From The Schiavo Controversy, Barbara A. Noah

Faculty Scholarship

The case of Theresa Marie Schiavo raises challenging legal and ethical issues, although the events of the case are not entirely novel. It is a well-settled principle under Florida law that individuals have a right to refuse life-sustaining medical treatment. After years of litigation, numerous courts have confirmed that removal of life support is legally appropriate under the facts of this case. Nevertheless, six days after Theresa's feeding tube was removed, the Florida legislature
opted to intervene in the final judicial decision by granting the Governor the authority to overrule the court's decision and to order the tube reinserted. These …

Achieving The Right Balance In Oversight Of Physician Opioid Prescribing For Pain: The Role Of State Medical Boards, Diane E. Hoffmann, Anita J. Tarzian

Faculty Scholarship

No abstract provided.

Ethical Issues In Dementia, Peter J. Whitehouse

Faculty Scholarship

The growing number of individuals affected by dementia will intensify the ethical issues that emerge in clinical practice and research, issues early in disease relate to genetic testing, use of medications in mildly affected persons, and diagnostic disclosure. Research issues relate to appropriate informed consent processes, conflict of interests, and research design issues, such as the use of placebos and the use of biological tissues. In the later stages of disease concern about appropriate therapeutic goals and end-of-life care is appropriate.

The Maladaptation Of Miranda To Advance Directives: A Critique Of The Implementation Of The Patient Self-Determination Act, Thaddeus Mason Pope

Faculty Scholarship

In this Article, Thaddeus Pope argues that the Patient Self Determination Act (PSDA) is a failure on its own terms. The Article first identifiesthe central purpose of the Act as the protection of patient autonomy. The Article then reviews much of the empirical research on the implementation of the Act. This research suggests that the medical preferences expressed in advance directives completed pursuant to the PSDA are usually not based on real understanding because patients are merely "Mirandized" of their right to direct their post-autonomous medical care. Although some scholars contend that this is the most that can be expected …

Pain Relief For The Dying: The Unwelcome Intervention Of The Criminal Law, Phebe Saunders Haugen

Faculty Scholarship

This Article addresses physician-assisted suicide and the medical treatment of pain and suffering. Part II discusses various medical misconceptions about the treatment of pain and how modern medicine fails to fulfill this aspect of its palliative care role. Part III reviews how the law currently circumscribes the patient and doctor's ability to make medical decisions when the patient is terminally ill. As will be shown, the law is clearer and more respectful of good medical practice than most medical practitioners currently believe. Moreover, this section will also establish that, while several competing philosophical positions surrounding physician-assisted suicide exist, these same …

Constitutional Aspects Of Physician-Assisted Suicide After Lee V. Oregon, Simon Canick

Faculty Scholarship

On November 8, 1994, Oregon voters narrowly passed the highly controversial Death with Dignity Act (Measure 16), which marked the first time that physician-assisted suicide was explicitly legalized anywhere in the world. In Lee v. Oregon, a group of physicians, several terminally ill persons, a residential care facility, and individual operators of residential care facilities sought to enjoin enforcement of the new law, claiming various constitutional infirmities. The U.S. District Court for the District of Oregon enjoined enforcement of the law, acknowledging that it raised important constitutional issues including possible violations of the Equal Protection and Due Process Clauses of …

The Promised End: Constitutional Aspects Of Physician-Assisted Suicide, George J. Annas

Faculty Scholarship

The debate over physician-assisted suicide has dramatically shifted to a discussion of constitutional issues. This spring, within a month of each other, U.S. Circuit Courts of Appeals on both coasts ruled that state prohibitions of assisted suicide are unconstitutional when applied to physicians who prescribe lethal medication for terminally ill, competent adults who wish to end their lives. The Ninth Circuit includes Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon, and Washington, and the Second Circuit includes New York, Connecticut, and Vermont. Both courts reached the same conclusion but for different legal reasons.

Insurance Risk Classification After Mcgann: Managing Risk Efficiently In The Shadow Of The Ada, Maria O'Brien

Faculty Scholarship

A significant part of the health insurance debate which gripped the country during the first two years of President Clinton's administration focused on the critical shortage of employer-sponsored health insurance for disabled, br high risk, employees. Indeed, President Clinton's promise of universal access in connection with the promotion of his health care plan is apparently designed to ensure that the increasingly popular employer practice of excluding high risk employees becomes obsolete. In the meantime, while the merits of the Clinton plan and its competitors are debated, individuals like John McGann-working and insured--continue to discover that like their health, their insurance …

Patients' Rights After Health Care Reform: Who Decides What Is Medically Necessary?, Wendy K. Mariner

Faculty Scholarship

President Clinton's Health Security Act entitles individuals not to unlimited health care, but to a package of defined insurance benefits with specific exclusions and limitations. Like virtually all reform proposals, it would limit covered benefits to services that are medically necessary. If health reform is to control costs, not all medically necessary care can be covered. In the absence of a generally accepted definition of medical necessity, many services will not be guaranteed to all patients unless they are explicitly covered in the federal legislation or regulations. Without a federal definition of medical necessity or regulations listing covered services, health …

The Victims Of Nimby, Michael B. Gerrard

Faculty Scholarship

It is a syndrome, a pejorative, and an acronym of our times: NIMBY, or Not In My Back Yard. It has a political arm, NIMTOO (Not In My Term Of Office), an object of attack, LULUs (Locally Undesired Land Uses), and an extreme form, BANANA (Build Absolutely Nothing Anywhere Near Anyone). Acronyms aside, however, the question remains as to whether or not NIMBY has victims. Is anyone hurt by NIMBY?

Many leading voices in the environmental justice movement believe that minority communities are victims of NIMBY. For example, Professor Robert D. Bullard has written that "[t]he cumulative effect of not-in-my-backyard …

The Boarder Baby And Foster Care Crises In New York City: Problems Of Policy And Poverty, James S. Bowen, Madeline Morris, Jose M. Rivera

Faculty Scholarship

No abstract provided.

Aids And Government: A Plan Of Action, Taunya L. Banks

Faculty Scholarship

No abstract provided.