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Full-Text Articles in Law
Tailoring Public Health Policies, Govind Persad
Tailoring Public Health Policies, Govind Persad
Sturm College of Law: Faculty Scholarship
In an effort to contain the spread of COVID-19, many states and countries have adopted public health restrictions on activities previously considered commonplace: crossing state borders, eating indoors, gathering together, and even leaving one's home. These policies often focus on specific activities or groups, rather than imposing the same limits across the board. In this Article, I consider the law and ethics of these policies, which I call tailored policies.In Part II, I identify two types of tailored policies: activity-based and group-based. Activity-based restrictions respond to differences in the risks and benefits of specific activities, such as walking outdoors and …
Improving The Ethical Review Of Health Policy And Systems Research: Some Suggestions, Govind Persad
Improving The Ethical Review Of Health Policy And Systems Research: Some Suggestions, Govind Persad
Sturm College of Law: Faculty Scholarship
Consistent and well-designed frameworks for ethical oversight enable socially valuable research while forestalling harmful or poorly designed studies. I suggest some alterations that might strengthen the valuable checklist Rattani and Hyder propose in this issue of Journal of Law, Medicine & Ethics Reference Rattani and Hyder for the ethical review of health policy and systems research (HPSR), or prompt future work in the area.
Choosing Affordable Health Insurance, Govind Persad
Choosing Affordable Health Insurance, Govind Persad
Sturm College of Law: Faculty Scholarship
The Affordable Care Act ("ACA") made health insurance accessible to many. Yet unaffordable insurance still abounds. This Article proposes a strategy for improving affordability that enables health insurance purchasers to choose, within reasonable limits, which treatments their insurance covers. After critiquing recently proposed strategies for improving affordability and reviewing past legal scholarship on content choice in health insurance, this Article introduces the "Affordable Choices" framework. This framework regulates choice in four ways. First, health plans should only exclude treatments whose merits are subject to reasonable disagreement among patients and physicians. Second, plans should appeal to purchasers' health-related values- values about …
Expensive Patients, Reinsurance, And The Future Of Health Care Reform, Govind Persad
Expensive Patients, Reinsurance, And The Future Of Health Care Reform, Govind Persad
Sturm College of Law: Faculty Scholarship
In 2017, Americans spent over $3.4 trillion-nearly 18% of gross domestic product-on health care. This spending is unevenly distributed: Almost a quarter is spent on the costliest 1% of patients, and almost half on the costliest 5%. Most of these patients soon return to a lower percentile, but many continue or economic, analysis of existing and proposed options for sharing expensive patients' costs. Third, it bridges the disconnected literature on reinsurance, limit setting, and health care financing, identifying how proposals in these different areas intersect. to incur health care costs in the top percentiles year after year. This Article focuses …
Disability Law And The Case For Evidence-Based Triage In A Pandemic, Govind Persad
Disability Law And The Case For Evidence-Based Triage In A Pandemic, Govind Persad
Sturm College of Law: Faculty Scholarship
This Essay explains why model policies proposed or adopted in response to the COVID-19 pandemic that allocate scarce medical resources by using medical evidence to pursue two core goals—saving more lives and saving more years of life—are compatible and consonant with disability law. Disability law, properly understood, permits considering medical evidence about patients’ probability of surviving treatment and the quantity of scarce treatments they will likely use. It also permits prioritizing health workers, and considering patients’ post-treatment life expectancy. These factors, when based on medical evidence and not inaccurate stereotypes, are legal to consider even if they disadvantage some patients …
The Case For Valuing Non-Health And Indirect Benefits, Govind Persad, Jessica Du Toit
The Case For Valuing Non-Health And Indirect Benefits, Govind Persad, Jessica Du Toit
Sturm College of Law: Faculty Scholarship
Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the overall impact of health policy. This chapter considers what weight health policy should give to its “spill-over effects,” namely …
Examining Pharmaceutical Exceptionalism: Intellectual Property, Practical Expediency, And Global Health, Govind Persad
Examining Pharmaceutical Exceptionalism: Intellectual Property, Practical Expediency, And Global Health, Govind Persad
Sturm College of Law: Faculty Scholarship
Advocates, activists, and academics have criticized pharmaceutical intellectual property ("pharma IP") rights as obstacles to access to medicines for the global poor. These criticisms of pharma IP holders are frequently exceptionalist: they focus on pharma IP holders while ignoring whether others also bear obligations to assist patients in need. These others include holders of other lucrative IP rights, such as music copyrights or technology patents; firms, such as energy companies and banks, that do not rely on IP; and wealthy private individuals. Their resources could be used to aid patients by providing direct medical assistance, funding prizes or biomedical research, …
Transparency Trade-Offs Priority Setting, Scarcity, And Health Fairness, Govind Persad
Transparency Trade-Offs Priority Setting, Scarcity, And Health Fairness, Govind Persad
Sturm College of Law: Faculty Scholarship
This chapter argues that rather than viewing transparency as a right, we should regard it as a finite resource whose allocation involves tradeoffs. It then argues that those tradeoffs should be resolved by using a multi-principle approach to distributive justice. The relevant principles include maximizing welfare, maximizing autonomy, and giving priority to the worst off. Finally, it examines some of the implications for law of recognizing the tradeoffs presented by transparency proposals.
Justice And Public Health, Govind Persad
Justice And Public Health, Govind Persad
Sturm College of Law: Faculty Scholarship
This chapter discusses how justice applies to public health. It begins by outlining three different metrics employed in discussions of justice: resources, capabilities, and welfare. It then discusses different accounts of justice in distribution, reviewing utilitarianism, egalitarianism, prioritarianism, and sufficientarianism, as well as desert-based theories, and applies these distributive approaches to public health examples. Next, it examines the interplay between distributive justice and individual rights, such as religious rights, property rights, and rights against discrimination, by discussing examples such as mandatory treatment and screening. The chapter also examines the nexus between public health and debates concerning whose interests matter to …
Evaluating The Legality Of Age-Based Criteria In Health Care: From Nondiscrimination And Discretion To Distributive Justice, Govind Persad
Evaluating The Legality Of Age-Based Criteria In Health Care: From Nondiscrimination And Discretion To Distributive Justice, Govind Persad
Sturm College of Law: Faculty Scholarship
Recent disputes over whether older people should pay more for health insurance, or receive lower priority for transplantable organs, highlight broader disagreements regarding the legality of using age-based criteria in health care. These debates will likely intensify given the changing age structure of the American population and the turmoil surrounding the financing of American health care. This Article provides a comprehensive examination of the legality and normative desirability of age-based criteria. In the Article, I defend a distributive justice approach to age-based criteria. Rather than viewing age as a personal characteristic akin to race or religion, the distributive justice approach …
Paying Patients: Legal And Ethical Dimensions, Govind Persad
Paying Patients: Legal And Ethical Dimensions, Govind Persad
Sturm College of Law: Faculty Scholarship
This Article explores the implications for medical care of a debate that is more familiar in the law and ethics of human subjects research: whether people should be paid to receive or decline medical interventions, or to reach certain health objectives. It examines the legal and ethical issues such payments raise, and considers various actors who might make such payments, including governments, employers, insurers, care providers, and private parties. It argues for two interrelated conclusions: first, that these payments should not be subject to blanket normative condemnation, and, second, that payments made in different settings and contexts frequently share underlying …
Bankruptcy Beyond Status Maintenance, Govind Persad
Bankruptcy Beyond Status Maintenance, Govind Persad
Sturm College of Law: Faculty Scholarship
This Article examines the tendency of current American bankruptcy law to maintain the social and economic status of middle- and upper-class debtors while doing much less to assist poorer debtors and non-debtors. In doing so, it examines and categorizes various aspects of statutory and case law that allow debtors to preserve their prior economic status. After reconstructing and rebutting the normative arguments offered in defense of these provisions, it suggests a proposal for reforming bankruptcy law to emphasize goals other than the maintenance of economic status. Part I of the Article begins by describing ways in which current bankruptcy law …
Beyond Administrative Tunnel Vision: Widening The Lens Of Costs And Benefits, Govind Persad
Beyond Administrative Tunnel Vision: Widening The Lens Of Costs And Benefits, Govind Persad
Sturm College of Law: Faculty Scholarship
Choices in one sector or department of public policy, such as health, frequently produce costs and benefits in other sectors, such as education or the environment. In this article, I argue that administrators should not make decisions in ways that ignore effects on other policy sectors, and arguablythough more debatably-should not give special priority to the interests of their own sector In Part I, I review contexts where administrators are directed to ignore or give a lower priority to effects on other policy sectors. In Part II, I lay out an argument that agencies should not ignore these effects (using …
Law, Science, And The Injured Mind, Govind Persad
Law, Science, And The Injured Mind, Govind Persad
Sturm College of Law: Faculty Scholarship
Even while we widely recognize legal liability for physical injury, we frequently discount mental, emotional, and psychological injury. We disfavor tort liability for emotional distress; we prohibit prisoners from suing for purely psychological injuries; and we tax the damages victims of emotional injury receive even while leaving damages for physical injury untaxed. This Article argues that neuroscientific, psychological, and technological advances challenge our traditional ideas about the set of injuries that are possible and that merit legal redress. The Article goes on to contend that, while these advances challenge our traditional ideas, they do not inevitably overturn traditional distinctions within …
Health Theater, Govind Persad
Health Theater, Govind Persad
Sturm College of Law: Faculty Scholarship
"Security theater" has been defined as an effort to "provide the feeling of security instead of the reality. " The concept of security theater has been discussed in both the popular press and academic literature, but has not yet entered health law. This project suggests that a parallel category of "health theater" picks out a set ofpractices in medical screening and health care delivery that provide a mere simulacrum ofprotection against medical risk, rather than providing genuine medical benefit. Part I summarizes some of the distinctive advantages and disadvantages of health and security theater. Like security theater, health theater frequently …
Sufficiency, Comprehensiveness Of Healthcare Coverage And Cost-Sharing Arrangements In The Realpolitik Of Health Policy, Govind Persad, Harald Schmidt
Sufficiency, Comprehensiveness Of Healthcare Coverage And Cost-Sharing Arrangements In The Realpolitik Of Health Policy, Govind Persad, Harald Schmidt
Sturm College of Law: Faculty Scholarship
This chapter explores two questions in detail: How should we determine the threshold for costs that individuals are asked to bear through insurance premiums or care-related out-of-pocket costs, including user fees and copayments? and What is an adequate relationship between costs and benefits? This chapter argues that preventing impoverishment is a morally more urgent priority than protecting households against income fluctuations, and that many health insurance plans may not adequately protect individuals from health care costs that threaten to drop their financial status below a decent minimum. A design that places greater emphasis on preventing impoverishment and finances the achievement …
The Medical Cost Pandemic:Why Limiting Access To Cost-Effective Treatments Hurts The Global Poor, Govind Persad
The Medical Cost Pandemic:Why Limiting Access To Cost-Effective Treatments Hurts The Global Poor, Govind Persad
Sturm College of Law: Faculty Scholarship
Medical innovation in developed countries like the U.S. leads to an ever-changing medical standard of care. This innovation frequently also brings rising costs. While these costs strain even the sizeable health care budgets of developed countries, imposing them on developing countries would be much more burdensome. Yet a variety of commentators and legal actors, such as the World Health OrganiZation and UNAIDS, have argued that the same standards of care must be provided worldwide, and have enforced mandates to that effect. Interpretations of the human rght to health as a tight to the "highest attainable standard of health" similarly advance …
Democratic Deliberation And The Ethical Review Of Human Subjects Research, Govind Persad
Democratic Deliberation And The Ethical Review Of Human Subjects Research, Govind Persad
Sturm College of Law: Faculty Scholarship
In the United States, the Presidential Commission for the Study of Bioethical Issues has proposed deliberative democracy as an approach for dealing with ethical issues surrounding synthetic biology. Deliberative democracy might similarly help us as we update the regulation of human subjects research. This paper considers how the values that deliberative democratic engagement aims to realize can be realized in a human subjects research context. Deliberative democracy is characterized by an ongoing exchange of ideas between participants, and an effort to justify decisions that bind participants by appeal to reasons that the participants can understand and share. Even when unanimous …
Libertarian Patriarchalism: Nudges, Procedural Roadblocks, And Reproductive Choice, Govind Persad
Libertarian Patriarchalism: Nudges, Procedural Roadblocks, And Reproductive Choice, Govind Persad
Sturm College of Law: Faculty Scholarship
Cass Sunstein and Richard Thaler's proposal that social and legal institutions should steer individuals toward some options and away from others-a stance they dub "libertarian paternalism"-has provoked much high-level discussion in both academic and policy settings. Sunstein and Thaler believe that steering, or "nudging," individuals is easier to justify than the bans or mandates that traditional paternalism involves. This Article considers the connection between libertarian paternalism and the regulation of reproductive choice. I first discuss the use of nudges to discourage women from exercising their right to choose an abortion, or from becoming or remaining pregnant. I then argue that …
When, And How, Should Cognitive Bias Matter To Law, Govind Persad
When, And How, Should Cognitive Bias Matter To Law, Govind Persad
Sturm College of Law: Faculty Scholarship
Recent work in the behavioral sciences asserts that we are subject to a variety of cognitive biases. For example, we mourn losses more than we prize equivalently sized gains; we are more inclined to believe something if it matches our previous beliefs; and we even relate more warmly or coldly to others depending on whether the coffee cup we are holding is warm or cold. Drawing on this work, case law and legal scholarship have asserted that we have reason to select legal norms, or revise existing norms, so as to eliminate the influence of these and other cognitive biases. …
What Marriage Law Can Learn From Citizenship Law (And Vice Versa), Govind Persad
What Marriage Law Can Learn From Citizenship Law (And Vice Versa), Govind Persad
Sturm College of Law: Faculty Scholarship
Citizenship and marriage are legal statuses that generate numerous privileges and responsibilities. Legal doctrine and argument have analogized these statuses in passing: consider, for example, Ted Olson’s statement in the Hollingsworth v. Perry oral argument that denying the label “marriage” to gay unions “is like you were to say you can vote, you can travel, but you may not be a citizen.” However, the parallel between citizenship and marriage has rarely been investigated in depth. This paper investigates the marriage-citizenship parallel with a particular focus on three questions prompted by recent developments in law and policy: 1) Should we provide …
Risk, Everyday Intutions, And The Institutional Value Of Tort Law, Govind C. Persad
Risk, Everyday Intutions, And The Institutional Value Of Tort Law, Govind C. Persad
Sturm College of Law: Faculty Scholarship
This Note offers a normative critique of cost-benefit analysis, one informed by deontological moral theory, in the context of the debate over whether tort litigation or a non-tort approach is the appropriate response to mass harm. The first Part argues that the difference between lay and expert intuitions about risk and harm often reflects a difference in normative judgments about the existing facts, rather than a difference in belief about what facts exist, which makes the lay intuitions more defensible. The second Part considers how tort has dealt with this divergence between lay and expert perspectives. It also evaluates how …