Law Commons^™

Discrimination Against The Unhealthy In Health Insurance, Mary Crossley

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As employers seek to contain their health care costs and politicians create coverage mechanisms to promote individual empowerment, people with health problems increasingly are forced to shoulder the load of their own medical costs. The trend towards consumerism in health coverage shifts not simply costs, but also insurance risk, to individual insureds, and the results may be particularly dire for people in poor health. This Article describes a growing body of research showing that unhealthy people can be expected disproportionately to pay the price for consumerism, not only in dollars, but in preventable disease and disability as well. In short, …

Sports Medicine Conflicts: Team Physicians Vs. Athlete-Patients, Steve P. Calandrillo

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Team physicians for professional sports franchises face a conflict of interest created by the competing loyalties they owe to the team that employs them and to the athlete-patient they must treat. Marketing agreements under which physicians pay significant sums of money to be designated as the team's "official healthcare provider" exacerbate this conflict. These marketing arrangements call into question the independent judgment of team physicians and cause players to question the quality of care they receive.

This paper explores several solutions to the growing conflicts between athletes and team doctors with the goal of enhancing players' trust in the medical …

Race As Proxy: Situational Racism And Self-Fulfilling Stereotypes, Lu-In Wang

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In our society, race can act as a proxy for a long list of characteristics, qualities, and statuses. For people of color, the most powerful of these associations have too often been negative, and have carried with them correspondingly negative consequences. We often link color with undesirable personal qualities such as laziness, incompetence, and hostility, as well as disfavored political viewpoints such as lack of patriotism or disloyalty to the United States. Race even acts as a proxy for susceptibility to some diseases. Medical professionals so often diagnose schizophrenia in blacks, for example, that the association has come full circle, …

Benumbed, Carl E. Schneider

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I originally intended to write a column on tort liability and research ethics, and I still plan to do so. But this column is a cri de coeur as I finish another semester teaching law and bioethics. This year, I asked with growing frequency, urgency, and exasperation, "Must law's reverence for autonomy squeeze out the impulse to kindness? Where is the beneficence in bioethics?" These questions assail me every term. Why? Consider Steele v. Hamilton County Community Mental Health Board. Mr. Steele was involuntarily "hospitalized after his family reported that he was 'seeing things and trying to fight imaginary …

Infected Judgment: Legal Responses To Physician Bias, Mary Crossley

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Substantial evidence indicates that clinically irrelevant patient characteristics, including race and gender, may at times influence a physician's choice of treatment. Less clear, however, is whether a patient who is the victim of a biased medical decision has any effective legal recourse. Heedful of the difficulties of designing research to establish conclusively the role of physician bias, this article surveys published evidence suggesting the operation of physician bias in clinical decision making. The article then examines potential legal responses to biased medical judgments. A patient who is the subject of a biased decision may sue her doctor for violating his …

On The Theory Class's Theories Of Asbestos Litigation: The Disconnect Between Scholarship And Reality, Lester Brickman

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No abstract provided.

Experts, Carl E. Schneider

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George Bernard Shaw famously said that all professions are conspiracies against the laity. Less famously, less elegantly, but at least as accurately, Andrew Abbott argued that professions are conspiracies against each other. Professions compete for authority to do work and for authority over work. The umpire in these skirmishes and sieges is the government, for the state holds the gift of monopoly and the power to regulate it. In Abbott's terms, "bioethics" is contesting medicine's power to influence the way doctors treat patients. If it follows the classic pattern, bioethics will solicit work and authority by recruiting government's power. A …

Telemedicine And Integrated Health Care Delivery: Compounding Malpractice Liability, Patricia C. Kuszler

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This Article considers how theories of medical negligence might be applied in the context of telemedicine and integrated delivery health plans. Part Two summarizes the history of telemedicine, its increasing breadth of application and opportunity and promise for the future. Part Three reviews traditional negligence principles and precedents and demonstrates how they might be applied when a telemedicine interaction results in negligence and harm to the patient. Part Four discusses evolving theories of shared liability applicable to health plans and managed care entities. Finally, Part Five demonstrates how shared liability theories will be applied to situations involving telemedicine technologies.

Why Basic Liberties Are Bilateral, James W. Nickel

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No abstract provided.

Hard Cases, Carl E. Schneider

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Robert Latimer was born in 1953 on a farm on the prairies of Saskatchewan and grew up to own a 1,280-acre farm. In 1980 he married, and that year Tracy, the first of four children, was born. During her birth, Tracy's brain was terribly damaged by lack of oxygen, and severe cerebral palsy ensued. By 1993 Tracy could laugh, smile, and cry, and she could recognize her parents and her siblings. But she could not understand her own name or even simple words like "yes" and "no." She could not swallow well and would so often vomit her parents kept …

Medicaid Managed Care And Disability Discrimination Issues, Mary Crossley

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This article examines issues potentially raised under the Americans with Disabilities Act (ADA) by states' decisions whether and how to include disabled Medicaid recipients in the massive shift towards Medicaid managed care. Part II briefly examines the special issues that disabled Medicaid recipients pose with respect to managed care enrollment. These include issues of cost, quality, access, and program design and implementation. Part III describes various approaches that state programs have taken or are proposing to take with respect to the enrollment of disabled Medicaid recipients in managed care. These approaches range from simply excluding the SSI population from managed …

On The Meaning And Impact Of The Physician-Assisted Suicide Cases. (Symposium: Physician-Assisted Suicide: Facing Death After Glucksberg And Quill), Yale Kamisar

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I read every newspaper article I could find on the meaning and impact of the U.S. Supreme Court's June 1997 decisions in Washington v. Glucksberg' and Vacco v. Quill.2 I came away with the impression that some proponents of physician-assisted suicide (PAS) were unable or unwilling publicly to recognize the magnitude of the setback they suffered when the Court handed down its rulings in the PAS cases.

Physician-Assisted Suicide: The Problems Presented By The Compelling, Heartwrenching Case, Yale Kamisar

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Now that the U.S. Supreme Court has upheld New York and Washington state laws prohibiting the aiding of another to commit suicide,2 the spotlight will shift to the state courts, the state legislatures and state referenda. And once again proponents of physician-assisted suicide (PAS) will point to a heartwrenching case, perhaps the relatively rare case where a dying person is experiencing unavoidable pain (i.e., pain that not even the most skilled palliative care experts are able to mitigate), and ask: What would you want done to you if you were in this person's shoes?

The Future Of Physician-Assisted Suicide, Yale Kamisar

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I believe that when the Supreme Court handed down its decisions in 1997 in Washington v. Glucksberg and Vacca v. Quill, proponents of physician-assisted suicide (PAS) suffered a much greater setback than many of them are able or willing to admit.

Making Sausage: The Ninth Circuit's Opinion, Carl E. Schneider

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As I write, the Supreme Court has just agreed to hear Compassion in Dying v. Washington and Quill v. Vacco, the two cases in which United States circuit courts of appeals held that a state may not constitutionally prohibit physicians from helping a terminally ill person who wishes to commit suicide to do so. These cases have already received lavish comment and criticism, and no doubt the Supreme Court's opinion will garner even more. Reasonably enough, most of this analysis addresses the merits of physician-assisted suicide as social policy. I, here, want to talk about how setting bioethical policy …

The Reasons So Many People Support Physician-Assisted Suicide - And Why These Reasons Are Not Convincing, Yale Kamisar

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It would be hard to deny that there is a great deal of support in this country-and ever-growing support-for legalizing physician-assisted suicide (PAS). Why is this so? I believe there are a considerable number of reasons. In this article, I shall discuss five common reasons and explain why I do not find any of them convincing.

Physician Assisted Suicide: A Bad Idea, Yale Kamisar

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It would be hard to deny that there is a great deal of support in this country - and ever-growing support - for legalizing physician-assisted suicide (PAS). Why is this so? I believe there are a considerable number of reasons. I shall discuss five common reasons - and explain why I do not find any of them convincing.

The 'Right To Die': On Drawing (And Erasing) Lines, Yale Kamisar

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Until this year, no state or federal appellate court had ever held that there was a right to assisted suicide no matter how narrow the circumstances or stringent the conditions. In 1996, however, within the span of a single month, two federal courts of appeals so held; in an 8-3 majority of the Ninth Circuit (sitting en banc) in Compassion in Dying v. Washington and a three-judge panel of the Second Circuit in Quill v. Vacco. What heartened proponents of a right to physician-assisted suicide even more, and pleased those resistant to the idea even less, was that the two …

It Started With Quinlan: The Ever Expanding 'Right To Die', Yale Kamisar

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Few rallying cries sound more straightforward than the "right to die"-but few are more fuzzy or more misunderstood. This becomes all too evident when comparing the right-to-die decision handed down by the U.S. Ninth Circuit Court of Appeals earlier this month and the New Jersey Supreme Court's decision in the Karen Ann Quinlan case twenty years ago. At different times, the "right to die" has embraced significantly different rights. On March 6, in Compassion in Dying v. Washington State, the Ninth Circuit held that because a Washington state statute prohibiting assisted suicide prevents physicians from providing assistance to competent, terminally …

Medical Futility And Disability Discrimination, Mary Crossley

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The concept of medical futility, which originally developed in the medical literature as a basis for allocating between physician and patient decisional authority regarding end-of-life treatment, is increasingly appearing in discussions regarding possible methods of containing medical costs by limiting treatment. This use of medical futility as a rationing mechanism, whether by a state Medicaid program or by a hospital, raises concerns regarding its impact on persons with severe disabilities near the end of life. This article considers how the applicability of the Americans with Disabilities Act to cost-conscious futility policies might be analyzed. After developing arguments that proponents and …

Against Assisted Suicide - Even A Very Limited Form (Symposium: Assisted Suicide, Health Care And Medical Treatment Choices), Yale Kamisar

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Professor Robert Sedler is a leading constitutional law professor and a well-known civil liberties lawyer. I think he is right about many things. To cite but one example, I think he was right when he led the ACLU's successful legal attack on certain University of Michigan restrictions on "hate speech."' But I cannot agree with him about physician-assisted suicide, no matter how narrowly he frames the issue.2

Bioethics With A Human Face, Carl E. Schneider

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This Article and the successor article I will shortly publish grow out of one reaction I have had to years of reading bioethical and legal literature. Let me begin by putting the point in its simplest, even crudest, form: That literature too often discusses the problems of health care in so disembodied and denatured a way that the patients and physicians, the family and friends, the dread and the disease are quite abstracted from the scene. The result is a literature that critically limits itself and that crucially oversimplifies the issues it confronts. There are, of course, reasons bioethical and …

Assisted Suicide And Euthanasia: The Cases Are In The Pipeline, Yale Kamisar

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When I first wrote about this subject 36 years ago, the chance that any state would legalize assisted suicide or active voluntary euthanasia seemed minuscule. The possibility that any court would find these activities protected by the Due Process Clause seemed so remote as to be almost inconceivable. Not anymore. Before this decade ends, at least several states probably will decriminalize assisted suicide and/or active voluntary euthanasia. [Editor's note: In November, Oregon became the first state to legalize physician-assisted suicide, allowing doctors to prescribe lethal medication for competent, terminally ill adults who request it.] A distinct possibility also exists that …

The 'Right To Die': A Catchy But Confusing Slogan, Yale Kamisar

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Some 30 years ago an eminent constitutional law scholar Charles L. Black, Jr., spoke of "toiling uphill against that heaviest of all argumental weights-the weight of a slogan. I am reminded of that observation when I confront the slogan the "right to die." Few rallying cries or slogans are more appealing and seductive than the "right to die." But few are more fuzzy, more misleading, and more misunderstood.

Should Active Euthanasia Be Legalized? No: Preserve Traditional Restraints, Yale Kamisar

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The distinction between letting people die and killing them by lethal injection is now an integral part of the medico-legal landscape. This is the compromise we have arrived at in the struggle to take a humane approach toward seriously ill patients while still preserving as many traditional restraints against killing as we possibly can. This may be neither the logician's or the philosopher's way to resolve the controversy, but it may nevertheless be a defensible pragmatic way to do so.

Are Laws Against Assisted Suicide Unconstitutional?, Yale Kamisar

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On 15 February of this year, shortly after the number of people Dr. Jack Kevorkian had helped to commit suicide swelled to fifteen, the Michigan legislature passed a law, effective that very day, making assisted suicide a felony punishable by up to four years in prison. The law, which is automatically repealed six months after a newly established commission on death and dying recommends permanent legislation, prohibits anyone with knowledge that another person intends to commit suicide from "intentionally providing the physical means" by which the other person does so or from "intentionally participat[ing] in a physical act" by which …

Active V. Passive Euthanasia: Why Keep The Distinction?, Yale Kamisar

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In the past two decades, we have witnessed a "sea change in public, medical, and legislative judgments" about "letting die" and the "right to die." But it is no less true today than it was 35 years ago, when I first wrote about this subject, that in Anglo-American jurisprudence active euthanasia (what used to be called "mercy killing") is murder.

Bioethics And The Family: The Cautionary View From Family Law, Carl E. Schneider

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For many years, the field of bioethics has been specially concerned with how the authority to make medical decisions should be allocated between doctor and patient. Today the patient's power-indeed, the patient's right-is widely acknowledged, at least in principle. But this development can hardly be the last word in our thinking about how medical decisions should be made. For one thing, sometimes patients cannot speak for themselves. For another, patients· make medical decisions in contexts that significantly include more participants than just the patient and doctor. Now, as this conference demonstrates, bioethics is beginning to ask what role the patient's …

Qualified Plans And Identifying Tax Expenditures: A Rejoinder To Professor Stein, Edward A. Zelinsky

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No abstract provided.

When Is There A Constitutional 'Right To Die'? When Is There No Constitutional 'Right To Live'?, Yale Kamisar

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When I am invited to participate in conferences on the "right to die," I suspect that the organizers of such gatherings expect me to fill what might be called the " 'slippery slope' slot" on the program or, more generally, to articulate the "conservative" position on this controversial matter. These expectations are hardly surprising. The "right to die" is a euphemism for what almost everybody used to call a form of euthanasia-" passive" or "negative" or "indirect" euthanasia-and some thirty years ago, in the course of raising various objections to proposed euthanasia legislation, I advanced the "thin edge of the …