Law Commons^™

Going To Pot, Carl E. Schneider

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In several earlier columns, I suggested that judges are usually poorly placed to make good biomedical policy, not least because the law so rarely offers them direct and cogent guidance. Recently, the U.S. Court of Appeals for the Ninth Circuit proffered a new example of this old problem. In 1996, California's voters approved Proposition 215. Its "Compassionate Use Act of 1996" provided -that a patient "who possesses or cultivates marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician" committed no crime.

Why We Need The Independent Sector: The Behavior, Law, And Ethics Of Not-For-Profit Hospitals, Jill R. Horwitz

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Among the major forms of corporate ownership, the not-for-profit ownership form is distinct in its behavior, legal constraints, and moral obligations. A new empirical analysis of the American hospital industry, using eleven years of data for all urban general hospitals in the country, shows that corporate form accounts for large differences in the provision of specific medical services. Not-for-profit hospitals systematically provide both private and public goods that are in the public interest, and that other forms fail to provide. Two hypotheses are proposed to account for the findings, one legal and one moral. While no causal claims are made, …

All My Rights, Carl E. Schneider

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Diane Pretty was an Englishwoman in her early 40s who had been married nearly a quarter of a century. In November 1999, she learned she had amyotrophic lateral sclerosis-in Britain, motor neurone disease. Her condition deteriorated rapidly, and soon she was "essentially paralysed from the neck downwards." She had "virtually no decipherable speech" and was fed by a tube. She was expected to live only a few months or even weeks. AB a court later explained, however, "her intellect and capacity to make decisions are unimpaired. The final stages of the disease are exceedingly distressing and undignified. AB she is …

How Underlying Patient Beliefs Can Affect Physician-Patient Communicaion About Prostate-Specific Antigen Testing, Michael H. Farrell, Margaret Ann Murphy, Carl E. Schneider

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Routine cancer screening with prostate-specific antigen (PSA) is controversial, and practice guidelines recommend that men be counseled about its risks and benefits. OBJECTIVE. To evaluate the process of decision making as men react to and use information after PSA counseling. DESIGN. Written surveys and semistructured qualitative interviews before and after a neutral PSA counseling intervention. PARTICIPANTS. Men 40 to 65 years of age in southeastern Michigan were recruited until thematic saturation—that is, the point at which no new themes emerged in interviews (n = 40). RESULTS. In a paper survey, 37 of 40 participants (93%) said that they interpreted the …

The Bill For Rights, Carl E. Schneider

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Where today is legislative ingenuity lavished more bountiully than on the titles of statutes? And where has that ingenuity been better exercised than in the name "patients' bill of rights"? Do not our dearest liberties flow from the Bill of Rights? And who more deserves similar protection than patients in the hands of an angry Managed Care Organization? And behold, both Democrats and Republicans, both President Clinton and President Bush, have summoned us to arms. The patients' bill of rights is an idea whose time has seemed to have come for several years, and only conflicts among the numerous proposals …

Gang Aft Agley, Carl E. Schneider

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In my last contribution to this column (HCR, July-August 2000), I argued that the law of bioethics has repeatedly failed to achieve the hopes cherished for it. I presented evidence, for example, that most doctors breach the duty of informed consent, that advance directives do not direct patients' care, and that repeated legal attempts to increase organ donation have failed to find the success predicted for them. I closed that column by promising to try to explain this chastening experience. It would, of course, take a lifetime of columns to capture all the reasons the law of bioethics …

The Best-Laid Plans, Carl E. Schneider

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It is natural to suppose law is like the centurion and can do as it will: "I say to this man, Go, and he goeth; and to another, Come, and he cometh; and to my servant, Do this, and he doeth it." But a thousand years ago, King Canute tried to disillusion his courtiers about his efficacy by commanding the waves to stop beating. And fifty years ago, Harry Truman predicted of Dwight Eisenhower, "He'll sit here, and he'll say, 'Do this! Do that!' And nothing will happen. Poor Ike-it won't be a bit like the Army. He'll find it …

Regulating Doctors, Carl E. Schneider

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Alawyer today can hardly speak to a doctor--or even be treated by one-without being assailed by lawyer jokes. These jokes go well beyond good-humored badinage and pass the line into venom and gall. They reflect, I think, the sense many doctors today have that they are embattled and endangered, cruelly subject to pervasive and perverse controls. This is puzzling, almost to the point of mystery. Doctors have long been the American profession with the greatest social prestige, the greatest wealth, and the greatest control over its work. Indeed, what other profession has been as all-conquering? One may need to go …

Justification By Faith, Carl E. Schneider

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In June 1997 a sixteen-year-old girl named Shannon Nixon began to feel ill. Her parents belonged to the Faith Tabernacle Church, one of a number of American sects which believe that illness should be treated spiritually rather than medically. Accordingly, the Nixons prayed for Shannon and took her to be anointed at their church. Shannon reported that she felt better and that the spiritual treatment had gained her her victory-her recovery. Before long, however, Shannon again felt ill. She became weaker and weaker and then fell into a coma. A few hours later she died. An autopsy revealed that she …

Testing Testing, Carl E. Schneider

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Last year, Congress passed the Ryan White Care Act Amendments of 1996. The amendments authorize ten million dollars for each fiscal year from 1996 through 2000 for counseling pregnant women on HIV disease, for "outreach efforts to pregnant women at high risk of HN who are not currently receiving prenatal care," and for voluntary testing for pregnant women. The amendments compromise a central question: whether prenatal and neonatal AIDS testing should be compelled. The compromise is complex. The director of the Centers for Disease Control and Prevention is instructed to establish a system for states to use to discover and …

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 …

From Consumer Choice To Consumer Welfare, Carl E. Schneider

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In trying to understand the I SUPPORT study, it may be useful to think of contemporary bioethics reform in terms of the principles of consumer protection. The central tendency of that reform (particularly in my own field-the law) has been to employ the model of consumer choice. That model sets as its purpose to allow consumers to choose the kinds of products they prefer. It seeks to accomplish that purpose primarily by supplying consumers the information they need to make choices and by insisting that they are given what they chose. Thus, for example, merchants may be required to reveal …

At Issue: Should Active Euthanasia Be Legalized?, Yale Kamisar, Cheryl K. Smith

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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, but it may nevertheless be a defensible pragmatic way to do so.

Opinion Letter As To The Patentability Of Certain Inventions Associated With The Identification Of Partial Cdna Sequences, Rebecca S. Eisenberg, Robert P. Merges

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You have asked for our legal opinion on the patentability of inventions claimed in U.S. patent applications 07/716,831, filed June 21, 1991 (the '831 application, or .'831"), 07/837,195, filed September 25, 1992 ("'195"), and 07/952,911, filed February 12, 1993 (."911"), all filed in the name of Craig Venter and others and assigned to the National Institutes of Health "(NIH)." We understand that NIH has abandoned these patent applications and has no present intention of filing similar applications in the future, but that NIH remains interested in the patenting of human DNA sequences from a broader public policy perspective. We have …

Helping The Grim Reaper: Oregon's Measure 16 And Three Court Cases Put Assisted Suicide On A Fast Track To Supreme Court, Yale Kamisar, N. Schuyler, T. Balmer

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Last November, Oregon's voters passed by initiative the first physician-assisted suicide law in the nation. Measure 16 authorizes physicians to prescribe lethal medicaiton for competent, terminally ill adults if they make three separate requests, wait 15 days to reconsider, and get a second medical opinion of their prognosis. The new law was challenged immediately on several legal grounds; plaintiffs have won a preliminary injunction, and arguments have been scheduled in cross motions for summary jugement. Lee v. Oregon (D Or. No. 94-6467-ITO).

The Oregon court's decision will mark the fourth time in the past year that the once-obscure issue of …

Reply To Comments On The Patentability Of Certain Inventions Associated With The Identification Of Partial Cdna Sequences, Rebecca S. Eisenberg, Robert P. Merges

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A brief reply is in order to clarify our position on the patenting of research tools. We stand by the statement that "there are reasons to be wary of patents on research tools," but that statement should not be understood as a broad condemnation of patents on research tools in all contexts. Indeed, immediately after the cited language our opinion letter acknowledges that withholding patent protection from research tools could undermine private incentives to develop research tools and to make them available to investigators or lead to greater reliance on trade secrecy. Unlike the government, which purports to pursue patent …

Bioethics In The Language Of The Law, Carl E. Schneider

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What happens when the language of the law becomes a vulgar tongue? What happens, more particularly, when parties to bioethical discourse are obliged to borrow in their daily controversies the ideas, and even the language, peculiar to judicial proceedings? How suited are the habits, taste, and language of the judicial magistrate to the political, and more particularly, the bioethical, questions of our time? We ask these questions because, as the incomparable Tocqueville foresaw, Americans today truly do resolve political-and moral--questions into judicial questions. As Abraham Lincoln hoped, the Constitution "has become the political religion of the nation," and many Americans …

Gay Men, Aids, And The Code Of The Condom, David L. Chambers

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The principal purpose of this Article is to explore the origins and moral content of the code of behavior among gay men that has developed around the condom. A second purpose is to consider whether this code is wise and defensible under current circumstances. A final purpose is to compare the condom rules to the code of sexual behavior that state governments have created in response to AIDS under their criminal laws.

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 …

Tales Of Two Cities: Aids And The Legal Recognition Of Domestic Partnerships In San Francisco And New York, David L. Chambers

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Here are two stories. They are of the quite different ways that domestic partnerships of lesbian and gay couples have come to be recognized, for some purposes, in San Francisco and New York City. I tell the stories for their own sake, but with a particular focus on the role that AIDS played in the political process in each city.

The Right To Die: Green Lights And Yellow Lights, Yale Kamisar

Articles

In the long-awaited and much-discussed Nancy Cruzan case, a 5-4 Supreme Court majority ruled that absent "clear and convincing evidence" that a once but no longer competent patient wishes to discontinue her life support (in this instance artificial nutrition and hydration) a state is not constitutionally compelled to terminate that support.

Nancy's situation is tragic. Since suffering severe injuries in 1983, she has been in a persistent vegetative state. Yet medical experts testified that if her feeding tube were not removed she could linger on in her present condition for many years.

But the first thing to keep in mind …

Rights Discourse And Neonatal Euthanasia, Carl E. Schneider

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Hard cases, they say, make bad law. Hard cases, we know, can also make revealing law. Hard cases identify the problems we have not found a way of solving. They reveal ways the law's goals conflict. They force us to articulate our assumptions and to examine our modes of discourse and reasoning. If there was ever a hard case for the law, it is the question of whether, how, and by whom it should be decided to allow newborn children who are severely retarded mentally or severely damaged physically to die. For many years, the law has not had to …

How To Argue About Health Care, Don Herzog

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Despite the aggressive title of this article, my goals are modest. I begin by explaining briefly what should at any rate be obvious: that health care policies inescapably raise moral and political difficulties, difficulties that no technical fix could resolve. I move on to puzzle over the connections between some of the more abstract issues of moral and political theory and medical policy: here I urge that we develop a more sustained taste for exploring the moral conflicts embedded in our current practices. Finally, I suggest a strategy for making nitty-gritty facts-from the concrete world of third-party payment, expensive technology, …

Alternatives To Civil Commitment Of The Mentally Ill: Practical Guides And Constitutional Imperatives, David L. Chambers

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In 1930, Ford sold Fords only in black and states offered treatment for mental illness only in public mental hospitals. Today, new views of mental health care and mental health problems have begotten a galaxy of new treatment settings. Few cities can boast community-based programs sufficient to meet their needs, but almost all cities of any size rely increasingly on outpatient programs. The large public mental hospitals still stand, of course. Indeed, every year more people enter public hospitals than entered the year before. Over 400,000 Americans were admitted as inpatients to state and county mental hospitals last year.1 Partly …

Confinement Of The Insane, Thomas M. Cooley

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The time is almost within the memory of living persons when it was deemed not only lawful but proper to confine persons afflicted with mental disease in dungeons and with chains, and to subject them to beating, at the discretion of their keepers, in order to subdue their senseless fury and drive away their delusions.1 The notions of an ignorant and barbarous age justified such treatment, but the common law on the subject has been so much modified in the greater intelligence of the present century that opinions as to how much of the old rules remain must be expressed …

Ho Ah Kow V. Matthew Nuan, Thomas M. Cooley

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"An ordinance of San Francisco, that every male person imprisoned in the county jail, under any judgment of the any court having jurisdiction in criminal cases in the city and county, should immediately upon his arrival at the jail, have the hair of his head 'cut or clipped to an uniform length of one inch from the scalp thereof,' and made it the duty of the sheriff to have this provision enforced, is invalid, being in excess of the authority of the municipal body....

The ordinance being directed against the Chinese only, imposing on them a degrading and cruel punishment, …