Health Law and Policy Commons^™

The Science Court: Reminiscence And Retrospective, Allan Mazur

RISK: Health, Safety & Environment (1990-2002)

A self-described "agnostic" on the merits of the Science Court proposal describes how he independently arrived at a similar notion and played a role in efforts to secure a major test of the proposal. Professor Mazur also analyzes university-based experiments structured around that model and concludes that the controversial "judges" are probably unnecessary to achieve his original objectives.

Procedural Choices In Regulatory Science, Sheila Jasanoff

RISK: Health, Safety & Environment (1990-2002)

This paper compares four approaches to using science in regulatory decision making - one very similar to the Science Court proposal. Professor Jasanoff argues generally that that proposal would be less useful than procedures more sensitive to the distinctive characteristics of regulatory science.

Regulation Of Physician Self-Referral Arrangements: Is Prohibition The Answer Or Has Congress Operated On The Wrong Patient, Christian D. Humphreys

San Diego Law Review

Rapidly increasing health care costs have created a national crisis. Perceiving physician referral behavior as the principal cause, Congress and several state legislatures have prohibited certain referrals. This Comment analyzes the data that spawned such legislation and critiques prohibition of referrals as a solution to the crisis. The Comment asserts that the prohibition remedy is overly broad and largely ineffective. The author recommends a more farsighted solution, such as the creation of a prepaid physician compensation system. The author argues that such a system would minimize the incentive to make unnecessary referrals while simultaneously reducing the level of health care …

Toward A Sustainable Maine : The Politics, Economics, And Ethics Of Sustainability, Richard Barringer (Ed.)

Maine Collection

Toward A Sustainable Maine : The Politics, Economics, and Ethics of Sustainability

Richard Barringer, editor, Professor Emeritus at the University of Southern Maine

Edmund S. Muskie Institute of Public Affairs, University of Southern Maine, Portland, Maine, 1993.

The proceedings of a conference presented at Bowdoin College on March 19 and 20, 1993, by the Edmund S. Muskie Institute of Public Affairs at the University of Southern Maine, and by the Natural Resources Council of Maine. Ellen Baum, conference organizer.

Contents; Foreword by Richard Barringer / Welcome by Everett Carson / Global, Canadian, and Maine Perspectives / Sustaining Our Natural and …

The Americans With Disabilities Act And The Corpus Of Anti-Discrimination Law: A Force For Change In The Future Of Public Health Regulation, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In this paper the author reviews the constitutional history of the courts' attempts to check the powers of the public health department. He demonstrates how ineffective and inconsistent constitutional review has been, and suggests that adequate review criteria have not emerged. The author shows that, whether the courts are applying First, Fourth, or Fourteenth Amendment standards, ultimately they are highly deferential to public health officials. Then he carefully examines the key concepts in the Americans with Disabilities Act (ADA) as they apply to communicable disease. He reveals Congress' clear intention to include communicable disease, even asymptomatic infection, as a disability. …

Drawing A Line Between Killing And Letting Die: The Law, And Law Reform, On Medically Assisted Dying, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Traditional medical ethics and law draw a sharp distinction between allowing a patient to die and helping her die. Withholding or withdrawing life sustaining treatment, such as by abating technological nutrition, hydration or respiration, will cause death as surely as a lethal injection. The former, however, is a constitutional right for a competent or once-competent patient, while the latter poses a risk of serious criminal or civil liability for the physician, even if the patient requests it.

Foreword: Health Care Reform In The United States—The Presidential Task Force, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This essay serves as the foreword to Implementing U.S. Health Care Reform, a symposium held in 1993.

The exact specifications of the new health care system depend on the package that President Clinton will send to Capitol Hill and the changes that Congress will make in the reform package. Some of the basic structures and organizing principles of the new system that are being considered by the President are already the subject of intense public scrutiny.

The design being considered would involve new relations between the federal government and the states, between the public and private sectors, and between …

Health Care Reform In The United States, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The author presents a brief description of the design features and objectives of the health care reform package, together with the reasons to support reform of the health care system in the United States.

The Economics And Politics Of Emergency Health Care For The Poor: The Patient Dumping Dilemma, Maria O'Brien Hylton

BYU Law Review

No abstract provided.

Risk And Rationality: The Centers For Disease Control And The Regulation Of Hiv-Infected Health Care Workers, Mary Anne Bobinski

Faculty Articles

The publicity surrounding the Bergalis case has created a new and powerful fear for some-the fear of contracting a fatal disease while obtaining medical or dental care. Following Bergalis' congressional testimony, Congress passed a bill requiring states to regulate HIV-infected health care workers (HCWs). Responding to constituents' fears, state legislatures had already been debating a wide range of bills designed to confront the risk of HIV transmission in health care settings. Private actors, such as hospitals and insurers, feared litigation or loss of business if the public perceived them to be ignoring the problem of HIV infection among HCWs. As …

The Interconnected Epidemics Of Drug Dependency And Aids, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Drug dependence and human immunodeficiency virus (HIV) are America's two most pressing epidemics, interconnected by a cycle of urban poverty, physical dependence and a culture of sharing needles and syringes. Extant political strategies to curb these interconnected epidemics involve two traditional approaches. The first--law enforcement and interdiction--is designed to limit the supply of illicit drugs to the marketplace. This strategy is advanced by broad criminal sanctions against importing, selling, distributing, medically prescribing, or possessing illicit drugs or drug paraphernalia. The second strategy to combat the drug and HIV epidemics involves reducing the demand for illicit drugs. Education, counseling, and treatment …

An Alternative Public Health Vision For A National Drug Strategy: "Treatment Works", Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article returns to a war waged virtually throughout this century--a war between the theories of punishment and rehabilitation in curtailing the drug epidemic. Today, the terms of the war are recast as supply-side policies based upon law enforcement; destroying crops in source countries; interdiction and increased sentencing; and demand reduction based upon prevention, education, and treatment. The war on drugs has reached a feverish pitch. New policies and statutes have tightened the grip of supply-side policies, with images of battle and hate mongering which go beyond the vilified drug lords and governments which harbor them, to the middle men, …

Ethical Principles For The Conduct Of Human Subject Research: Population-Based Research And Ethics, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This paper provides a halting first step in organizing a set of ethical guidelines for the conduct of population-based research, surveillance and practice. These principles are not distinct from, but an expansion of, traditional ethics. Research ethics, which matured significantly from the Nuremberg Code through to the Helsinki IV and the Council for International Organizations of Medical Sciences (CIOMS) guidelines, nourished the individual human spirit. Ethical principles should have a similarly profound impact in the development of science and the protection of human populations in the 1990s and beyond.

Genetic Discrimination: The Use Of Genetically Based Diagnostic And Prognostic Tests By Employers And Insurers, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This paper analyzes the law, ethics and public policy concerning "genetic discrimination," defined as the denial of rights, privileges or opportunities on the basis of information obtained from genetically based diagnostic and prognostic tests. The Human Genome Initiative will enhance the ability to gather and organize information that may predict a person's future potential and disabilities. Enormous human benefits may ensue from understanding the etiology and pathophysiology of genetic disorders, including disease prevention through genetic counseling, and treatment of the disorders through genetic manipulation. This information will help clinicians understand and eventually treat many of the more than 4,000 diseases …

Symposium: Ohioans Without Health Insurance: How Big A Problem? Are There Solutions?, Alan C. Weinstein

Law Faculty Articles and Essays

Ohioans Without Health Insurance: How Big A Problem? Are There Solutions?, was the INAUGURAL Conference of Cleveland State University's Law & Public Policy Program, an interdisciplinary program of instruction, public service and research sponsored jointly by the Cleveland-Marshall College of Law and the Maxine Goodman Levin College of Urban Affairs. The goal of the Conference was to facilitate an exchange of information and views among representatives of the public and major interests concerned with the growing numbers of persons who either lack health insurance or have inadequate coverage.

A Decade Of A Maturing Epidemic: An Assessment And Directions For Future Public Policy, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The author's goal in this article, is not merely to propose public health strategies for the future, but also to examine why government has been so slow, so equivocal, in its public health response to the acquired immune deficiency syndrome (AIDS) epidemic. He argues that there has been a fundamental ambivalence in perceptions of the epidemic. For some, AIDS is perceived as a disease, with sympathy for sufferers. Once AIDS is viewed as a disease, like other catastrophic diseases, it follows that public policy will be based upon science and epidemiology--health education, research and treatment.

For others, AIDS is caused …

The Politics Of Aids: Compulsory State Powers, Public Health, And Civil Liberties, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article argues that compulsory public powers are justified only if they meet the following criteria: there is a significant risk of transmission of the acquired immune deficiency syndrome (AIDS) virus; the public health response is efficacious in preventing a primary mode of transmission of the virus; the economic, practical, or human rights burdens are not disproportionate to the public health benefits; and the public health power is the least restrictive alternative that would prevent viral transmission.

The author carefully examines the levels of risk posed by behavior which can potentially transmit human immunodeficiency virus (HIV), and demonstrates that compulsory …

Hospitals, Health Care Professionals, And Aids: The "Right To Know" The Health Status Of Professionals And Patients, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article addresses why patients and health care professionals (HCPs) with human immunodeficiency virus (HIV) should have autonomy and privacy rights to choose whether to consent to an HIV test and to disclose their serologic status. It also demonstrates that the risk of HIV transmission in health care settings is exceedingly low, that it is probably lower than other well-accepted risks taken by patients and professionals, and that there are other less intrusive ways to further reduce the risk. The article concludes that knowledge of a patient's serologic status is unlikely to reduce risk, since no effective action could be …

Health Care As A Laboratory For The Study Of Law And Policy, Clark C. Havighurst

Journal of Legal Education

No abstract provided.

Introduction, Sylvia A. Law

Journal of Legal Education

No abstract provided.

Conceptualizing Health Law For Teaching Purposes: The Social Justice Perspective, Rand E. Rosenblatt

Journal of Legal Education

No abstract provided.

The Aids Epidemic: A Prism Distorting Social And Legal Principles, Alec Gray

New England Journal of Public Policy

The AIDS epidemic is affecting American society in far-reaching and unexpected ways. It touches our institutions, our value systems, and our private lives. Social issues seem to change and become distorted by the epidemic 's prismlike effect. This article examines some of the major public health issues raised by the epidemic, ranging from testing to contact tracing and quarantine. It argues that while the civil rights of individuals may have to be sacrificed to stem the spread of the disease, those rights should not be abandoned unless a clear benefit to the public health would result.

Issues of discrimination in …

How To Argue About Health Care, Don Herzog

Articles

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, …

The Future Of Public Health Law, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Developments in medicine and constitutional law dictate modification of public health legislation in the United States. Traditionally overlooked by legislators, present public health laws provide inadequate decision-making criteria and inappropriate procedures for dealing with issues. Revised legislation should provide health care officials and agencies with the tools to balance individual rights against public health necessities. This article makes four recommendations for legislative reform: (1) remove artificial legislative distinction between venereal and other communicable diseases; (2) provide criteria defining "public health necessity" to limit discretionary exercise of police power by health officials; (3) provide strong confidentiality protections in the collection and …

An Overview Of Health Law Research And An Annotated Bibliography, Richard A. Danner, Claire M. Germain

Cornell Law Faculty Publications

No abstract provided.

An Overview Of Health Law Research And An Annotated Bibliography, Richard A. Danner, Claire M. Germain

Faculty Scholarship

No abstract provided.

The Nucleus Of A Public Health Strategy To Combat Aids, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Since acquired immune deficiency syndrome (AIDS) was first identified in I98I, its rate of spread among a primarily young and vibrant population has chilled the medical and lay communities. Today, the public response is sober and oriented toward the examination of specific policies that could lessen the impact of the disease. After six years' experience it is now feasible to propose a strategy for combating AIDS. Consensus around the policies outlined in this article should form the nucleus of the public health strategy to combat AIDS before the intervention of an effective vaccine or treatment.

A Moment In Human Development: Legal Protection, Ethical Standards And Social Policy On The Selective Non-Treatment Of Handicapped Neonates, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Selective non-treatment decisions involving severely handicapped neonates have recently come under renewed judicial and legislative scrutiny. In this article, the author examines the legal, ethical and social considerations attendant to the non-treatment decision. In Part II he discusses the predominant ethical viewpoints relating to this issue and proposes a new moral standard based on personal interests. Part III presents a survey of the jurisprudence relating to selective non-treatment decisions. Parts IV and V of this article provide a critical examination of the recently enacted Child Abuse Amendments of 1984, a federal legislative initiative designed to regulate treatment decisions relating to …

Foreword: Public And Private Barriers To Competitive Reform Of Health Care Services Delivery, Clark C. Havighurst

Faculty Scholarship

No abstract provided.

Private Credentialing Of Health Care Personnel: An Antitrust Perspective, Part 2, Clark C. Havighurst, Nancy M. P. King

Faculty Scholarship

Having argued in Part One against extensive judicial or regulatory interference with private personnel credentialing in the health care field, this Article now shifts its focus to emphasize the anticompetitive hazards inherent in credentialing as practiced by professional interests. Competitor-sponsored credentialing is shown to be a vital part of a larger cartel strategy to curb competition by standardizing personnel and services and controlling the flow of information to health care consumers. Instead of altering the conclusions reached in Part One, however, Part Two sets forth a new and hitherto unexplored agenda for antitrust enforcement, one that the authors believe will …