Health Law and Policy Commons^™

Health Of The People: The Highest Law?, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Law and ethics in population health are undergoing a renaissance. Once fashionable during the Industrial and Progressive eras, the ideals of population health began to wither with the rise of liberalism in the late twentieth century. In their place came a sharpened focus on personal and economic freedom. Political attention shifted from population health to individual health and from public health to private medicine.

The field of public health law and ethics needs a theory and definition (what is public health law and ethics and what are its doctrinal boundaries?); a well-articulated vision (why should health be a salient public …

Pandemic Influenza: Public Health Preparedness For The Next Global Health Emergency, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Severe Acute Respiratory Syndrome (SARS) garnered a great deal of public attention because it was novel and its potential for spread was unknown. However, the SARS corona virus is significantly less virulent than pandemic influenza viral infections. The annual number of deaths for seasonal influenza is 36,000 people in the United States and 250,000- 500,000 worldwide. However, highly pathogenic influenza pandemics have occurred roughly 2-3 times per century, causing untold morbidity and mortality. The Spanish influenza pandemic of 1918 was believed to have caused over 20 million deaths in a world less than one-third the size of the current global …

Sars And International Legal Preparedness, Lawrence O. Gostin, Jason W. Sapsin, Jon S. Vernick, Stephen P. Teret, Scott Burris

Georgetown Law Faculty Publications and Other Works

This article does not advance arguments regarding the efficacy or circumstances under which governments should exercise personal control measures such as quarantine or isolation. A literature on this aspect of SARS disease control strategies is just starting to develop more fully. Instead, we highlight the legal aspects of personal control measures employed against SARS in order to emphasize the importance of understanding public health law's role in authorizing and constraining disease control strategies, as well as the importance of legal preparedness in nations governed under the rule of law. In the contemporary international environment, one nation's failure in legal preparedness …

The Human Rights Of Persons With Mental Disabilities: A Global Perspective On The Application Of Human Rights Principles To Mental Health, Lawrence O. Gostin, Lance Gable

Georgetown Law Faculty Publications and Other Works

This Article examines the human rights of persons with mental disabilities and the application and development of these rights by the various international and regional systems that have been established to protect human rights. An international system of human rights with universal application has been developed under the auspices of the United Nations. Regional human rights systems have applied additional human rights protections to their respective geographic regions. Both the international and regional systems have addressed the human rights of persons with mental disabilities through treaties, declarations, and thematic resolutions. Moreover, regional institutions have incrementally formulated a body of law …

Pushing Drugs: Genomics And Genetics, The Pharmaceutical Industry, And The Law Of Negligence, Heidi Li Feldman

Georgetown Law Faculty Publications and Other Works

This article presents a piece of a larger, ongoing project on the phenomenon of market-driven manufacturing (MDM) and how tort law should address it. In contrast to the larger project, this article provides a relatively brief overview of the general phenomenon of MDM, but zeros in on how pharmaceutical manufacturers specifically practice MDM. MDM is a well-documented, much practiced activity, although American courts do not recognize MDM as a discrete category of conduct. The basic idea of MDM is that marketing considerations should continuously control every aspect and stage of a product's lifecycle. When a company engages in MDM, it …

A Tribute To Gene W. Matthews, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Conference Center, across the street from the Centers for Disease Control and Prevention (CDC) on Clifton Road in Atlanta, I sat on a leather sofa with one of my oldest, dearest friends-Gene Matthews, Legal Adviser to the CDC. Gene asked to meet me to talk about how we might invigorate the field of public health law. Matthews and his colleagues at CDC were hatching an idea to commence a grass-roots movement in public health law.

When Terrorism Threatens Health: How Far Are Limitations On Personal And Ecomonic Liberties Justified, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The government is engaged in a homeland-security project to safeguard the population's health from potential terrorist attacks. This project is politically charged because it affords the state enhanced powers to restrict personal and economic liberties. Just as governmental powers relating to intelligence, law enforcement, and criminal justice curtail individual interests, so too do public health powers.

Clinical Uncertainty And Healthcare Disparities, Maxwell Gregg Bloche, Ana I. Balsa, Thomas G. Mcguire, Naomi Seiler

Georgetown Law Faculty Publications and Other Works

The Institute of Medicine Report, Unequal Treatment: Confronting Racial and Ethnic Disparities, affirms in its first finding: "Racial and ethnic disparities in health care exist and, because they are associated with worse outcomes in many cases, are unacceptable." The mechanisms that generate racial and ethnic disparities in medical care operate at the levels of the health care system and the clinical encounter. Research demonstrates the role of health care system factors, including differences in insurance coverage and other determinants of healthcare access, in producing disparities. Research also shows, however, that even when insurance status and other measures of access are …

The Politics Of Public Health: A Response To Epstein, Lawrence O. Gostin, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

Conservatives are taking aim at the field of public health, targeting its efforts to understand and control environmental and social causes of disease. Richard Epstein and others contend that these efforts in fact undermine people’s health and well-being by eroding people’s incentives to create economic value. Public health, they argue, should stick to its traditional task—the struggle against infectious diseases. Because markets are not up to the task of controlling the transmission of infectious disease, Epstein says, coercive government action is required. But market incentives, not state action, he asserts, represent our best hope for controlling the chronic illnesses that …

The Invention Of Health Law, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

By default, the courts are inventing health law. The law governing the American health system arises from an unruly mix of statutes, regulations, and judge-crafted doctrines conceived, in the main, without medical care in mind. Courts are ill-equipped to put order to this chaos, and until recently they have been disinclined to try. But political gridlock and popular ire over managed care have pushed them into the breach, and the Supreme Court has become a proactive health policy player. How might judges make sense of health law's disparate doctrinal strands? Scholars from diverse ideological starting points have converged toward a …

The Global Reach Of Hiv/Aids: Science, Politics, Economics, And Research, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This Article examines the major social, political, economic, and ethical issues involved in the global HIV pandemic. First, it examines the steps needed to prevent and treat HIV effectively and examines why many leaders have not responded more forcefully. This Part discusses the intangible, but crucial, aspect of political will. Second, this Article looks at the divisive issue of drugs, patents, and international trade law. Highly developed countries usually want to uphold the patent system to protect the proprietary interests of drug companies, which keeps the price of HIV/AIDS drugs high, placing them out of the reach of resource-poor countries. …

Personal Privacy And Common Goods: A Framework For Balancing Under The National Health Information Privacy Rule, Lawrence O. Gostin, James G. Hodge Jr.

Georgetown Law Faculty Publications and Other Works

In this Article, we discuss how these principles for balancing apply in a number of important contexts where individually identifiable health data are shared. In Part I, we analyze the modern view favoring autonomy and privacy. In the last several decades, individual autonomy has been used as a justification for preventing sharing of information irrespective of the good to be achieved. Although respect for privacy can sometimes be important for achieving public purposes (e.g., fostering the physician/patient relationship), it can also impair the achievement of goals that are necessary for any healthy and prosperous society. A framework for balancing that …

Public Health Law: A Renaissance, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Public health seeks to assure the conditions for people to be healthy. Public health can be distinguished from health care in several critical respects. Public health focuses on: (1) the health and safety of populations rather than the health of individual patients; (2) prevention of injury and disease rather than treatment and care; (3) relationships between the government and the community rather than the physician and patient; and (4) population based services grounded on the scientific methodologies of public health (e.g., biostatistics and epidemiology) rather than personal medical services. These critical features - populations, prevention, government and communities, and epidemiological …

Trust And Betrayal In The Medical Marketplace, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

The author argues in this Comment that disingenuity as first resort is an unwise approach to the conflict between our ex ante and our later, illness-endangered selves. Not only does rationing by tacit deceit raise a host of moral problems, it will not work, over the long haul, because markets reward deceit's unmasking. The honesty about clinical limit-setting that some bioethicists urge may not be fully within our reach. But more candor is possible than we now achieve, and the more conscious we are about decisions to impose limits, the more inclined we will be to accept them without experiencing …

Commentary: Public Health And Civil Liberties In An Era Of Bioterrorism, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Safeguarding the public's health, safety, and security took on new meaning and urgency after the attacks on the World Trade Towers in New York and the Pentagon in Washington, D.C., on September 11, 2001. The subsequent intentional dispersal of anthrax through the U.S. postal system resulted in five confirmed deaths, hundreds treated, and thousands tested. The potential for new, larger, and more sophisticated attacks have created a sense of vulnerability. National attention has urgently turned to the need to detect and react rapidly to bioterrorism as well as to naturally occurring infectious diseases.

Conceptualizing The Field After September 11th: Forward To A Symposium On Public Health Law, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Safeguarding the public's health, safety, and security took on new meaning and urgency after the attacks on the World Trade Center in New York and the Pentagon in Washington, D.C. on September 11, 2001. On October 4, 2001, a Florida man named Robert Stevens was diagnosed with inhalational anthrax. The intentional dispersal of anthrax through the U.S. postal system in New York, Washington, Pennsylvania and other locations resulted in at least five deaths, hundreds treated, and thousands tested. The prospects of new, larger, and more sophisticated attacks have created a sense of deep vulnerability. The need to rapidly detect and …

The Nationalization Of Health Information Privacy Protections, Lawrence O. Gostin, James G. Hodge Jr., Lauren Marks

Georgetown Law Faculty Publications and Other Works

In Part II, this article examines the justifications for implementing comprehensive national health information privacy regulations, including the personal nature of health information and the increasing threats to personal privacy from the shift to an electronic health information infrastructure. In doing so, it looks at historical attempts by federal and state officials to regulate the use and disclosure of personal health information, and concludes that prior standards have been largely inadequate. In Part III, this article explains the new national health information privacy regulations: (1) what do they cover?; (2) to whom do they apply?; (3) how do they safeguard …

Surrogacy From The Perspectives Of Economic And Civil Liberties, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The field of law and economics, of which Judge Posner is the leading theorist, has offered a rich and sophisticated framework for thinking about a wide variety of problems at the interface of law and society. The theory, based on economic principles for understanding behavioral incentives and disincentives, is widely taught in law schools and is influential in scholarship. I have not always agreed with the application of the theory to complex problems of individual and group behavior, yet I constantly have been impressed with the elegance of the writing and analysis.

Judge Posner thinks about surrogacy arrangements in terms …

A Vision Of Health And Human Rights For The 21st Century: A Continuing Discussion With Stephen P. Marks, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Professor Marks offers an eloquent vision of health and human rights in the 21st Century. As the Director of the Francois-Xavier Bagnoud Center for Health and Human Rights, Professor Marks ably carries the torch that Jonathan Mann lit in the field until his tragic death on September 2, 1998. Professor Marks stands along with the leading figures in health and human rights - e.g., Audrey Chapman, Sofia Gruskin, Michael Kirby, Daniel Tarantola, Brigit Toebes, Katarina Tomasevski, and Virginia Leary.

Public Health, Ethics, And Human Rights: A Tribute To The Late Jonathan Mann, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The late Jonathan Mann famously theorized that public health, ethics, and human rights are complementary fields motivated by the paramount value of human well-being. He felt that people could not be healthy if governments did not respect their rights and dignity as well as engage in health policies guided by sound ethical values. Nor could people have their rights and dignity if they were not healthy. Mann and his colleagues argued that public health and human rights are integrally connected: Human rights violations adversely affect the community's health, coercive public health policies violate human rights, and advancement of human rights …

Race And Discretion In American Medicine, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

The author’s focus in this article is on racial disparities in medical care provision--that is, on differences in the services that clinically similar patients receive when they present to the health care system. Racial disparities in health status, which is not greatly influenced (on a population-wide basis) by medical care, are beyond his scope here. Disparities in medical care access-potential patients' ability, financial and otherwise, to gain entry to the health care system in the first place, are also outside his focus. The author begins this article by putting the problem of racial disparities in medical care provision within the …

Handling Cases Of Willful Exposure Through Hiv Partner Counseling And Referral Services, Lawrence O. Gostin, James G. Hodge Jr.

Georgetown Law Faculty Publications and Other Works

Cases of willful exposure reveal the existing and future risks to the public health (especially women) which may be presented by individuals who willfully expose others to HIV through unsafe sexual or needle-sharing behaviors. In response to a documented case of willful exposure, a PCRS counselor or other public health official may, in his or her professional judgment, decide to act to avert a legitimate public health threat to known or unknown persons in the community. Yet handling such cases raises difficult issues in law, ethics, and public health practice. Public health authorities may be unable or ill-equipped to successfully …

Caretakers And Collaborators, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

A chilling subplot in the twentieth-century saga of state-sponsored mass murder, torture, and other atrocities was the widespread incidence of medical complicity. Nazi doctors’ human “experiments” and assistance in genocidal killing are the most oft-cited exemplar, but wartime Japanese physicians’ human vivisection and other grotesque practices rivaled the Nazi medical horrors. Measured by these standards, Soviet psychiatrists’ role in repressing dissent, Latin American and Turkish military doctors’ complicity in torture, and even the South African medical profession’s systematic involvement in apartheid may seem, to some, almost prosaic. Yet these and other reported cases of medical complicity in human rights abuse …

Dc Consortium Of Legal Service Providers: Legal Services 2000 Symposium, Peter B. Edelman

Georgetown Law Faculty Publications and Other Works

My main point is to urge you to the see what is possible in the way of what I might call a public health approach to lawyering for the poor. In a public health approach you find something that has polluted the river and you clean it up at its source instead of just treating its victims one by one. In legal and societal terms, when we are discussing why so many children are growing up poor and dying a slow death of disappointment, the challenge is to think about it in a public health way. Of course we cannot …

Discrimination Based On Hiv/Aids And Other Conditions: "Disability" As Defined Under Federal And State Law, Lawrence O. Gostin, David W. Webber

Georgetown Law Faculty Publications and Other Works

In this Article, we examine the disability definition "problem" from the standpoint of HIV infection, specifically HIV infection in its "asymptomatic" phase . . . We begin by summarizing the need for federal nondiscrimination standards offering protection for individuals with HIV. We then provide a brief discussion of the definition of disability under the resulting legislation, the Americans with Disabilities Act of 1990 (ADA). We summarize the early judicial and administrative views of the ADA as protecting individuals with HIV. We next turn to judicial interpretation of the ADA in cases in which that understanding has been disputed, including, most …

The Public Health Improvement Process In Alaska: Toward A Model Public Health Law, Lawrence O. Gostin, James G. Hodge Jr.

Georgetown Law Faculty Publications and Other Works

In this Article, we present the findings of our study on the improvement of public health law in Alaska. We examine and analyze the public health laws supporting the state's public health system. The fact that Alaska has attained statehood comparatively recently, and has a governing structure involving state, municipal, rural, and tribal entities presents unique opportunities for the State to improve its public health system and its supporting legal infrastructure

Liberalism And Abortion, Robin West

Georgetown Law Faculty Publications and Other Works

First in a groundbreaking book, Breaking the Abortion Deadlock: From Choice to Consent, published in 1996, then in various public fora, from academic conference panels to Christian radio call-in shows, and now in a major law review article entitled My Body, My Consent: Securing the Constitutional Right to Abortion Funding, Eileen McDonagh has sought to redefine drastically our understanding of the still deeply contested right to an abortion, and hence, of the nature of the constitutional protections which in her view this embattled right deserves. Her argument is complicated and subtle, but its basic thrust can be readily …

A Tribute To Jonathan Mann: Health And Human Rights In The Aids Pandemic, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

A tribute to Jonathan Mann, former head of the World Health Organization's global AIDS program and a key figure in the early fight against HIV/AIDS. The author discusses Mann's work in health and human rights, prevention of disease, and eliminating social injustice.

Rights And Efficiency In American Health Law, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

During the 1960s and 1970s, the individual rights revolution that swept through American society remade much of the nation's health law in its image. Sick people acquired the right to be told of the risks and benefits of proposed treatments and then to give thumbs-up or thumbs-down to their doctors' decisions. Successful suits for medical negligence went from rare to commonplace. Elderly and poor Americans achieved statutory rights of access to publicly funded healthcare, and courts burnished these rights with myriad procedural protections. The critically ill and their families won the right to refuse aggressive, life-sustaining treatments. Psychiatric patients acquired …

The Constitutional Right To Die: Ethical Considerations, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In this commentary, the author first looks at some ethical reasoning supporting physician-assisted dying. Second, he examines some of the lines that have been drawn between withdrawing and withholding life-sustaining treatment on the one hand, and physician-assisted dying on the other. Finally, he relates both of these matters to constitutional reasoning, beginning with Cruzan and ending with the cases before the Supreme Court at the time of the article's publication.