Health Law and Policy Commons^™

Remembrance Of Lives Past: The Challenge Of Addressing Epigenetic Risk In Society, Fazal Khan

Popular Media

Do our ancestors’ experiences from several generations ago play a role in our current health? Could a famine or a period of food abundance experienced by our grandfathers affect whether we are currently obese or likely to develop diabetes? Can being the grandchildren of those who suffered through genocide or intense racial discrimination affect levels of certain chemicals in our brains even if we are not exposed to the same social stresses? In other words, do we biologically inherit the “memories” of past generations independent of changes to our ancestors’ genetic code or DNA? Assistant Professor Fazal Khan explores how …

Public Health Law For A Brave New World; Book Review: Lawrence O. Gostin, Public Health Law: Power, Duty, Restraint, Elizabeth Weeks Leonard

Scholarly Works

This is book review of Lawrence O. Gostin's new edition of Public Health Law: Power, Duty, Restraint (University of California Press, Berkeley, California, 2d ed., 2008). A review of a second edition of a book may be somewhat unusual as subsequent editions of already published works typically do not break new ground. But this book is different. Gostin's first edition, published in 2000, established and defined the modern field of public health law. The revised and expanded second edition emerges in the post-9/11, post-Katrina, post-Bush world. Gostin now seeks to apply public health paradigms to social problems beyond the field's …

Designating Health Care Decisionmakers For Patients Without Advance Directives: A Psychological Critique, Nina A. Kohn, Jeremy A. Blumenthal

Georgia Law Review

States' default surrogate statutes allow family or friends to make health care decisions for incapacitated patients who lack advance directives. Although such statutes are commonly justified on the grounds that they honor the wishes of incapacitated persons, the review of empirical research on surrogate decision making in this Article challenges this justification. The authors find that default surrogate statutes do a reasonable job of capturing majority preferences for health care decision making processes, but do not ensure that patients receive the treatment they would have selected for themselves if able. Rather,surrogates appointed under default surrogate statutes can be expected to …

What Do We Have Against Parents?: An Assessment Of Judicial Bypass Procedures And Parental Involvement In Abortions By Minors, Wade Schueneman

Georgia Law Review

It is the established law of the land that minors enjoy a limited right to terminate unwanted pregnancies. States may restrain the exercise of this right by requiring parental consent or notification, but they must allow minors an opportunity to bypass consent requirements. This Note examines the history and present state of judicial and nonjudicial bypass mechanisms. It details the constraints and requirements imposed by state and federal constitutions, assesses the current landscape of parental involvement statutes, and provides prescriptive analysis as to how states might choose to refine and improve their bypass mechanisms to better protect parental rights.

Failure To Connect: The Massachusetts Plan For Individual Health Insurance, Elizabeth Weeks Leonard

Scholarly Works

This Article briefly describes the key features of the Massachusetts Health Care Reform Act, focusing particularly on the Connector. It then offers preliminary thoughts on the expected effect of that mechanism for creating quality, affordable health insurance products for individuals. Observers anticipate that commercial insurers will offer scant coverage and high-premium, high-deductible plans through the Connector, which coverage ultimately may be neither more affordable than products currently or more helpful to covering the cost of health care than no coverage at all. If the Connector fails to facilitate the individual insurance mandate, Massachusetts's promise of universal coverage may begin to …

Beyond Compensation: Using Torts To Promote Public Health, Elizabeth Weeks Leonard

Scholarly Works

Personal injury litigation, or tort law, traditionally, has been viewed as antithetical to the goals of public health. The focus on individual compensation for injuries resulting from accidents, products, and international wrongdoing arguably does not serve the "greater good" or communitarian objectives of public health. This Article, originally presented on a January 2006 AALS Panel on Teaching Public Health In Law School, takes issue with the traditional view and will demonstrate ways that personal injury litigation and public health objectives may be complimentary and mutually reinforcing. Some areas of tort law, such as mass torts against tobacco companies, toxic polluters, …

The Fragility Of The Affordable Care Act's Universal Coverage Strategy, Elizabeth Weeks Leonard

Scholarly Works

This paper was presented at DePaul University in March 2006, as part of a Symposium on Shaping a New Direction for Law and Medicine: An International Debate on Culture, Disaster, Biotechnology & Public Health. Following the catastrophic events of 2005, including Hurricane Katrina, Pakistani Earthquakes, bird flu transmission to human populations, and the real threat of bioterrorism, government struggled in the aftermath to make sense of the devastation and human displacement. Medical teams, try as they might, are not always prepared and alerted as to how best investigate and quickly render assistance. The Symposium addressed the role of government, policy-makers, …

Lessons From Katrina: Response, Recovery And The Public Health Infrastructure, Elizabeth Weeks

Scholarly Works

This paper was presented at DePaul University in March 2006, as part of a Symposium on Shaping a New Direction for Law and Medicine: An International Debate on Culture, Disaster, Biotechnology & Public Health. Following the catastrophic events of 2005, including Hurricane Katrina, Pakistani Earthquakes, bird flu transmission to human populations, and the real threat of bioterrorism, government struggled in the aftermath to make sense of the devastation and human displacement. Medical teams, try as they might, are not always prepared and alerted as to how best investigate and quickly render assistance. The Symposium addressed the role of government, policy-makers, …

Bibliography Of Law Review Articles On Disability Law, Ann Puckett

Scholarly Works

Bibliography of law review articles discussing legal issues pertaining to disabilities, originally presented as a continuously updated online database.

Cooperative Federalism And Healthcare Reform: The Medicare Part D 'Clawback' Example, Elizabeth Weeks Leonard

Scholarly Works

This symposium article recounts recent litigation by several states over a provision of the Medicare Modernization Act Part D prescription drug benefit: The clawback, which requires states to pay the a potentially substantial portion of new federal program. I then examine the unique federalism implications of the clawback for ongoing state and federal health reform initiatives.

In spring 2006, several states petitioned the United States Supreme Court for original jurisdiction to hear a challenge to one provision of the new Medicare Part D prescription drug law. The federal government, while taking over prescription drug coverage for dually eligible beneficiaries, required …

A Penny For Your Thoughts: Private And Collective Contracting For Traditional Medicinal Knowledge Modeled On Bioprospecting Contracts In Costa Rica, Katie Bates

Georgia Law Review

For decades, pharmaceutical companies have prospected biologically diverse developing countries for plants and molecules that may form the foundations of groundbreaking medicines. In many cases, native populations have aided researchers by directing them to the plants used in their traditional medicines. Only recently, however, have native peoples pushed for compensation for this valuable contribution. The governments of developing countries, too, have begun to assert legal and physical control over their natural resources, making access to these resources by pharmaceutical companies more difficult and costly. Simultaneously, scientific developments have made drug discovery through alternative methods more feasible. Despite these changes, it …

Medical Tourism: Symptom Or Cure?, Kerrie S. Howze

Georgia Law Review

"Medical tourism" is the phrase used to describe the phenomenon whereby patients travel to a foreign country to consume medical services. This practice has gained momentum in recent years, largely due to accessibility and affordability issues plaguing the U.S. healthcare system. Notably, medical tourism has progressed from being only an option considered by uninsured or under-insured individuals to an option considered by employers as a means of reducing the cost of employee health benefits. This Note examines the medical tourism practice and discusses potential problems with the practice, specifically the lack of remedy in case of medical negligence. Although medical …

The Plan B For Plan B: The New Dual Over-The-Counter And Prescription Status Of Plan B And Its Impact Upon Pharmacists, Consumers, And Conscience Clauses, Brittany L. Grimes

Georgia Law Review

On August 24,2006, the U.S. Food and Drug Administration decided to approve Plan B, the "morning-after"contraceptive pill, as an over-the-counter drug for women ages eighteen and older only. Individuals aged seventeen years and younger must still obtain a prescription in order to purchase Plan B, resulting in confusion and complications in implementing the age limitation. Additionally, the dual status of Plan B as both a prescription and over-the-counter drug might still be undermined by pharmacists choosing to refuse sale of contraceptives under various state protective conscience clauses. This Note explores the impact of the FDA's novel decision to create a …

A Mystery Of Motherhood: The Legal Consequences Of Insufficient Research On Postpartum Illness, Lindsey C. Perry

Georgia Law Review

Postpartum illness is a real and serious affliction, suffered by many mothers throughout the country. For decades, courts have struggled with the issue of how postpartum illness fits into the current framework for legal insanity. Recent publicity of the Andrea Yates trial and her subsequent acquittal brought postpartum psychosis to the attention of the American public. This Note explores the background of postpartum psychosis and its treatment in U.S. courts. It discusses the possibilities for addressing postpartum psychosis in criminal proceedings and proposes that further research and understanding are necessary to provide justice for female defendants afflicted with postpartum psychosis. …

Trans Fat: Can New York City Save Its Citizens From This "Metabolic Poison"?, Elizabeth Y. Spivey

Georgia Law Review

Trans fat was developed by chemists at the turn of the century and became an increasingly large part of the American diet. Trans fat in the form of partially hydrogenated vegetable oil now makes up 2% of all calories consumed in the United States. In the past two decades, studies have shown that artificially created trans fat increases cholesterol and increases the risk of coronary heart disease, heart attack, and type II diabetes. In response to these health concerns, New York City's Board of Health voted to ban trans fat from restaurant fare in December 2006. Other cities and local …

After The Catastrophe: Disaster Relief For Hospitals, Elizabeth Weeks Leonard

Scholarly Works

Disaster planning for health care providers following the September 11, 2001, terrorist attacks and, more recently, Hurricane Katrina, focuses on preparing hospitals and other emergency services to respond to victims' medical needs. But little attention has been paid to the challenges that providers would face resuming normal operations after responding to the catastrophe. A large-scale catastrophe could create unprecedented demand for health care and emergency services. Hospitals already struggle to fulfill the high demand for and high costs of emergency care. Following a major disaster, hospitals would face additional financial challenges. Strained capacity and financial reserves, may force hospitals to …

The Rhetoric Of Disputes In The Courts, The Media, And The Legislature, Geoffrey C. Hazard, Jr

Georgia Law Review

Recent events like the Terri Schiavo case typify the familiar phenomenon of a matter of legal significance becoming the focus of attention on the part not only of the courts, but also of the public, the media, and the government. Legal contemplation tends to consider these and other legal disputes isolated from their community roots and insulated from their political implications. Most private disputes remain private, and do not attract the interest of the media or the political branches of government. The media's estimate of public curiosity, however, transforms a select number of disputes into high-profile cases, which leads to …

The Impact Of Hsas On Health Care Reform: Preliminary Results After One Year, Edward J. Larson, Marc Dettmann

Scholarly Works

With over one year having passed since the Medicare Modernization Act ("MMA") authorized the creation of the first individual Health Savings Accounts ("HSA"), this Article reviews the context, structure, promise, and impact of this new type of tax-advantaged account. The Article begins by briefly reviewing the context of this reform, documenting what both Presidents Clinton and Bush noted about rising costs and decreasing access. The Article then reviews the HSA legislation itself, H.R. 2596, and summarizes how HSAs operate. Part IV of this Article reviews the claims made for HSAs when H.R. 2596 passed as part of the MMA. Part …

Gauging The Cost Of Loopholes: Health Care Pricing And Medicare Regulation In The Post-Enron Era, Elizabeth Weeks Leonard

Scholarly Works

This article explores the problem of risk perception and regulatory loopholes in the unique era of corporate governance that followed Enron and other high-profile corporate scandals. The article draws on behavioral law and economics theory to examine pressing issues in U.S. welfare policy reform. The current Administration's domestic agenda features proposals to privatize traditional government welfare programs, including Social Security and Medicare. Those proposals rely on market competition and other profit incentives to improve quality and reduce program costs. The article traces a detailed case study of a prominent for-profit hospital corporation, the impact of public perceptions of corporate wrongdoing, …

The New Economic Credentialing: Protecting Hospitals From Competition By Medical Staff Members, Elizabeth Weeks

Scholarly Works

This Article addresses hospitals' use of economic criteria to determine a physician's qualifications for staff privileges. Hospitals are resorting to economic conflict-of-interest credentialing policies in an attempt to ensure physicians' loyalty and mantain their own economic viability. Physicians, however, argue that entrepenurial activities are necessary for them to meet the economic challenges posed by declining reimbursement and rising insurance costs. This Article surveys the numerous legal theories that litigants and enforcement authorities could employ in attacking these new types of credentialing policies. The Article concludes that, in most jurisdictions, hospitals should be able to implement their policies in ways that …

Foreword, Edward D. Spurgeon, Charles P. Sabatino, Nancy M. Coleman, Stephen R. Mcconnell, Rebecca C. Morgan

Georgia Law Review

The Joint Conference on Legal/Ethical Issues in the Progression of Dementia grew out of the pressing need to address the very real legal and ethical dilemmas that arise in situations like the one of Marie McDonough Larson and her family. Five groups joined forces to sponsor the Conference: the Borchard Foundation Center on Law and Aging; the Alzheimer's Association; the American Bar Association's Commission on Legal Problems of the Elderly; the National Academy of Elder Law Attorneys; and the University of Georgia School of Law. Held at the Center for Continuing Education at the University of Georgia, the Conference spanned …

Dementia And Alzheimer's Disease: An Overview, Peter V. Rabins

Georgia Law Review

Dementia is a syndromic diagnosis defined by three criteria: cognitive decline, multiple impairments, normal level of consciousness. It is an acquired disorder characterized by multiple impairments of cognition (distinct elements of intellectual processing such as memory, abstraction, judgment, and language) occurring in an individual who is fully alert and attentive. It is now known that at least seventy-five distinct diseases can present as this syndrome and that most of these diseases have specific syndromic patterns that allow clinicians to distinguish among them.

Ethics, Ethnicity, And Dementia: A "Culture-Fair" Approach To Bioethical Advocacy In Dementing Illness, Ramon Valle

Georgia Law Review

The aims of this discussion are to twofold. The first is to apply what Post et al. term a cultural lens to bioethical decisionmaking processes in dementing illness.' The second is to assist the ethical advocate to develop a cultural analysis strategy for application of ethical decisionmaking processes within ethnically diverse populations. An assumption made here is that, as human inventions, ethical systems are an extension of culture, taking their imprint from the ethnocultural systems from which they emerge.' It is true that ethical systems and their principles can be widely shared across cultures. Modern bioethics, as promulgated within the …

Creating And Supporting The Proxy-Decider: The Lawyer-Proxy Relationship, Nancy N. Dubler

Georgia Law Review

Advance directives have been identified as the "quick fix" of bioethics. The logic goes something like this: If we could only get patients to tell us, in advance of disability, the specifics of the health care they would want to receive in the future, we could put our ethical and legal qualms aside and march ahead with care that we know is patient appropriate and legally protected. If we could only get the patient to commit, we could proceed with moral certainty and risk assurance. If we could only be given explicit instructions, we could act accordingly and be comfortable …

Decisionmaking At The End Of Life: Patients With Alzheimer's Or Other Dementias, Leslie P. Francis

Georgia Law Review

Patients with dementia present difficult issues for health-care decisionmaking. This article addresses the moral and legal issues posed by end of life decisionmaking for such patients. In general, the ethical goals of care are to assure that patients' choices are respected and that patients' best interests are protected. These goals may not always recommend the same decisions about care, however, and there is controversy about how they should be balanced when they conflict. In addition, the law may not always further these goals, nor be as helpful as it could be in resolving conflicts between them. In the bioethics literature, …

Freedom Fading: On Dementia, Best Interests, And Public Safety, Bruce Jennings

Georgia Law Review

Having Alzheimer's Disease does not make a person evil, but it does sometimes cause behavior that poses a danger to the person with dementia or to others. On what grounds can we justify overriding and restricting the liberty of a person with dementia? How far should such restrictions go? Who should authorize them and who should carry them out, and under what theory? Given that all behavior carries some degree of risk, what level of risk is acceptable? What should society tolerate as a part of the back- ground conditions within which most people conduct their lives? To what level …

Public Policy Implications Of Liability Regimes For Injuries Caused By Persons With Alzheimer's Disease, Edward P. Richards

Georgia Law Review

People in the United States and the developed world are living longer than ever before. While gains in the average life expectancy have been modest, these gains greatly underestimate the growth of the elderly population. Most of this elderly population is healthier and more active in everyday life than people of comparable age in decades past. The amelioration of many of the diseases of age has accentuated the problems of the chronic diseases for which there are no effective treatments. Perhaps the most devastating of these is Alzheimer's disease, a progressive dementia leading to incapacity and death. As discussed in …

Dementia Research: Ethics And Policy For The Twenty-First Century, Rebecca Dresser

Georgia Law Review

People in developed countries rank dementia among the most feared threats to human health and life. With an increasing portion of the U.S. population living into the seventh, eighth, and ninth decades, the incidence of dementia is on the rise. So is the incidence of dementia research. In an effort to lighten the burdens on future patients and caregivers, government agencies, pharmaceutical companies, and philanthropic organizations are devoting abundant resources to the study of dementia. Like most human endeavors, dementia research can yield both benefits and harms. On the positive side, research holds out the possibility of better medications and …

Thinking About Life-Sustaining Treatment Late In The Life Of A Demented Person, Thomas Finucane

Georgia Law Review

This paper will consider a specific clinical situation: an elderly patient with dementia who becomes seriously ill, where treatment would likely be burdensome but might prolong life. Generic questions are described and the lawyerly Standard Paradigm is developed. Questions are raised about every step of the Standard Paradigm. Finally, there is a discussion of two treatment decisions that are commonly faced late in the course of advanced dementia: tube feeding and attempted cardiopulmonary resuscitation.

Predictive Genetic Testing For Alzheimer's Disease In Long-Term Care Insurance, Mark A. Rothstein

Georgia Law Review

The promise of new genetic research is the ability to prevent, treat, and cure a wide range of physical and mental disorders-both monogenic and complex disorders. While astonishing progress has been made in gene discovery and the development of genetic tests, progress has been much slower in developing medicalinterventions. Consequently, there is likely to be a gap of varying and indetermi- nate time-lasting years or decades-between the ability to identify and predict genetic risk and the ability to prevent, treat, or cure the condition. The gap between the ability to predict genetic risk and the ability to ameliorate the risk …