Health Law and Policy Commons^™

Patients As Stakeholders, Isaac D. Buck

William & Mary Law Review

Once a provider of public support and charity, the American hospital is now a source of dividends for private actors. Profit interests have encroached on, and increasingly replaced, the publicly minded heroism of the American hospital, the central hub of a complex and disordered health care system. This new profit-first posture creates ill effects for the people who rely on health care delivery: those who work within it, those who are treated within it, and those who pay for it. When hospitals need to deliver for their corporate shareholders, legitimate questions arise about how much they are delivering for patients …

The New Transgender Tipping Point: Trumpism, Medical Necessity & Gender-Affirming Care, Molly J. Nunn

William & Mary Journal of Race, Gender, and Social Justice

Following the rise and eventual triumph of Trumpism 2024, President Donald J. Trump and his administration have sought to discredit the internationally recognized standards of effective health care practice for gender-affirming care. Now, ten years after Time Magazine published “The Transgender Tipping Point,” the political discourse of transgender identity is tipping again. Under the second Trump Administration, transgender identity sits at the edge of an abyss. Trumpism seeks to eradicate or significantly limit access to gender-affirming care through executive actions and the judiciary, despite the plethora of medical associations stating that that care is medically necessary. Public policies that widely …

A Fate Worse Than Death: The Perpetuation Of Ableism Through California's "End Of Life Option Act", Skyler Powell

William & Mary Bill of Rights Journal

This Note discusses why physician-assisted suicide is inconsistent with California’s laws and how it should be remedied. First, Part I examines the history of physician-assisted suicide in the United States; the federal and Californian stances on the issue; how the EOLOA [End of Life Option Act] works today; and California’s stance on suicide prevention. Next, Part II looks at how California’s Equal Protection Clause and Civil Rights laws apply to individuals eligible for aid-in-dying medication, then analyzes a recent lawsuit brought against the state of California by disability advocacy groups regarding the EOLOA. Part III considers California and supporters’ interests …

Dirty Water, Breanna Booker, Michael S. Sinha

William & Mary Environmental Law and Policy Review

There are tens of thousands of unregulated industrial substances manufactured and used in the United States. This Article focuses on three specific to plastic and its manufacturing process: microplastics, phthalates, and BPAs. These substances have been attributed to many known health harms and potentially more that have yet to be identified. The research is still nascent and continues to evolve, but what we do know is who is creating the problem. From big oil companies and plastics manufacturers, to creators of textiles and tires, to investors who all contribute to the problem, how can we hold these accountable for the …

The Overlooked Harms Of Inaccurate And Biased Medical Records, Myrisha S. Lewis

Popular Media

No abstract provided.

Reproductive Innovation And Reproductive Exceptionalism: How Private Health Insurance Coverage Of Fertility Treatment Complements Hostile Governmental Action And Expands Access To Assisted Reproduction In The United States, Myrisha S. Lewis

Faculty Publications

The use of fertility treatment and assisted reproductive technology (ART) in the United States and globally is increasing over time. As of April 2023, the World Health Organization estimates that approximately one in six individuals have faced infertility globally. Fertility treatment includes the use of drugs to stimulate egg production, in vitro fertilization (IVF), and, for some, the use of gestational surrogacy to aid in childbirth. Debates have abounded and continue to abound in federal legislatures, state legislatures, and society more broadly about the morality of abortion, contraception, and assisted reproduction, as well as whether governments, public insurers, and private …

Personhood, Politics, Assisted Reproduction, And The Law Post-Dobbs, Myrisha S. Lewis

Faculty Publications

With the end of the federal constitutional right to abortion, state legislatures and state courts have become far more important in the sphere of reproductive rights. Before Dobbs, anti-abortion advocates had significant (albeit increasingly porous) ceilings on what they could prohibit in relation to reproductive health care. A significant check on those actions is now gone.

In the wake of Dobbs, societal debates about personhood have increased and expanded in terms of their practical implications. Before Dobbs, anti-abortion advocates admitted that Roe and subsequent cases limited the scope of their arguments, especially in relation to the legality …

The Initial Response Of Biodiversity Conventions To The Covid-19 Pandemic, Royal C. Gardner, Lauren Beames, Katherine Pratt

William & Mary Environmental Law and Policy Review

The COVID-19 pandemic disrupted the operations of global biodiversity conventions, requiring virtual meetings in place of in-person events. Yet the pandemic also highlighted the importance of biodiversity conservation as a mechanism to reduce the risk of zoonotic diseases, as the October 2020 report issued by the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (“IPBES”) emphasized. Now that in-person, international meetings have resumed, this Article examines the extent to which four biodiversity conventions—the Agreement on the Conservation of African-Eurasian Migratory Waterbirds, the Ramsar Convention, the Convention on International Trade in Endangered Species, and the Convention on Biological Diversity—considered the nexus …

Accessing The Arts: The Use Of Reproductive Justice In The Fight For Lgbt+ Rights, Leila Y. Vicinelli

William & Mary Journal of Race, Gender, and Social Justice

Procreation has long been an integral component within the family structure. While the ability to produce offspring was once a privilege reserved for fertile, heterosexual pairings, modern advancements in Assisted Reproduction Technology (ART) have made same-sex procreation possible. Although ART makes it possible for same-sex couples to biologically produce offspring , accessibility to treatment is often hindered by financial, legal, and social impediments. This Note will explore the current limitations on LGBT+ accessibility to ART treatments and provide much needed solutions for these challenges. In a post-Obergefell world, the prominence of and rights owed to same-sex households can no …

Growing Pains: An Arkansas Case Study On Adolescent Autonomy And Access To Puberty Blockers For Gender-Affirming Care, Katherine T. Litaker

William & Mary Journal of Race, Gender, and Social Justice

Arkansas Act 626 outlaws any gender-affirming medical treatment for persons under eighteen years of age. This Note focuses on the evolving litigation surrounding Arkansas Act 626, the potential repercussions of the issues facing transgender adolescents, and the legal protections that may be implemented whether or not Arkansas Act 626 is upheld as a constitutional piece of legislation. It begins by examining the standard bases for administering puberty blocker treatments and addressing many of the misconceptions in medical treatment that have influenced the shaping of legislation on transgender healthcare. The Note discusses the current legal barricades for adolescents trying to access …

Promoting Healing And Avoiding Retraumatization: A Proposal To Improve Mental Health Care For Detained Unaccompanied Minors Through A Best Interests Of The Child Standard, Francesca J. Babetski

William & Mary Law Review

Part I of this Note will describe the circuit split. It will provide background on the A.M. [A.M. v. Luzerne County Juvenile Detention Center] and Doe 4 cases, including an explanation of the major precedents on which the Third and Fourth Circuits based their respective decisions. Then, Part II will argue that A.M. and its deliberate indifference standard cannot appropriately be applied in cases involving detained unaccompanied minors, also called Unaccompanied Alien Children (UACs). This almost twenty-year-old standard does not consider the latest information about immigration policy and the unique mental health needs of UACs such as Doe …

Jail Health And Early Release Practices, Brandon L. Garrett, Deniz Ariturk, Jessica Carda-Auten, David L. Rosen

William & Mary Bill of Rights Journal

Local jails in the United States incarcerate millions of people each year. The COVID-19 pandemic made jail health a pressing public health concern nationally, where releasing individuals from jails occurred across the country in order to prevent pandemic spread. But releases also faced substantial resistance and exposed long-standing challenges in delivering adequate healthcare in jail settings. People in jail have substantially higher levels of medical need than individuals in the general population, with large numbers having serious mental illnesses and substance use disorders. Further, overcrowded conditions and poor healthcare standards and delivery make jails harmful to those already-vulnerable people. What …

Thinking Outside The Box: Preimplantation Genetic Diagnosis, In Vitro Fertilization, And Disability Screening In The Wake Of Box V. Planned Parenthood, Christian J. Sorensen

William & Mary Bill of Rights Journal

A circuit split has recently emerged regarding the constitutionality of state laws banning trait-selective abortions, i.e., abortions based on fetal characteristics like disability. Much of the dialogue surrounding trait selection has revolved around whether such abortions are eugenic in nature and whether they could be regulated differently than other forms of abortion—under either Roe and Casey or the post- Roe regime ushered in by Dobbs. However, the same concerns underlying this debate over eugenic abortions apply with equal force to preimplantation genetic diagnosis (PGD) coupled with in vitro fertilization. Because PGD seems certain to be the next battlefield in …

Segmented Innovation In The Legalization Of Mitochondrial Transfer: Lessons From Australia And The United Kingdom, Myrisha S. Lewis

Faculty Publications

The U.S. is often characterized as a leader in innovation—a home of Nobel Prize‐winning scientists, innovators, and abundant research funding. Yet, in the area of assisted reproduction combined with genetic modification or substitution, what I call “reproductive genetic innovation,” that characterization begins to wane. This Article focuses on the regulation of mitochondrial transfer, a subset of reproductive genetic innovation. While human clinical trials related to mitochondrial transfer go forward in the U.K., the clinical use of the technique remains illegal in the U.S. due to a system of subterranean regulation by the U.S. Food and Drug Administration and a now-recurring …

Preimplantation Genetic Testing: A Fundamental Right, Julianna S. Swann

William & Mary Journal of Race, Gender, and Social Justice

Unlike many European countries of similar economic, social, scientific, and political advancement, there is virtually no regulation of preimplantation genetic testing in the United States. This Note will explore preimplantation genetic testing and demonstrate that potential parents in the United States have a right to conduct said testing under the umbrella of the fundamental right to privacy. This Note will demonstrate the need for the regulation for preimplantation genetic testing that will comply with the Undue Burden Test set out in Planned Parenthood v. Casey, while acknowledging and supporting the fundamental right of potential parents to conduct testing. This …

Patent Prophylaxis: Expanding Access To Prep Through 28 U.S.C. § 1498, Jonathan A. Bell

William & Mary Law Review

Part I of this Note details the discovery of Truvada for PrEP [pre-exposure prophylaxis] and the ongoing patent infringement litigation brought by HHS [United States Department of Health and Human Services], discusses the patents currently held by CDC and Gilead, and examines the shortcomings of infringement litigation as a means to expand access to the drug. Part II analyzes the mechanism of march-in rights under the Bayh-Dole Act and discusses two previously attempted applications for the HIV-management drug ritonavir to demonstrate why march-in rights will always fail to expand access to life-saving medications or reduce costs to consumers. Part III …

Neuroscience And Criminal Justice: Time For A "Copernican Revolution"?, John S. Callender

William & Mary Law Review

The main purpose of this Article is to argue for a fundamental change in the conceptual orientation of criminal justice: from one based on concepts such as free will, desert, and moral responsibility, to one based on empirical science. The Article describes research in behavioral genetics, acquired brain injuries, and psychological traumatization in relation to criminality. This research has reached a level of development at which the traditional approach to criminality is no longer tenable and should be discarded. I argue that mental health legislation provides a model that could be adapted and applied to offenders.

An Unfulfilled Promise: Section 1557'S Failure To Effectively Confront Discrimination In Healthcare, Majesta-Doré Legnini

William & Mary Journal of Race, Gender, and Social Justice

When the Patient Protection and Affordable Care Act passed, it offered a broad promise to provide access to quality care on a nondiscriminatory basis. To achieve nondiscrimination, Congress included Section 1557, which integrated the nondiscrimination protections granted under Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments, Section 504, and the Age Discrimination Act. The language of the statute has proved that the section cannot achieve its broad promise. Covering only intentional discrimination and usually interpreted to divide the standard so that intersectional discrimination cannot be redressed, Section 1557 fails to address discrimination in …

How Analogizing Socio-Legal Responses To Organ Transplantation Can Further The Legalization Of Reproductive Genetic Innovation, Myrisha S. Lewis

Faculty Publications

The Nobel Foundation emphasized the significance of genetic innovation to society, science, and medicine by awarding the 2020 Nobel Prize in Chemistry to “the CRISPR/Cas9 genetic scissors.” This Article focuses on “reproductive genetic innovation,” a term that includes cytoplasmic transfer, mitochondrial transfer, and germline or heritable gene editing techniques that are all categorized as “experimental” in the United States. These techniques all use in vitro fertilization, a legal and widely available practice. Yet reproductive genetic innovation has resulted in controversy and numerous barriers including a recurring federal budget rider, threats of federal enforcement action, and the unavailability of federal funding. …

Accelerating The Gains Of The Free Maternity Care In Kenya's Urban Informal Settlements, Juliet K. Nyamao

William & Mary Journal of Race, Gender, and Social Justice

The 2010 Constitution of Kenya recognizes the special group of women living in urban informal settlements, and provides for their access to the highest attainable standards of health care, including reproductive health care. The Health Act, which was enacted in 2017, recognizes the significant challenges of accessing maternal health services among the poorest populations. Pursuant to the resolutions of the African Union, the Health Act abolished user fees for pregnant women. The Health Act instructs the county and national governments to expand free maternity care and childhood immunizations through funding. Despite Kenya’s commitment to increase the national budget for health …

Revolving Doors Of Hospitalization And Incarceration: How Perceptions Of Procedural Justice Affect Treatment Outcomes, Maria Slater

William & Mary Journal of Race, Gender, and Social Justice

This Article compares the levels of procedural justice afforded to persons with severe mental illness in the civil and criminal systems, either via involuntary commitment in state psychiatric hospitals in the civil system or via mental health court as an alternative to incarceration in the criminal system. Using Virginia’s mental health courts and civil commitment systems as case studies, this Article compares the procedures by which a person can be involuntary committed in the civil system with those afforded to persons who are funneled into mental health treatment courts in the criminal system, analyzing how levels of procedural justice—both actual …

Fiscal Waivers And State "Innovation" In Health Care, Matthew B. Lawrence

William & Mary Law Review

This Article describes how the Department of Health and Human Services (HHS) has used fiscal waiver authorities—delegated power to alter federal payments to states under Medicaid and the Affordable Care Act (ACA)—to influence state health policy choices. It highlights how the agency uses its fiscal waiver authorities to shape which reforms states choose to pursue, in some cases inspiring genuine state innovation and in others encouraging states to adopt reforms favored by HHS or discouraging states from adopting disfavored reforms. Moreover, while HHS has sometimes influenced state policy making in ways that further the substantive goals of the ACA and …

The Hoosiers Got It Wrong: The Need For States To Enact Stricter Prescribing Regulations Via Telemedicine Services, Gabrielle A. Vance

William & Mary Business Law Review

In 2016 and 2017, Indiana amended its state telemedicine regulations to allow Indiana physicians to prescribe controlled substances to patients without an in-person examination. Although there are many promising benefits of telemedicine, researchers have not yet conducted enough tests or studies to fully know the consequences of prescribing without an in-person examination as well as other concerns with telemedicine services. In light of the ongoing opioid epidemic, lawmakers should be even more hesitant to lower the standards for prescribing regulations.

This Note will propose alternative solutions for legislators regarding telemedicine regulations and explain why other states should not mirror Indiana’s …

Professional Medical Judgment And Pharmaceutical Marketing: Drawing Legal And Ethical Lines Around Conflict Of Interest, Steven R. Salbu

William & Mary Business Law Review

Pharmaceutical manufacturers develop relationships with healthcare providers for several purposes, including the marketing and sale of their products. Professional associations give guidance to physicians and companies for managing these relationships ethically. Some practices permitted by these associations entail conflicts of interest. This Article explores two of these practices: (i) company funding of external educational seminars, conferences, and continuing medical education; and (ii) company-hosted speaker programs. The conflict of interest concerns raised by the former practice are manageable, and the practice should continue to be permitted subject to appropriate safeguards; however, the conflict of interest concerns raised by the latter practice …

Is Germline Gene Editing Exceptional?, Myrisha S. Lewis

Faculty Publications

Advances in gene editing have recently received significant scientific and media attention. Gene editing, especially CRISPR-Cas9, has revived multiple longstanding ethical debates, including debates related to parental autonomy, health disparities, disability perspectives, and racial and economic inequalities. Germline, or heritable, gene editing generates several newer, neglected bioethical debates, including those about the shared human germline and whether there is a "line" that humans should not cross.

This Article addresses several interrelated ethical and legal questions related to germline gene editing. Those questions address why, if at all, germline gene editing needs to be regulated and, if germline gene editing needs …

Fostering States As Laboratories, Myrisha S. Lewis

Popular Media

No abstract provided.

Genetic Duties, Jessica L. Roberts, Alexandra L. Foulkes

William & Mary Law Review

Most of our genetic information does not change, yet the results of our genetic tests might. Labs reclassify genetic variants in response to advances in genetic science. As a result, a person who took a test in 2010 could take the same test with the same lab in 2020 and get a different result. However, no legal duty requires labs or physicians to inform patients when a lab reclassifies a variant, even if the reclassification communicates clinically actionable information. This Article considers the need for such duties and their potential challenges. In so doing, it offers much-needed guidance to physicians …

Distracted Guardians Yield Deadly Results: When Memory Fails, Additional Regulations Can Protect Childen And Animals From Vehicular Heat-Stroke, Shannon Murphy

William & Mary Environmental Law and Policy Review

When the sun is shining bright on a scorching ninety-degree summer day, it takes less than an hour for tragedy to strike, even in the shade. Within less than sixty minutes, the temperature inside a closed vehicle will rise rapidly from the outdoor ninety-degree mark to upwards of more than one hundred and thirty degrees. As this temperature spike takes effect, any animal or child left in a vehicle will only have about fifteen minutes before being exposed to potentially deadly conditions.

While most of us think we are incapable of accidentally leaving our beloved child or companion in the …

Investigating Healthcare Fraud: Its Scope, Applicable Laws, And Regulations, Nicole Forbes Stowell, Carl Pacini, Nathan Wadlinger, Jaqueline M. Crain, Martina Schmidt

William & Mary Business Law Review

Healthcare costs are not only an enormous strain on the U.S. economy but are expected to increase in the foreseeable future. Not surprisingly, clever fraudsters view the healthcare industry as a lucrative and attractive hotspot for illegal activity. Although federal and state governments have increased their funding and prosecution efforts relating to healthcare fraud, this fraud continues to be a major threat to the U.S. economy and every patient and consumer. The impact of healthcare fraud is substantial and far-reaching. Healthcare fraud in the U.S. affects not only the government, but also insurance companies, patients, healthcare providers, and consumers. This …

When Improper Disposal Leads To More Than Hospital Visits: The Need For A National Standard For Used Medical Sharps, Albana Zherka

William & Mary Environmental Law and Policy Review

No abstract provided.