Health Law and Policy Commons^™

Walking The Talk Of Trust In Human Subjects Research: The Challenge Of Regulating Financial Conflicts Of Interest, Robert Gatter

All Faculty Scholarship

There has been a call for more stringent regulation of financial conflicts of interest in human subjects research following the deaths of several individuals who volunteered to participate in human subjects research, which deaths were linked to the financial conflicts of interest of participating researchers and research institutions. Each proposal argues that regulation is necessary to restore trust in medical research. This Article examines whether proposed strategies for regulating financial conflicts of interest are likely to achieve the goal of a trustworthy human research enterprise. It does not question whether enhancing trustworthiness is an appropriate goal; rather, it assumes that …

A Healer Or An Executioner: The Proper Role Of A Psychiatrist In A Criminal Justice System, Gregory Dolin

All Faculty Scholarship

This article argues that despite the benefits of ridding the criminal justice system of some uncertainty and ignorance with respect to mental health issues, the very close involvement of psychiatrists in the criminal justice system as practiced in the United States is not only illogical and bad policy, but also unethical from the viewpoint of medical ethics. Part II of this article will lay the groundwork for the argument by discussing the history of the insanity defense, and of science's involvement with criminal justice; while Part III, will look into the association of science and the administration of justice in …

Giving A Voice To The Silent Mentally Ill Client: An Empirical Study Of The Role Of Counsel In The Civil Commitment Hearing, Donald H. Stone

All Faculty Scholarship

In the civil commitment arena, where a mentally ill person is allegedly a danger to the life or safety of themselves or of others and in need of in-patient care or treatment, there are two groups assigned to protect the people: one, the hospital presenter, who is responsible for investigating and presenting evidence and testimony at a hearing to secure admission to a psychiatric facility as an involuntary patient, the other, the lawyer, who represents and defends the allegedly mentally ill person from such involuntary civil commitment confinement. These are their stories.

The attorney representing a mentally ill client at …

Protecting The Endangered Human: Toward An International Treaty Prohibiting Cloning And Inheritable Alterations, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Whither Antitrust? The Uncertain Future Of Competition Law In Health Care, Thomas L. Greaney

All Faculty Scholarship

Although instrumental in ushering in competition to the health care industry and later in safeguarding the competitive structure of markets, antitrust law has come under attack. A series of questionable judicial decisions has clouded the standards applicable to analyzing health care markets. Legislative efforts to immunize conduct from antitrust challenge also have gathered support in recent years. This study finds scant economic or policy basis for these developments and concludes that anti-managed sentiments have diluted enthusiasm for applying competitive principles in health care. This phenomenon has resulted in outcome-driven judicial decisions and legislative activity geared to serving political expediency rather …

Disability, Doctors And Dollars: Distinguishing The Three Faces Of Reasonable Accommodation, Elizabeth Pendo

All Faculty Scholarship

Despite a decade of litigation, there is no consistent understanding of the reasonable accommodation requirement of Title I of the Americans with Disabilities Act of 1990 (the 'ADA'). Indeed, there are three inconsistent distributive outcomes that appear to comport with the reasonable accommodation requirement: cost-shifting, cost-sharing, and cost-avoidance.

One reason for such inconsistent outcomes is a failure to develop a coherent and consistent theory of disability. Because disability has been and continues to be medicalized, this Article takes a fresh look at the medical literature on health, illness, and disability. It recommends the use of the experiential health model over …

Nord Issues Gene Patenting Statement, Valerie Gutmann Koch

All Faculty Scholarship

No abstract provided.

A Conceptual Framework For Genetic Policy, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Exploitation Of The Elite: A Case For Physician Unionization, Dionne L. Koller

All Faculty Scholarship

Our intuition tells us that physicians are elites, and therefore they cannot be exploited. Relying on this intuition, we adopt policies which attempt to provide a health care system that gives first-quality care, at the lowest prices, delivered through a “free-market” system. As the key gatekeepers to health care, physicians are thus caught in the middle. Top-notch American health care costs money and for-profit MCOs must watch their bottom line. Rationing, therefore, is key. The issue is, assuming we have decided that free-market health care is the solution, how much should physicians have to sacrifice in the name of the …

Banning The Clone, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Informed Consent Law And The Forgotten Duty Of Physician Inquiry, Robert Gatter

All Faculty Scholarship

Courts and commentators have forgotten that embedded in the duty of physicians to obtain a patient's informed consent is a prior obligation for physicians to get to know that patient. This is most clear in jurisdictions employing the reasonable person standard of disclosure. That standard requires physicians to disclose to a patient information that a reasonable person would want to know if that person were in the patient's position or, more precisely, if that person were "in what the physician should know to be the patient's position." Thus, a physician must learn some minimal information about each patient's "position." An …

Health Care Divided: Race And Healing A Nation, Sidney D. Watson

All Faculty Scholarship

Race matters. Race—particularly racial segregation—casts a pervasive shadow over the organization of American health care. It influences the ownership and governance of institutional providers. It helps account for the high cost of health care in the United States. It contributes to America’s abysmal health status, among the worst of the industrialized world. It is reflected, in part, in the lack of national health insurance. So David Barton Smith begins this book, a book he describes as the story of “a divided nation, a divided health care system, and the uncompleted journey to heal both.”[1]

Most of us are not comfortable …

The Benefits Of Voluntary Inpatient Psychiatric Hospitalization: Myth Or Reality?, Donald H. Stone

All Faculty Scholarship

Throughout the United States, mentally ill persons are confined against their will in psychiatric hospitals as a result of being accused of dangerous behavior. Some are committed involuntarily by a judge after an administrative hearing during which they are afforded legal representation, a right to be present, and important due process protections, including the right to cross-examine witnesses and present one's own witnesses. However, a significant number of individuals, initially confined in psychiatric institutions for allegedly posing a danger to life or safety, never see an impartial judge, lawyer, or even a family member. These mentally ill individuals are not …

Government As God: An Update On Federal Intervention In The Treatment Of Critically Ill Newborns, Dionne L. Koller

All Faculty Scholarship

Whether a severely impaired or critically ill infant should receive lifesaving, and sometimes extraordinary, medical treatment, or be allowed to die, is hotly debated. The issue initially garnered public attention in 1982, when an infant who was born with Down's Syndrome, “Baby Doe,” was allowed to die from a correctable birth defect. Following this, the federal government took a lead role in determining the fate of critically ill newborns. In the meantime, doctors, philosophers, and others have debated whether federal interference in this area is appropriate.

This essay will bring the reader up to date on the “Baby Doe” issue …

Reproductive Technology Comes Of Age, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Unnecessary Adversaries At The End Of Life: Mediating End-Of-Life Treatment Disputes To Prevent Erosion Of Physician-Patient Relationships, Robert Gatter

All Faculty Scholarship

Professor Gatter estimates that institutional ethics consultation processes are used to resolve as many as 13,500 end-of-life treatment (EOLT) disputes each year. Despite this sizable case load, the law has largely ignored the method of dispute resolution used to address EOLT disagreements. This article argues that, at the stage when an ethics consultation is requested in an EOLT dispute, mediation is the most appropriate method for attempting to resolve that dispute. This article challenges current wisdom that mediation is inappropriate for addressing disputes between physicians and patients. The challenge is based on four key points. First, EOLT disputes between physicians …

Managed Care And Mental Health: Clinical Perspectives And Legal Realities, Jesse Goldner

All Faculty Scholarship

Managed care is beginning to dominate the delivery of mental health services. The Article reviews limitations on managed care's ability to deal adequately with mental illness. It discusses empirical and other research examining the use of primary care providers as gatekeepers and it explores utilization review mechanisms, focusing particularly on providers' responses to UR. The impact on quality, access and continuity of care on discrete populations is analyzed. The article then surveys a variety of legal issues in the regulation of managed care, particularly as they apply to the provision of mental health services. These include ERISA, parity and liability …

Antitrust And The Health Care Industry: The View From The Three Branches, Thomas L. Greaney

All Faculty Scholarship

This article provides a critical appraisal of the summer's three major health care antitrust events. The California Dental Association case, the Justice Department's challenge to the Aetna-Prudential merger, and the proposed Quality Health Care Coalition Act of 1999 are likely to have a significant influence on the trajectory of antitrust enforcement in the coming years. The author argues that the reasoning of these precedents suffers from an over reaction to the managed care bogeyman and a lack of attention to sound antitrust jurisprudence. In a postscript, it finds similar shortcomings with the Eighth Circuit's recent decision in FTC & State …

Drug Treatment Courts: Evolution, Evaluation, And Future Directions, Gloria Danziger, Jeffrey Kuhn

All Faculty Scholarship

No abstract provided.

Managed Care And Managed Sentencing — A Tale Of Two Systems, Ronald Weich

All Faculty Scholarship

The daily injustices mount. The front line professionals who administer the system cry out for more discretion to depart from the rigid rules that bind them, Congress finally hears their call, and is poised to enact sweeping reforms.

Are improvements in federal sentencing law on the way? Probably not in the near future. But the new Congress will surely take up proposals to regulate the managed health care industry, and the impending debate over a proposed "Patients' Bill of Rights" law offers important lessons for federal sentencing policy.

At first blush, sentencing reform and health care reform have about as …

Adoption, Reproductive Technologies And Genetic Information, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Is There A Right To Clone? Constitutional Challenges To Bans On Human Cloning, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Do The Dead Have Interests? Policy Issues For Research After Life (With D. Nelkin), Lori B. Andrews

All Faculty Scholarship

No abstract provided.

How Many Libertarians Does It Take To Fix The Health Care System?, Thomas L. Greaney

All Faculty Scholarship

The libertarian prescription for health care reform is a admixture of deregulation and purportedly utilitarian calculation of social benefits and costs. In Mortal Peril: Our Inalienable Right to Health Care?, Richard Epstein's offers a stark roadmap that embraces an unfettered free market for health care services, indigent care left primarily to the charitable impulses of providers and no cross subsidies between classes, generations or other categories of citizens (including the sick and healthy). This review essay argues that the history, economics, and politics of health markets belie Epstein's abstract reasoning. Though much of the argument in Mortal Peril is written …

Research Report: A Preliminary Analysis Of Medical Futility Decisionmaking: Law And Professional Attitudes, Richard L. Wiener Ph.D., David Eton M.A., Vincent P. Gibbons M.D., Jesse A. Goldner J.D., Sandra H. Johnson J.D.

All Faculty Scholarship

The debate in medical futility decisionmaking centers on the conflict between a patient insisting treatment and a doctor refusing to furnish it. Courts have taken two disparate approaches to the legal status of medical futility. Believing that such legal ambiguity may reflect ambiguity in the medical profession itself, this research report sought to identify any emerging consensus among professionals handling medical futility issues.

The report explains the results of the Life Sustaining Treatment Survey, a nationwide survey of health care professionals at hospitals. Presented with a list of criteria, respondents assigned important ratings to the factors used in recent futility …

End-Of-Life Decision Making: What We Don’T Know, We Make Up; What We Do Know, We Ignore, Sandra H. Johnson

All Faculty Scholarship

The recent emergence of substantial empirical research in bioethics reveals gaps between “reality” and the normative principles that largely instruct American bioethics and the legal framework of health care. This Article examines how the debate over the appropriate source of legal and ethical norms in medicine has been played out in judicial decisions regarding the legalization of physician-assisted suicide.

The article begins with an analysis of the Ninth Circuit’s 1996 majority opinion in Compassion in Dying v. Washington, later reversed by the Supreme Court. In support of the legalization of physician-assisted suicide, the Ninth Circuit emphasized the role of empirical …

Body Science, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

Night Landings On An Aircraft Carrier: Hospital Mergers And Antitrust Law, Thomas L. Greaney

All Faculty Scholarship

Abstract: Analysis of the competitive effects of hospital mergers requires antitrust tribunals to make exceedingly fine-tuned appraisals of complex economic relationships. The law requires fact finding in a number of complex areas, e.g., defining product and geographic markets, predicting the possibility of that firms will engage in coordinated behavior; and assessing efficiencies flowing from the merger. Further complicating the process is the fact that these decisions require judgments regarding what the future may hold in an industry undergoing revolutionary change. Like pilots landing at night aboard an aircraft carrier, courts are aiming for a target that is small, shifting and …

Prenatal Screening And The Culture Of Motherhood, Lori B. Andrews

All Faculty Scholarship

No abstract provided.

The Shadow Health Care System: Regulation Of Alternative Health Care Providers, Lori B. Andrews

All Faculty Scholarship

No abstract provided.