Health Law and Policy Commons^™

Private Credentialing Of Health Care Personnel: An Antitrust Perspective, Part 1, Clark C. Havighurst, Nancy M. P. King

Faculty Scholarship

This Article explores the antitrust and other implications of private credentialing and accrediting programs in the health care industry. Although such programs are usually sponsored by powerful competitor groups, they serve the procompetitive purpose of providing useful information and authoritative advice to independent decision makers. Part One examines the risk that credentialing will sometimes be unfair to competitors and deceive consumers. Its survey of common-law, antitrust, and regulatory interventions to correct such unfairness and deception seeks to determine the degree of oversight to which credentialing and similar activities have been and should be subjected. In recommending that judicial or regulatory …

Institutional Review Of Medical Research: Cost-Benefit Analysis, Risk-Benefit Analysis, And The Possible Effects Of Research On Public Policy, Robert L. Schwartz

Faculty Scholarship

It is reasonable to expect IRBs to develop and apply policy as other public policy agencies do. In fact, the risk-benefit analysis now required of IRBs appears to be analogous to the cost-benefit analysis adopted by public policy analysts. But, as we shall see, the new risk-benefit criterion is far less comprehensive and valid than the traditional cost-benefit model.

Mandatory Pku Screening: The Other Side Of The Looking Glass, George J. Annas

Faculty Scholarship

The challenge that PKU screening programs face is to be effective without sacrificing individual liberty. Most states have assumed that this is impossible, and have enacted mandatory PKU screening tests. It now appears that in fact voluntary screening for PKU can be effective. Accordingly, it seems appropriate to reexamine existing mandatory screening statutes to determine if we can replace government coercion with voluntary informed consent. Focus should be placed on the proper role of the government in screening, and on improving the consent process, and not on those few couples who withhold consent.

The Emerging Stowaway: Patients' Rights In The 1980s, George J. Annas

Faculty Scholarship

At one point in Edgar Allan Poe's Narrative of Arthur Gordon Pyr of Nantucket, Pym, who has stowed away in the hold of a whaling vessel, believes he has been abandoned and that the hold will be his tomb. He expressed sensations of "extreme horror and dismay," and "the most gloomy imaginings, in which the dreadful deaths of thirst, famine, suffocation, and premature interment, crowded in as the prominent disasters to be encountered."

Delimiting Religion And Ethics, Robert L. Schwartz

Faculty Scholarship

The author argues that people need to make a distinction between religious belief and logical ethics.

Teaching Physicians And Lawyers To Understand Each Other: The Development Of A Law And Medicine Clinic, Robert L. Schwartz

Faculty Scholarship

The discomfort doctors and lawyers feel with one another is not a consequence of the perceived medical malpractice crisis or any other single area of substantive disagreement. Rather, it is a reflection of the different epistemologies of the professions. The truth seeking activities of the two professions are very different, and these differences are reflected in the widely divergent professional educations provided to medical and law students. Much of the animosity which has developed between doctors and lawyers could be avoided, and members of each profession could have a much better understanding of the substance and analytic methods of the …

Physicians And Lawyers: Science, Art, And Conflict, Robert L. Schwartz, Joan M. Gibson

Faculty Scholarship

The relations between physicians and lawyers have deteriorated rapidly over the past several decades, most particularly since the early 70s when the perception that a medical malpractice crisis existed in America became widespread. Some believe that the factors dividing the two professions . are linked (1) to professional jealousy, (2) to sometimes conflicting economic interests, or (3) to difficulties in communication, since both professions use many of the same words, or terms of art, but with different intended meanings. While the authors agree that these factors may have aggravated the problem, they believe that the conflict's real roots are in …

Report On The National Commission: Good As Gold, George J. Annas

Faculty Scholarship

The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research ended its work by substantially endorsing the status quo which places primary reliance on local Institutional Review Boards for subject protection. This was predictable because of the Commission's researcher-dominated composition which permitted it to assume that (1) research is good; (2) experimentation is almost never harmful to subjects; and (3) researcher-dominated IRBs can adequately protect the Interests of human subjects. The successor Presidential Commission can learn much by reexamining these premises.

The Case For Medical Licensure, George J. Annas

Faculty Scholarship

Locke et al. argue elsewhere in this issue that medical licensure should be abolished. Their reasoning is direct and seductive - but their free market cure is worse than the disease they describe. Their major premise, for example, is simply wrong: "Any governmental action that violates individual rights is improper." For this notion they cite the ultraconservative novelist Ayn Rand who talks about things that are "right" for humans to do. But there are two confusions: (I) rights do not exist in a vacuum; in an interdependent society the rights of individuals must sometimes be balanced against the rights of …

How To Make The Massachusetts Patients' Bill Of Rights Work, George J. Annas

Faculty Scholarship

The movement for enhanced patients' rights is based on two premises: (I) citizens possess certain rights that are not automatically forfeited by entering into a relationship with a physician or health care facility; and (2) most physicians and health care facilities fail to recognize these rights, fall to provide for their protection or assertion, and limit their exercise without recourse.

The primary argument against patients' rights is that patients have "needs" and defining these needs in terms of rights leads to the creation of an unhealthy adversary relationship.' It is not, however, the creation of rights, but the disregard of …

Defining The Role Of The Physician: Medical Education, Tradition, And The Legal Process, Robert L. Schwartz

Faculty Scholarship

The professional conflict and animosity that have developed between the legal and medical professions are symptomatic of something that is basic and disturbing to the traditional science and practice of medicine. Even a cursory review of the literature will reveal that physicians, lawyers, philosophers, and others (with greater or lesser degrees of insight and awareness) are currently engaged in serious reevaluations of such concepts as the definition of medicine as science and/or art, the structure and administration of effective medical curricula, and the goals of the medical profession itself. Such analyses require not only that physicians evaluate what they ought …

The Care Of Private Patients In Teaching Hospitals: Legal Implications, George J. Annas

Faculty Scholarship

In Herman Melville's novel Moby Dick Ishmael searches for knowledge in diverse ways; he views the world not only through his senses but symbolically and metaphorically. At one point, he is tied to the pagan harpooner Queequeg by a "monkey-rope," and it is his duty to use this rope to pull Queequeg free from the sharks surrounding the dead whale that Queequeg is butchering when Queequeg slips from his perch atop the whale. Should he fail, Queequeg's weight will pull them both into the shark-filled waters. Ishmael ponders: "I seemed distinctly to perceive that my own individuality was now merged …

Fathers Anonymous: Beyond The Best Interests Of The Sperm Donor, George J. Annas

Faculty Scholarship

Alex Haley concludes his international best seller, Roots, with the burial of his father in Little Rock, Arkansas. Walking away from the graveside he ponders the past generations, observing "I feel that they do watch and guide." The book inspired whole industries devoted to the development of family trees, and locating one's "roots" has become somewhat of an obsession with many. Because of the current secrecy surrounding the practice of Artificial Insemination Donor (AID), there are an estimated 250,000 children conceived by AID (at the rate of 6-10,000 annually in the United States) who will never be able to find …

Reconciling Quinlan And Saikewicz: Decision Making For The Terminally Ill Incompetent, George J. Annas

Faculty Scholarship

One of the most perplexing problems in the medicolegal field concerns the criteria on which decisions not to treat terminally ill incompetent patients should be made. These decisions traditionally have been made by physicians in hospitals-sometimes with the assistance of the patient's family-on the basis of their perceptions of the patient's "best interests." Recently, two state supreme courts have ruled on this question. The New Jersey Supreme Court, in the Quinlan case, developed a medical prognosis criterion, and permitted the patient's guardian, family, and physicians to apply it with the concurrence of a hospital "ethics committee." The Massachusetts Supreme Judicial …

Laetrile: The Battle Moves Into The Courtroom, Robert L. Schwartz

Faculty Scholarship

Controversy over the supposed cancer-curing drug laetrile continues to rage. Now it's up to the courts. substance that was used by ancient Greek physicians, has been available in the United States, legally or illegally, for a quarter of a century. The government's increased efforts to eliminate laetrile "pushing" by what are seen to be profiteering physicians has created a strengthened laetrile lobby that has successfully fought the medical establishment and succeeded in making the drug legal in more than a dozen states. The pro-laetrile lobby an assortment of cancer patients and their families, medical professionals, and conservative politicians -threatens to …

Where Are The Health Lawyers When We Need Them, George J. Annas

Faculty Scholarship

A momentous event in the field of health law occurred in April of 1978: the first national meeting of teachers of health law was held at Boston University. Of sixty individuals invited, almost all of whom teach health law as a full-time profession in various graduate schools, forty-five participated in the two-day workshop. While that response alone may have revealed the answer, the first topic on the agenda was: "Is health law a discipline?"

Judges At The Bedside: The Case Of Joseph Saikewicz, George J. Annas

Faculty Scholarship

In what may prove to be the most controversial medicolegal decision of the year, the Massachusetts Supreme Judicial Court has ruled that, in certain cases, courts are the proper forum in which life-sustaining medical decisions should be made.1 The controversy goes deep. It involves questions of who should make life-prolonging decisions, in what forum, and on what criteria. Until the last few years, these questions arose almost exclusively in the context of Jehovah's Witnesses cases - cases in which life-saving blood transfusions were being refused for religious reasons. But with society's increasing consciousness about the way people die in hospitals, …

More On Regulation: A Reply To Stephen Weiner, Clark C. Havighurst

Faculty Scholarship

In Volume 3, Number 3 of this journal, Professor Havighurst* wrote a brief Comment in which he observed that the function of health care cost-containment regulation is the rationing of health care resources, and argued that the fostering of health care consumers' and providers' free choice in the competitive marketplace is preferable to conventional cost-containment regulation as a mechanism for such rationing. He briefly outlined various reforms, including changes in federal tax treatment of health insurance premiums, aimed at implementing his ap- proach. Subsequently, in a Comment in Volume 4, Number 1, Stephen M.Weiner, then Chairman of the Massachusetts Rate …

The Rights Of The Employee As Patient, Frances H. Miller

Faculty Scholarship

No abstract provided.

Scientific Research With Children: Legal Incapacity And Proxy Consent, Leonard H. Glantz, George J. Annas, Barbara Katz

Faculty Scholarship

Before an investigator can use any person as a subject in biomedical or behavioral research, he must obtain that person's informed consent. This consent must be voluntary, competent, and understanding.¹ There are two questions that arise in regard to experimentation on children. First, is a child legally capable of giving an informed and understanding consent? Second, do parents have the legal capacity to consent to the performance of research on their children? This article will attempt to answer both of these questions.

Allocation Of Artificial Hearts In The Year 2002: Minerva V. National Health Agency, George J. Annas

Faculty Scholarship

The rapid growth of medical technology gives rise to difficult dilemmas concerning the appropriateness of, and access to, new equipment and devices capable of maintaining life or improving its quality. Such a dilemma already exists, for example, with regard to kidney dialysis machines. In 1972, Congress amended the Social Security Act to make such machines available under Medicare to all who needed them. But almost immediately the overwhelming cost of such equipment-in the billions of dollars-made the original appropriations totally inadequate, and prompted serious questions of whether access to kidney dialysis should be made available at public expense-and, if so, …

Psro Data And Information: Disclosure To State Health Regulatory Agencies, Frances H. Miller

Faculty Scholarship

No abstract provided.

Health Care Cost-Containment Regulation: Prospects And An Alternative, Clark C. Havighurst

Faculty Scholarship

Regulation of the health care system to achieve appropriate containment of overall costs is characterized by Professor Havighurst as requiring public officials to engage, directly or indirectly, in the rationing of medical services. This rationing function is seen by the author as peculiarly difficult for political institutions to perform, given the public's expectations and the symbolic importance of health care. An effort on the part of regulators to shift the rationing burden to providers is detected, as is a trend toward increasingly arbitrary regulation, designed to minimize regulators' confrontations with sensitive issues. Irrationality and ignorance are found to plague regulatory …

Regulation Of Electroconvulsive Therapy, Carol Sanger

Faculty Scholarship

Electroconvulsive therapy (ECT) is a psychiatric procedure that induces a convulsive seizure in the patient in order to treat severe depression. Recently, courts, legislatures, and the medical profession have paid increasing attention to the regulation of ECT. Their interest has been stimulated by the growing recognition of the rights of mental patients, the developing role of consent in medical transactions, and the results of recent scientific research on the efficacy and consequences of ECT.

Regulation of ECT has generally focused on whether the patient or his representative effectively consented to the treatment. The highly intrusive nature of ECT and the …

When You Enter The Hospital Check Your Rights At The Door, George J. Annas

Faculty Scholarship

Civil libertarians have little difficulty appreciating the plight of prisoners or mental patients. But tell the average civil libertarian that there are significant and unnecessary restrictions on the individual rights and liberties of patients in general hospitals, and you are likely to encounter a blank stare. There are a number of reasons for this lack of attention to hospitals. One is the general misconception that the problems are minor, or that certain temporary restrictions on individuals are essential if hospitals are to treat sick people properly. An unconscious desire not to perceive ourselves as being at risk may be another …

Blue Cross: What Went Wrong?, Frances H. Miller

Faculty Scholarship

No abstract provided.

Medical Malpractice Litigation Under National Health Insurance: Essential Or Expendable, George J. Annas, Barbara F. Katz, Robert G. Trakimas

Faculty Scholarship

"Medical malpractice" denotes the basis for a civil action brought by a patient against a physician for injuries resulting from negligence. The current method for compensating victims of these occurrences is primarily a fault-and-liability insurance system. The first principle of tort liability is that the party at fault pays for the damage inflicted upon an innocent victim. Whether a doctor is at fault is determined in an adversary proceeding, with both the doctor and the patient represented by counsel. The triers of fact have the task of ascertaining whether the defendant was at fault, and if so, what compensation he …

The Patient Rights Advocate: Redefinig The Doctor-Patient Relationship In The Hospital Context, George J. Annas, Joseph M. Healey Jr.

Faculty Scholarship

As Western man approaches the last quarter of the twentieth century, he is developing the power to control the forces of nature. Few areas of human behavior have not been affected by new technologies. In health care, progress has been dramatic in such areas as the determination of prenatal genetic defects through amniocentesis, asexual reproduction through artificial insemination, the use of an artificial placenta, cloning,artifical modification of man-especially through transplantation, ' modification of human behavior through psychosurgery and chemotherapy,' and the mechanical postponement of death. No aspect of health care has escaped the impact of technology.

Debate, The Right To Treatment: Encounter And Synthesis, Aaron Twerski

Faculty Scholarship

No abstract provided.

Medical Remedies And Human Rights: Why Civil Rights Lawyers Must Become Involved In Medical Decision-Making, George J. Annas

Faculty Scholarship

As recently as the turn of the century a random patient meeting a random physician had less than a 50:50 chance of benefiting from the encounter. Physicians were just beginning to emerge from the era when they were essentially tradesmen, often with little more to offer their patients than comfort and company during illness and death. The principal causes of mortality were the infectious diseases against which the medical community stood impotent. There were few medical schools, few diagnostic tests, no specific treatment of disease, and no specialization of physicians. In the words of former AMA president Dwight L. Wilbur, …