Health Law and Policy Commons^™

Enterprise Liability And The Emerging Managed Health Care System, William M. Sage

Faculty Scholarship

“Enterprise medical liability” is a term used to describe a system in which health care organizations bear responsibility for medical malpractice in addition to or instead of individual health professionals. Enterprise liability is in many senses a natural outgrowth of the increasing dependence of medical practice on institutional resources and expertise. Proposals for enterprise liability surfaced briefly from the academic literature into the political spotlight during the 1993-94 health care reform debate. At that time, objections to the concept as a basis for medical malpractice liability, even in a restructured health care system, were nearly universal.

Just five years later, …

Breast Cancer, The Genetic "Quickfix," And The Jewish Community: Ethical, Legal, And Social Challenges, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

Reefer Madness: The Federal Response To California's Medical-Marijuana Law, George J. Annas

Faculty Scholarship

Marijuana is unique among illegal drugs in its political symbolism, its safety, and its wide use. More than 65 million Americans have tried marijuana, the use of which is not associated with increased mortality. Since the federal government first tried to tax it out of existence in 1937, at least partly in response to the 1936 film Reefer Madness, marijuana has remained at the center of controversy. Now physicians are becoming more actively involved. Most recently, the federal drug policy against any use of marijuana has been challenged by California's attempt to legalize its use by certain patients on the …

The Managed Care Dilemma: Can Theories Of Tort Liability Adapt To The Realities Of Cost Containment?, Barbara A. Noah

Faculty Scholarship

Over the years, the United States health care system has undergone a transformation from a market comprised mainly of self employed physicians· in solo or small group practices to one in which far fewer physicians engage in this type of independent practice. More than three quarters of the physicians in this country now practice medicine within some form of managed care organization ("MCO") or see some managed care patients. The public increasingly perceives the care provided through MCOs as inferior to traditional feefor-service care. Responding to constituent pressures, legislatures in more than twenty states recently have considered bills regulating managed …

Principles And Passions: The Intersection Of Abortion And Gun Rights , Nicholas J. Johnson

Faculty Scholarship

In this article, Professor Nicholas J. Johnson explores the parallels between the right of armed self-defense and the woman's right to abortion. Professor Johnson demonstrates that the theories and principles advanced to support the abortion right intersect substantially with an individual's right to armed self-defense. Professor Johnson uncovers common ground between the gun and abortion rights - two rights that have come to symbolize society's deepest social and cultural divisions - divisions that prompt many to embrace the abortion right while summarily rejecting the gun right. Unreflective disparagement of the gun right, he argues, threatens the vitality of the abortion …

Medical Discipline In The Twenty-First Century: Are Purchasers The Answer?, Frances H. Miller

Faculty Scholarship

Millenia prompt reflection about change, both past and future. Tons of newsprint have already been devoted to documenting the astonishing developments in medicine during the past century, and to speculating about what breakthroughs to expect in the next one.¹ Health economists generally accept that these changes, particularly advances in technology, have been the dominant factor propelling U.S. health care costs into the stratosphere over the past hundred years.' Analysts by the score have also examined the myriad ways in which this nation's health care delivery system has been (and must continue to be) transformed to cope with these expensive …

Tobacco Litigation As Cancer Prevention: Dealing With The Devil, George J. Annas

Faculty Scholarship

Tobacco companies have come to personify the devil, and strategies to exorcise tobacco smoking from the United States proliferate. Tobacco's demonic status is even reflected in popular fiction. John Grisham's latest bestseller, The Runaway Jury, for example, is a broadside attack on tobacco companies. He opens the book by noting that tobacco companies “had been thoroughly isolated and vilified by consumer groups, doctors, even politicians.” This was bad, but it was getting even worse: “Now the lawyers were after them.”

The Bell Tolls For A Constitutional Right To Physician-Assisted Suicide, George J. Annas

Faculty Scholarship

For Whom the Bell Tolls, Ernest Hemingway's novel about the Spanish Civil War, ends with its American hero, Robert Jordan, mortally wounded and trying to decide whether to commit suicide with a machine gun or risk capture by trying to retain consciousness long enough to cover the retreat of his comrades. Confronting his impending death, Jordan thinks, “Dying is only bad when it takes a long time and hurts so much that it humiliates you.” Hemingway, one of the most American of American writers, committed suicide with a shotgun. Most suicides in the United States are committed with guns, but …

Patients' Rights In Managed Care - Exit, Voice, And Choice, George J. Annas

Faculty Scholarship

The ability of consumers to complain effectively about services and products is a key ingredient of the market. In Exit, Voice, and Loyalty, economist Albert O. Hirschman argues that the ability to take one's business elsewhere may not be enough to empower consumers in markets where all providers act similarly. Instead of simply going elsewhere, consumers need to have an effective way to voice their complaints, in order to give providers an incentive to be more responsive to consumers' interests. Marc Rodwin has suggested that the Hirschman analysis may be particularly relevant to members of managed-care organizations and ``individuals with …

State Regulation Of Managed Care And The Employee Retirement Income Security Act, Wendy K. Mariner

Faculty Scholarship

The federal Employee Retirement Income Security Act (ERISA)1 is the federal law that governs employee-benefit plans offered by private employers and unions. ERISA has long hindered state efforts to expand access to health care, because it prohibits states from requiring all employers to offer benefits to their employees.2 States have shifted their attention from seeking universal insurance coverage for health care to regulating the benefits of people who already have health insurance. Reports describing how some managed-care organizations limit the care provided to their enrollees have prompted a rash of legislative efforts intended to protect patients from receiving …

Funding Fairness: Public Investment, Proprietary Rights And Access To Health Care Technology, William M. Sage

Faculty Scholarship

In her accompanying Article, "Public Research and Private Development: Patents and Technology Transfer in Government-Sponsored Research," Professor Rebecca Eisenberg suggests that federal technology transfer policies should be reexamined in light of actual experience with patented technologies. Indeed, the relationship among federal research funding, patent law, and medical innovation has become more complicated in the years since the passage of the Bayh-Dole Act. Rising health care spending despite slowing overall economic growth has fostered the development of private sector managed care, has led to cutbacks in government support for both research and clinical services, and has increased the percentage of uninsured …

Liability For Managed Care Decisions: The Employee Retirement Income Security Act (Erisa) And The Uneven Playing Field, Wendy K. Mariner

Faculty Scholarship

As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized …

Gender Matters: Implications For Clinical Research And Women's Health Care, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

Mediating Bioethical Disputes, Diane E. Hoffmann, Naomi Karp

Faculty Scholarship

No abstract provided.

Women Of Childbearing Potential In Clinical Research: Perspectives On Nih Policy And Liability Issues, Karen H. Rothenberg, Eugene G. Hayunga, Vivian W. Pinn

Faculty Scholarship

No abstract provided.

The Dangers Of Directives Or The False Security Of Forms, Diane E. Hoffmann, Sheryl Itkin Zimmerman, Catherine J. Tompkins

Faculty Scholarship

No abstract provided.

Introductory Remarks Of Panel Ii: Legal, Medical, And Ethical Considerations For The Future Of Physician-Assisted Suicice Symposium: Physician-Assusted Suicide: Legal Rights In Life And Death: Introductory Remarks Of Panel Ii: Legal, Medicial, And Ethical Considerations For The Future Of Physician-Assisted Suicide, Tanya K. Hernandez

Faculty Scholarship

Once the Supreme Court issues it decision in the cases of Quill v. Vacco1 and Compassion in Dying v. Washington2 regarding the constitutionality of outlawing physician-assisted suicide for competent and terminally ill persons, the tension surrounding legal, medical, religious and ethical issues concerning end of life decision making will not be resolved.

The Law And Ethics Of Organ Sales, Keith N. Hylton

Faculty Scholarship

The proposed solutions to my hair supply hypothetical, transfer of property and reliance on altruism, are essentially the only two solutions formally adopted in response to the real world "organ supply" problem.' Because of the shortcomings of these solutions, a number of commentators, myself among them, ² have suggested the allowance of some limited commerce in body parts. This solution can be seen as a compromise between the extremes of transferring property rights and relying entirely on altruism. Property rights are maintained under the market system because anyone who wants the body part of another must gain the consent of …

The Politics Of Human-Embryo Research: Avoiding Ethical Gridlock, George J. Annas, Arthur Caplan, Sherman Elias

Faculty Scholarship

[...]abortion is about more than politics; it is fundamentally about ethics, morals, equality, and religion, and how we think about abortion reveals much about how we are likely to think about other life-and-death issues in contemporary American medical practice. Because politics as currently practiced seems so unprincipled, there have been sporadic attempts to redefine abortion-related issues as ethical questions and to set up national panels and advisory groups to examine various practices and make recommendations about their ethics.

Questing For Grails: Duplicity, Betrayal And Self-Deception Postmodern Medical Research, George J. Annas

Faculty Scholarship

Contemporary physicians and scientists often describe their experi-
ments as part of a search for the "Holy Grail." Sometimes this quest is
expressed more specifically, as when the Human Genome Project is de-
scribed as a search for the "Holy Grail of biology."1 This rhetoric sug-
gests that experimental work is holy, God's work, and that the results will
prove miraculous and good for everyone. But this type of blind devotion
produces uncritical action that can ultimately destroy values essential to
human dignity.

The Promised End — Physician-Assisted Suicide And Abortion, George J. Annas

Faculty Scholarship

The debate over late term intact dilation and evacuation abortions (so-called "partial birth" abortions) has been an uncomfortable one for those in the pro-choice community.' Although the United States Senate narrowly refused to override President Clinton's veto of a bill criminalizing this procedure, many in Congress agreed with Senator Daniel Patrick Moynihan (D-N.Y.) that it was "as close to infanticide as anything I have come upon." States have a compelling interest in preventing infanticide that is not contradicted by a woman's constitutional right to decide whether to continue a pregnancy. Similarly, states have a legitimate and perhaps even compelling interest …

Racist Health Care?, Barbara A. Noah

Faculty Scholarship

During the past few years, rationing has become an explicit feature in decisions concerning optimal delivery of health care services, and it poses difficult choices for health care providers and policymakers. Insurers and patients increasingly must balance the desire for access to every possible treatment against concerns about affordability. Costdriven treatment decisions are becoming an unavoidable reality for most patients. Apparently, however, another more pernicious type of rationing occurs in this country. It does not depend on factors such as the likelihood of an optimal outcome, the comparative efficacy of different available treatment modalities, or even the ability to pay …

Nicotine Withdrawal: Assessing The Fda's Effort To Regulate Tobacco Products, Lars Noah, Barbara A. Noah

Faculty Scholarship

At a press conference held on August 23, 1996, just one year after initially revealing his plans, President Clinton announced sweeping federal regulations to combat the underage use of tobacco products. The Food and Drug Administration (FDA) subsequently published a lengthy preamble to accompany the final regulations, detailing the Agency's assessment of the problem and responding to numerous public comments to its notice of proposed rulemaking (NPRM). Characterizing the growing use of tobacco products as a "pediatric disease," FDA Commissioner David Kessler previously had vowed to alter the smoking habits of the newest generation of tobacco users in order to …

Why Mandatory Hiv Testing Of Pregnant Women And Newborns Must Fail: A Legal, Historical, And Public Policy Analysis Special Issue: Mandatory Hiv Testing Of Newborns And Their Mothers, Elizabeth B. Cooper

Faculty Scholarship

The debate surrounding mandatory HIV testing of newborns and pregnant women requires an understanding of the historical context of women in the epidemic. Although the epidemic first was recognized in gay men in 1981, anecdotal reports reveal that women already were dying from what seems to have been HIV-related symptomatology. Indeed, in Gena Corea's book, The Invisible Epidemic, we learn that, as early as 1981, not insignificant numbers of drug-using and former drug-using women were falling ill and not recovering from conditions that normally are not fatal, including bacterial pneumonia. Yet, because we did not necessarily expect these populations to …

Medicine And Human Rights: Reflections On The Fiftieth Anniversary Of The Doctors’ Trial, George J. Annas, Michael A. Grodin

Faculty Scholarship

1996 marks the fiftieth anniversary of the commencement of the trial of Nazi physicians at Nuremberg, a trial that has been variously designated as the "Doctors' Trial" and the "Medical Case." In addition to documenting atrocities committed by physicians and scientists during WWII, the most significant contribution of the trial has come to be known as the "Nuremberg Code," a judicial codification of 10 prerequisites for the moral and legal use of human beings in experiments. Anniversaries provide us with an opportunity to reflect upon the past, but they also ena ble us to renew our efforts to plan for …

Cowboys, Camels, And The First Amendment: The Fda's Restrictions On Tobacco Advertising, George J. Annas

Faculty Scholarship

The Marlboro Man and Joe Camel have become public health enemies number one and two, and removing their familiar faces from the gaze of young people has become a goal of President Bill Clinton and his health care officials. The strategy of limiting the exposure of children to tobacco advertisements is based on the fact that almost all regular smokers begin smoking in their teens. This approach is politically possible because most Americans believe that tobacco companies should be prohibited from targeting children in their advertising.

Facilitating Choice: Judging The Physician's Role In Abortion And Suicide, George J. Annas

Faculty Scholarship

When I was invited to give this talk I thought, "I'll just give my standard slide show on death in America." I thought I would just talk about the right to die, something I can do in my sleep, and everybody would be happy. And you probably would, since it's a pretty good speech. I am going to give it at a Pennsylvania Judges Conference in a couple of weeks, and they will like it. But it is not very challenging, either for me or for you. So, what I want to explore with you today is how judges have …

The Promised End: Constitutional Aspects Of Physician-Assisted Suicide, George J. Annas

Faculty Scholarship

The debate over physician-assisted suicide has dramatically shifted to a discussion of constitutional issues. This spring, within a month of each other, U.S. Circuit Courts of Appeals on both coasts ruled that state prohibitions of assisted suicide are unconstitutional when applied to physicians who prescribe lethal medication for terminally ill, competent adults who wish to end their lives. The Ninth Circuit includes Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, Oregon, and Washington, and the Second Circuit includes New York, Connecticut, and Vermont. Both courts reached the same conclusion but for different legal reasons.

Are The Antitrust Agencies Overregulating Physician Networks?, Clark C. Havighurst

Faculty Scholarship

No abstract provided.

Aids Phobia, Public Health Warnings, And Lawsuits: Deterring Harm Or Rewarding Ignorance?, Wendy K. Mariner

Faculty Scholarship

Courts in more than a dozen states have decided cases in which a person has claimed money damages for his or her fear of getting acquired immunodeficiency syndrome (AIDS). Although most courts have rejected such claims in the absence of actual exposure to the human immunodeficiency virus (HIV), their reasoning has varied slightly from state to state. This article argues that negligence law should not permit people who are HIV negative to recover damages for an unfounded fear of AIDS. Public health statements intended to educate the public about preventing HIV transmission may have encouraged some fear-of-AIDS lawsuits against health …