Health Law and Policy Commons^™

Death By Prescription, George J. Annas

Faculty Scholarship

Society and physicians in the United States remain unable to accept death and thus unable to deal with the physical, psychological, and spiritual approach of death. The hour of death itself “is commonly tranquil,” but “the serenity is usually bought at a fearful price -- and the price is the process by which we reach that point” -- a process that has been described as “a purgatory that may last for weeks.” Suicide has been seen as a rational way to avoid that purgatory, especially as a response to end-stage cancer and AIDS, and proposals to “legalize” physician-assisted suicide in …

When Should Preventive Treatment Be Paid For By Health Insurance?, George J. Annas

Faculty Scholarship

In the national debate about who should have health insurance, surprisingly little attention has been focused on what medical services health insurance itself should cover. Historically, discussions of this topic have centered on concepts such as basic health care or medically necessary care. When the power of medical diagnosis and treatment was limited, these terms had boundaries as well. As physicians' diagnostic prowess has increased, however, especially in the area of genetics, such terms have become open-ended. To avoid predictable conflicts over benefit coverage, much more precise definitions will be required, so that patients and health care providers can understand …

Federalism And Health Care Reform: Is Half A Loaf Really Worse Than None?, Richard Briffault

Faculty Scholarship

Health care reform dominates the domestic agenda of the Clinton Administration. Policy analysts, media pundits, and ordinary citizens are abuzz with the once-arcane terminology of health reform – "managed competition," "single-payer," "regional alliances," "global budgets" – as they ponder the merits and demerits of the leading reform alternatives. At the center of the public debate are questions concerning the role of government in constraining health care costs, maintaining quality, and widening access. But in our federal system there are two governments that can address most domestic problems – the national government and the states – and, although considerable ink has …

Malpractice Liability And Physician Autonomy, Frances H. Miller, Anthony Harrison

Faculty Scholarship

Opinion. Discusses legal modifications concerning liability for medical negligence evolving in similar ways in the United States and Great Britain. Parallel and divergent trans-Atlantic trends; Ailing and increasingly costly health care systems; Traditional relationships among doctors, hospitals and other health sector players.

Partner Notification And The Threat Of Domestic Violence Against Women With Hiv Infection, Karen H. Rothenberg, Richard L. North

Faculty Scholarship

No abstract provided.

Evaluating Ethics Committees: A View From The Outside, Diane E. Hoffmann

Faculty Scholarship

No abstract provided.

Physician-Assisted Suicide — Michigan's Temporary Solution, George J. Annas

Faculty Scholarship

Lewis Thomas has noted that doctors “are as frightened and bewildered by the act of death as everyone else”. “Death is shocking, dismaying, even terrifying,” Thomas has written. “A dying patient is a kind of freak . . . an offense against nature itself”. It is thus not surprising that many physicians have difficulty talking candidly with dying patients and caring for them, a reaction that often results in undermedication for pain and expensive and ineffective overtreatment.

American patients know this, and although death is a culture-wide enemy, many Americans fear the process of dying in an impersonal modern hospital …

The Law's Response To Reproductive Genetic Testing: Questioning Assumptions About Choice, Causation And Control, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

Life Style, Health Status, And Distributive Justice, Robert L. Schwartz

Faculty Scholarship

The newest and most original scapegoat upon which we can place the blame for the high cost of health care are those whose life style choices puts their health or lives at risk. Of course, if our health care cost and access problems are a consequence of unhealthy choices made by autonomous individuals, we are relieved of the obligation of figuring out how to reform our health care delivery system. In that case, the solution to our health care problem is obvious - we merely need to impose appropriate penalties on those who make costly, immoral and unhealthy life style …

The Supreme Court's Narrow View On Civil Rights, Jack M. Beermann

Faculty Scholarship

The right to choose abortion, although recently significantly curtailed from its original scope,' is a federally protected liberty interest of women, and is at least protected against the imposition of "undue burdens" by state and local government.² Some of the most serious threats to women's ability to choose abortion have come not from government regulation, but from private, national, organized efforts to prevent abortions. In addition to seeking change through the political system, some of these organizations, most notably Operation Rescue, have focused on the providers of abortion, and have attempted to prevent abortions by forcibly closing abortion clinics …

Detention Of Hiv-Positive Haitians At Guantanamo, George J. Annas

Faculty Scholarship

Speaking for the United States, Secretary of State Warren Christopher told the June 1993 World Conference on Human Rights in Vienna that human rights are universal and that “we cannot let cultural relativism become the last refuge of repression”. The universality of human rights was first recognized internationally in the 1948 United Nations Declaration of Human Rights. But the fact that these rights are recognized and even seen as universal does not ensure that they will be respected, even by their strongest supporters. The lack of an international tribunal with jurisdiction to hear complaints about human-rights violations and provide remedies …

Control Of Tuberculosis -- The Law And The Public's Health, George J. Annas

Faculty Scholarship

In their history of tuberculosis, The White Plague, Rene and Jean Dubos note that the first national movement to control tuberculosis in the United States came from the Medico-Legal Society of the City of New York, a group of lawyers, scientists, and physicians devoted to solving social problems. At a meeting in 1900 to organize an American Congress on Tuberculosis, the group drafted legislation designed to prevent the spread of the disease. Even though almost every state eventually passed tuberculosis-control laws, it was not the passage of legislation, or even the development of effective treatment, that led to the decline …

Problems With Employer-Provided Health Insurance — The Employee Retirement Income Security Act And Health Care Reform, Wendy K. Mariner

Faculty Scholarship

Health care reform is in the wind. As the nation prepares for a new presidential term, a more equitable and cost-effective health care system is beginning to sound inevitable.1 But the shape of that system remains a matter of debate. Employer-provided health insurance is the cornerstone of several national proposals for reform.2 3 4 5 6 The Bush administration's preference for tax credits rested on the assumption that most employers would continue to provide health insurance to their employees. President-elect Bill Clinton's proposal relies on insurance reform to enable small businesses to buy affordable private health insurance. Lawmakers …

Myth And Reality: The Threat Of Medical Malpractice Claims By Low Income Women, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

The Supreme Court, Abortion, And The Jurisprudence Of Class, Wendy K. Mariner

Faculty Scholarship

The US Supreme Court's decision in Planned Parenthood of Southeastern Pennsylvania v Casey both protects a woman's liberty to choose to terminate her pregnancy and permits the state to make it more difficult for her to exercise her choice. In their opinion on the case, Justices O'Connor, Kennedy, and Souter eloquently defend constitutional protection of the right to make intimate decisions like continuing or ending a pregnancy. At the same time, they permit the state to try to persuade pregnant women not to have abortions and to make abortion harder to obtain and more costly, as long as the state's …

Staffing National Health Care Reform: A Role For Advanced Practice Nurses, Linda H. Aiken, William M. Sage

Faculty Scholarship

Expanding access and coverage while containing costs can only be accomplished by getting more health care value for our money. Two facts about our current system make this seem possible. First, the currently uninsured are not costless. Providing stop-gap health care to those who lack health insurance is extremely expensive -- people without formal coverage cannot afford preventive services, delay treatment of illness and face substantial barriers to reaching appropriate providers. When they receive care, it is often degrading, usually complicated and costly, and more than occasionally too late. The cost of this "uncompensated" care is borne by all of …

Competition Law And Anticompetitive Professional Behavior Affecting Health Care, Frances H. Miller

Faculty Scholarship

No abstract provided.

Mum's The Word: The Supreme Court And Family Planning, Wendy K. Mariner

Faculty Scholarship

On May 23, 1991, the US Supreme Court upheld federal regulations that prohibit federally funded family planning programs from counseling about or referring for abortion. As a result, government benefits may now entail substantial costs. The regulations changed the nature of government-assisted family planning from comprehensive care and counseling to limited services and government-prescribed information. The reasoning in Rust v Sullivan allows government to limit freedom of speech in federally funded programs. The decision may have been influenced by antiabortion sentiment, but it does not affect the legality of abortion. Instead, it sets a precedent for government control of whether …

The Changing Landscape Of Human Experimentation: Nuremberg, Helsinki, And Beyond, George J. Annas

Faculty Scholarship

Since World War II there have been persistent efforts at both the national and international level to develop rules to protect the rights and welfare of subjects of human experimentation.' These efforts have focused primarily on codifying the rights of subjects, and protecting their welfare by prior peer review of research protocols. In recent years research regulations have been under attack by politicians, drug companies, researchers, and advocacy groups. In less than half a century, human experimentation has been transformed from a suspect activity into a presumptively beneficial activity. With this transformation, traditional distinctions between experimentation and therapy, subject and …

Adding Injustice To Injury - Compulsory Payment For Unwanted Treatment, George J. Annas

Faculty Scholarship

A New York court this year issued one of the most disturbing and aberrant appellate opinions of the past two decades concerning the right to refuse treatment.1 In my view, the judges ruling in Grace Plaza v. Elbaum made a series of errors: they assumed that institutions can have ethics apart from those of their physicians; they believed that both institutions and physicians are primarily motivated by money; and they approved the use of legal threats by institutions and physicians against patients and their families. In this court's idiosyncratic view, dying and medical care seem to be not about …

Health Warnings, Smoking, And Cancer - The Cipollone Case, George J. Annas

Faculty Scholarship

The figures have become familiar. Tobacco use has been declared "the single most important preventable cause of [premature] death in the United States, accounting for one of every six deaths, or some 390,000 deaths annually. "The health goals of the nation for the year 2000 call for reducing the prevalence of cigarette smoking to 15 percent among adults (a 48 percent decrease from the current 29 percent) and reducing the rate of beginning smoking among teenagers to 15 percent (a 50 percent decrease from the current rate of 30 percent). The goal of reducing smoking in the United States is …

National Institutes Of Health Workshop Statement. Reproductive Genetic Testing: Impact On Women, Karen H. Rothenberg, Elizabeth Thomson

Faculty Scholarship

No abstract provided.

The Economics And Politics Of Emergency Health Care For The Poor: The Patient Dumping Dilemma, Maria O'Brien

Faculty Scholarship

As the numbers of uninsured mount⁴ because of job dislocations, exhaustion of benefits, and unaffordably high premiums, the incidence of "dumping" by private hospitals is, predictably, on the rise. Dumping occurs when a hospital, in violation of federal or state law, transfers an emergency patient to another (usually public) hospital or simply refuses any treatment based on the patient's inability to pay.5 In addition to the completely uninsured, favorite dumping targets include Medicare and Medicaid patients, AIDS patients, and cancer patients whose therapy may cost more than the maximum reimbursement under private insurance.

Dumping is merely a part of …

Setting Standards For The Use Of Dna-Typing Results In The Courtroom — The State Of The Art, George J. Annas

Faculty Scholarship

DNA typing, sometimes called DNA fingerprinting or profiling, has been the focus of heated exchanges in courtrooms, the popular press, and scientific journals. It is a powerful law-enforcement weapon, especially in cases of rape, because it has the potential to exonerate a suspect or to place him at the scene of a crime. On the other hand, it is of no use in rape cases like those in which William Kennedy Smith and Mike Tyson were accused, in which coitus is conceded to have occurred and the only real issue is consent. When should judges permit evidence from DNA typing …

Using Genes To Define Motherhood - The California Solution, George J. Annas

Faculty Scholarship

Sometimes (although not often) new forms of medical technology raise unique legal and social-policy issues that require new laws. In vitro fertilization, followed by the transfer of the embryo to a woman who did not contribute the ovum, is such a technique, because when the child's gestational mother is not the child's genetic mother, society must decide which is the child's legal mother. A California Court of Appeal, the first appellate court anywhere in the world to rule on this issue, decided in late 1991 that genes determine motherhood.

Cleaning House: Environmental Hazards Can Undermine A Property's Use And Value, Michael B. Gerrard

Faculty Scholarship

Numerous horror movies and books depict the woes that befall fictional homeowners who don't know or care that they are living too close to cemeteries or brooding woods or scenes of hauntings.

However, even the vivid imaginations of filmmakers and novelists can't conjure up some of the real-life horrors that environmental hazards can create for property owners. These hazards can destroy the value and salability of property, render it unusable for its intended purpose, and burden owners with clean-up costs, fines and lawsuits.

Fortunately, an alert eye and inexpensive tests can identify most common environmental dangers.

Introduction: The Right To Die After Cruzan, Diane E. Hoffmann

Faculty Scholarship

No abstract provided.

Of Mice But Not Men: Problems Of The Randomized Clinical Trial, Samuel Hellman, Deborah Hellman

Faculty Scholarship

No abstract provided.

The Influence Of Law And Lawyers On Patient Care, Diane E. Hoffmann

Faculty Scholarship

No abstract provided.

Medical Treatment Decisions And Competency In The Eyes Of The Law: A Brief Survey, Patricia D. White, Susan J. Hankin

Faculty Scholarship

No abstract provided.