Health Law and Policy Commons^™

Medicaid Reform Through Setting Health Care Priorities, Robert L. Schwartz

Faculty Scholarship

The face of American health care has changed since the creation of the two largest government funded health programs, Medicare and Medicaid. Whatever positive cultural benefits those programs have provided, they have carried with them one overwhelming defect: a language with obscure and untreatable words and phrases which has added to the mystery and impenetrability of the underlying substantive law. This article discusses Oregon’s proposal for prioritization, reviews legal arguments, a policy argument against the proposal, and finally concludes that any priority list that generalizes from condition-treatment pairs necessarily overgeneralizes, that the range of cost-utility ratios for any condition-treatment pair …

The Health Care Proxy And The Living Will, George J. Annas

Faculty Scholarship

A legally enforceable declaration can be executed only 14 days or more after a person is diagnosed as having a terminal illness, defined as one that will cause the patient's death "imminently," whether or not life-sustaining procedures are continued. [...]even though this statute was inspired by her story, it would not have helped Quinlan, because she was not terminally ill.

Regulating Ethics Committees In Health Care Institutions - Is It Time?, Diane E. Hoffmann

Faculty Scholarship

No abstract provided.

The Long Dying Of Nancy Cruzan, George J. Annas

Faculty Scholarship

With the Nancy Cruzan decision, ¹ the post-Reagan Supreme Court continued recreating America's legal landscape by transferring traditional rights from its citizens to state legislatures and state officials. Attorneys Bopp and Marzen see Cruzan as a cause for celebration. ² The more common view is that it is a hollow acceptance of the technological imperative that requires all Americans to engage in extensive damage control. Given the composition of the Court, constituted by President Ronald Reagan to overrule Roe v. Wade, Bopp and Marzen correctly note that the result in Cruzan was "practically inevitable." But its inevitability does not …

Restricting Doctor–Patient Conversations In Federally Funded Clinics, George J. Annas

Faculty Scholarship

We have come to accept, as a matter of both law and medical ethics, that open and honest discussion is crucial to the doctor–patient relationship. We accordingly deplore the practice in Plato's Greece whereby, for slaves, "verbal communication between healer and patient was reduced to a minimum." But restricting conversation between doctor and patient has now become a matter of government policy, again distinguishing patients according to economic class.

Mengele's Birthmark: The Nuremberg Code In United States Courts, George J. Annas

Faculty Scholarship

Experimentation on human beings is so difficult to justify that the attempt is seldom even made. Usually its justification is simply assumed, and vague notions of progress or national emergency are suggested as sufficient rationales. The United States, a society dedicated to both progress and human rights, has been profoundly ambivalent about human experimentation. On the one hand, we have consistently argued in our ethical codes that the rights and welfare of research subjects must be protected; on the other hand, we have consistently used perceived emergencies, both national and medical, as an excuse to jettison individual rights and welfare …

Gestational Surrogacy And The Health Care Provider: Put Part Of The "Ivf Genie" Back Into The Bottle, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

Professional Decisions And Ethical Values In Medical And Law Students, Robert L. Schwartz, Agnes G. Rezler, Pamela Lambert, S. Scott Obenshain, Joan Mciver Gibson, David A. Bennahum

Faculty Scholarship

The purpose of this project is to evaluate and compare the values used by medical and law students when dealing with ethical dilemmas in the professional practice of law and medicine. It is assumed that conflict between doctors and lawyers often arises out of the different values that members of each profession apply to similar dilemmas.

The Law And Economics Of Organ Procurement, Keith N. Hylton

Faculty Scholarship

This paper presents an economic analysis of the organ procurement system in the U.S. and examines proposals to alleviate the shortage of transplantable organs. The paper's principal conclusions are: (1) Although non-market solutions deserve the highest priority, demand increases fueled by improvements in transplant technology will probably make some market-based solution necessary in the future. (2) Quality deterioration and coercion will not necessarily be worrisome problems under a market-based procurement system.

New Fda Drug Approval Policies And Hiv Vaccine Development, Wendy K. Mariner

Faculty Scholarship

Conducted a study of Food and Drug Administration (FDA) law and policy including interviews with FDA officials in the Center of Biologics Evaluation and Research and the Office of the General Counsel. Suggests that the new FDA drug review policies do not fit vaccines. Instead, the nature of vaccines, and HIV vaccines in particular, argues for adherence to a more rigorous form of review. (JLN)

Women And Aids - Racism, Sexism, And Classism, Taunya L. Banks

Faculty Scholarship

No abstract provided.

Nancy Cruzan And The Right To Die, George J. Annas

Faculty Scholarship

[...]the majority improperly implied that continued existence and treatment in a persistent vegetative state is either beneficial or neutral, whereas in fact "an erroneous decision not to terminate life-support robs a patient of the very qualities protected by the right to avoid unwanted medical treatment... [a] degraded existence is perpetuated; his family's suffering is protracted; the memory he leaves behind becomes more and more distorted.5 " Finally, Justice Brennan argued that the Missouri rules are simply out of touch with reality; people do not write elaborate documents about all the possible ways they might die and the various interventions doctors …

Women In The Aids Epidemic: A Portrait Of Unmet Needs, Arlene Zarembka, Katherine M. Franke

Faculty Scholarship

While rarely a month goes by that the topic of AIDS escapes discussion in the legal literature, a survey of legal publications reveals that the implications of AIDS for women has received scant treatment by legal commentators. Unfortunately, this neglect is not unique to the legal community, but reflects a larger societal disinterest in women with AIDS.

In fact, this epidemic looks quite different from the perspective of women. The medical, social, and legal needs of women affected by AIDS are in many ways needs that preexisted AIDS, but which have been magnified by the threat and implications of HIV …

Surrogate Fatherhood?, Frances H. Miller

Faculty Scholarship

No abstract provided.

Pregnancy, Drugs, And The Perils Of Prosecution, Wendy K. Mariner, Leonard H. Glantz, George J. Annas

Faculty Scholarship

In the war on drugs an offensive has been launched against pregnant women who use drugs. Over the past four years, prosecuting attorneys have been indicting women who use drugs while pregnant. In South Carolina alone, eighteen women who allegedly took drugs during pregnancy were indicted last summer for criminal neglect of a child or distribution of drugs to a minor.' In the only successful prosecution so far, Jennifer Johnson was convicted in Florida for delivering illegal drugs to a minor via the umbilical cord in the moment after her child was born and before the cord was clamped.^{2 …}

Doctors And Lawyers And Wolves, George J. Annas

Faculty Scholarship

Relations between lawyers and physicians, and therefore between law and medicine, are getting more and more destructive and counterproductive. It used to be a joke, but it's not funny anymore. We can't afford the continuing and escalating acrimony between our professions and it's time that we take constructive steps in the public interest to deal with it.

The Right To Forego Life-Sustaining Treatment: Legal Trends And Emerging Issues, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

The Biotechnology Revolution And Its Regulatory Evolution, Diane E. Hoffmann

Faculty Scholarship

No abstract provided.

Predicting The Future Of Privacy In Pregnancy: How Medical Technology Affects The Legal Rights Of Pregnant Women, George J. Annas

Faculty Scholarship

The bodies of pregnant women are the battleground on which the campaign to define the right of privacy is fought. The ultimate outcome will likely be shaped at least as much by new medical technologies as by politics or moral persuasion. This is because medical technologies do much more than change what we can do: they can radically alter the way we think about ourselves. Technologies have the power to change "not only the relation of man to nature but of man to man."1 More than that, they can alter our very concept of what it means to be human, …

Equitable Access To Biomedical Advances: Getting Beyond The Rights Impasse, Wendy K. Mariner

Faculty Scholarship

In 1988, gay rights activists and supporters demonstrated outside a Food and Drug Administration building demanding unrestricted access to experimental drugs being tested for the treatment of human immunodeficiency virus ("HIV") infection and acquired immunodeficiency syndrome ("AIDS").² Across the ocean in France, in October of the same year, came an equally insistent demand from women's groups, scientists, and family planning agencies that the pharmaceutical company Groupe Roussel Uclaf put its abortifacient RU 486 back on the market.' Early in 1989, people were outraged when newspapers reported that New Hampshire's Medicaid program would not pay for a life-saving bone marrow …

Aids And Government: A Plan Of Action, Taunya L. Banks

Faculty Scholarship

No abstract provided.

Setting Limits On Autonomy: Saving Money In An Aging Society, Robert L. Schwartz

Faculty Scholarship

In Setting Limits Dr. Daniel Callahan poses a solution: the termination of some kinds of treatment for the very elderly. His solution undercuts autonomy of the individual. This Article describes the values served by autonomy and explains why autonomy is so basic to making health care decisions and why its importance is especially great in the United States. Of course, autonomy is not absolute. This Article will define those classes of cases in which autonomy can be trumped by other interests. The Article will next determine whether the class of cases defined by Dr. Callahan fits within that definition. Finally, …

Feeding The Permanently Unconscious And Terminally Ill Or Dying Is Not Always Compassion, Phebe Saunders Haugen

Faculty Scholarship

A surrogate decision maker may conclude that efforts to mechanically provide liquid nourishment would cause considerable suffering in return for little gain. But such a decision is unquestionably one that can produce great conflict for families and for medical caregivers. Assessment must be made of each patient's situation and of the benefits and burdens that will result if tube feeding is withheld or withdrawn. It may well be, however, that in some cases, the most humane and compassionate treatment for a patient is the withdrawal of all technological interventions, including those that supply nourishment.

Who Cares?: The Evolution Of The Legal Duty To Provide Emergency Care, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

There Is No Archbishop Of Science - A Comment On Elliot's Toward Incentive-Based Procedure: Three Approaches For Regulating Scientific Evidence, Robert L. Schwartz

Faculty Scholarship

As is usual when Professor Elliott writes about turning retrospective judge-oriented procedural rules into prospective attorney-oriented procedural incentives, his proposal for dealing with scientific testimony not accepted within the scientific community is both interesting and provocative. It also serves as an apology for those judges who are so in awe of science that they believe that only they or their peers in the scientific establishment-and not the common folk selected for jury service-are likely to understand the complex truths that science yields. Professor Elliott starts with the assumption that there is a need for some kind of judicial intervention to …

Amici For Appellees: Brief For Bioethicists For Privacy As Amicus Curiae Supporting Appelles Brief For Bioethicists For Privacy As Amicus Curiae Supporting Appellees, George J. Annas, Leonard H. Glantz, Wendy K. Mariner

Faculty Scholarship

Amicus is an ad hoc group of 57 philosophers, theologians, attorneys and physicians .. .who teach medical ethics to medical students and physicians. The members believe that permitting competent adults to make important, personal medical decisions in consultation with their physician is a fundamental principle of medical ethics, and that the doctor-patient relationship deserves the constitutional protection the Court has afforded it under the right of privacy.

The Politics Of Transplantation Of Human Fetal Tissue, George J. Annas

Faculty Scholarship

Research involving human fetal tissue has been the subject of intense political debate in this country for almost two decades, and the use of fetal tissues in transplantation continues this controversy in another forum. Since Roe v. Wade ,1 the landmark decision on abortion by the U.S. Supreme Court in 1973, the federal government has focused public attention on fetal research by creating panels of experts. "3 This conclusion was accepted on a vote of 15 to 2, and included recommendations that the decision to abort be kept independent of the decision to retrieve and use fetal tissue, that recipients …

Why Clinical Trials Of Aids Vaccines Are Premature, Wendy K. Mariner

Faculty Scholarship

No abstract provided.

Evaluating Child Care Legislation: Program Structures And Political Consequences, Lance Liebman

Faculty Scholarship

The American political system is not good at choosing among worthy goals and then adopting programs well designed to achieve the desired purposes. Scholars and activists continue to debate the success and failure of the last quarter century of efforts to reduce inequality and achieve other social reforms. But we have no well developed methodology for evaluating proposed programs and attempting to predict their likely consequences.

This Article asks what we know about choosing legal structures for programmatic efforts that seek social change. In particular, it asks whether we can predict relationships between different ways of pursuing public ends and …

The Supreme Court, Privacy, And Abortion, George J. Annas

Faculty Scholarship

Although states can regulate abortions after the point of fetal viability (or, more accurately, can restrict the induction of premature birth), since Roe only 13 states have enacted laws to restrict such abortions.8 Decisions after Roe In more than a dozen major cases over the succeeding 15 years, the Supreme Court applied Roe to specific attempts by some states to limit abortion rights during the first and second trimesters. [...]1989, the Court consistently struck down almost all such limitations. The Court did find it constitutional, however, for the state and federal governments to refuse to fund abortions through the Medicaid …