Health Law and Policy Commons^™

An Alternative Public Health Vision For A National Drug Strategy: "Treatment Works", Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article returns to a war waged virtually throughout this century--a war between the theories of punishment and rehabilitation in curtailing the drug epidemic. Today, the terms of the war are recast as supply-side policies based upon law enforcement; destroying crops in source countries; interdiction and increased sentencing; and demand reduction based upon prevention, education, and treatment. The war on drugs has reached a feverish pitch. New policies and statutes have tightened the grip of supply-side policies, with images of battle and hate mongering which go beyond the vilified drug lords and governments which harbor them, to the middle men, …

Genetic Discrimination: The Use Of Genetically Based Diagnostic And Prognostic Tests By Employers And Insurers, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This paper analyzes the law, ethics and public policy concerning "genetic discrimination," defined as the denial of rights, privileges or opportunities on the basis of information obtained from genetically based diagnostic and prognostic tests. The Human Genome Initiative will enhance the ability to gather and organize information that may predict a person's future potential and disabilities. Enormous human benefits may ensue from understanding the etiology and pathophysiology of genetic disorders, including disease prevention through genetic counseling, and treatment of the disorders through genetic manipulation. This information will help clinicians understand and eventually treat many of the more than 4,000 diseases …

Advance Directives Under State Law And Judicial Decisions (Medical Decision-Making And The ‛Right To Die’ After Cruzan), Judith C. Areen

Georgetown Law Faculty Publications and Other Works

In the decision of the United States Supreme Court in Cruzan v. Director, Missouri Department of Health on June 25, 1990, a majority of the Court announced that it will leave to the states the question of what legal requirements may be imposed on decisions to discontinue treatment for incompetent patients.

Almost every state now recognizes some form of written advance directive, be it living wills or appointments of proxy decision-makers. The problem with directives is thus increasingly not legal as much as it is practical: very few people prepare advance directives.

The Interconnected Epidemics Of Drug Dependency And Aids, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Drug dependence and human immunodeficiency virus (HIV) are America's two most pressing epidemics, interconnected by a cycle of urban poverty, physical dependence and a culture of sharing needles and syringes. Extant political strategies to curb these interconnected epidemics involve two traditional approaches. The first--law enforcement and interdiction--is designed to limit the supply of illicit drugs to the marketplace. This strategy is advanced by broad criminal sanctions against importing, selling, distributing, medically prescribing, or possessing illicit drugs or drug paraphernalia. The second strategy to combat the drug and HIV epidemics involves reducing the demand for illicit drugs. Education, counseling, and treatment …

Ethical Principles For The Conduct Of Human Subject Research: Population-Based Research And Ethics, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This paper provides a halting first step in organizing a set of ethical guidelines for the conduct of population-based research, surveillance and practice. These principles are not distinct from, but an expansion of, traditional ethics. Research ethics, which matured significantly from the Nuremberg Code through to the Helsinki IV and the Council for International Organizations of Medical Sciences (CIOMS) guidelines, nourished the individual human spirit. Ethical principles should have a similarly profound impact in the development of science and the protection of human populations in the 1990s and beyond.

A Decade Of A Maturing Epidemic: An Assessment And Directions For Future Public Policy, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The author's goal in this article, is not merely to propose public health strategies for the future, but also to examine why government has been so slow, so equivocal, in its public health response to the acquired immune deficiency syndrome (AIDS) epidemic. He argues that there has been a fundamental ambivalence in perceptions of the epidemic. For some, AIDS is perceived as a disease, with sympathy for sufferers. Once AIDS is viewed as a disease, like other catastrophic diseases, it follows that public policy will be based upon science and epidemiology--health education, research and treatment.

For others, AIDS is caused …

The Politics Of Aids: Compulsory State Powers, Public Health, And Civil Liberties, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article argues that compulsory public powers are justified only if they meet the following criteria: there is a significant risk of transmission of the acquired immune deficiency syndrome (AIDS) virus; the public health response is efficacious in preventing a primary mode of transmission of the virus; the economic, practical, or human rights burdens are not disproportionate to the public health benefits; and the public health power is the least restrictive alternative that would prevent viral transmission.

The author carefully examines the levels of risk posed by behavior which can potentially transmit human immunodeficiency virus (HIV), and demonstrates that compulsory …

Bioethics And Law: The Second Stage – Balancing Intelligent Consent And Individual Autonomy, Judith C. Areen

Georgetown Law Faculty Publications and Other Works

The principle that government rests on the consent of the governed eventually spread beyond the political arena to alter such private behavior as the relationship between physician and patient. This Article examines the successive transformations of the principle of consent as it has developed in the field of law and bioethics from bare consent to informed consent, and then, more strikingly, to beyond informed consent. This most recent form of the principle may prove to be every bit as revolutionary as the idea of popular sovereignty in 17th century England.

Hospitals, Health Care Professionals, And Aids: The "Right To Know" The Health Status Of Professionals And Patients, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article addresses why patients and health care professionals (HCPs) with human immunodeficiency virus (HIV) should have autonomy and privacy rights to choose whether to consent to an HIV test and to disclose their serologic status. It also demonstrates that the risk of HIV transmission in health care settings is exceedingly low, that it is probably lower than other well-accepted risks taken by patients and professionals, and that there are other less intrusive ways to further reduce the risk. The article concludes that knowledge of a patient's serologic status is unlikely to reduce risk, since no effective action could be …

A Need For Caring, Judith C. Areen

Georgetown Law Faculty Publications and Other Works

Review of AIDS AND THE LAW: A GUIDE FOR THE PUBLIC. Edited by Harlon L. Dalton, Scott Burris, and the Yale AIDS Law Project. New Haven: Yale University Press. 1987. Pp. vii, 382.

Review Of Reproductive Genetics And The Law, Judith C. Areen

Georgetown Law Faculty Publications and Other Works

No abstract provided.

A Scarcity Of Organs, Judith C. Areen

Georgetown Law Faculty Publications and Other Works

The scarcity of organs will be eliminated only if significantly more people agree to donate their own organs and those of close family members. For this, a more fundamental rethinking of the present system of organ retrieval may be required. Such a revision would begin by placing the debate between supporters of a system based on voluntary giving and those who favor either a market system or one based on expropriation (presumed consent) in the larger context of debate about the kind of society we favor.

The Future Of Public Health Law, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Developments in medicine and constitutional law dictate modification of public health legislation in the United States. Traditionally overlooked by legislators, present public health laws provide inadequate decision-making criteria and inappropriate procedures for dealing with issues. Revised legislation should provide health care officials and agencies with the tools to balance individual rights against public health necessities. This article makes four recommendations for legislative reform: (1) remove artificial legislative distinction between venereal and other communicable diseases; (2) provide criteria defining "public health necessity" to limit discretionary exercise of police power by health officials; (3) provide strong confidentiality protections in the collection and …

Foreword: Public Health & The Law—A Symposium Dedicated To Professor William J. Curran, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This essay serves as the foreword to Public Health & the Law, a symposium dedicated to Professor William J. Curran held in 1987.

During his career, Professor Curran chaired the Harvard School of Public Health Committee on Human Research; he directed the Program in Law and Public Health; and he was co-director of the Harvard Interfaculty Program in Medical Ethics from 1973 to 1980. He was also an advisor to the World Health Organization and spent two sabbatical periods in Europe with WHO organizations. He advised and lectured in countries throughout the world.

At Harvard Law School and at …

Aids Policies Raise Civil Liberties Concerns, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Testing for the AIDS virus and segregation of AIDS carriers raise extremely important civil liberties questions in contemporary corrections. The NPP survey revealed 420 cases of fully diagnosed AIDS cases in state prisons across the country. Given the AIDS-toinfection ratio used by the U.S. Centers for Disease Control, there are between 21,000-42,000 prisoners infected with HIV. Up to 30% of these prisoners will probably develop some serious manifestations of AIDS. More importantly, this figure may continue to double every year. Corrections departments have responded to the AIDS crisis in a variety of ways: 90% use the ELISA test to detect …

The Nucleus Of A Public Health Strategy To Combat Aids, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Since acquired immune deficiency syndrome (AIDS) was first identified in I98I, its rate of spread among a primarily young and vibrant population has chilled the medical and lay communities. Today, the public response is sober and oriented toward the examination of specific policies that could lessen the impact of the disease. After six years' experience it is now feasible to propose a strategy for combating AIDS. Consensus around the policies outlined in this article should form the nucleus of the public health strategy to combat AIDS before the intervention of an effective vaccine or treatment.

Aids - Pushing The Limits Of Scientific And Legal Thought, Jane H. Aiken

Georgetown Law Faculty Publications and Other Works

Perhaps one of the greatest challenges to the scientific and legal community confronts us now-not by choice but by tragic happenstance. It has taken the form of a mysterious disease that is striking down its victims at an alarming rate. The disease is AIDS. The scientific community is pushing the limits of medical knowledge in its effort to cure and contain the illness. At the same time the legal community, in the face of scientific uncertainty, must balance the needs of a frightened public and the rights of those persons who are affected by the disease. One thing is clear: …

Regulating Human Gene Therapy, Judith C. Areen

Georgetown Law Faculty Publications and Other Works

Scientific developments have moved the public debate on genetic engineering to the issue of human gene therapy.

Because so many important societal values must be weighed in deciding which, if any, of the first protocols for human gene therapy should be approved, it is obviously important to look closely at who will make the decision to approve or disapprove the protocols.

A Moment In Human Development: Legal Protection, Ethical Standards And Social Policy On The Selective Non-Treatment Of Handicapped Neonates, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Selective non-treatment decisions involving severely handicapped neonates have recently come under renewed judicial and legislative scrutiny. In this article, the author examines the legal, ethical and social considerations attendant to the non-treatment decision. In Part II he discusses the predominant ethical viewpoints relating to this issue and proposes a new moral standard based on personal interests. Part III presents a survey of the jurisprudence relating to selective non-treatment decisions. Parts IV and V of this article provide a critical examination of the recently enacted Child Abuse Amendments of 1984, a federal legislative initiative designed to regulate treatment decisions relating to …

Contemporary Social Historical Perspectives On Mental Health Reform, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The argument presented in this article is that a new role has been developing in law which can and should be used as a strategy in the provision of services. It will be further argued that there is an important place for the law in setting limits on established psychiatric measures relating, for example, to compulsory admission and treatment, and even to particularly hazardous measures taken with the consent of the patient. The final role of law is to ensure the civil status of those who are the consumers of psychiatric services. One must accept the fact that pernicious legal …

Compulsory Treatment In Psychiatry: Some Reflections On Self-Determination, Patient Competency And Professional Expertise, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

In this article the author examines the rationale, in legal and policy terms, of the inextricable association traditionally formed between certification and incompetency. He argues that forming categories of people in which the law automatically dispenses with the requirement of seeking consent is fraught with conceptual inconsistencies and practical difficulties. He further argues that clinical judgments made without the consent of the patient should be made subject to an independent statutory review. Such a review procedure could also be adopted for treatments which are unusually hazardous, irreversible or not fully established even if the doctor purports to proceed with the …

International Year Of Disabled Persons: The Institution In England And Wales, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

A notable characteristic of American federalism is that domestic policy has been substantially determined by the courts. The judiciary has introduced its own social morality to ensure reasonable access to services for minority groups.

The concept of judicial policy making has found no greater expression than in the field of mental retardation where the service provided has been largely mandated by judges.

A Mental Patient's Right To Vote: An Analysis Of The Wild Case, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article is an analysis of the Wild case that was heard on 15 June 1976 by Judge Lloyd Jones of the County Court, Warrington.

In order to vote, the person's name must appear on the register of electors as a resident of a particular locality. Any place where the elector legitimately resides (even a hostel, a general hospital or a university) may be used as an address which qualifies a person for entry onto the register. The one exception is found in section 4(3) of the Representation of the People Act 1949, as amended by the Mental Health Act, …

Freedom Of Expression And The Mentally Disordered: Philosophical And Constitutional Perspectives, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

Mental illness is usually described as an impaired ability to communicate effectively. Yet the societal response--both historically and under modem psychiatric practice--has been to retard, rather than encourage, the acquisition of linguistic skills. This impediment to normal social intercourse leaves individual interests in free expression ineffectuated; it concerns the legal profession because the government condones and enforces the restriction of first amendment rights in a potentially large segment of the population. This article examines the philosophical justification for free communication for the mentally handicapped. It further suggests a systematic application of the first amendment to the particular problems of the …

The Constitutional Right To Free Communication Of The Institutionalized Resident, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

This article comes from the notes and comments section of the North Carolina Central Law Journal from 1973.

Justified by the generic first amendment protection to unabridged expression and association, a United States citizen cannot be unreasonably denied the right to communicate by mail; by telephone; with legal counsel; with the opposite sex; with others. In most states where such a citizen becomes "mentally ill," the person may be involuntarily civilly committed. Although there is no justification for such a commitment beyond the fact that the individual is sick and is in need of care, often the individual's first amendment …