bluuebunny/crossref_metadata_2025 huggingface dataset:
Commentary: A Call for Authoritative CDC Guidelines for HIV-Infected Health Care Workers
Authors: Hermann Donald H. J.
Published: June 2007

Recent court decisions imposing liability on physicians who fail to inform patients that they carry the human immunodeficiency virus (HIV) before performing invasive procedures create an urgent need for the Centers for Disease Control and Prevention (formerly the Centers for Disease Control) to reopen the issuance of guidelines and to address authoritatively the question of the appropriate limits within which HIV-infected health care providers can treat patients.

Public fear of HIV-infected physicians (polls show 80 to 90 percent of patients surveyed want to know if their physicians are HIV-infected) were kindled by reports, beginning in 1990, that Dr. David Acer, an HIV-infected dentist, had infected a number of his patients. However, great skepticism has arisen as to whether Dr. Acer’s patients were infected as a result of procedures conducted in accordance with universal precautions against transmission. Moreover, look back studies have failed to identify even one patient, among the thousands who have undergone procedures administered by HIV-infected physicians, who contracted the virus directly from his/her physician.
Recent Developments in Health Law
Authors:   Harvard Law & Health Care Society
Published: June 2007

On June 20,1991, Dr. Craig Venter, then a molecular biologist at the National Institute of Neurological Disorders and Stroke, a member agency of the National Institutes of Health (NIH), revealed that the NIH was filing an application with the Patent and Trademark Office (PTO) to patent 351 genetic fragments sequenced from brain tissues. The first of many applications filed by the NIH during the next two years, the agency also applied to patent the complete set of genes encompassing each fragment. These applications were filed despite the fact that the full gene sequences, their protein products, and their functions were still unknown (several genetic fragments make up a gene, and these fragments code for protein those products that have physiological functions; an example of such a product is insulin).
Sentinel Effect of Drug Testing for Anabolic Steroid Abuse
Authors: Fuentes Robert J. , Davis Art , Sample Barry , Jasper Kim
Published: June 2007

George Will, the well-known pundit, once observed: “A society's recreation is charged with moral significance. Sport—and a society that takes it seriously—would be debased if it did not strictly forbid things that blur the distinction between the triumph of character and the triumph of chemistry.” In opposition, Dan Duchaine, the highly publicized “steroid guru” and counter-culture columnist, declared: “There comes a time for many in competitive athletics where winning is more important than those initial goals of health, recreation, and relaxation.” Theparallels of these twophilosophies to life in general are patent simply by substituting “sports” and “winning” for “career” and “success,” respectively.

This paper will review the basis for banning anabolic steroids in athletics, and consider especially the recent medical findings that support this prohibition. This survey leads into a discussion of the available deterrents, and the secondary, but essential, role of random drug testing as a final safeguard.
A Way of Looking at the Dalla Corte Case
Authors: Roberts Melinda A.
Published: June 2007

When her baby was born last June, Rossana Dalla Corte, age sixty-two, was thought to be the oldest woman ever to have given birth. Her pregnancy was achieved at a private fertility clinic in Italy, the same clinic that treated “Jennifer F.,” a London woman who, on Christmas day, 1993, at the age of fifty-nine, gave birth to twins. The reproductive procedure, likely to become more common during the next few years, has received intense scrutiny from health officials in Great Britain, France, and Italy. Moral questions concerning that procedure already have been taken up by the popular press in the United States. Such questions can be expected to take on a new urgency as the United States considers reshaping its health care system and, specifically, the circumstances under which coverage for infertility treatment will be provided.
Guidelines for Clinical Practice: What They are and Why They Count
Authors: Lohr Kathleen N.
Published: June 2007

Are clinical practice guidelines a means for improving the quality of health care? For saving money in the health care system? For solving the malpractice problem? For making the health care system work better for all? Or, are they a recipe for disaster? This overview sets out conceptual, definitional, and practical aspects of clinical practice guidelines as a broad framework for reflecting on the issue of what guidelines are and why they count. It draws mainly on work done since 1990 at the Institute of Medicine (IOM) and focuses on five questions. First, what are guidelines, and who develops them? Second, what criteria or principles should be used to create good guidelines? Third, what problems or pitfalls exist in developing and disseminating guidelines? Fourth, in what ways can guidelines help improve medical care, and in what ways will they not be as practical or useful, particularly with respect to quality of care? Finally, what ethical context might guide deliberations on this topic?
Critical Interests and Sources of Familial Decision-Making Authority for Incapacitated Patients
Authors: Nelson James Lindemann
Published: June 2007

How ought we to understand the sources and limits of the authority of family members to make health care decisions for their decisionally incapacitated relatives? This question is becoming increasingly crucial as the population ages and the power of medical technology waxes. It is also becoming increasingly contested, as faith in advance directives shows signs of waning, and the moral complexities of intimate relationship become more theoretically patent.

This last point—the newly visible moral richness of intimate relationship—provides this paper with its field. I am interested in probing the images of the relationship between self and other, particularly self and intimate other, that seem presupposed by some leading attempts to determine the basis for proxy decision-making authority, and what constraints it must observe. In the light of both recent work in the philosophy of mind and considerations closer to common experience, the reigning images seem too slight to support the weight of current practices and beliefs about proxy authority; supplanting them with images more faithful to our experience will have implications for our practice with proxies.
Should We Hold the (Germ) Line?
Authors: Parens Erik
Published: June 2007

In 1982, the President's Commission produced its report on human gene therapy. One of that report's recommendations was to expand the Recombinant DNA Advisory Committee (RAC) to the National Institutes of Health to include a subcommittee on human gene therapy. In 1984, the Human Gene Therapy Subcommittee was established, and in 1989 it produced a document—“Points to Consider for Protocols for the Transfer of Recombinant DNA into Human Subjects”—that stated the RAC's position on what sorts of protocols it would approve.

In assessing the impact of the President's Commission report, Alexander Capron wrote,

[t]he line [the report] drew between somatic cell and germ-line therapies has shaped subsequent discussions and policy formulation. Its conclusion … that somatic cell therapy resembles medical treatment is the basic premise of the RAC subcommittee's “Points to Consider,” while the Commission's view that ethical as well as technical barriers preclude present attempts to alter germ cells continues to be generally accepted by scientists and nonscientists alike.
Ethically Important Distinctions among Managed Care Organizations
Authors: Christensen Kate T.
Published: June 2007

Due to society's need to control health care costs and to the failure of legislated health care reform, managed care is expanding at a rapid rate and will soon be the predominate form of health care delivery. Plans by Congress to bring Medicare and Medicaid under managed care will further consolidate this trend. Barring some legislative fiat, managed care is here to stay.

The termmanaged caredescribes a diverse set of organizational forms. Wide variations in approach, financing, physician involvement, and philosophy exist among the different types of managed care organizations (MCOs). While many articles on the ethics of managed care acknowledge this variety, most analyses focus on the for-profit entities, paying less attention to the ethical distinctions among the different forms of managed care. This paper discusses the key distinctions among MCO types, in particular the difference between for-profit and non-profit plans; the relationship of the physician to the MCO; the incentives used to control costs; the incentives that improve patient care; and the organizational features that nurture the principled practice of medicine.
Ethics Consultation: Persistent Brain Death and Religion: Must a Person Believe in Death to Die?
Authors: Spike Jeffrey , Greenlaw Jane
Published: June 2007

We first heard about this case from nurses in one of our intensive care units (ICUs) while we were conducting an inservice. When the session was over, we discussed it between ourselves, and decided that it must have been misrepresented. The case had been presented as one of a teenager who was brain dead, had been so for six months, yet had been brought into the ICU for treatment. We have run into this before, we thought: medical professionals confusing brain death with persistent vegetative state (PVS). But, of course, we reasoned, no one can be brain dead for six months. To us, as it would to many, the case sounded like a clinical and ethical impossibility.

A week later, we were called by an attending physician from another ICU, at the urging of that unit's nursing staff. They had a patient who was brain dead, whose presence was causing distress among the staff. Ronald Chamberlain, a fifteen-year-old boy, had been a patient at a nearby longterm rehabilitation facility that is equipped to care for ventilator-dependent patients.
Nevada Court Clarifies Recovery in Wrongful Birth Claim
Authors: Gralton Sean H.
Published: June 2007

On March 30, 1995, the Supreme Court of Nevada, in Greco v. United States, determined that medical professionals who fail to make a timely diagnosis of gross and disabling fetal defects, thereby denying a pregnant woman her right to terminate a pregnancy, had acted negligently, and a malpractice claim could be brought against them. The court supported the plaintiff's claim of “wrongful birth,” but determined that the disabled child born to the plaintiff has no personal cause of action for “wrongful life.”

Sundi Greco, the plaintiff, alleged that her doctors at Nellis Air Force Base in Nevada failed to make a timely diagnosis of her son's physical defects and abnormalities before his birth. Their negligence denied her the opportunity to terminate her pregnancy, causing her damages attendant to the avoidable birth of a child with birth defects. On her child's behalf, Greco asserted that the physicians' negligence, and resultant denial of his mother's right to terminate the pregnancy, allowed him to be born into a “grossly abnormal life of pain and deprivation.”
Genetic Privacy
Authors: Gostin Lawrence O.
Published: June 2007

Human genomic information is invested with enormous power in a scientifically motivated society. Genomic information has the capacity to produce a great deal of good for society. It can help identify and understand the etiology and pathophysiology of disease. In so doing, medicine and science can expand the ability to prevent and ameliorate human malady through genetic testing, treatment, and reproductive counseling.

Genomic information can just as powerfully serve less beneficent ends. Information can be used to discover deeply personal attributes of an individual's life. That information can be used to invade a person's private sphere, to alter a person's sense of self- and family identity, and to affect adversely opportunities in education, employment, and insurance. Genomic information can also affect families and ethnic groups that share genetic similarities.
Drafting the Genetic Privacy Act: Science, Policy, and Practical Considerations
Authors: Annas George J. , Glantz Leonard H. , Roche Patricia A.
Published: June 2007

Only 27 percent of Americans in a 1995 Harris poll said they had read or heard “quite a lot” about genetic tests. Nonetheless, 68 percent said they would be either “very likely” or “somewhat likely” to undergo genetic testing even for diseases “for which there is presently no cure or treatment.” Perhaps most astonishing, 56 percent found it either “very” or “somewhat acceptable” to develop a government computerized DNA bank with samples taken from all newborns, and their names attached to the samples. This does not necessarily mean the public is unconcerned about genetic privacy. More likely it means that the public is still uninformed about the risks associated with genetic testing, and has not thought at all about the risks involved in storing identifiable DNA samples.

A central question presented by genetic screening and testing is whether the genetic information so obtained is different in kind from other medical information (such as family history and cholesterol levels), and, if so, whether this means that it should receive special legal protection.
The Dangers of Directives or the False Security of Forms
Authors: Hoffmann Diane E. , Zimmerman Sheryl Itkin , Tompkins Catherine J.
Published: June 2007

During the past several years, numerous studies have been conducted regarding advance directives (that is, living wills and durable powers of attorney (DPAs) for health care). Studies have examined how many individuals have executed advance directives, who is more likely to execute such directives, and whether factors such as education, income, race, religiosity, or family status affect the likelihood of having executed an advance directive or one's willingness to do so. Studies have also investigated the effectiveness of different educational strategies aimed at increasing the number of individuals who execute these documents. Finally, a number of researchers have looked at the implementation of advance directives (that is, whether they are followed in the institutional setting).

Although we now have a better understanding of some of these issues, one area that has been virtually ignored is the reliability, validity, and overall user friendliness of the advance directive forms themselves, and, in particular, of the statutory advance directive forms.
Harms of excluding Pregnant Women from Clinical Research: The Case of HIV-Infected Pregnant Women
Authors: Kass Nancy E. , Taylor Holly A. , King Patricia A.
Published: June 2007

Since the beginning of the AIDS epidemic, the proportion of AIDS cases among women has continued to rise. Women constituted 23 percent of the AIDS cases reported to the Centers for Disease Control and Prevention (CDC) in 1995, and 81 percent of these women were of childbearing age (13 to 44 years). It was not until 1991, however, that epidemiological studies of women were initiated. By comparison, the representation of HIV-infected women in clinical trials gradually has grown. Undoubtedly, a consequence of the increased numbers of women in clinical and epidemiological research is the earlier identification of and more appropriate treatments for HIV-related syndromes when women present in the clinical setting. Despite this expanded focus on women, however, clear information to guide the treatment of HIV-infected women who are pregnant is still lagging behind.
Minor Rights and Wrongs
Authors: Oberman Michelle
Published: June 2007

Inconsistency may well be the hallmark of the teenage years. Frequently, teenagers are serious and adult-like, yet just as often, they are callow and unpredictable. Generally, they are all of these things, in no particular order. They studiously observe the adults in their lives, adopting certain values and behaviors, while wholly rejecting others. Their moods shift without warning, leaving entire households with the sensation that they are living on a roller-coaster. As a result, it is not entirely surprising that the legal system has had difficulty deciding how to respond to them. The laws devised to govern teenagers are layered, reflecting society's alternating perceptions of teenagers as adult-like and child-like, and our accompanying impulses to respect as well as to protect this population. Read together, these laws defy any consistent description of adolescent capacity. We have lived with these inconsistencies for so long, though, that they have grown rather familiar to us, and that we hardly recognize the puzzle in the fact that we trust eighteen year olds enough to let them fight and die in the military, but not enough to let them drink alcoholic beverages.
Placebo Orthodoxy in Clinical Research II: Ethical, Legal, and Regulatory Myths
Authors: Freedman Benjamin , Glass Kathleen Cranley , Weijer Charles
Published: June 2007

Placebo-controlled trials are held by many, including regulators at agencies like the United States Food and Drug Administration (FDA), to be the gold standard in the assessment of new medical interventions. Yet the use of placebo controls in clinical trials has been the focus of considerable controversy. In this two-part article, we challenge a number of common beliefs concerning the value of placebo controls. Part I critiques statistical and other scientific justifications for the use of placebo controls in clinical research. The continued use of placebo controls in clinical trials on diseases for which accepted treatment exists raises equally important ethical, legal, and regulatory issues for which various justifications have been given. Defense of this practice relies on normative as well as empirical myths.

In their attack on the prevailing use of placebo controls, Kenneth Rothman and Karin Michels emphasize that this practice stands in violation of the World Medical Association's guidelines on the ethics of human experimentation, most commonly known as the Helsinki Declaration.
Falsification of Credentials in the Research Setting; Scientific Misconduct?
Authors: Parrish Debra M.
Published: June 2007

The debate about the definition ofscientific miscon ductis being revisited by the scientific community in response to the Commission on Research Integrity's (CRI) recommendation for a new definition. Scientists and lawyers are debating whether scientific misconduct should include acts that are not unique to the scientific community and do not affect the research. Falsification of credentials is one form of such misconduct.

The Office of Research Integrity (ORI) and the National Science Foundation (NSF), the two federal agencies primarily responsible for developing policies onscientific misconduct, have struggled to define scientific rnisconduct and to decide which forms of professional misconduct do and do not fall within the definition. Although falsification of credentials is not unique to the scientific community, OR1 and NSF have determined that when researchers lie about their credentials, such conduct may constitute scientific misconduct. The question is why this form of professional misconduct has been labeled scientific misconduct when it occurs in a research setting, and whether any distinction exists between this white coat crime and white collar crime.
Controlled Substances and Pain Management: Regulatory Oversight, Formularies, and Cost Decisions
Authors: Pisano Douglas J.
Published: June 2007

Pharmacists, physicians, and other health care personnel practice within an integrated system of laws and regulations that influence many treatment modalities. Capitation, managed care, and other controls strain these relationships by mandating greater oversight of how health care is delivered. From a pharmacists’s perspective, any use of medication requites knowledge of three omnipresent factors: regulatory control, formularies (product selection), and economic decision making. My objective is to raise awareness of these issues as they relate to the prescription of pain medication and to pain management generally.

All practice-oriented drug law and regulation is based on the federal Controlled Substances Act of 1970. The Act, also known as Title II, is part of a much larger piece of legislation, the Comprehensive Drug Abuse Prevention and Control Act of 1970 (CSA). CSA was enacted to regulate the manufacturing, distribution, dispensing, and delivery of drugs or substances that are subject to, or have the potential for, abuse or physical or psychological dependence.
Disciplinary Actions and Pain Relief: Analysis of the Pain Relief Act
Authors: Johnson Sandra H.
Published: June 2007

The problem is pain. Patients and their families tell the story:

He is your son. You love him. You want to help him in every way you can, but when he is in that kind of pain, you are helpless in a sense. Im his daddy. It was-what was I supposed to do for him? I felt, you know, helpless.

It terrifies you. You want to run away from it. Pain is something you wish would kill you but does not. Agony results from the pain that does not have the decency to knock you out.

[W]e had a good family, but how much can you watch? How much suffering can you watch from your child, your 7-year-old child, and still keep your mind?

I am a forty-six-year-old registered nurse who specializes in oncology care and education. I am also a patient who suffers from chronic nonmalignant pain, and this malady has been the most frightening, the most humiliating, and the most difficult ordeal of my life .
Clinical Commentary: The Law of Unintended Ethics
Authors: Biesecker Leslie G.
Published: June 2007

The law of unintended consequences is generally applied to technological advances that solve one problem but cause another. In this view, the problem created may be worse than that which was solved, hence the law is used as an argument against technological advances. Concern about intent and consequence comes to mind when reading the article by Ronald Green on parental decision making and prenatal genetics. Green's analysis, combined with the realities of genetic practice, raises questions about parental power, eugenics, and the interests of children affected by genetic or congenital disorders. Green proposes rules and draws conclusions that are not useful for clinicians and that promise harm to families and individuals affected by genetic disorders. Green's analysis may be an example of a corollary that could be viewed as the Law of Unintended Ethics.

Green's paper begins with an apparently contradictory dual thesis. First, he supports unfettered parental decision making about their fetuses and children. Second, he suggests that we should strive to give our children lives unimpaired by serious genetic (or congenital) disorders.
Creutzfeldt-Jakob Disease: The Problem of Recipient Notification
Authors: DuVal Gordon
Published: June 2007

In the past twelve to eighteen months, another perceived threat to the safety of America's blood supply has arisen. The fear is that Creutzfeldt-Jakob disease (CJD) will join hepatitis, HW and AIDS in the public and medical consciousness as the 1990s next infectious disease epidemic. A particular kind of ethical dilemma has arisen causing much debate and consternation for hospitals, regulators, and blood suppliers, and has elicited a remarkably varied response.

CJD is a rare but uniformly fatal neurological disease: it affects the brain and the rest of the central nervous system. Its incidence in the population of the developed world is about one per million per year, although some geographic anomalies exist. CJD manifests itself in two broad ways. First, the disease is associated with symptoms of mental deterioration and dementia, including memory loss, anxiety, and cognitive impairment. Second, CJD is also associated with a range of neurological symptoms, including muscle rigidity, seizures, tremors, muscle twitching, and spasticity, as well as problems with muscle coordination and unsteady gait, sometimes resulting in total disability.
Procreation by Cloning: Crafting Anticipatory Guidelines
Authors: Bonnicksen Andrea L.
Published: June 2007

To clone humans is deliberately to generate two or more individuals who share the same nuclear deoxyribonucleic acid (DNA). Using animals, researchers have performed two basic types of cloning that will eventually yield commercial benefits. Embryo twinning involves separating the individual cells of an embryo and allowing each to cleave for later transfer to a uterus. Cloning by nuclear transfer involves removing the nuclei from embryonic cells or fetal or adult somatic (body) cells and fusing those nuclei with enucleated donor egg cells. Although for the purposes of commercial biotechnology these techniques do not raise undue concern when attempted with animals, embryo twinning, embryo nuclear transfer, fetal somatic cell nuclear transfer, and adult somatic cell nuclear transfer all provoke intense ethical discussions when considered for human use.
Money-Back Guarantees for IVF: An Ethical Critique
Authors: Murray Thomas H.
Published: June 2007

When infertility clinics offer money-back guarantees, they prefer to give them more delicate names such as “shared risk,” “warranty,” or “outcome” programs. We should not allow such daintiness to distract us from the bottom line of these programs which are all about the bottom line.

John Robertson and Theodore Schneyer defend such programs as special forms of insurance, what they call “risk-of-failure insurance.” They argue, in “Professional Self-Regulation and Shared-Risk Programs for In Vitro Fertilization,” that the criticisms of in vitro fertilization (IVF) shared-risk programs by the American Medical Association (AMA) and others are off the mark. It would be sufficient, Robertson and Schneyer contend, to develop guidelines for informed consent or protocols that discourage risky clinical procedures. They acknowledge that shared risk plans “present problems if not offered with full disclosure and attention to patient interests,” but they insist that “there is no reason why they cannot be implemented in an ethically sound way.”
Medical Record Confidentiality and Data Collection: Current Dilemmas
Authors: Woodward Beverly
Published: June 2007

All scientific activity involves some method of observation and some method of recording what is observed. These activities can be carried out in ways that involve little interaction between subject and object, as is the case when a telescope observes a far-away star. At the other end of the scale are experiments in modern high energy physics in which there is little distinction between the observer and the observed, and the process of observation materially affects the data that are recorded. In this regard, research on human phenomena resembles modern physics more than it does classical astronomy.

Research on human phenomena, however, differs from modern physics in the way in which it affects that which is observed. Both the procedures and the findings of research on human phenomena alter the modes of thinking and the self-awareness of the (human) objects of study.
Institutional Efforts to Promote Advance Care Planning in Nursing Homes: Challenges and Opportunities
Authors: Bradley Elizabeth H. , Blechner Barbara B. , Walker Leslie C. , Wetle Terrie T.
Published: June 2007

During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals (10 to 25 percent) have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.

In December 1991, the federal Patient Self-Determination Act (PSDA) became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments.
Genetic Privacy and Confidentiality: Why They are So Hard to Protect
Authors: Rothstein Mark A.
Published: June 2007

Genetic privacy and confidentiality have both intrinsic and consequential value. Although general agreement exists about the need to protect privacy and confidentiality in the abstract, most of the concern has focused on preventing the harmful uses of this sensitive information. I hope to demonstrate in this article that the reason why genetic privacy and confidentiality are so difficult to protect is that any effort to protect them inevitably implicates broader and extremely contentious issues, such as the right of access to health care. Moreover, the tentative legislative and policy steps undertaken and proposed thus far have been, for the most part, misguided, simplistic, and ineffective.
Clinical Commentary: The Challenges of Genetic Medicine to the Patient-Physician Relationship
Authors: Pauker Susan P.
Published: June 2007

The interface between genetic research results and clinical practice occurs when patients present them- selves to physicians. When patients ask their doctors about the potential impact of a family disease on themselves, their children, and their grandchildren, physicians have an opportunity to be helpful. Unfortunately, the scientific discoveries are occurring faster than most physicians can read about them in their speciality journals and hence adjust their practice. Meanwhile, the press and media are proclaiming the latest scientific breakthroughs, creating a preventive and curative expectation that physicians cannot fulfill.

In this time of health system reorganization and consolidation, many people do not know who their primary caregiver is, no less which insurer is likely to cover which visit or genetic test.
A Tribute to Jonathan Mann: Health and Human Rights in the AIDS Pandemic
Authors: Gostin Lawrence O.
Published: June 2007

It was a characteristically cold, bright morning in Geneva in 1986, and I had just taken the Number 8 bus from the Cornavin to the headquarters of the World Health Organization (WHO). I wandered into a cluttered and cramped office filled with unopened boxes and scattered papers. Jonathan Mann and a competent Swiss secretary, Edith Bernard, had just moved in. Together, they alone constituted the WHO team that would mobilize the global effort against an emerging plague-the acquired immunodeficiency syndrome (AIDS). Jonathan had recently come from Kinshasa where he led Projet SIDA, an innovative international program to reduce the already weighty burden of the human immunodeficiency virus (HIV) in Africa.
Charitable Hospital Accountability: A Review and Analysis of Legal and Policy Initiatives
Authors: Noble Alice A. , Hyams Andrew L. , Kane Nancy M.
Published: June 2007

Hospitals long ago shed their role as alms houses for the poor. What vestiges remain of the early American hospital are the tax-exempt, nonprofit hospital form and a general perception that hospitals, as charitable institutions, owe a duty to their communities. The appropriateness of the nonprofit hospital tax exemption has long been debated, and many theories have been advanced to justify the tax exemption of nonprofit hospitals. In a growing number of jurisdictions, however, state and local authorities have gone beyond the theoretical debate and are challenging the tax exemption of their nonprofit hospitals. For various reasons, efforts are afoot to capture greater community benefit from nonprofit hospitals.

At the heart of such challenges is the debate over the nature and extent of the duty charitable institutions owe to their communities. A demand is growing for nonprofit hospitals to earn their tax exemptions by benefiting their communities in concrete ways. Some have been stripped of their tax-exempt status by local authorities or pressured to make payments in lieu of taxes. A number of states have recently implemented initiatives in an attempt to make hospitals more accountable for their community benefits. Many hospitals are responding to this heightened scrutiny in a proactive way, by voluntarily documenting community benefits. A number of nonprofit hospitals and hospital associations are cooperating with—or even sponsoring—state legislation in this area.
Bioethics and the Whole: Pluralism, Consensus, and the Transmutation of Bioethical Methods into Gold
Authors: Martin Patricia A.
Published: June 2007

In 1785, George Washington described a “knowing farmer” as “one who can convert every thing he touches into manure,as the first transmutation towards Gold.”With these words, Washington linked the “knowing farmer” to the alchemist who endeavored to transform base metals into gold with the aid of a philosopher's stone. In each instance, the challenge was to convert raw materials into something new and precious.

Today, the “knowing bioethicist” is in a similar position. American bioethics harbors a variety of ethical methods that emphasize different ethical factors, including principles, circumstances, character, interpersonal needs, and personal meaning. Each method reflects an important aspect of ethical experience, adds to the others, and enriches the ethical imagination.
Are We Prepared for Tomorrow’s Health Challenges?
Authors: Monson Angela Z. , Hardy George E. , Thompson Ed
Published: June 2007

Thank you so much for the invitation to be here with you. It is always a pleasure to be with people who understand, believe in, and know the importance of public health. Those of us who work in the legislative arena know how infrequent it is to have dialogue and conversation with people who really have a good, tangible, hands-on working knowledge of health care, and particularly of public health.

The notion of public health is an interesting one. It will range—if you talk to people in the legislature or out of the legislature—from just complete ignorance to total unawareness of what we mean by the words “public health.” When you talk to individuals like us in this room, we find a mixture of definitions, a mixture of understandings, and a mixture of appreciation as to what public health really is.
New Pressures/New Partnerships: Public Health and Law Enforcement
Authors: Karchmer Cliff , Tully Pam , Devlin Leah , Whitney Frank , Sage Michael
Published: June 2007

The, Police Executive Research Forum is completing a major initiative that encourages police chiefs to formalize working relationships with emergency medical personnel. The effort is sponsored by the U.S. Department of Justice, Bureau of Justice Assistance as a demonstration with the goal of preventing recurring violence that eventually leads to homicide. The initiative originally involved a consortium of emergency room clinicians, emergency medical service (EMS) personnel, as well as police executives. The collaboration initially focused on arguably preventable dimensions of domestic violence and homicide. However, after “9/11” and the ensuing anthrax crisis, the project developed into a three-step draft interactive protocol for earlier police intervention in situations involving possible deaths and mass casualties. With this shift in the project, Police Executive Research Forum’s (PERF) principal collaborators shifted from emergency clinicians to public health practitioners.
Should Your State Have a Public Health Law Center?
Authors: Moore Jill , Ashe Marice , Gray Patricia , Blanke Doug
Published: June 2007

The Tobacco Control Legal Consortium is a national “network” designed to tap expertise about tobacco control legislation and to leverage existing resources. Based at the William Mitchell College of Law in St. Paul, Minnesota, the Consortium supports local counsel with research, strategic advice, sample materials and pleadings, and amicus briefs. The Consortium’s priorities are to support capacity nationally, to offer education, and to perform outreach activities to a variety of audiences.

The Consortium seeks to advance policy change by making legal expertise more readily available to the tobacco control community. Legal issues are inevitably involved in policy change. The Consortium does not provide legal representation, but conducts analysis and research. They publish on important and emerging legal issues as well as on specific cases, assist in the development of legislation, and train public health practitioners and policy makers on recurring legal issues.
Using Science-Based Guidelines to Shape Public Health Law
Authors: Zaza Stephanie , Clymer John , Upmeyer Linda , Thacker Stephen B.
Published: June 2007

Compared to evidence-based public health, evidence-based medicine is a more familiar phrase. Evidence-based medicine has become increasingly popular in the past decade, due in large part to the emergence of computerized database search technology and advanced statistical tools which allow researchers to quickly identify and summarize vast amounts of scientific information.

Today, the concept of evidence-based public health is gaining momentum and has grown in popularity. However, the term “evidence-based” lacks clarification and is subject to a variety of interpretations. The evidence that supports evidence-based medicine or public health may include individual experience, anecdotal information, the content of a single scientific article, or the results of a sophisticated systematic review of scientific literature. The imprecise language used to describe evidence leads to confusion over what types of evidence are most appropriate in answering different types of questions.
The HIPAA Privacy Rule: Reviewing the Post-Compliance Impact on Public Health Practice and Research
Authors: Kutkat Lora , Hodge James G. , Jeffry Thomas , Bontá Diana M.
Published: June 2007

Current economic conditions have coincided with the implementation of the Health Insurance Portability and Accountability Act (HIPAA) and forced public health officials to consider how to ethically incorporate compliance into their already strained budgets, while maintaining the integrity and intent of the legislation.

As of April 14, 2003, the HIPAA Privacy Rule provides a new federal floor of protections for personal health information. The Privacy Rule establishes standards for the protection of health information held by many physicians’ offices, health plans, and health care clearinghouses. The Rule protects personal health information by establishing conditions regulating the use and disclosure of individually identifiable health information by these entities, also referred to as covered entities. The Rule does not prevent the daily operations of health care establishments (i.e., the treatment of patients and the collection of payment).
The Role of Non-Governmental Organizations (NGOs) in Public Health Law
Authors: Ruhl Suzi , Stephens Mari , Locke Paul
Published: June 2007

NGOs can play an important role in the development, implementation, and reform of public health laws. To be effective, NGOs must recognize the critical role law plays in protecting the health of the public and in the public health system’s emergency preparedness. They must be ready to work with federal, state, and local leaders to advance the goals that public health laws were enacted to achieve. NGOs also have technical expertise, which they can utilize to help translate highly complex scientific concepts into public health action steps that regulators, legislators, and members of the public can readily understand.

Those who are most often affected by pollution tend to be low income people, the working class, Native Americans, and people of color. Those most affected by pollution issues, however, usually have the least input in the creation of policy.
Workshop on Public Health Law and Ethics I & II: The Challenge of Public/Private Partnerships (PPPs)
Authors: Reich Michael R. , Hershey Jody Henry , Hardy George E. , Childress James F. , Bernheim Ruth Gaare
Published: June 2007

The issue of public health ethics has received much attention in recent years and is seen as a new field, distinct from medical ethics. Faculty from the University of Virginia, Johns Hopkins School of Public Health, Georgetown University, the University of Minnesota, and others received a grant from the Greenwall Foundation to examine this new field of public health ethics and identify the unique principles that distinguish it from the study of medical ethics. In the course of that study, which included exploring the field with public health practitioners, a number of distinguishing ethical principles emerged. The moral principles appropriate for public health officials included producing benefits; avoiding, preventing and removing harms; producing a maximum balance of benefits over harms; and distributing benefits and burdens fairly.
Public Health Ethics: The Voices of Practitioners
Authors: Bernheim Ruth Gaare
Published: June 2007

Public health ethics is emerging as a new field of inquiry, distinct not only from public health law, but also from traditional medical ethics and research ethics. Public health professional and scholarly attention is focusing on ways that ethical analysis and a new public health code of ethics can be a resource for health professionals working in the field. This article provides a preliminary exploration of the ethical issues faced by public health professionals in day-to-day practice and of the type of ethics education and support they believe may be helpful.
Science, Psychotherapy and Anti‐Psychiatry
Authors: Will David
Published: June 2007

ABSTRACT: I give here a brief review of Bhaskar's transcendental realist view of science both to clarify my differences with my critics and to spell out some of the ideas presupposed in an earlier paper (Will 1984). I hope that this exposition might stimulate readers to explore Bhaska's own writings.
The Impact of Maternal Depression on Young Children
Authors: Pound Andrea , Puckering Christine , And Tony Cox , Mills Maggie
Published: June 2007

Depression in mothers of young children is a common condition, and is highly associated with disturbance in the children and with later reading delay. A group of depressed and control women with children aged two and three was interviewed and observed at home and the children assessed. The depressed women had more difficult backgrounds and more current adversity than the controls. They played and talked as much with their children, but the quality of interaction was less satisfactory, with poorer‘meshing’, more distress and more unresolved conflict. Social policy and service implications are discussed.
Jung: A Racist
Authors: Dalal Farhad
Published: June 2007

ABSTRACT: The paper examines Jung's perception of the non‐European. It is argued that his perception of black people is racist and that these same views permeate the entire fabric of Jung's psychological theory. Further, that these views are woven into the theoretical foundations of two major Jungian concepts: the Collective Unconscious and Individuation. Finally, the paper examines the consequences of these theories as perceived by Jung, in terms of the possibilities or otherwise of people of different races living together.
Superego‐Based Physical Symptoms
Authors: Elliott Mitchell
Published: June 2007

SUMMARY. Freud's‘Dora’case is an example of hysteria in which the symptoms themselves are fundamentally id‐phenomena modified and disguised. In other hysteria cases the symptoms may originate in the harsh superego and represent childhood punishments, reinvoked in a desperate effort to hold forbidden impulses in repression. Analytic interpretation of such symptoms can help to loosen the repressive barrier. At the same time the fact of reinvocation of childhood punishments can alert the analyst to the presence of forbidden impulses clamouring for expression.
A Relation Called Father Part 1: The Father in Depth Psychology
Authors: Samuels Andrew
Published: June 2007

SUMMARY (OF PARTS 1 AND 2). In Part 1 an analysis is made of the neglect of the father in depth psychology. This is followed by an attempt to find meaning and purpose in incestuous fantasy and behaviour. The role of the father in the formation of gender identity in his sons and daughters is discussed. In Part 2 it is proposed that clinicians begin to think of an optimally erotic relation between father and daughter, and of the father as transforming the aggression of the son. A further new concept is introduced, that of unconscious‘gender certainty’. The paper includes some reflections on the general cultural aspects of the ideas raised in it.
New Ideas About the Unconscious Family Structure
Authors: Berenstein Isidoro
Published: June 2007

SUMMARY. Unconscious Family Structure (UFS) is the virtual, symbolic space, the deep level level where lies the meaning which organises the family relations or the manifest level. Within the UFS space there are subspaces: that of the marital couple, later to become the parents, that of the children in relation to the parents, that of the children in relation to each other. Within these subspaces certain places are to be found: the father's place, the mother's place and the child's place. Between the spaces lie the relationships or links: the couple or marital link; the filial link between parents and their children; the consanguineous link between siblings. To these I add a fourth: the avunculus link with the representative of the mother's family.

I depict a series of verbal or preverbal stipulations: the unconscious accords, pacts and rules.

In addition I describe four UFS configurations: grade a (‘normal’), b (‘neurotic’), c‘perverse’) and d (‘psychotic’).

I conclude with some observations about family transference and countertransference.
Supervision: A Choice between Equals?
Authors: Jones Richard
Published: June 2007

ABSTRACT. The two main functions of supervision are safeguarding the patient and training the therapist. When difficulties arise in therapy the supervisor faces the dilemma of which of these is his priority. The purpose of this paper is to suggest a solution to this by focusing on the role responsibilities of the supervisor.
Listening With the Body: An Exploration in the Countertransference
Authors: Field Nathan
Published: June 2007

ABSTRACT. This paper describes a specific but little‐discussed manifestation of the countertransference: namely the spontaneous arousal of physical feelings in the therapist. It considers three questions arising from this phenomenon: (1) Are they meaningless bodily sensations or evidence of unconscious communication from the patient? (2) If the latter, do they have any therapeutic relevance? (3) What sort of psychological mechanism might enable such messages to be transmitted?
Symbolism in a Group
Authors: Whyte Robert
Published: June 2007

The theoretical background to symbolism is introduced with reference to the work of Klein and Segal. Thereafter, an analytical psychotherapy group conducted in a day hospital is described and thumbnail sketches of the individual patients are given. Several group sessions in the course of a month are reported. The use or absence of symbolism in the group is discussed with particular reference to the primitive level of functioning of the group and the use of‘bad’language by the group.