bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional water quality management for the Karun–Dez River basin, Iran
Authors: Afkhami Mehran , Shariat Mahmood , Jaafarzadeh Nemat , Ghadiri Hossein , Nabizadeh Ramin
Published: June 2007

To achieve water quality goals in a river basin, a water quality management model (WQMM) has been developed through the geographic information system (GIS) approach and a mathematical water quality model. The developed model has been applied to the Karun and Dez Rivers, where water quality has decreased due to heavy pollutant loads from Khuzestan province cities and surrounding areas. Pollution sources, land use, geographic features and measured water quality data of the river basin were incorporated into the Arc‐View GIS database. With the database, the management model calculated management type and management cost for each management project in the river basin. Until now, river management policy for polluted rivers in Iran first penalizes pollution sources and then constructs treatment plants for the pollution sources whose wastewater is released untreated and for which the wastewater quality goal of the Iranian Department of Environment is not met. Different management projects with a time programme were proposed and they were compared with the results of the river quality without any management approach. It became clear that the results based on the management approach were much better than those for the unmanaged condition from the viewpoint of the achievement of water quality goals and cost optimization.
The Medical Device Amendments of 1976
Authors: Needleman Gordon
Published: June 2007

by Gordon Needleman, Esq.

On May 28 1976 President Ford signed the Medical Device Amendments of 1976 (Amendments) to the Federal Food Drug and Cosmetic Act (FDCA) which substantially increase regulatory control of medical devices The Amendments are the first major Federal legislation concerning the regulation of medical devices since the FDCA of 1938 This article presents a summary of the background leading to the Amendments and 115 important provisions.

Background

The legislative history of the 1938 Act indicates it was intended to provide limited Food and Drug Administration (FDA) control over medical devices In 1938 most medical devices were of simple Construction and operation allowing health practitioners to easily determine if the devices were functioning properly Under the 1938 Act, the FDA functions were mainly surveillance and policing Tho policing was accomplished through the Federal Court system an expensive and time-consuming Process.
Mass. Supreme Judicial Court Reverses Conviction of Dr. Kenneth Edelin
Authors: Glantz Leonard H.
Published: June 2007

On April 12,1974 Dr. Kenneth Edelin was indicted for manslaughter in connection with a legal abortion he performed at Boston City Hospital. Specifically he was charged with causing the death of the baby boy who, the prosecution charged, was born as the result of a hysterotomy. After a lengthy trial that consisted almost exclusively of complex medical testimony Dr. Edelin was found guilty of the charge. On December 17, 1976 the Massachusetts Supreme Judicial Court reversed the verdict and ordered that a judgment of acquittal be entered.

All six judges who heard the case voted to reverse the conviction with five Justices deciding that a judgment of acquittal should be entered. These five Justices found that there was insufficient evidence lo go to a jury on the issue of whether Or. Edelin was guilty of wanton or reckless conduct, and that motions for a directed verdict of acquittal should have been granted by the trial judge. Three of the live Justices would have reached the same result on both the grounds that there was insufficient evidence of live birth. and that there was a prejudicial divergence between the accusation and the instructions to the jury.
The Role of Physicians in the Disability Programs of the Social Security Administration or the Care and Feeding of a Beneficent Monster
Authors: Franklin Joseph
Published: June 2007

The cover story of the June 12, 1978, issue of TIME magazine characterized the US. Department of Health, Education and Welfare as The Beneficent Monster. The physicians and lawyers of this nation often find themselves acting as sometime keepers and trainers of The Monster in many of its activities. While numbers of monstrous proportions may not intimidate the current generations who have witnessed the coining of the words googol (the number 1 followed by 100 zeros) or googolplex (10 raised to the 100th power), most of us are impressed when we discover that millions are affected and billions of dollars spent annually by the Social Security Administration.

That we will come into contact with The Monster is quite likely: As individuals we may become members of the beneficiary population; as practicing professionals, we may be involved in pursuing for another what may appear to be a tortuous process to guide that person to benefit status under the Social Security Administration Disability Programs.
Post-SaikewiczJudicial Actions Clarify the Rights of Patients and Families
Authors: Glantz Leonard H.
Published: June 2007

As Lee Dunn points out in his accompanying article, theSaikewiczcase has been widely misunderstood and misinterpreted by health care providers both in Massachusetts and elsewhere. Two Massachusetts Appeals Court cases,DinnersteinandLone v. Canduru,have clarified some of the more controversial aspects ofSuikewiczand should allay some of the fears which that case produced. The more important of the two decisions —Dinnerstein— involved the legality of “do not resuscitate” orders (DNR's) in the absence of a court order.

Mrs. Dinnerstein was diagnosed as suffering from Alzheimer's disease in July of 1975, although she probably had been afflicted with the disease since 1972. Alzheimer's disease is a progressive, unremitting disease of the brain which leads to disorientation, memory loss, loss of intellectual function, and, eventually, loss of all motor function. The usual course of the disease is five to seven years during which time the patient generally becomes a complete invalid and has to be institutionalized.
Judges at the Bedside: The Case of Joseph Saikewicz
Authors: Annas George J.
Published: June 2007

In what may prove to be the most controversial medicolegal decision of the year, the Massachusetts Supreme Judicial Court has ruled that, in certain cases, courts are the proper forum in which life-sustaining medical decisions should be made. The controversy goes deep. It involves questions of who should make life-prolonging decisions, in what forum, and on what criteria. Until the last few years, these questions arose almost exclusively in the context of Jehovah's Witnesses cases — cases in which life-saving blood transfusions were being refused for religious reasons. But with society's increasing consciousness about the way people die in hospitals, medical decisions are increasingly coming under public scrutiny.

Death, of course, is a natural process and a uniquely personal experience. If pressed to categorize it, most would probably term the major controversies surrounding it ethical, rather than medical or legal. Nevertheless, there is a trend to ask the courts whether or not life-sustaining treatment should or should not be withheld from patients who are unable to make this decision themselves.
Earle Spring
Authors: Doudera A. Edward
Published: June 2007

A new and potentially important decision is expected from the Massachusetts Supreme Judicial Court on the issue of withdrawing life-sustaining medical treatment from those unavailable to decide for themselves. The case of Earle Spring is but an example of an increasingly familiar situation: individuals who are not totally “incompetent,” and for whom there is a poor, dismal, and certain prognosis. The lives of hundreds of patients may depend upon being hooked up to life-sustaining or life-prolonging examples of medical technology, and some will indicate that they do not want such procedures to continue.

A right to refuse medical treatment is generally accepted and patients are. presumably, able to exercise this right and instruct their physicians to stop rendering medical care even if death is the clear result.
Health Planning and the Law: An Update on the Statute
Authors: Berriman W. Thomas
Published: June 2007

This column, the first in a series, addresses the legal background and program issues involved in comprehensive health planning, a concept that has become a permanent factor in the management of health care delivery. An examination of the 1974 Health Planning Act, its 1979 Amendments, and its evolution from voluntary planning to government control provides insights concerning the path of future regulation.

Planning for health care services originated in hospital and community initiatives that sought to guide the distribution of charitable and governmental funds to the neediest hospitals. Purely voluntary in nature, the success of these efforts depended almost entirely on the cooperation and acquiescence of the affected institutions, motivated primarily by their own desire to reduce competition among themselves in fund raising efforts. However, because the desirability of more services was usually assumed, little effort was made to measure the need for the services being proposed.
Legislative Efforts to Reform Medical Malpractice: Unconstitutional in Practice?
Authors: Dunn Lee J.
Published: June 2007

In response to the alleged medical malpractice crisis of the mid-1970s, many states enacted remedial legislation requiring that medical malpractice cases be filed and heard by some type of screening mechanism prior to being filed in the trial court. Several challenges to the constitutionality of those statutes were raised, but generally speaking, they were unsuccessful.

The most common challenge was that the statutes impermissibly discriminated against malpractice plaintiffs by requiring them to endure the expense and the time involved in such proceedings, as well as depriving them of their right to jury trial. The appellate courts considering these challenges generally upheld the legislation as an attempt by the legislatures to remedy a perceived crisis. Absent a showing of infringement upon a “fundamental right” or “suspect classification,” the legislation was held to be constitutional as it was reasonably related to the task sought to be accomplished. Such a response was predictable since, in most jurisdictions, there had been a marked increase in the number of malpractice actions filed as well as a marked increase in physicians’ malpractice insurance premiums.
The Case of Earle Spring: Terminating Treatment on the Senile
Authors: Glantz Leonard H.
Published: June 2007

Since the Massachusetts Supreme Judicial Court's opinion in Saikewicz, a great deal of controversy has existed over going to court prior to discontinuing or deciding not to commence medical care for the benefit of an incompetent person; the use of do not resuscitate (DNR) orders; the role of the family in making such decisions; the recognition of “brain death;” and the use of the incompetent's “quality of life” as a basis for making such determinations. Both the legal and medical communities waited expectantly while the Supreme Judicial Court considered the case of Earle N. Spring, with the hope that the court would resolve at least some of these issues. The opinion did clarify a number of important issues, but either did not deal with, or confused, others.
Implementing the Medical Device Amendments: The Case of Serum Vitamin B12 Kits
Authors: Necheles Thomas
Published: June 2007

Within the past decade, in vitro diagnostic kits have become increasingly important to the clinical laboratory. Smaller hospital laboratories, in particular, lack the resources to develop and evaluate the large number of laboratory tests considered standard today. For these laboratories, the commercially available reagents, packaged with directions for use, provide a simple method of adding an otherwise unavailable test to the laboratory “menu.” These laboratories, however, are precisely the ones which lack the time, resources, and personnel to evaluate each kit. Furthermore, many manufacturers provide little or no information to back up their labeling claims for in vitro diagnostic kits, and there is little independently published information on the subject. The laboratory director is left to rely upon the integrity of the manufacturer, and typically chooses between competing products on the basis of unit cost and ease of performance.

Congress addressed these problems with the Medical Device Amendments of 1976, which extended the application of the Food, Drug and Cosmetic Act.
An Open Letter from the ANA President
Authors: Nichols Barbara
Published: June 2007

Aparamount issue facing registered nurses in the eighties is the choice of trade union or professional association representation for purposes of collective bargaining. This act of choice recasts the profession's historical dilemma. The question no longer is whether professionalism is compatible with collective bargaining but rather, “Which labor organization shall represent me?”

History will record and interpret these events. As president of the American Nurses’ Association, my task is not to be reflective but to speak out. Will the profession's collective bargaining contracts be articulated by truck drivers, teachers, electricians, jewelry makers, and meatcutters rather than nurses? Who best can represent the professional and economic interests of nurses?

Let there be no mistake about it; the nursing profession is under siege by trade unions. This is not simply a battle for contracts, but for control of our right to speak in our own behalf on all issues confronting the profession.
Market Share Liability and the Health Care Professional
Authors: Brushwood David B.
Published: June 2007

Attorneys practicing in the area of drug-products liability occasionally encounter a case in which there is no question that the drug taken was defective or that misrepresentations were made concerning the drug, but it is impossible to identify the particular drug company that manufactured the product taken by the patient. This problem undoubtedly will be encountered more frequently in the years to come in light of the almost uniform repeal of antisubstitution laws, resulting in generic products being dispensed far more frequently now than in the past. A pharmacist will be unlikely to remember, years or even months later, which company’s product was used to fill a particular prescription. To resolve this problem, pharmacists in the future may have a duty to create and retain detailed records concerning which manufacturer’s products were used to fill specific prescriptions. Such records, if properly maintained, would eliminate problems encountered in many cases in which defective generic drugs were dispensed.
Medical and Legal Developments in Paternity Testing
Authors: Taub Sheila
Published: June 2007

Recently a front-page article in the New York Times reported on a new method of blood-testing for paternity determination which is “revolutionizing the way courts determine the identity of a child's father in paternity cases.” The HLA (Human Leucocyte Antigen) test represents a significant advance over the standard red blood cell antigen tests for paternity. The large number of genetically determined factors in the HLA system makes it possible, by typing the blood of mother, child, and accused father, to either 1) rule out the possibility that the man could be the child's biological father in a large number of cases where the man is falsely accused; or 2) show that the accused man has a high probability of being the child's biological father, where the possibility of paternity has not been ruled out. Red blood cell typing, because of the much smaller number of factors examined, could only exclude a falsely accused male in a relatively small number of cases.
Terminating Treatment for Newborns: A Theological Perspective
Authors: Paris John J.
Published: June 2007

In a recent issue of the Hastings Center Report, Paul and Marilyn Bridge discuss the difficulties and frustrations they encountered with the physicians and hospital concerning a proposal to withhold treatment from their severely defective newborn son, Christopher. Born some three months prematurely, he had signs of viral encephalitis. His long-term outlook was quite dim: he had severe mental retardation, and would possibly suffer from uncontrollable convulsions, deafness, blindness, and quadraplegia. Brain damage was extensive, and was thought to extend to the cortex. While Christopher was not terminally ill nor in any immediate danger of dying, the pediatrician suggested that there would be situations in the future which perhaps ought not be treated, such as infection or the aspiration of food. The family rejected that option, and insisted on treatment until Christopher, on his 75th day of life, suffered cardiac arrest. After three days of ventilator support, the parents agreed to discontinue the heroic means supporting their son whom they now believed to be terminally ill and approaching brain death.
Cancer and the Law of Informed Consent
Authors: Taub Sheila
Published: June 2007

The law of informed consent is in a state of flux. Originally a judicially-created doctrine, the doctrine varies from jurisdiction to jurisdiction in its theoretical basis for imposing liability (battery vs. negligence), the scope of the physician's duty to disclose (the “professional” vs. the. “prudent patient” standard), and, where negligence is the basis for the action, the requirement for finding proximate causation (subjective vs. objective basis). Many states have recently enacted statutes on informed consent which differ markedly in their provisions. Coexistent with this uncertainty about the precise form that the law should take, and perhaps underlying it, is a basic uncertainty about the purposes and rationale behind the informed consent doctrine, the feasibility of executing its dictates, and the effects of its application on the delivery of health care.
The Aftermath of Maricopa
Authors: Cohen Harry Philip , Tiano Linda V.
Published: June 2007

An individual practice association (IPA) is a corporation or a partnership composed of physicians which contracts with health maintenance organizations (HMOs) to provide medical services to HMO subscribers. Since physicians typically practice independently, any agreement or arrangement among them may be perceived as an agreement of competitors. Hence, IPAs run the risk of challenge under the antitrust laws for activities such as price-fixing and the exclusion of physicians from membership.

Prior to the recent Supreme Court decision in Arizona v. Maricopa County Medical Society, it appeared that courts were willing to consider a variety of factors that distinguished antitrust cases concerning health care providers from antitrust cases in the commercial marketplace, and to find that conduct by providers did not constitute antitrust offenses. Indeed, an earlier article appearing in Law, Medicine & Health Care analyzed the lower court's decision in Maricopa and discussed the development of this trend.
Hospital Collections: Can Hill-Burton Noncompliance Be Raised by Former Patients as an Affirmative Defense?
Authors: Speisman Albert
Published: June 2007

The Hill-Burton Program was enacted in 1946 to provide federal assigtance to communities for the purpose of constructing and modernizing health care facilities. As a condition of Hill-Burton funding, the contracting hospital is required to assume obligations of “uncompensated care” and “community service.” Indigents eligible for Hill-Burton free care can, after exhausting administrative remedies, obtain injunctive relief to enforce compliance with the Program's regulations. However, it is unsettled today whether a hospital's noncompliance with these obligations to provide free care can be raised as an affirmative defense in a hospital collection action. Until recently, courts throughout the country have held that a patient could not raise the affirmative defense of Hill-Burton noncompliance. Yet, the 1979 Hill-Burton Regulations, as well as the recent decision inHospital Center at Orange v. Cook,are indicators of the start of a contrary trend to allow the defense. This article examines the 1979 Regulations and court decisions on the affirmative defense and argues against allowing the defense.
The Causes of “Wrongful Life” Suits: Ruminations on the Diffusion of Medical Technologies
Authors: Furrow Barry R.
Published: June 2007

New causes of action in tort law do not simply emerge, fully grown, like Athena from the head of Zeus. They develop as a result of a struggle between older case law on the one hand and the need to respond to an emerging problem on the other. This metamorphosis can be seen in many areas of jurisprudence, but most notably in the fields of products liability and medical malpractice litigation.

The explosion in products liability litigation, for example, is linked in part to the vastly increased proliferation of a variety of consumer goods and to new forms of marketing mechanisms for selling these goods, so that consumers are exposed to a wider range of risks. Medical malpractice litigation in the “wrongful life” area similarly reflects not only a change in social values toward abortion, but also changes in the perceived ability of medicine to detect and predict defects in the unborn fetus or the likelihood of such defects based upon the genetic history of the potential parents.
The Forensic Pathologist's Role in Product-Related Deaths
Authors: Wecht Cyril B.
Published: June 2007

Product liability litigation may proceed under several theories when someone has suffered harm caused by a product furnished by a commercial supplier. Liability for injuries or death caused by defective products can be based on the negligence of the manufacturer, wholesaler, or retailer of a product; on breach of warranty; on misrepresentations made by the seller regarding the nature or quality of the product; and on a theory of strict liability. In all cases, however, the plaintiff must prove that the negligence of the supplier of the product or the defective or unreasonably dangerous product itself caused the injury. Very often the testimony of an expert witness on the issues of defect and causation may be required to establish a prima facie case.
Comments and Recommendations on the “Infant Doe” Proposed Regulations
Authors:   Committee on the Legal and Ethical Aspects of Health Care for Children
Published: June 2007

The decision whether or not to treat a newborn infant with a major birth defect or other life-threatening condition presents a multitude of medical, ethical and legal problems for all individuals involved. This is particularly true when the child’s prognosis, even with therapy, is uncertain or when treatment may result in or prolong a life fraught with substantial suffering. The proper roles of the physician and other hospital personnel, and especially of the child‘s parents, have yet to be fully or adequately resolved. Nonetheless, recent public awareness of isolated cases has made it clear that the status quo is not acceptable. The Committee on the Legal and Ethical Aspects of Health Care for Children (Children’s Committee) believes that hospitals and state agencies must do more to protect seriously ill newborns and to provide greater support—medical, psychological, and financial—to those in need.
Decisions about Hospital Staff Privileges: A Case for Judicial Deference
Authors: Hollowell Edward E.
Published: June 2007

The refusal of a hospital to grant medical staff membership and clinical privileges is, generally, subject to judicial review. Because a hospital can be held liable for negligence in the selection and retention of medical staff members, and because a hospital is better situated than a court to make a decision concerning staffing needs, courts should, and generally do, afford great deference to the appointment decisions of hospital governing boards and medical staffs. An analysis of selected cases involving judicial review of hospitals selection and retention of medical staff members will be instructive in reviewing judicial deference to hospital governing boards.

When a physician who has been denied medical staff membership and clinical privileges by a hospital seeks judicial review, the court generally first determines whether the hospital is private or public. This distinction frequently determines the outcome. The activity of a public hospital, as a governmental entity, is deemed state action. Under the fifth and fourteenth amendments to the Constitution, neither a state nor the federal government can deprive a person of life, liberty, or property without due process of law.
Impaired Children and Tort Remedies: The Emergence of a Consensus
Authors: Furrow Barry R.
Published: June 2007

The “medical malpractice crisis” in the 1970s involved not only a greater number of suits, but also the emergence of new sorts of claims against medical practitioners. One such claim was the wrongful birth suit, where parents sued their physician on their own behalf for negligence that resulted in the birth of an unwanted child. A related claim, wrongful life, involved a suit brought on behalf of a defective infant against a physician or laboratory that failed to give correct information about a potential defect to the parents. These claims have been the subject of much controversy for judges and commentators.

The debate over wrongful life suits involving “impaired” children continues. Courts in Michigan have recently rejected the wrongful life cause of action, while, in Washing ton, the action has been allowed. Some academic critics have also continued to oppose the wrongful life action. In a recent commentary in the pages of this journal, one critic wrote: “Wrongful life actions, by whatever name they may be called, accord with neither logic nor experience, and should not be allowed.”
Survey of Legislation on Third Party Reimbursement for Nurses
Authors: Cohn Sarah D.
Published: June 2007

Direct reimbursement by insurers for the services of nurses and nurse practitioners is a primary goal of many state and national associations of nurses. Direct reimbursement means either that a nurse is paid directly by the insurer for nursing or nurse practitioner services rendered, or that the patient is reimbursed for costs incurred for those services. The issue is important to nurses for several reasons.

First, reimbursement allows rhe consumer of health care a wider choice of types of providers from whom to purchase care. As a practical matter, if an insurer does not reimburse for the care rendered by one type of professional, patients are likely to seek care from another whose services are paid by health insurance. The General Accounting office, for example, has lited restrictive third party reimbursement practices as one of the obstacles impeding the wider use of nurse-midwives. Second, some types of health care are less expensive when rendered by a nurse or a nurse practitioner; reimbursement thus can provide quality care at a lower cost. Third, reimbursement is a form of recognition that practice styles are changing. In 1983, West Virginia became the first state that explicitly reimburses for care provided by “nonsalaried duly licensed registered professional nurses engaged in private nursing practice or partnership.”
Conflicting Rights of Privacy and the Duty of Disclosure Between Sexual Partners
Authors: Kohn Roger L.
Published: June 2007

Although only historians in the future will know, it appears that non-marital and unconventional sexual relations between individuals today are on the increase. One of the more notable landmarks of this trend is the case,Marvin v. Marvin,in which the court recognized the rights of unmarried cohabitants. Individuals now seek wider legal recognition of a variety of interpersonal relationships and, by so doing, are rejecting the limitations of society's traditional agreement, marriage.

This article examines a small subset of the legal interactions and consequences when individuals establish non-marital relationships. Two types of situations and cases will be examined—“reluctant paternity” and the transmission of herpes simplex disease. These may turn out to be unimportant legal curiosities, but they are useful for examining the conflict of rights of privacy and duties of disclosure (right to information) in intimate (here, sexual) interactions between two people. The cases to be examined in detail are in areas of great flux, where a court in one state cites to recently overturned decisions in another state's courts.
Is There a Pharmacist-Patient Privilege?
Authors: Brushwood David B.
Published: June 2007

Under a variety of circumstances, courts of law have attempted to compel pharmacists to publicly disclose confidential information contained within the pharmacists’ prescription drug records. The disclosure of patient medication records maintained by a pharmacist has been sought in a civil action against a drug manufacturer, a child custody proceeding, a civil action against a physician, and criminal prosecutions of a pharmacist and a physician A request for production of clearly confidential information places the pharmacist in a dilemma. The Code of Ethics of the American Pharmaceutical Association allows for the unauthorized release of a pharmacist's professional records only where it is required in the best interests of the patient or demanded by the law. Therefore, pharmacists have sought judicial clarification of the circumstances under which the law demands the release of information contained within confidential patient medication records.
Equal Employment Opportunity under Title VII and the Exclusion of Fertile Women from the Toxic Workplace
Authors: Devereux Mary Ellen
Published: June 2007

Many modern work environments expose employees to the risk of injury from toxic substances. Attention to this risk may extend beyond the immediate concern for the worker's personal health, to concern that the worker's capacity to produce healthy offspring may be impaired. The conditions of employment in a particular workplace may require exposure to chemical agents that are toxic to the reproductive system of one sex and not of the other, toxic to the reproductive processes in both sexes, toxic to the developing fetus but not to the adult, or a combination of the above. Employers that exclude susceptible members of one sex from the workplace in order to prevent exposure to toxic agents, do so at the risk of violating federal employment discrimination law.
Functional Evaluation of the Elderly in Guardianship Proceedings
Authors: Nolan Bobbe Shapiro
Published: June 2007

Guardianship has traditionally been presented by courts and in the literature as a benevolent mechanism through which those who cannot protect themselves will be assisted through surrogate management of their assets, their persons, or both. While notice has been taken of the significant deprivation of property and liberty inherent in a total guardianship, authorities recognize the sad necessity of imposing plenary external control over some of us when sufficient need is shown. The power to do so is grounded in the state's police power and the traditional role of the state as parens patriae.
Legal Issues in School Nursing Practice
Authors: Cohn Sarah D.
Published: June 2007

School health nursing in the United States began in 1902 when a school nurse named Lina Rogers was placed in four New York City schools. Her work and that of twenty-five other nurses hired a month later quickly reduced the number of children excluded from school for communicable diseases from 10,567 in September 1902 to 1101 in September 1903. The number of excluded children could be reduced so dramatically because the school nurse was available to educate parents and staff and because she was able to make home visits to known cases of disease.
Patients' Attitudes toward Hospital Ethics Committees
Authors: Youngner Stuart J. , Coulton Claudia , Juknialis Barbara W. , Jackson David L.
Published: June 2007

There is a growing concern in our society about the proper application of life-sustaining medical treatments. This concern has been stimulated by both the explosion in medical technology and the increasing emphasis on patients’ rights and autonomy in clinical decisionmaking. Technological progress enables us to prolong or sustain life, even when its “value” or “quality” is questionable. There is also increased concern, both within and outside the medical community, about the optimal process for making decisions to withhold or withdraw treatment.

Hospital ethics committees have been suggested as a possible solution to this problem. Although few hospitals have actually adopted ethics committees, and little is known about the way that they function or their effectiveness, there have been some recent efforts to study these issues. Despite the increasing recognition of patients’ wishes to know more about and to influence their medical care, there have been no reports about patients’ attitudes toward the role of ethics committees in decisionmaking.
The Supportive Care Plan—Its Meaning and Application: Recommendations and Guidelines
Authors:   The Task Force on Supportive Care
Published: June 2007

Several incidents involving the withdrawal of treatment and/or the ordering of supportive care for nursing home residents came to public attention in the spring and summer of 1981, raising serious concerns among advocates, attorneys, and health care professionals about the use of supportive care orders. It appeared that there was little consistency or consensus with respect to the meaning or application of the Supportive care concept.

In response to such concerns, a task force of interested individuals long term care staff and administrators, consumer advocates, medical, legal and social service professionals, and government agency officials was convened to identify and discuss issues raised by the use of supportive care. The task set by the group was to make recommendations and propose a set of guidelines for the provision of supportive care in long term care settings.
Malpractice in Hospitals: Ten Theories for Direct Liability
Authors: Peters J. Douglas , Peraino Jeanette C.
Published: June 2007

When a medical malpractice injury occurs in a hospital, the hospital is often sued under the theory that it is vicariously liable for the actions of its employees, through the doctrine of respondeat superior. Depending on the facts of the case and the laws of the state, however, the hospital may also be directly liable to the patient. Establishing the direct liability of the hospital where the facts will not support a vicarious claim may ensure for the plaintiff an adequate “deep pocket” in cases where the physician is inadequately insured. In addition, direct liability carries a longer statute of limitations.

Imposing liability on hospitals, whether vicarious or direct, encourages hospitals to oversee physicians’ competence.
Reflections on Organ Transplantation in the United Kingdom
Authors: Miller Frances H.
Published: June 2007

When asked which patients receive kidney transplants in England, a social worker attached to a prestigious British teaching hospital recently told me, “Probably the undeserving.” By that she meant that trouble-making patients who lacked the self-discipline to cooperate with dialysis regimes, or who complained the loudest, were often “gotten rid of” by eliminating the need for dialyzing altogether.

Such candor was unexpected, but it points up the fact that even under Great Britain's National Health Service, where egalitarian concerns have always been paramount, criteria other than pure medical need can determine access to organ transplants. Ironically. “negative” social factors provided the key to transplant availability in the cases that the social worker described, although unconventional social factors are probably more often used in the United States to deny the benefits of transplantation to patients who do not fit the middleclass ideal.
If There's a Will, is There a Way?
Authors: Caplan Arthur L.
Published: June 2007

The recent Report of the Massachusetts Task Force on Organ Transplantation represents a watershed in public policy formulation in the health care field. The Report reflects the views of a diverse group drawn from fields which include public health, religion, surgery, law, private industry and consumer affairs. As such, it is, happily, unlike nearly every other advisory study of health care technology that has been commissioned by federal or state bodies during the past twenty-five years.

All too often, assessments of medical technology commissioned by government or publicly funded scientific agencies, such as the National Institutes of Health, the Office of Technology Assessment, or the Public Health Service, have been confined to the views of “experts” in the area of technology being assessed.
Organ Transplantation and the Art of the Possible
Authors: Kissick William L.
Published: June 2007

Ethicists, lawyers, economists, and clinicians have been invited to comment on the Report of the Massachusetts ‘Task Force on Organ Transplantation In this issue of Law, Medicine & Health Care. One can assume that the issues of access, equity, social justice, efficiency, and choice will be addressed. Accordingly, I shall return to the perspective of my earlier career as a federal bureaucrat to offer an overall appraisal and to comment on the political dimensions of resource allocation in dramatic, life-threatening diseases.

Nearly two decades ago, I served as the Director of Program Planning and Evaluation for the Surgeon General, at the time that cost-benefit analysis was introduced into the Great Society. The treatment of chronic kidney disease circa 1966 was then a problem akin to those of heart, heart-lung, and liver transplantation in 1984 or, perhaps, the next decade's problem of the artificial heart.
Organ Transplants and the Principle of Fairness
Authors: Jonsen Albert R.
Published: June 2007

The Report of the Massachusetts Task Force on Organ Transplantation can be described as an incunabulum. This strange word, properly referring to a book produced in the first decades of printing with movable type, literally means “in the cradle.” The Task Force document appears in the infancy of a discussion that is certain to grow: the public policy debate over the allocation of scarce resources. The debate was born several years ago, but until now has either been argued in general terms or by way of administrative devices. The Task Force addresses a quite particular issue: how to or whether to make available to the citizens of the Commonwealth and their neighbors the medical technology of organ transplantation. It approaches the problem with a vivid awareness of the expense of this technology as well as the constraints on health care resources and financing.
Litigation on Third Party Prescription Programs: An Update
Authors: Abood Richard R.
Published: June 2007

The American health care system is currently engaged in one of the most profound transitions in recent history. Demands for cost containment propel this transition, catalyzed by third party payers—federal and state governments, Blue Cross/Blue Shield, private insurers, third party administrators, and employers. The era of usual and customary compensation for health care providers participating in third party programs may be rapidly ending. Pharmacy witnessed the demise of usual and customary compensation in the early 1960s and has been fighting to regain it since then.

In recent years, third party prescription programs (TPPPs) have been the subject of, or have been affected by, various lawsuits, rulings by the Federal Trade Commission (FTC), and state attorney general opinions. Most have not been favorable for pharmacists. In a previous article inLaw, Medicine & Health Care,this author explored some of the litigation and legislation which pharmacists attempted as a means to solve the problems presented by TPPPs.
Technology Assessment, Public Policy and Transplantation: A Restrained Appraisal of the Massachusetts Task Force Approach
Authors: Overcast Thomas D. , Evans Roger W.
Published: June 2007

The February 1985 issue ofLaw, Medicine & Health Carepublished excerpts from the Report of the Massachusetts Task Force on Organ Transplantation, along with a report by its chairman, Professor George Annas, and commentary by a number of esteemed scholars and practitioners who were generally complimentary of both the approach and substance of the work of the Task Force. We have thoroughly reviewed the Task Force Report and feel it necessary to take strong exception to a number of points, both procedural and substantive, raised there. In general, we are concerned that the Task Force Report perpetuates and reinforces a number of serious misconceptions about the issues surrounding transplantation that, in turn, lead to conclusions that are both inaccurate and misleading. This situation is most unfortunate be cause the complexities of the issues raised by transplantation require care ful scrutiny, especially where there are empirical data that clearly call into question these often strongly held predispositions. In the following sections we point out what we feel are the major shortcomings of the Massachusetts effort.
Enforcement of Quality Nursing Home Care in the Legal System
Authors: Jost Timothy S.
Published: June 2007

In the mid-1970s the alarming state of nursing home care in the United State was dramatically exposed by the Subcommittee on Long-Term Care of the special Committee on Aging of the United States Senate, which released a series of papers collectively entitledNursing Home Care in the United States: Failure in Public.Simultaneously a plethora of media investigations, exposés in the popular literature, scholarly articles, and state commission reports condemned conditions in nursing homes and called for reform. These investigations and reports uniformly demanded more rigorous government regulation of nursing homes. In response, in the late 1970s and early 1980s, virtually all of the states adopted some form of nursing home reform legislation. The federal government also adopted regulations mandating oversight of long-term care facilities participating in the Medicare and Medicaid programs.
Jumping from the Frye Plan into the State Farm Fire: An Analysis of Spinal Thermography as Scientific Test Evidence
Authors: Finnegan Walter J. , Koson Dennis F.
Published: June 2007

“Pictures of Pain Pay Off,” proclaimed the title of a recent article in the legal literature. The thermographic picture, or thermogram, is raising the stakes in plaintiff back cases and gaining national attention in both the medical and legal communities. Doctors see it as a diagnostic tool; lawyers, as an objective means of documenting injuries.

Yet the diagnostic and demonstrative potentials of this modality are also arousing considerable controversy—of the kind that has attended the use in court of blood tests to determine paternity, intoxication tests, polygraphs tests, hypnosis, spectrographs, and neutron activation analysis. This article will examine the use and value of thermographic pictures as evidence of spinal conditions and nerve root compression.
1. Medical Technology and New Frontiers of Family Law
Authors: Kirby M.D.
Published: June 2007

In Mount Isa Mines Limited v. Pusey, Windeyer, justice of the High Court of Australia, wrote of “[l]aw, marching with medicine but in the rear and limping a little.“ This remark, characterizing the stumbling approach of the law in providing damages for nervous shock occasioned by negligence, may be too kind when applied to the response of family law to the remarkable advances of knowledge and technology affecting human sexuality and conception.

Nowadays, there is a growing sense of urgency and impatience about the response of the law to medical developments. One writer trained both in law and medicine observed from his informed standpoint:

Those doctors who have studied law have always been uneasy at the extent to which Anglo-Saxon law departs from reality in dealing with biological issues. The nervous shock cases which continue to be based on medical principles discarded during the 19th century provide a notorious example.
4. The Legal Status of the Embryo in Vivo and in Vitro: Research on and the Medical Treatment of Embryos
Authors: Leenen H.J.J.
Published: June 2007

Modern developments in biomedical science and technology have raised legal problems regarding the initial phase of human life. The possibility of genetic manipulation and of influencing the human genome is in sight, embryos are already being treated in utero, and in vitro fertilization and embryo transfer have been successfully performed. Embryos have been fertilized in vivo, flushed from the womb. and implanted in surrogate mothers.

These developments have raised questions not only for family law but also for health law. These questions include the permissibility and regulation of genetic manipulation, the equitable distribution of the new techniques, the consequences for future generations of present-day decisions, the right to procreation, the role of the state, and the freedom of parents, especially the pregnant woman, in relation to the embryo. Other problems involve confidentiality and privacy, the relationships among the several people who are producing the child, and the status of the embryo in vivo and in vitro.
3. Bentham in a Box: Technology Assessment and Health Care Allocation
Authors: Jonsen Albert R.
Published: June 2007

Jeremy Bentham, the founding father of utilitarianism, would have been delighted by technology assessment. Contemporary health policy planners are, unwittingly, aping the great man's felicific calculus, as they attempt to discern the efficacy and safety of magnetic resonance imaging or cardiac bypass surgery or extracorporeal shockwave lithotripsy. They try to design methods to calculate the effects of these technologies on mortality and morbidity and to compare the costs of one to the costs of alternatives. In recent years, the methods of technology assessment have been refined, but they remain, in essence, a copy of Bentham's proposal to plan and effect a rational course of action and to create a rational world.

The great philosopher and social reformer is, of course, still with us in a dessicated form. He bequeathed his body to the fellows of University College, London, and to this day his mummified figure is encased in a glass box, sitting in his favorite chair, dressed in his own clothes, his waxen face peering out with a bemused smile.
Riff v. Morgan Pharmacy
Authors: Brushwood David B.
Published: June 2007

A pharmacist may be liable to a patient for negligence in filling a prescription, even if the pharmacist correctly fills the prescription as written by the prescribing physicion. The holding in Riff v. Morgan Pharmacy is that each member of the health care team “has a duty to be, to a limited extent, his brother's keeper.“ The court in Riff boldly and eloquently justifies this position by noting:

Fallibility is a condition of the human existence. Doctors, like other mortals, will from time to time err through ignorance or inadvertence. An error in the practice of medicine can be fatal; and so it is reasonable that the medical community including physicians, pharmacists, anesthesiologists, nurses and support staff have established professional standards which require vigilance not only with respect to primary functions, but also regarding the acts and omissions of the other professionals and sup port personnel in the health care team.