bluuebunny/crossref_metadata_2025 huggingface dataset:
Surrogacy: A Preferred Treatment for Infertility?
Authors: Taub Nadine
Published: June 2007

No matter what one's position, Baby M is a difficult case. Once a child of contract parenthood has come into being, sorting out the competing claims that changed intentions produce is inevitably a troubling process. Even when taken in the abstract, surrogacy arrangements raise disturbing questions: Can we expand the available options for forming families without risking sex, race, and class exploitation? Can we address the pain experienced by those unable to conceive and bear children without commodifying human life? Whatever our views of surrogacy, we cannot hope to resolve the dilemmas it poses without acknowledging and seeking to address the pain of infertility.

Given what we know about infertility, is commercial surrogacy—however troublesome—an appropriate response? Even with only partial information before us, the answer would seem to be a fairly clear no. Surrogacy is at best an after-the-fact accommodation to the problem of infertility, available only to those with substantial financial resources.
Baby M, the Surrogacy Contract, and the Health Care Professional: Unanswered Questions
Authors: Rothenberg Karen H.
Published: June 2007

The Baby M case has forced us to take sides in the public debate over surrogate motherhood. Last year, advocates of this form of noncoital reproduction praised the New Jersey trial court for supporting the freedom to contract for such womb renting services, while critics warned that enforcement of such surrogacy contracts would condone the sale of babies and the exploitation of women as baby factories. In its unanimous opinion, the New Jersey Supreme Court sided with the critics. Based on New Jersey's adoption law and public policy, the court refused to enforce the contract that provided money to a surrogate mother in return for her agreeing to be artificially inseminated with the Semen of another woman's husband, to conceive a child, to carry it to term, and to relinquish her parental rights and surrender her child to the natural father and his wife, regardless of the child's best interests.
Prevention and Torts: The Role of Litigation in Injury Control
Authors: Teret Stephen P. , Jacobs Michael
Published: June 2007

Those who study, teach, and practice in the field of injury epidemiology and prevention often compare injuries to diseases; to do so enhances the understanding that injuries, like diseases, have etiologic agents that act within particular environments to affect predictable hosts. It is important to stress the scientific underpinnings of injury control, so that injuries will not continue to be seen as randomly occurring events that strike the unlucky, who have little or no preventive opportunity available to them. Those within the field argue that injury prevention, like disease prevention, when approached with the proper scientific method, holds the prospect of saving thousands of lives per year in the United States.

The comparison of injuries to diseases, however, can distract attention from some crucial aspects of injury prevention. Infectious disease control is the story of man's battle with living organisms that often do their damage to hosts at the cellular or sub-cellular level. The pathways of those diseases can be difficult to discern, and some mysteries are yet to be solved. Injuries, on the other hand, do their initial damage on a more visible level. Their etiologic events are often apparent, and do not require epidemiologic or biochemical detective work for an understanding of the causes of injury.
Deterring Death in the Workplace: The Prosecutor's Perspective
Authors: Reiner Ira , Chatten-Brown Jan
Published: June 2007

In 1970, when Congress was debating the Occupational Safety and Health Act, it was argued that:

The problem of assuring safe and healthful workplaces for our working men and women ranks in importance with any that engages the national attengion today …

Congress cited some grim statistics necessitating vigorous action:

… 14,500 persons are killed annually as a result of industrial accidents … more than in the Vietnam war. By the lowest count, 2.2 million persons are disabled on the job each year, resulting in the loss of 2 15 million man days of work …

The human tragedy associated with the loss of lives, adverse health impacts, and serious injuries were the focus of legislative hearings, but Congess also addressed the economic impact of industrial deaths and disability.

Over $1.5 billion is wasted in loss of wages, and the annual loss to the gross national product is estimated to be over $8 billion.
Injury, Community and the Republic
Authors: Beauchamp Dan E.
Published: June 2007

Injury and its prevention, like other areas of public health regulation, pose a number of interesting challenges to the theory of democratic self government. To understand these challenges, a good starting point is the Great Society era, when in a brief ten year period, major new agencies were created to promote safety in the workplace, the marketplace, and on our nation's highways—agencies like the Environmental Protection Agency (EPA), the Occupational Safety and Health Administration (OSHA), the Consumer Product Safety Commission (CPSC), and the National Highway Traffic Safety Administration (NHTSA).

The theory of injury that lay behind the new agencies was in sharp contrast to injury policy as pursued up to that time. The new public health and safety agencies were based on the idea that injury must be approached as an environment, not an individual, problem. The most articulate advocate of this view was William Haddon, Jr., the physician and injury researcher who became President Johnson's first head of NHTSA. Haddon argued for well over a decade for abandoning the view of injury as “accidents,” unpredictable and inevitable “acts of God.”
Injury Prevention as a Public Health Responsibility: The New York State Department of Health Injury Control Program
Authors: Standfast Susan J.
Published: June 2007

In December 1986 the New York State Commissioner of Health, David Axelrod, MD, designated an Injury Control Program within the Division of Epidemiology. This action was in recognition of the importance of injuries as a major public health problem in New York State. The public health importance of injuries is highlighted by the fact that injury particularly affects young and productive members of society as well as the poor and needy who make up the traditional clientele of public health departments. Injury is the leading cause of death in persons under age 35 in New York State and accounts for more years of potential life lost before age 65 than cancer, heart disease or AIDS (Figure 1). Injury is the fourth leading cause of death for all ages and a major cause of hospitalization and disability.

The New York State Health Department's authority to engage in injury control activities derives from four sources: the general powers and duties of the Health Commissioner as described in the New York Public Health Law; specific provisions of the law which direct the Department to engage in discrete injury-related activities, such as burn treatment and poison control; executive orders of the Governor, such as Executive Order #35 establishing the Governor’s Advisory Council on Highway Safety; and the authority of the Public Health Council to promulgate a State Sanitary Code which includes requirements for operation of swimming pools and bathing beaches, temporary residences (including children’s camps), regulations for emergency medical services, and so forth. The Injury Control Program’s major functions are based on the Department’s general authority.
Alcohol, Injury, and Legal Controls: Some Complex Interactions
Authors: Hingson Ralph , Howland Jonathan
Published: June 2007

Despite considerable declines in the early 1980’s, drunk driving remains a major public health problem in the US. In 1986, 46,050 people were killed on the nation's highways. Traffic crashes are the leading cause of death in the age group 1-34 years. Alcohol is unquestionably a major contributor to these crashes. In 1986, 23,987 traffic deaths, 52 percent of the total, involved a driver or pedestrian who had been drinking, and 16,728, 36 percent of the total, involved someone with a blood alcohol level above 10 percent. Many of the victims of drunk driving crashes were not drinking at the time of the event; more than one third of alcohol related vehicular deaths were persons other than drinking drivers: passengers, other drivers or pedestrians.

Legislation may influence drinking and driving behavior, and the consequences thereof, in a variety of ways: limiting access to alcohol; restricting access to vehicles; making vehicles and roadways safer; separating drinking and driving. Taxation, dram shop laws, minimum drinking ages, server liability, land use laws pertaining to the location of alcohol outlets, and prohibitions on advertising alcoholic beverages affect the driver's access to alcohol.
Fires, Cigarettes and Advocacy
Authors: McGuire Andrew
Published: June 2007

America is burning at a faster rate than any other industrialized nation. Approximately 2.3 million fires costing $40 billion were reported in 1984. Over 5,400 American citizens are killed as a result of these fires and an estimated 130,000 are seriously injured. The leading cause of fire death and injury is cigarette initiated fires with the 1984 toll being 1,570 deaths and 7,000 serious injuries.’ Property damage alone totals over $390 million.

These numbers do not portray the human devastation caused by fires. No other injury causes more pain and suffering. Movies, television and radio have rarely documented the emotional and physical sequelae of a severe burn injury. One day's headline proclaims the devastation of a house fire, and then the story disappears at the point when the survivors begin the agonizing process of healing. The daily routine of burn treatment in America's burn centers is hidden from public view.
On Touching “The Happy Isles”: Reflections about Past, Future, and Present
Authors: Katz Jay
Published: June 2007

Ever since I learned a year ago about the honor you intended to bestow upon me, I have asked myself: What is it in my life's work that led you to confer upon me your Second Presidents' Award? You could have chosen many other, perhaps more deserving, recipients. But tonight I do not wish to compare myself to others. It would be most ungracious to charge you with being mistaken, or too self-effacing to charge myself with being unworthy of your Award.

Ultimately, I concluded that you honor me less for the work I have published and more for the impact I have had on so many of you as your teacher and colleague during the last thirty years. I have lived my life with people—family, friends, students. I have cherished, and still cherish, the contacts with my students, a remarkable number of whom soon became collaborators, colleagues, friends or took off on their own, enriching in significant ways what we had first learned together.
Controlling the Woman to Protect the Fetus
Authors: Field Martha A.
Published: June 2007

Even many women who view reproductive capabilities not as a detriment but as an important source of joy in their lives recognize that women's reproductive capabilities have long been used to oppress them. The ability to reproduce has been an important factor in women's loss of control over their own lives, contributing to their being controlled by chance, by government, and by other people—husbands, boyfriends, parents. In the past, to the extent that reproduction has not been left to chance, the woman herself has often not been the decision-maker. Husbands have often coerced women into producing and raising offspring when they did not want to, and societal attitudes have had the same effect of encouraging marriage, then motherhood. Historically, state governments have participated in coercing childbirth as well, some by prohibiting or restricting birth control and all states by prohibiting abortion.
Solving the Medical Malpractice Problem: Difficulties in Defining What “Works”
Authors: Kapp Marshall B.
Published: June 2007

Although in its 1986 Report on medical malpractice, the General Accounting Office found “No Agreement on the Problem or Solution,” it is readily apparent to any participant in or informed observer of health care delivery in the United States today that problems do exist regarding both the occurrence of medically-induced patient injuries and the management and resolution of medical liability claims. Public policymakers, on both the federal and state levels, have devoted a great amount of attention and energy in the past several years to attempts to devise solutions to these troubling patient injury and provider liability difficulties, difficulties that arguably impact negatively on the quality of medical care, its accessibility, its costs, the physician/patient relationship, and the progress of medical innovation. Private organizations have also undertaken initiatives in this area.
Dying Patients: Who's in Control?
Authors: Childress James F.
Published: June 2007

The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research undertook a study of “Deciding to Forego Life-Sustaining Treatment” because this issue seemed to the commissioners “to involve some of the most important and troubling ethical and legal questions in modern medicine,” even though it was not part of the commission's original legislative mandate. In submitting the report to the President, Morris Abrams, the chairman of the commission, noted: “Although our study has done nothing to decrease our estimation of the importance of this subject to physicians, patients, and their families, we have concluded that the cases that involve true ethical difficulties are many fewer than commonly believed and that the perception of difficulties occurs primarily because of misunderstandings of the dictates of law and ethics.”
Do-Not-Resuscitate Orders: Public Policy and Patient Autonomy
Authors: Miller Tracy E.
Published: June 2007

The issuance of do-not-resuscitate orders was one of the first dilemmas scrutinized by lawyers, health care professionals and philosophers in the field of bioethics. In 1983, the President's Commission articulated the basic principles that should guide decisions about CPR: respect for the choices of patients capable of deciding for themselves, recognition of family members as appropriate surrogates for decisionally incapable patients and the importance of an open dialogue with the physician as a predicate to informed consent.

Six years have passed since the President's Commission issued its landmark report. More than a decade of discussion and written commentary has clarified the ethical and social questions presented by resuscitation decisions. In many states, judicial decisions and legislation have addressed some of the legal uncertainties associated with do-not-resuscitate (DNR) orders. Nonetheless, the gulf between recognized ethical principles and clinical practice remains broad and resistant to change. Nowhere is this gap more evident than in decisions about cardiopulmonary resuscitation (CPR) for competent patients.
New Jersey's “Granny Doe” Squad: Arguments about Mechanisms for Protection of Vulnerable Patients
Authors: Price David M. , Armstrong Paul W.
Published: June 2007

A decision not to hospitalize, dialyze or resuscitate a dying, elderly, nursing home resident is regarded as “possible abuse.” Any physician, nurse, administrator, social worker, aide or other staff member who learns of plans to withhold treatment is required to report this fact to a state official. That official will conduct an investigation “to determine whether the legal guidelines...are satisfied.” While the often protracted investigation is pending, “the facility itself (must) preserve the patient's health.”

A letter declaring this to be the requirement of current New Jersey law was recently sent to administrators of all nursing homes and psychiatric hospitals by the state's Office of the Ombudsman for the Institutionalized Elderly.

The policy has provoked strong protests from health professional organizations and advocates for the privacy of patients and families. Alert clinicians are reportedly maneuvering to place their patients beyond the Ombudsman's reach.
Making Universal Health Insurance Work in Massachusetts
Authors: Sager Alan
Published: June 2007

High U.S. health costs have been one of the main barriers to enacting universal access to care in recent decades. It is therefore surprising that Massachusetts, with the nation's highest per capita health spending, last year promised health insurance to all citizens. Declaring that “the access of residents of the Commonwealth to basic health care services is a natural, essential, and unalienable right” protected by the Massachusetts Constitution, the new health law, Chapter 23 of the Acts of 1988, legislates a promise that insurance be offered to all by 1 April 1992.

The law was the product of almost three years of bargaining. One closely involved person said this was “the most controversial and heavily fought battle in the past 25 years in the Massachusetts State House.” Deals had to be struck. Perhaps the most important of the law's compromises is embodied in its title: “An Act to Make Health Security Available to All Citizens of the Commonwealth and to Improve Hospital Financing.” Obtaining the votes for the law's universal access provisions required promising Massachusetts hospitals substantially higher revenues.
What Actually Happened: An Informed Review of the Linares Incident
Authors: Goldman Gilbert M. , Stratton Karen M. , Brown Max Douglas
Published: June 2007

Last April, 23 year-old Rudy Linares disconnected his 15-month-old comatose son, Sammy, from the mechanical ventilator that was maintaining the infant's life. He then used a gun to keep hospital staff from interfering while he withdrew the machine, allowing his son to die of acute respiratory failure. The death of this infant stirred great controversy among doctors, nurses, lawyers and ethicists. It also generated much discussion in the news media. The clearest common denominator of this discussion has been the willingness of commentators to advance opinions and interpretations without knowledge of the facts of the case. Some of the opinions have been critical of the hospital, the doctors, and/or the nurses. The present report is not intended to answer such criticism. The report will simply provide the facts and legal opinions as to the case. To the extent this information leads the reader to understand or agree with the management of the case the report will serve as a defense of these actions. To the extent it leads to rejection or criticism of the management, the report will support the detractors.
On Heroes and Villains in the Linares Drama
Authors: Mitchell Christine
Published: June 2007

The Linares case is one of the memorable moral dramas played out in a pediatric intensive care unit and in the press in a decade of momentous moral cases concerning the care of children. It was a vivid tragedy that posed intense conflict. Its characters were sharply drawn, and it culminated in a final, dramatic scene.

High drama tends toward heroes who are admired for their courage and distinguished performance, and villains who are embodiments of evil reviled for their wickedness. To make it simple for the audience, the good often wear white and the bad wear black. Not so in this story. Two nurses who took care of Samuel Linares, Karen Stratton and Laura Stark, wrote, ‘‘The media sensationalized Rudy Linares as a hero while Rush PICU staff members were portrayed as the villains. Who is right?”’

Nurses played a central role in the Linares case. Accounts of the drama in newspapers, television stories, and articles across the country contained opening paragraphs giving the basic facts: Rudy Linares, a 23-year-old laborer, held nurses at gunpoint just after midnight on April 26, 1989, while he disconnected his 16-month-old unconscious son, Samuel, from a respirator at Rush Presbyterian St. Luke's Hospital in Chicago and held him in his arms until he died.
The Malpractice Standard under Health Care Cost Containment
Authors: Hall Mark A.
Published: June 2007

For decades, medicine has been dominated by a “spare-no-expense’’ philosophy that fostered an ethic of providing all care that is of any conceivable benefit, regardless of the cost. This extended financial honeymoon has now ended. Sweeping reimbursement reform is limiting payment for health care under both public programs and private insurance. As physicians respond to this emerging cost consciousness in health care by declining to perform procedures once considered necessary, will they be exposed to liability or will legal standards shift to accommodate the new constraints? This dilemma is one of the most important issues that will confront health care tort law throughout the remainder of the century.

The potential conflict between malpractice law and cost containment has received considerable scholarly attention over the past dozen years, particularly following the 1983 reform of the Medicare program and the 1986 California appellate decision in Wickline v. State of California concerning that state's Medicaid program.
Stratified Scarcity: Redefining the Standard of Care
Authors: Morreim E. Haavi
Published: June 2007

Professor Hall is to be congratulated on his thoughtful analysis of an issue that, as he rightly suggests, “is one of the most important issues that will confront health care tort law throughout the remainder of the century.”’ He argues that malpractice law currently can accommodate considerable latitude both for a conservative streamlining of medical practices in general and for a cost-sensitivity in individual treatment decisions. And he further argues that existing tort principles, such as the locality rule, can comfortably be stretched to embrace still greater room for economics in the medical standard of care. I quite agree.

Unfortunately, Hall's arguments do not go nearly far enough, for they are framed around a seriously oversimplified picture of the economic changes that are revolutionizing medicine in the United States. He envisions a fairly uniform, global set of resource constraints that generally pressure physicians to conserve on care—pressures that tort law can then encompass equally globally as it accepts more cost-efficient standards of care. However, neither the changing economics of medicine nor the resulting jurisprudential challenges are anywhere near this generalized.
Abortion and Legal Process in the United States: An Overview of the Post-WebsterLegal Landscape
Authors: Baron Charles H.
Published: June 2007

On July 3,1989, the Supreme Court finally handed down its much-anticipated decision inWebster v. Reproductive Health Services.Observers interested in the issue of abortion rights had anxiously awaited the decision for indications of whether the court would maintain the constitutional course it had charted inRoe v. Wade.At stake was the extent to which the Court would continue to find limits in the Fourteenth Amendment upon the power of states to proscribe and regulate abortions. The majority which had supportedRoeand other abortion cases3 had been whittled away. Two dissenters from the original 1973 decision (Chief Justice Rehnquist and Justice White) and one subsequent appointee (Justice O’Connor) had consistently shown antipathy toRoe.The author of the Court's opinion inRoe(Justice Blackmun), two other participants in the original decision (Justice Brennan and Marshall), and a subsequent appointee (Justice Stevens) had been consistent defenders ofRoeand were still on the Court. But with the retirement of Chief Justice Burger and Justice Powell, two new, reputedly “conservative” Justices (Scalia and Kennedy) had been appointed to the Court.Websterwould be their first opportunity to show where they stood onRoe.
Realism, Law and Aging
Authors: Cohen Elias S.
Published: June 2007

In 1962, theJournal of law and Contemporary Problemsdevoted its entire winter issue to aging. The remarkable thing about that issue was that it had only one article that dealt with legal questions—and that with tax treatment of the elderly. The remainder of the issue contained articles dealing with the demographic and sociological characteristics of the elderly, currently held views and theories of aging and human development, and some special concerns from other disciplines like geriatric psychiatry.

In less than a generation, old age and the law has evolved into a field of study of consuming interest to legal scholars, practitioners, sociologists, and consumers. The Chicago-Kent Law Library established a special catalog of the law and aging in 1983. By 1987 (the year in which the last entries were made for the collection), the catalog had grown to over 500 pages. Earlier (1982) theSouthern Culifornia Law Reviewpublished a similar catalog which was updated in 1984 and 1987.
The Fear of Liability and the Use of Restraints in Nursing Homes
Authors: Johnson Sandra H.
Published: June 2007

The routine use of chemical and physical restraints in nursing homes is bad care. Medical and nursing literature on the care of nursing home patients consistently criticizes the use of restraints when that use is unrelated to diagnosis and treatment considerations. Federal and state laws have included restrictions on the use of restraints for some time. The criticisms of inappropriate and indiscriminate use of chemical and physical restraints are not new. What, then, supports their continued misuse despite the ordinarily powerful combination of professional and governmental approbation?

The use of restraints responds to generally quite acceptable and desirable patient-oriented goals. Restraints are used in an attempt to protect the patient with physical or mental disabilities from avoidable injury caused by falling or wandering away from the facility. In the social context of nursing homes, restraints are also used to protect residents from injury by threatening, violent patients. When the rationale is measured against the known effects of restraints, however, the self-evident nature of the justification begins to break down.
State of the Law: Nursing Homes
Authors: Kapp Marshall B.
Published: June 2007

Health care for the elderly, already a major social concern in the United States, is fated to become even more dominant on our social, political, and legal agendas. The effect on the nursing home industry and nursing home law will border on the revolutionary.

In a review of the “prospects for an ageing population,” Jacob Brody observed that:

In 1900, only a quarter of the U.S. population survived to the age of 65. Now almost 70 per cent achieve this age, and the proportion of those aged 80 and over is 30 per cent and increasing. Within a very few years, about half the population will live more than 80 years.

A report of the Congressional Office of Technology Assessment (OTA) notes the same trend and gives a sense of the numbers involved:

The elderly population has grown from 4.0 percent of the total in 1900 to more than 11.5 percent in 1983. The number of those over 65 is projected to grow from today's 27 million to an estimated 39.3 million by 2010, when they will constitute almost 14 percent of the Nation's population. More significantly, between 2010 and 2020 the older population is expected to increase by more than 12 million….
Bioethics, ’89: Can Democracy Cope?
Authors: Kirby Michael
Published: June 2007

This conference comes together at a critical time for law, ethics, and medicine. The issues which come under attention are of the greatest variety, complexity, sensitivity, and urgency.

The topics span the whole of human life. They begin at a point before human life has commenced. The revolutionary developments of biology as they affect conception and the use and limits of reproductive and genetic techniques arrest our thoughts in section VI of this special issue ofLaw, Medicine&Health Care.The rationing of health care as it is made available to patients and the community is the focus of attention in section III. The subject of medical malpractice and the litigation which attends it where the patient or the family claim that things have gone wrong are considered in section II.

The new challenge of AIDS is discussed with its many faceted problems: medical, legal, and ethical. It is difficult now to remember the world before AIDS.
Global Coordination of National Public Health Strategies
Authors: Mann Jonathan , Dam Marjorie , Kay Kathleen
Published: June 2007

Three periods can be distinguished in the brief history of global AIDS: silence, discovery and mobilization. The first period, starting in the mid-l970s, was the time of the “silent pandemic,” during which HIV spread — unnoticed—to at least five continents. During this period, when the virus was unrecognized, HIV could have — but did not — spread even more widely.

The description of AIDS in 1981 ended the silence and initiated the second period in the history of global AIDS — a period of discovery which culminated symbolically at the first International Conference on AIDS in June 1985 (Atlanta, USA). During this period, the modes of transmission were defined, the virus was discovered, and the capacity to detect anti-viral antibodies led to the discovery of large numbers of infected persons and to awareness of the long latency between infection and manifest disease.
Screening for HIV Infection and Public Health Policy
Authors: Fineberg Harvey V.
Published: June 2007

The subject of screening stands at the intersection of medicine and public health and the law. Medicine is concerned about the care of the individual patient; public health focuses on maintaining and improving the health of entire populations. The law is concerned with the balance of rights and responsibilities, protecting society from errant individuals and protecting the individual from undue constraints of society.

In looking specifically at the questions of screening or testing for the Human Immunodeficiency Virus (HIV) it is useful to consider the meaning of the words “tests” and “screening” because many different terms are applied to these concepts — diagnostic testing, case finding, screening, surveillance, and so on. In all cases, medical tests have a common purpose: to provide information that sheds light on the probability that the disease of interest actually is present in the patient being tested.
An Institutional Policy on the Right to Benefit from the Commercialization of Human Biological Material
Authors: Prentice Ernest D. , Wiltse John C. , Sharp John G. , Antonson Dean L.
Published: June 2007

The marriage of academic research laboratories to the biotechnology industry has raised some very complex ethical and legal issues regarding commercialization of human body parts, products and derivatives thereof. Current statutes prohibit the sale of one's body or bodily organs although people may legally sell their blood or semen and are generally encouraged to donate certain body parts for transplantation or research both in life and death. No existing legislation, however, clearly addresses ownership rights with respect to human cells and tissues used in research, Commercialization of human biological material, either by the donor or by the recipient, e.g., researcher and/ or pharmaceutical company, is an uncharted area of the law.

The question of proprietary rights to one's own cells and tissues did not arise until the biotechnology industry rapidly expanded in the 1980s. Now, human organs, tissues and cells are used in research that may lead to the development of products with tremendous commercial value.
Gestational Surrogacy and the Health Care Provider: Put Part of the “IVF Genie” Back into the Bottle
Authors: Rothenberg Karen H.
Published: June 2007

Medical advances in new reproductive technologies continue to raise complex legal and ethical issues. Last October, a California Superior Court judge issued his opinion on the first contested case in this country involving gestational surrogacy. Upholding the surrogacy contract as valid and declaring that the genetic parents had exclusive custody and parental rights, Judge Richard Parslow observed:

The IVF genie is out of the bottle and you’re not going to be able to put it back.

I contend that we must put part of the genie back into the bottle. Gestational surrogacy is not an acceptable option for the extension of in vitro fertilization (IVF). This is not a reaction to the facts of the California case, but rather a recognition that the medicalization of surrogacy as a reproductive technology attempts to legitimize a practice that professionals should not support.
Public Policy in the Wake ofCruzan: A Case Study of New York's Health Care Proxy Law
Authors: Miller Tracy E.
Published: June 2007

On June 25,1990, seven years after Nancy Cruzan lapsed into permanent unconsciousness following a car accident, the United States Supreme Court handed down its landmark decision inCruzan v. Director, Missouri Department of Health.The decision provided the Court's first ruling on the right to forgo life-sustaining treatment, addressing both the right of individuals to decide for themselves and the right of family members to decide on their behalf.

Inextricably linked to the Court's holding on individual rights were questions about the authority and responsibility of each state to fashion policy for treatment decisions on behalf of incompetent patients. TheCruzuncase presented an opportunity for the Court to comment upon and reshape the patchwork of laws that define the right to decide about life-sustaining treatment in states across the country.
Medical Determination (and Preservation) of Decision-Making Capacity
Authors: Howe Edmund G. , Gordon Daniel S. , Valentin Manuel
Published: June 2007

A recent case report described a 62-year-old woman who had suffered a stroke and subsequently had global aphasia, hemiplegia, and could not respond consistently to yes-no questions. She remained hospitalized for four years and throughout this period was irritable, uncooperative, and often refused food. Her care providers considered it very likely that she was depressed and treated her with antidepressant medication, but these drugs did not have beneficial effect.

Her situation subsequently deteriorated. She refused food and water to a greater extent and lost 22 pounds over one month. At that time electroconvulsive therapy was instituted. Thereafter, presumably responding to electroconvulsive therapy, she became pleasant and cooperative and drank and ate heartily.
The Effect of the Treatment Setting on the Decision-Making Process: Acute Care Hospitals and Emergency Services
Authors: Weiss Ellen Covner
Published: June 2007

This paper discusses the obligation of acute care hospitals and emergency services to treat patients. Since care rendered in these settings is, of necessity, provided by health care professionals, not buildings or programs, the obligation may be twofold. First, are there obligations for hospitals and emergency services to offer treatment? Second, do health care professionals practicing in these settings have an independent obligation to treat? How has the Supreme Court decision in Cruzan affected these obligations?

The tradition in this country has been that private hospitals had no obligation to treat patients, as opposed to public hospitals which were frequently set up for the very purpose of treating patients who had no other access to care. Over the years, statutes and case law have limited the rights of private hospitals and physicians to refuse to treat patients.
Impact of the Cruzan Case on Medical Practice
Authors: Pawlson L. Gregory
Published: June 2007

Just over a year has elapsed since the decision of the Supreme Court of the United States in Cruzan. In the year prior to and since the decision there have been a substantial number of articles in the medical literature that have discussed the possible impacts of the decision on medical care along with suggestions as to how to avoid the more onerous consequences. These analyses are constrained by the lack of any direct measurements, an activity that is itself complicated by other events such as the publicity surrounding episodes of assisted suicide and so-called mercy killing. In this paper we will limit our focus to how the decision in Cruzan is likely to affect the doctor-patient relationship, especially in the critical activities surrounding decision-making about the use of life sustaining treatments.
Why Withdrawal of Life-Support for PVS Patients is Not a Family Decision
Authors: Baron Charles H.
Published: June 2007

We presently are not really leaving withdrawal of treatment decisions to families and there are good reasons why we ought not to do so. To see why this is, we need to focus on what is special about PVS cases as opposed to other kinds of medical cases in which we are forced to make life and death decisions.

One thing which is very special about PVS is the fact that it is a condition which intuitively pushes us to rethink, once again, society's definition of “death.” We have already changed our definitions of death to include situations in which respiration and circulation continue but the “whole brain” is dead. Defining death to include irreversible PVS would merely require extending the definition to include situations where the brain stem is functioning but the neocortex is dead. There are, of course, obstacles to overcome in extending the definition in that fashion.
A Response to Gostin, “The HIV-Infected Health Care Professional: Public Policy, Discrimination, and Patient Safety”
Authors: Feldblum Chai R.
Published: June 2007

On February 21-22, 1991, the Centers for Disease Control convened an Open Meeting on the Risk for Transmission of Bloodborne Pathogens to Patients During Invasive procedures in Atlanta, Georgia. Over 80 organizations testified at that meeting.

Almost without fail, every organization testified against the use of mandatory HIV testing to screen out HIV-infected surgeons and dentists from practice. Various groups and individuals, however, advocated that HIV-infected professionals should voluntarily restrict themselves from selected procedures and/or should voluntarily disclose their HIV status to their patients.

Larry Gostin, the Executive Director of the American Society of Law and Medicine, argued that HIV-infected health care workers should voluntarily self-defer from selected invasive procedures. I believe that the approach of voluntary self-deferral has legal and practical flaws and is not the appropriate public policy for the CDC to adopt.
Protection of Research Subjects: Do Special Rules Apply in Epidemiology?
Authors: Capron A.M.
Published: June 2007

Imagine, if you will, a place where health, hospitalization, education, military, employment, law enforcement, housing, tax and financial records, as well as disease registries and the data sources for the census, vital statistics, and all aspects of people's private activities, are meticulously kept, fully linked together, and easily accessible to qualified researchers. What is that place? Epidemiologists’ heaven.

Of course, formidable problems face epidemiologists trying to reach heaven. The data sources on many aspects of our lives are incomplete and the means of linking them are typically nonexistent or partial at best. But even if the data all existed, there would be a further “catch”: epidemiologists would probably find themselves facing great obstacles in gaining access to the data.

Epidemiologists sometimes think of “ethics” as the source of those obstacles, which are believed to be embodied in the federal rules for the protection of research subjects—colloquially called 45 CFR Part 46—especially as they are interpreted by some institutional review boards (IRBs).
Epidemiology and Ethics: The People's Perspective
Authors: Khan Kausar S.
Published: June 2007

To a Western audience the terms “people” and “people's perspective” could appear somewhat perplexing. Technically, every person belongs to the class of “people”; hence, to talk of “people's perspective” seems to make an artificial division within one monolithic group. This ostensibly artificial division reflects a reality that necessitates it. In a Third World context, the term “people” has a fairly distinct connotation. It is not just a majority which is governed by a system that gives all people a minimal quality of life and allows them a meaningful participation in the political process. In a Third World context “people” are a “mass”—a faceless body of massive energy to be manipulated and kept domesticated in the interest of the powerelite. It is a power-bloc that is threatening as well as inescapable.
Existing International Ethical Guidelines for Human Subjects Research: Some Open Questions
Authors: Christakis Nicholas A. , Panner Morris J.
Published: June 2007

International guidelines regarding ethics, and in particular the ethics of clinical research, are problematic on two broad levels. First, by asserting their universality, “international” guidelines obscure real and legitimate crosscultural differences in ethical expectations. International guidelines seek to make homogeneous something which is not necessarily so. Second, existing guidelines are ambiguous about their objectives and purposes. On the one hand, guidelines are structured as a set of goals, largely aspirational in language and content. But on the other hand, such guidelines also suggest a normative function, providing a set of standards by which to judge and, if appropriate, sanction investigators’ conduct.

These criticisms are not intended to argue that international guidelines are useless. Nor are they intended to question the good faith under which such guidelines are developed. Rather, we wish to suggest that the role of present international guidelines is somewhat more limited than is ordinarily appreciated.
What's in a Name? The Policy Implications of the CDC Definition of AIDS
Authors: Levine Carol , Stein Gary L.
Published: June 2007

Disease classification systems and surveillance definitions are ordinarily tools for medical professionals, not matters for political debate and patient advocacy. It is hard to imagine a protest march complaining about the classification system for colon cancer. But when it comes to AIDS, nothing is ordinary.

The Centers for Disease Control's (CDC) case definition of AIDS is used by public health officials, researchers, clinicians, hospital administrators, disability specialists, insurance administrators, health economists, legislators, social workers, policy makers, and the media. It has influenced the way the HIV epidemic is perceived, managed, and funded.

It is not surprising, then, that the CDC definition of AIDS and its proposed revision is currently the subject of intense scrutiny. The case definition has transcended epidemiology to become a symbol for the inadequacies of the U.S. government's response to the HIV epidemic, and a particular symbol for the failure to address the needs of HIV-infected women.
Germ-line Gene Therapy: A New Stage of Debate
Authors: Fletcher John C. , Anderson W. French
Published: June 2007

Ethical debate on human germ-line gene therapy is in a new stage. After an era when only individual convictions could be examined, technology is on a threshold of real possibilities. Germ-line gene therapy can conceivably be carried out in either of two practical ways: 1) insertion of a gene into a pre-embryo, which is the subject of this paper, or 2) insertion of a gene into the germ cells of an individual.

Transgenic animal research and pre-implantation embryo diagnosis have implications for human embryonic germ-line experiments to correct single gene disorders. When would such experiments be feasible and ethically acceptable? If further animal research supports it, we argue for a moral obligation to learn if human germ-line experiments are feasible and safe to attempt. The obligation is grounded in several social-ethical principles that lead society and researchers to set gods for studies that promisc to relieve and to prevent human suffering and premature death. These principles also shape the practices and restrictions of biomedical research.
Whodunit? Causal Responsibility of Utilization Review for Physicians' Decisions, Patients' Outcomes
Authors: Morreim E. Haavi
Published: June 2007

In the “olden days,” only a few years ago, physicians were free to order virtually any service they believed their patients needed, confident that virtually everything would be paid for. Reimbursernent was retrospective, fee-for-service and generous, essentially a cost-plus system in which insurers only rarely challenged medical decisions. That system is now gone. Uncontrolled escalations in the cost of health care have prompted those who pay its costs—primarily governments, businesses, and insurers—to initiate a broad array of cost controls in hopes of at least restraining the rise of their expenditures, even if not actually reducing them. Among the most prominent cost-containment mechanisms is utilization review (UR).

Insurers have always engaged in retrospective review, denying payment for services that are not medically necessary, or not covered by the patient's policy, or not documented in the patient's records. Recently, however, payers have added prospective review, in which physician and patient must secure advance payer approval for certain interventions if they wish to ensure reimbursement.
An Axiology for National Health Insurance
Authors: Dougherty Charles J.
Published: June 2007

Approximately 35 million Americans have no health insurance coverage. They receive no health insurance where they work, nor do they qualify for Medicare, Medicaid, or any other program of health insurance. Eighty-five percent of these Americans live in households headed by someone working full time. One third of the 35 million uninsured are children.

Several reasonable inferences can be drawn from these statistics. First, the problem of the uninsured is a serious one in the United States. Thirty-five million Americans represent approximately 15 percent of the population. Second, the fact that the vast majority of the uninsured are in households headed by a working American shows that this problem is systemic. It is not simply a matter of unemployment, nor is it linked significantly to laziness or refusal to work. Finally, the fact that over 10 million uninsured Americans are children shows that many of the uninsured have this status beyond any intelligible notion of personal responsibility.
Studying the Acceptability and Feasibility of Medical Abortion
Authors: Winikoff Beverly , Coyaji Kurus , Cabezas Evelio , Coyaji Banoo , Krishna Usha , de la Concepcion Oscar , Eschen Andrea , Sivin Irving , Brady Martha
Published: June 2007

“Acceptability research” is a term first coined to describe inquiries into individuals’ responses to family planning and contraceptive technology. As defined by WHO, “acceptability” is a “quality which makes an object, person, event, or idea attractive, satisfactory, pleasing or welcome.” In fact, the word “acceptable” in English is distinct from other issues that are also encompassed within “acceptability research.” “Acceptable,” to many, connotes faint praise. It may mean that something is tolerable only to the point of not being protested. On the other hand, the attributes “desirable” and “preferable” are more positive. In fact, all of these qualities are examined within the meaning of “acceptability research” as currently used by the Population Council.

Acceptability of a product or a medical procedure is most commonly studied in terms of patients or clients. Do those who will undergo the procedure or be the subjects of the technology find its use acceptable? But, in fact, acceptability can also be tested in relation to the providers of the technologies (i.e., the medical professionals), to the program managers or to policymakers.