bluuebunny/crossref_metadata_2025 huggingface dataset:
Revocation of Nurses’ Licenses: How Does it Happen?
Authors: Cohn Sarah D.
Published: June 2007

Even though physicians, lawyers, dentists, school teachers, life insurance brokers, and peddlers were licensed in the United States as early as 1890, nursing occupational licensure did not begin until 1938, when New York became the first state to pass such a law. By 1962, eight states had mandatory licensing laws, and sixteen more had nursing boards which claimed that licensure was mandatory.

Today every state requires that nurses who practice within its jurisdiction possess licenses. Since the purpose ofnursing licensureis protection of the public, the state may require qualifications which are reasonably related to the practice of nursing. A license, because it is granted upon condition, is not a permanent right, and the state may revoke it if the licensee does not continue to meet licensing standards. The state also has discretion to use remedies less extreme than revocation. It may limit or suspend the license, and/or fine or reprimand the nurse.
Infant Doe Regulations and the Absolute Requirement to Use Nourishment and Fluids for the Dying Infant
Authors: Paris John J. , Fletcher Anne B.
Published: June 2007

On July 5, 1983. the Department of Health and Human Services (HHS) issued a revised version of its Proposed Rules for the so-called Infant Doe Regulations. The regulations are designed to prevent discriminatory denial of medical treatment to handicapped infants. An earlier version published last March had been struck down for procedural defects by Federal District Court Judge Gerhard Gesell. In the course of his opinion, Judge Gesell noted that the regulations touch upon one of the most difficult and sensitive medical and ethical problems facing society—the question of what, if any, life-sustaining medical treatment should be utilized to preserve the lives of severely mentally or physically defective newborn infants.

In his view not only were the original regulations procedurally flawed, but they also were substantively deficient. Arbitrary and capricious was Gesell's phrase to describe HHS's actions in establishing a toll-free 24-hour-a-day hotline on which anonymous tipsters could trigger an investigation of alleged nontreatment.
Dilemma of Tarasoff: Must Physicians Protect the Public or Their Patients?
Authors: Roth Michael D. , Levin Laurie J.
Published: June 2007

Physicians nationwide, already worried by an increasing number of professional liability lawsuits and an expanding scope of liability, now face a new and potentially more troublesome development that had its genesis in what many thought was an extraordinary court decision. In Tarasoff v. Regents of the University of California, a psychiatrist was held, in a suit brought by the victim's parents, to be liable for negligence in the death of a woman who was murdered by a patient of that physician. The court held that even though the physician had complied with the traditional duty of protecting the patient's confidentiality, he nonetheless had a duty to warn the victim of the potential threat against her life. Tarasoff was eventually followed by a number of decisions that imposed liability on physicians under similar circumstances.

This article reviews and analyzes the original Tarasoff decision and subsequent judicial rulings on this subject. In addition, the authors briefly explore the historical backdrop of this decision and suggest practical steps that physicians can take to deal with the conflicting duties of protecting confidentiality and protecting potential victims from the danger posed by patients.
Revising Medical Consent Forms: An Empirical Model and Test
Authors: Kaufer David S. , Steinberg Erwin R. , Toney Sarah D.
Published: June 2007

Recent years have brought increasing pressure from the public and the courts for truly informed patient consents to medical treatment and surgical procedures. Many courts have recognized that a patient's signature on a consent form is no assurance that the patient has received sufficient information, much less that he or she truly understood the information. A Pennsylvania court articulated this principle this way:

[S]ince the patient must rely on the physician to tell her of all the appropriate risks, the physician cannot discharge this duty by having the patient execute a form which states that the risks have been explained. The courts will look beyond forms signed by patients to determine if the duty to inform has been discharged.
Standards of Medical Care Based on Consensus Rather than Evidence: The Case of Routine Bedrail Use for the Elderly
Authors: Rubenstein Howard S. , Miller Frances H. , Postel Sholem , Evans Hilda B.
Published: June 2007

“An 88-year-old male patient was found on his hands and knees on the floor beside his bed. The bedrails were up.”—From an indent report filed by a nurse at the Stillman Infirmary, University Health Services, Harvard University, in May 1980.

Finding elderly patients lying on the floor beside their beds despite the presence of elevated bedrails seems paradoxical: how can a patient fall out of bed when the bedrails are up? Surprisingly, this paradox constitutes one of the leading incidents plaguing hospitals in the United States today. It exemplifies a much larger problem created, we believe, by the uncritical adoption of measures designed to enhance patient welfare, but which may in fact undermine it. This article documents our experience with bedrails, reviews the literature, and comments on the rationale for routine adoption of bedrails for the hospitalized elderly. It concludes by advocating that a randomized, controlled study be conducted to determine whether bedrails constitute protection or a hazard to the average elderly patient.
The Predisposition to File Claims: The Patient's Perspective
Authors: Press Irwin
Published: June 2007

The past dozen years have witnessed an astounding rise in costs relating to the prevention and management of medical malpractice claims. Not surprisingly, a crisis of trust has also been building over the same period. Public interest in alternatives to traditional health care has increased as has the plethora of defensive medical procedures in hospitals. In addition, the past decade has seen the rise of such hospital professions as risk management, patient representation, quality assurance, and utilization review. The current high interest in “patient services” and “patient relations” is just that-current: a reflection of low priority until gathering crises made such interests relevant.

The cost crisis has led to both reactive and preventive behaviors on the part of hospital personnel. Reactive behaviors are those designed to respond to errors and claims after they occur. Examples are incident investigation, adjustment decisions, and insurance reserve manipulation. Preventive behaviors are designed to head off incidents before they occur, by identifying and reducing sources of clinical error, legal liability, and patient aggravation.
State Legislation and the Handicapped Newborn: A Moral and Political Dilemma
Authors: Feldman Eric , Murray Thomas H.
Published: June 2007

The treatment of severely handicapped newborns was, for a long time, an issue of concern only to medical practitioners and involved parents. Recently, however, it has drawn the interest of a much broader constituency. Philosophers, lawyers, politicians, and the clergy, as well as public interest groups, are but a few of the groups enmeshed in the controversy over whether all handicapped infants must be treated aggressively, regardless of their physical or mental condition. Similarly, the dispute has expanded beyond academic journals and medical rhetoric. The United States Department of Health and Human Services has issued several versions of regulations concerning the care of handicapped infants (the latest proposing voluntary Infant Care Review Committees to supplement federal and state review mechanisms).
The Changing Role of Nurses in Making Ethical Decisions
Authors: Murphy Catherine P.
Published: June 2007

In past decades, biomedical technology has created such advances that many health care professionals and consumers are overwhelmed by the apparently unlimited choices in treatment decisions. Problems in human reproduction, preservation of life, research on human subjects, and allocation of scarce resources are just a few of the categories of concerns that we now face. These dilemmas are complex both from conceptual and ethical perspectives. Thus, it becomes more and more difficult to define such important concepts as “human life” or ‘extraordinary treatment,” and to apply these concepts to clinical situations. It has become almost impossible to objectively interpret and apply ethical principles which should guide actions of health care providers.
The New Reproductive Possibilities: Seeking a Moral Basis for Concerted Action in a Pluralistic Society
Authors: Capron Alexander Morgan
Published: June 2007

As the media have recently reminded all Americans, biomedical capabilities that are being developed in this country and around the world present us with unfamiliar possibilities in human reproduction, from which flow unprecedented ethical, social and legal issues.

The transfer of a human embryo from one woman to another is one such possibility, though far from the only one. The time has come for a public examination of the full range of developments in reproduction from artificial insemination through in vitro fertilization to the freezing and banking of sperm, eggs, and embryos.
The Professional Advertiser: How Do We Draw the Line (If There is a Line)?
Authors: Grad John D.
Published: June 2007

A half-page advertisement in the 1982 Yellow Pages of a large East Coast metropolis read: “The Podiatry Center. For information on foot health, call the following numbers….” The advertisement contained an address and some other information pertinent to foot health, but did not contain the names of any individual podiatrists.

Many podiatrists were angry be cause the “Podiatry Center” was not a hospital, podiatry school or any other kind of institution; instead, it was a doctors’ office. The advertisement, many podiatrists felt, was purposely misleading to the public, suggesting that the ‘Podiatry Center” was something more than just an office of individual podiatrists.
Therapeutic Privilege: Variation on the Theme of Informed Consent
Authors: Somerville Margaret A.
Published: June 2007

Since 1980. the Supreme Court of Canada has handed down two judgments which have had a major impact on the law of informed consent in this country. These are Reibl v. Hughes and Hoppv.Lepp. The doctrine of therapeutic privilege, the subject of this article, was discussed in both cases. But, in order to examine this doctrine, first, a brief explanation of the Court's more fundamental ruling on the doctrine of informed consent is needed.

The Basic Structure of Informed Consent and Therapeutic Privilege

Citing and relying on the United States case of Canterburyv.Spence, the Supreme Court of Canada changed the reference point for establishing the standard to be used to determine the legally required scope of disclosure of information to a patient in order to obtain his or her informed consent. Previously, this standard had been set according to the information that “the reasonable physician in the same circumstances” would disclose. It became what “the reasonable patient in those circumstance? would want to know, which encompasses information concerning “the nature of the proposed operation, its gravity, any material risks and any special or unusual risks attendant upon the performance of the operation.”
Nursing Negligence in Collaborative Practice: Legal Liability in California
Authors: Kelly Mary E. , Garrick Thomas R.
Published: June 2007

Over the past two decades, discussion has increased among health care professionals about joint or collaborative practice. In 1971, the American Nurses” Association (ANA) and the American Medical Association (AMA) established the National Joint Practice Commission to examine and make recommendations regarding the roles of physicians and nurses in the provision of quality health care. The Commission, comprised of three nurses and three physicians appointed respectively by the ANA and the AMA, defined joint practice as “nurses and physicians collaborating together as colleagues to provide patient care”. The purpose of this broad definition was to include all collaborating registered nurses, not only nurse practitioners.
Institutional Ethics Committees: Issues of Confidentiality and Immunity
Authors: Cranford Ronald E. , Hester F. Allen , Ashley Barbara Ziegler
Published: June 2007

Institutional ethics committees (IECs) now exist at many health care facilities and are in the planning stages at others. Due in part to the recent origins of IECs and the continuing debate over their optimal composition, role, and status in health care institutions, legislatures and courts have yet to recognize or clarify their legal status. Neither reported cases nor statutes clearly explain whether the proceedings and records of IECs must be disclosed to prosecuting attorneys or to parties to civil lawsuits, whether such information can be introduced as evidence in a trial, or whether persons serving on IECs or those providing information to IECs may be held civilly or criminally liable for actions by the committees.

This article sets forth some basic principles relating to the composition and functions of IECs, then examines the questions of confidentiality of IEC proceedings and immunity for persons serving on or providing information to the committees. Several reasons against and in favor of confidentiality and immunity are stated.
Consent Forms, Readability, and Comprehension: The Need for New Assessment Tools
Authors: Mariner Wendy K. , McArdle Patricia A.
Published: June 2007

Recent efforts to evaluate the effectiveness of the informed consent process between physician and patient have focused on the ability of patients to understand written “informed consent” documents. Several researchers, employing traditional readability formulas to measure the reading level of such documents, have noted that many of these forms are written at a level too difficult for most people to understand. Readability formulas, such as those of Flesch and Fry, and the SMOG formula, have become convenient measures of the effectiveness of informed consent documents in conveying information to patients to enable them to make decisions about recommended therapies.

Our experience, in a pilot study, with readability formulas to test an informed consent document used in childhood poliomyelitis immunizations led us to conclude that readability formulas are an inadequate measure of patients’ comprehension of written information about medical procedures.
Family Responsibility Initiatives and Justice between Age Groups
Authors: Daniels Norman
Published: June 2007

Only one of the Ten Commandments offers a reward. We should honor our parents, we are told, so that our days may be long. When the federal or state governments appeal to traditional religious and family values, however, we should look to the costs and not the benefits. In Hawaii, House Resolution 54 would seek to reinstate a relative responsibility law that was repealed in 1965; the immediate concern is to correct a $30 million shortfall in Medicaid. In Massachusetts, a pending bill, House Bill 1753, would make each “responsible relative” of a Medicaid recipient residing in a nursing home accountable for up to 25 percent of the amount paid, although the total collected from all responsible relatives must not exceed 100 percent of Medicaid payments. According to the bill, responsible relatives are spouses, natural and adoptive children, or natural or adoptive parents of blind or disabled children under 18.
Medical Uncertainty, Diagnostic Testing, and Legal Liability
Authors: Fortess Eric E. , Kapp Marshall B.
Published: June 2007

Health care cost considerations exert increasing influence today over clinical decision-making. One way to help contain costs while maintaining the quality of health care may be to increase among both physicians and patients an acknowledgment of, and tolerance for, a reasonahle degree of medical uncertainty. By medical uncertainty we mean here those clinical situations in which, based on available data, absolute scientific proof regarding some aspect of a patient's heallh status cannot be obtained.

To the extent that acceptance of medical uncertainty and a corresponding restraint among physicians can he encouraged without exposing the physicians to an undue risk of legal liability, all participants in the health care system would benefit from this tolerance. To help provide this encouragement. we will explore the legal implications of medical uncertainty, focusing on diagnostic testing, and argue that our legal system does now and will continue to recognize, tolerate, and perhaps even promote some medical uncertainty in the diagnostic realm.
The Lawyer's Perspective on the Use of Ultrasound in Obstetrics and Gynecology
Authors: Bundy Albert L. , James A. Everette
Published: June 2007

Diagnostic sonography, also known as ultrasound, has become an invaluable aid in the practice of obstetrics and gynecology. Rapid improvements in instrumentation have caused the sonologist and sonography to assume a primary role in the care of these patients. Patient and physician expectations have increased with the technological advances. This paper will outline the advances and capabilities of diagnostic sonography in obstetrics and gynecology, while reflecting upon the foreseeable legal implications.

The physics of ultrasound is rather complex. Briefly, ultrasound utilizes high-frequency, non-ionizing, mechanical waves, 2.25 to 10 megahertz, that require a molecular medium for propagation. The reflected energy is processed to produce an image. Because it employs non-ionizing waves, ultrasound is considered safe by most authorities when used at the intensities currently employed for diagnosis. No clinically significant adverse effects have been reported in humans to date.
New Initiatives in Financing and Delivering Health Care for the Medically Indigent: Report on a Conference
Authors: Butler Patricia A.
Published: June 2007

Despite the current debate be tween proponents of regulation and of competition over the best way to control the inflation of medical care costs, both camps agree that health care for the uninsured poor is primarily a government obligation and cannot be left to market forces. Health care for the “medically indigent,” people unable to afford needed care due to poverty or inadequate insurance, has always been the responsibility of state or local governments. But it has often been rendered through the charity care of hospitals and other health care providers. As the willingness of private hospitals to render such care declines, policy-makers are beginning to study the uninsured and to develop new ways to finance and deliver health care to them. This interest is both timely, as the number of uninsured is increasing, and confounding, as health care costs and the pressure to reduce the federal deficit limit government's ability to expand public programs.
Innovative Statutory Approaches to Civil Commitment: An Overview and Critique
Authors: Shuman Daniel W.
Published: June 2007

The study of society's approach to civil commitment of the mentally ill is made particularly interesting by the strength of the values it finds in conflict. On one plane, “good” or “moral” people are supposed to provide care for those unable to care for themselves. The capacity to consider the needs of others helps define our “humanness.” In this context, this value manifests itself in the attempt to provide mental health care for those unable, because of their illness, to provide it for themselves.

On another plane, however, the oppression that drove many to immigrate to America and that resulted in our own revolution has left us with an abiding fear of governmental limitations on individual autonomy. Cries of totalitarianism and “big brotherism” often accompany governmental attempts to restrict that autonomy. In this context, this value manifests itself in the attempt to permit individuals to choose whether to receive mental health care.
Against Infanticide
Authors: Keyserlingk E.W.
Published: June 2007

I agree with Dr. Kuhse and Prof. Singer on many points. It is of course ethically defensible to decide sometimes that a seriously handicapped newborn baby may be better off dead, that medicine can do no more to help, and that to stop or not initiate medical treatment may be the best we can do. It is equally true and ethically defensible that these decisions are sometimes based at least in part on predictions about the baby's present and future quality of life. It would be foolish to pretend that quality-of-life considerations should be or can be excluded from these decisions. I argue that the interests and wishes of the family must be given serious consideration, if not that they should be decisive at the expense of the newborn's best interests.

I do, however, seriously object to the claim that some infants with severe disabilities should be killed. I will not repeat the familiar philosophical and other arguments as to why there is arguably, given certain conditions, a significant moral difference between not treating and killing. Instead, my refutation of infanticide will take a more indirect route.
The Genesis of Fear: AIDS and the Public's Response to Science
Authors: Eisenberg Leon
Published: June 2007

The AIDS (acquired immunodeficiency syndrome) crisis has aroused scientists to major research efforts and the public at times to near-hysteria. The media and their audience eagerly await the latest scientific reports, yet the public seems to respond selectively, embracing the most frightening interpretation of the data and discounting attempts to place those data in perspective. One might be tempted to conclude that questions of public health policy are best dealt with by expert judgment unsullied by lay opinion. Yet such an attitude supposes scientists to be governed by pure reason and to be beyond influence by narrow self-interest or by political or moralistic considerations, a self-serving assumption belied by an examination of the record. The erosion of public confidence in science has indeed bedeviled health authorities in their efforts to generate consensus on the policies they wish to implement, but the public response—including the response of scientists to AIDS—is a far more complex phenomenon.
Screening for HIV Infection: Risks, Benefits, and the Burden of Proof
Authors: Barry Michael J. , Cleary Paul D. , Fineberg Harvey V.
Published: June 2007

In 1984, scientists isolated a new pathogen, now called human immunodeficiency virus (HIV), that is almost certainly the etiological agent for the acquired immunodeficiency syndrome (AIDS). It has been estimated that there are between 500,000 and 1,750,000 asymptomatic, chronically HIV-infected individuals in the United States. In a remarkably short time, investigators developed a number of blood tests that indicate whether an individual is likely to be infected with this virus. These assays are now being used to test patients with symptoms suggesting AIDS or related syndromes, to screen donated blood, to evaluate individuals concerned about their infection status, and to screen new military recruits, active-duty soldiers, and ROTC students. Almost weekly, new proposals are advanced for screening different subsets of the population.
The Clinical Challenges of AIDS and HIV Infection
Authors: Mayer Kenneth H.
Published: June 2007

Researchers trying to resolve the questions surrounding the AIDS epidemic may feel like Hercules trying to slay the Hydra: for every head that is cut off, two new ones grow in its place. Doctors have never treated their patients in a social vacuum, but the expectations and anxieties engendered by AIDS are bringing fundamental changes in clinical p-actice. Drugs are being raced from the laboratory bench to the bedside, health care providers are being forced to recognize new types of family constellations, and the general public is being shocked into awareness of the importance of prudent infection control policies. Clinical practitioners have had to deal with the ethical consequences of routine and arcane decisions as never before, knowing that yesterday's experiment or hospital rounds can become tomorrow's lead feature in the news media.
A Review of AIDS-Related Legislative and Regulatory Policy in the United States
Authors: Gostin Larry , Ziegler Andrew
Published: June 2007

This article surveys proposals for public health statutes and regulations to control the spread of the human immunodeficiency virus (HIV). The data were collected by the Harvard School of Public Health in pursuance of a contract for the U.S. assistant secretary for health and by the Intergovernmental Health Policy Project at George Washington University. The intention is to provide a representative overview of legal and policy alternatives, not to offer a comprehensive account of statutes and proposals in all jurisdictions.

The AIDS epidemic has refocused attention on public health law, raising anew questions about the application, effectiveness, and constitutionality of various disease control measures. State and local legislatures have considered a broad range of measures designed to control the spread of AIDS. Virtually every state legislature has debated AIDS-related bills; between January 1 and April 15, 1987, more than 360 AIDS-related bills were introduced in the United States. Thus far, approximately twenty-eight states have enacted AIDS-related legislation.
AIDS and the Limits of Discrimination Law
Authors: Parmet Wendy E.
Published: June 2007

Throughout history, disease has been associated with bigotry and prejudice. Since biblical times the leper has been shunned and treated as an outcast. In the Middle Ages, the arrival of the plague brought with it violent social upheaval and persecution of the Jews. In the earlier part of this century, prostitutes thought to have venereal disease were quarantined en masse.

Given this sorrowful history, it is not surprising that the AIDS epidemic has brought with it mistreatment of persons associated with AIDS, the term I shall use for people who either have or are thought to have AIDS, AIDS-related complex (ARC), or antibodies to the virus that causes the disease. Indeed, considering that AIDS is a sexually transmitted disease that has in this country primarily afflicted homosexual men and intravenous (IV) drug abusers, it is perhaps surprising that overt acts of prejudice have not been more common.
Pediatric Ethics Committees: Ethical Advisers or Legal Watchdogs?
Authors: Weir Robert F.
Published: June 2007

Over the past ten years or so, an increasing number of health care institutions have established institutional ethics committees (IECs) for the purposes of education, policy making, and review of cases. Proponents of IECs view them as important interdisciplinary mechanisms that improve decision making in the complex cases that sometimes arise in clinical medicine. Critics of IECs tend to interpret them as threats to the autonomy of physicians and an unnecessary bureaucratization of decision making. In spite of these criticisms, IECs seem to have filled an important role in many institutions and have a reasonably secure future.
Federal Regulations for Fetal Research: A Case for Reform
Authors: Fletcher John C. , Ryan Kenneth J.
Published: June 2007

In 1974 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research considered many aspects of fetal research. The Commission received some detailed ethical, legal, and scientific analyses, invited public testimony, and recommended guidelines for biomedical research involving the human fetus. One of the authors of the present article (KJR) chaired the Commission. Many of its recommendations became federal regulations on fetal research issued in 1975.

These regulations explicitly govern only research “conducted by the Department of Health and Human Services (DHHS) or funded in whole or in part by a Department grant, contract, cooperative agreement or fellowship.” However, as Baron pointed out in his legal review, they effectively cover all federally funded institutions, regardless of the source of the funds the institution may be using for fetal research.
Unionization by Salaried Physicians and the Managerial-Employee Exclusion: The Need for a Modified Approach by the National Labor Relations Board
Authors: Wanger David Kushlan
Published: June 2007

The increased concern with cost-containment and the cost-efficient delivery of medical services has led to fundamental changes in the management of health care institutions over the past few decades. Health care is becoming concentrated in large facilities, since they are perceived to have the resources to plan cost-efficient allocation and utilization of medical services. In the past, physicians provided most of the executive and administrative leadership in American health care facilities and used them primarily for the private practice of medicine. Today, professional administrators and bureaucrats run these institutions as large corporate entities. Moreover, more and more physicians are taking salaried positions, due in large part to the oversupply of doctors that developed during the 1970s and 1980s. In fact, some observers believe that in the near future, the majority of physicians will be “employees” of some kind.
Reproduction without Sex—But with the Doctor
Authors: Brody Eugene B.
Published: June 2007

Nine years after the appearance of the world's first “test tube baby,” the public is being deluged with technical and ethical opinions about non-coital reproduction. U.S. legislators, policymakers, and lawyers, energized by the court battle about “Baby M,” are reconsidering the rights of would-be parents and of the children created by the new technologies. But in the course of this turmoil one salient fact has been ignored: social policy and technological advances in respect to reproduction are mediated for the individual woman through her interaction with her doctor.

Doctors have gotten by with remarkably little scrutiny in this regard. The perception of them as benevolent magicians has, indeed, been enhanced. The only criticism has come from religious leaders concerned with the experimental use of fetal or reproductive materials, and from those who see the doctor-scientist “playing God.”
Justice Blackmun and the Right to Medical Privacy
Authors: Gostin Larry
Published: June 2007

In his foreword to a forthcoming issue of theAmerican Journal of Law & Medicinededicated to Harry A. Blackmun, Supreme Court Justice William J. Brennan calls it “superbly right that the American Society of Law & Medicine honors Mr. Justice Harry A. Blackmun with this edition of its Journal.” Last October the Society presented its first Presidents' Award for Outstanding Contributions to Law and Medicine to Justice Blackmun. Justice Blackman attended our Annual General Meeting and a banquet at Boston University School of Law, where he was presented with the award. We found Justice Blackmun to be a gentle, modest man despite the unique illumination and perception that he has contributed to health law in America. “That makes it only the more fitting,” as Justice Brennan says, “that the American Society of Law & Medicine should award this richly deserved honor, in Learned Hand's words, to ‘Acclaim one who—all unaware of his deserts—has so richly earned our gratitude.’”
Policy, Ritual, Purity: Gays and Mandatory AIDS Testing
Authors: Mohr Richard D.
Published: June 2007

for Robert W. Switzer

“[T]here is not a good word to be said for anybody's behavior in this whole mess.”

—Larry Kramer, The Normal Heart

Well after Brown v. the Board of Education, Jackson, Mississippi, maintained racially segregated public swimming pools, claiming that only through segregation could violence and social chaos be avoided there. The federal courts saw through this stratagem, noting that it was a variant of the heckler's veto thinly masking racial animus. But did Jackson integrate its pools? No. The city council voted instead to close them all. This time out, the courts were not so wise.

In 1971, the Supreme Court upheld the constitutionality of the pool closings. The Court was snookered by the surface similarity of the policy's treatment of blacks and whites—neither could, after all, use the swimming pools. The practice appeared to treat similar cases similarly. And indeed the pool-closing statute did not refer in any way to blacks.
Fairy Tales Surrogate Mothers Tell
Authors: Annas George J.
Published: June 2007

How did surrogate motherhood evolve from a hare-brained, fly by night idea of the late 1970s into one that had at least some mainstream, middle-class support in the mid-1980s? Many explanations have been suggested. Although the rate of infertility has not increased, infertility is no longer a secret, and there are major public support groups, like RESOLVE, that advocate for infertile couples. New and powerful techniques like IVF (in vitro fertilization) have been developed, and although they help very few people, they have been widely publicized and approved. And babies are fashionable again. As one movie critic put it: Men and women do not fall in love with each other in the movies anymore. They fall in love with babies. Babies are the new lovers—unpredictable, uncontrollable, impossible and irresistible.

These explanations all have some merit. But the core of surrogate motherhood lies in the modern fairy tale that babies can properly be viewed as a consumer product for those with money to purchase them, and that by permitting this transaction we will all live happily ever after. As a product babies have been hyped by slick, white, middle-class professionals and advertised in the free-market environment of the 1980s. We are asked not to look behind the resulting children to see their lower-middle-class and lower-class mothers.
Surrogate Motherhood as Prenatal Adoption
Authors: Steinbock Bonnie
Published: June 2007

The recent case of Baby M has brought surrogate motherhood to the forefront of American attention. ultimately, whether we permit or prohibit surrogacy depends on what we take to be good reasons for preventing people from acting as they wish. A growing number of people want to be, or hire, surrogates; are there legitimate reasons to prevent them? Apart from its intrinsic interest, the issue of surrogate motherhood provides us with an opportunity to examine different justifications for limiting individual freedom.

In the first section of this article, I examine the Baby M case and the lessons it offers. In the second section, I examine claims that surrogacy is ethically unacceptable because it is exploitive, inconsistent with human dignity, or harmful to the children born of such arrangements. I conclude that these reasons justify restrictions on surrogate contracts, rather than an outright ban.
The Ethics of Surrogate Motherhood: Biology, Freedom, and Moral Obligation
Authors: Cahill Lisa Sowle
Published: June 2007

Proponents of the new reproductive arrangements tend to speak in terms of reproductive freedom, the right to be a parent, contractual obligation, and infertility therapy, while opponents speak of the natural bond of motherhood, the gift of a child, the integrity of the family, and playing God with the reproductive process. Underlying the rhetorical slogans are deep differences about the values that should guide evaluation of the disputed practices and policies. The proponents of surrogacy contracts place a high value on freedom and autonomy, and consequently on legally binding agreements to embark on birth projms that will alleviate for some the physiological blight of infertility. The opponents of surrogacy and other forms of nontraditional reproduction, on the other hand, defend the physical and genetic foundations not only of parenthood but also of marriage and family. The right to self-determination, they hold, should not extend beyond the personal relationships derived from the basic biological realities of marriage cemented sexually and natural parenthood.
Surrogate Motherhood: The Challenge for Feminists
Authors: Andrews Lori B.
Published: June 2007

Surrogate motherhood presents an enormous challenge for feminists. During the course of the Baby M trial, the New Jersey chapter of the National Organization of Women met and could not reach consensus on the issue. The feelings ranged the gamut, the head of the chapter, Linda Bowker, told the New York Time. We did feel that it should not be made illegal, because we don't want to turn women into criminals. But other than that, what you may feel about the Baby M case may not be what you feel about another.

We do believe that women ought to control their own bodies, and we don't want to play big brother or big sister and tell them what to do, Ms. Bowker continued. But on the other hand, we don't want to see the day when women are turned into breeding machines.
ATVs—The Hidden Danger
Authors: Kitzes William F.
Published: June 2007

In 1967 Osamu Takeuchi of Honda Research and Development Co., Ltd. took some spare motorcycle parts to an outdoor area in Japan. American Honda Motor Corporation, the United States distributor for Honda Motor Company, Limited of Japan had requested the development of a vehicle to compete with snowmobiles. The result of Mr. Takeuchi's work was the All Terrain Vehicle (ATV), first distributed in the United States in 1970.

By the end of 1987, an estimated 2.5 million ATVs had been sold by the major Japanese manufacturers and distributors: Honda, Yamaha, Kawasaki and Suzuki, and by Polaris, the sole American-owned manufacturer and distributor. According to U.S. Consumer Product Safety Commission (CPSC) estimates, over 340,000 hospital-emergency-room treated injuries have been associated with the use of ATVs. Almost 1000 deaths have been recorded by CPSC through their system for tracking state medical examiner's and coroner's offices. Almost half the deaths were children under 16 years of age and approximately 20 percent were children 12 and under. CPSC estimates that approximately 5 percent, or one of every 20 three-wheeled ATVs, is involved in a hospital emergency room treated injury each year.
AIDS: The Ethical Dilemma for Surgeons
Authors: Peterson Lynn M.
Published: June 2007

“No man is an island entire of itself; every man is a piece of the Continent, a part of the maine.”

J. Donne, “Devotions,” XVII

“… Father Paneloux evoked the august figure of Bishop Belzunce during the Marseille plague. He reminded his hearers how, toward the end of the epidemic, the Bishop, having done all that it behoved him, shut himself up in his palace, behind high walls, after laying in a stock of food and drink. With a sudden revulsion of feeling, such as often comes in times of extreme tribulation, the inhabitants of Marseille, who had idolized him hitherto, now turned against him, piled up corpses around his house in order to infect it, and even flung bodies over the walls to make sure of his death. Thus in a moment of weakness the Bishop had proposed to isolate himself from the outside world—and lo and behold, corpses rained down on his head! This had a lesson for us all; we must convince ourselves that there is no island of escape in time of plague.

A. Camus, The Plague
Reconceptualizing the Euthanasia Debate
Authors: Devettere Raymond J.
Published: June 2007

For humane reasons, with informed consent a physician may do what is medically necessary to alleviate severe pain, or cease or omit treatment to let a terminally ill patient die, but he should not intentionally cause death.

—Current Opinion of the Judicial Council of the American Medical Association—1984

This well known position of the AMA Judicial Council implies that the distinction between intentionally causing death and letting a patient die is conceptually clear and ethically significant. Most opponents of active voluntary euthanasia accept the validity of this distinction; proponents inevitably do not. The President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research is a notable exception.
Role of in-House Counsel in Decisions about Withdrawal of Life Sustaining Treatment
Authors: Wynstra Nancy A.
Published: June 2007

For any hospital attorney, but especially for in-house legal counsel, the thought of a dissatisfied patient or other person turning to physical force or violence to achieve a particular outcome is the stuff of which nightmares are made. Apart from the human consequences of such situations, their occurrence means that counsel has failed to prevent problems. Problem prevention is one of the most important roles of any attorney and is the role which many in-house counsel view as their most important.

Resort to force within a health care setting is especially troubling, yet the potential for such outcomes exists in a variety of situations about which counsel are likely to be consulted. These include employee terminations, medical student or resident terminations from training programs, and, in the patient care context, situations where patient or family wishes are not mer. Just such an outcome occurred at Rush-Presbyterian-St. Luke Hospital, in Chicago, Illinois, (hereafter “Rush”) when Mr. Rudolfo Linares held hospital staff at gunpoint while he disconnected his infant son's respirator so that the child would die.
Do the Right Thing: Samuel Linares and Defensive Law
Authors: Fost Norman
Published: June 2007

Let us start with a conclusion that seems not to be in dispute: that in April of 1989 Samuel Linares had little or no interest in living. He had been competently diagnosed as being in a persistent vegetative state, by then eight months long. The cause was clearly prolonged asphyxiation, so that whatever uncertainty exists in cases of unknown etiology was not a factor. It could also be claimed that he had little interest in dying, in that he wasprobablyincapable of suffering from prolonged treatment. But few advocate prolonged intensive care for preservation of mere vegetative functions. Nor is there serious argument that patients or surrogates who request discontinuation of treatment in such circumstances, when it serves no interest of the patient, are acting immorally. Even the vitalist federal Baby Doe regulations concede that life-sustaining treatment may be discontinued when the patient is permanently comatose.
Clinical Ethics and Public Policy: Reflections on the Linares Case
Authors: Thomasma David C.
Published: June 2007

When the Linares case broke in Chicago, the media immediately began contacting ethicists and hospital lawyers in the area. Eventually, and somewhat wistfully as one paper reported, they were unable to find a single ethicist who did not think that the decision should have been made to withdraw treatment from Samuel far earlier in his treatment. Furthermore, ethicists argued that the family and physician should have made that decision. There was no need to consult with lawyers and especially not with courts.

On the other hand, most lawyers contacted felt it was necessary to go to court to obtain permission to withdraw the respirator, since the legal status of such decisions in Illinois (as in most other states) was terribly unclear. Lack of “clarity” was a catchword in these interviews.

This dichotomy between the instinctive reactions of ethicists and lawyers is natural. It should be so. The ethicists consulted, philosophers, theologians, and physicians, are all skilled in clinical ethics.
Assessing Decision-Making Capacity
Authors: Lo Bernard
Published: June 2007

Physicians frequently are asked to assess whether a patient has the capacity to make informed decisions about his or her medical care. Such assessments may be difficult and controversial. There are few explicit legal standards for judging competency to make medical decisions. Furthermore, clinical practices for evaluating decision-making capacity are problematic. The following case illustrates some of these problems.

Mrs. C., a 74 year old widow with congestive heart failure, angina pectoris, and mild dementia, has been admitted to the hospital for shortness of breath and chest pain. In the past three years she has suffered two heart attacks. During the past two months, her symptoms have worsened despite several medications, including maximally tolerated doses of diltiazem, furosemide and enalapril. She now develops shortness of breath and chest pain when walking one block. Because there are no other medical treatments for her condition, her physician recommends angioplasty or bypass surgery in order to ameliorate her symptoms.
Biomedical Research Involving Older Human Subjects
Authors: Sachs Greg A. , Cassel Christine K.
Published: June 2007

The increasing life expectancy and increasing proportion of the population over the age of 65 in most developing countries are both unprecedented demographic phenomena. In the United States, life expectancy has increased more in the last century than in all previous recorded history. Even in the last 20 years, there have continued to he unexpected and largely unexplainable declines in mortality rates leading to increasing numbers of people living beyond even the ages of 85, 90 or 100. It is not surprising, then, that there is a great interest in studies of aging among researchers in social science and policy studies. Further, since aging is generally associated with an increased risk of medical illness and declining function, research has been stimulated in many different health-related areas, such as clinical disease, basic molecular causes of aging, and health services research.
Assuring Quality of Care for the Elderly
Authors: Lohr Kathleen N. , Donaldson Molla S.
Published: June 2007

Health, Health Care, and the Elderly

Health means different things to different people, but all people want access to essential health care services of high quality—not too much (the likelihood of benefit should outweigh the likelihood of harm), not too little (necessary and appropriate services must be available, and equitably so), and of a satisfactory technical and interpersonal character. The object of organized quality assurance programs in the private and the public sectors is to ensure that practitioners and institutions deliver care of high caliber.

Many developments in health care are drawing attention to its quality. Health care costs conrinue to rise, both for the elderly out-of-pocket and for the Medicare program. In 1987, health care expenditures stood at $500.3 billion, or 11.1 percent of the nation's gross national product, and will be an estimated $647 billion in 1990.
Legal Issues in Nursing Home Admissions
Authors: Ambrogi Donna Myers
Published: June 2007

Entering a nursing home involves a significant loss of personal autonomy. Whether the resident or someone else, such as a court or conservator, makes the decision, personal freedom becomes subject to rules, policies and practices that often seem to favor the convenience of the facility over the autonomy of the resident. The previously independent resident may now find that a “financial guarantor” must co-sign the admission agreement and a staff nutritionist decide what the resident will eat.

As the impact of nursing home care on individual autonomy becomes more apparent, greater attention has focused on the rights of nursing home residents. Many of those rights derive from the admissions agreement signed when the resident enters the facility. While theoretically subject to negotiation, the boilerplate contracts used by most nursing homes subject the consumer to undeniable coercion in making an important consumer choice.