bluuebunny/crossref_metadata_2025_split huggingface dataset:
Constructed Attitudes toward the Roma: A French Case
Authors: Gagnon Audrey 
Published: February 2021

AbstractForty per cent of Europeans refuse to have Roma as their neighbours, while 80 per cent of these do not even have direct contact with them. Using these statistics as a point of departure, this study analyzes how attitudes toward Roma are constructed. It proposes to investigate this process in two similar environments but where local integration policies directed toward Roma differ, resulting in disparate forms of intergroup contact. The analysis is premised on two theoretical assumptions: that the integration of migrants is a local public policy issue and that intergroup contact frames attitudes between majority and minority groups. From semi-structured interviews in the French municipalities of La Courneuve and Ivry-sur-Seine, four theories are empirically tested: the contact theory, the halo effect, the impact of local immigrant integration policies and media influence. This study demonstrates that the implementation of municipal policies in favour of Roma integration can improve their living conditions and thus deconstruct prejudices attributable to their precarious situation. In addition, it illustrates how the media activate, maintain or solidify the way Roma are perceived.
Effect of grouping on behaviour of dairy heifers and cows in the transition period
Authors: Soonberg Maria , Kass Marko , Kaart Tanel , Barraclough Rosie , Haskell Marie J. , Arney David R. 
Published: February 2021

AbstractRegrouping dairy cows is a common feature of dairy farm management. Cows are grouped based on lactation stage, age, milk yield and other factors. Regrouping cows during the dry period (from far-off area to close up area and from close up area to the main herd) brings new challenges. This is especially true for heifers who, after being confirmed gravid, may be grouped into a new pen with dried off cows. The aims of this study were to determine how grouping affects activity, nearest neighbour relationships and aggression, and how heifers’ acclimatization to a new group differs from cows. Therefore, the hypotheses were that regrouping cows has less of an effect on older cows compared to heifers, and cows' individuality affects acclimatization to a new group. Aggression data were recorded using a video camera that was directed at the feed bunk, and activity was recorded with activity monitors that were attached around the right hind leg. Synchrony and distance to nearest neighbour were recorded, as was the cows' location on the first 3 d from the day they returned to the main herd. Motion index, mean number of steps and number of lying bouts were significantly higher after calving compared to the week before calving and the difference was higher amongst heifers compared to cows (P < 0.001). Both cows and heifers lay down more in the strawyard compared to cubicle housing (P < 0.01) and cows were more aggressive than heifers in both housing systems (P < 0.001 and P < 0.05, respectively). As hypothesized, heifers were more affected by regrouping and cows with more experience settled quicker to their new environment.
Health Care Cost-Containment Regulation: Prospects and an Alternative
Authors: Havighurst Clark C. 
Published: February 2021

AbstractRegulation of the health care system to achieve appropriate containment of overall costs is characterized by Professor Havighurst as requiring public officials to engage, directly or indirectly, in the rationing of medical services. This rationing function is seen by the author as peculiarly difficult for political institutions to perform, given the public's expectations and the symbolic importance of health care. An effort on the part of regulators to shift the rationing burden to providers is detected, as is a trend toward increasingly arbitrary regulation, designed to minimize regulators’ confrontations with sensitive issues. Irrationality and ignorance are found to plague regulatory decision making on health-related issues, even though it is the consumer who is usually thought to suffer most from these disabilities. The author argues that consumer choice under some cost constraints is a preferable mechanism for allocating resources because it better reflects individuals’ subjective preferences, has a greater capacity for facing trade-offs realistically, and can better contend with professional dominance of the resource allocation process.In view of the unlikelihood of regulation that is both sensitive and effective in containing costs, the author proposes that we rely primarily on consumer incentives to reform the system. A simple change in the tax treatment of health insurance or other health plan premiums, to strengthen consumers’ interest in cost containment while also subsidizing needy consumers, is advocated. Steps to improve opportunities for innovation in cost containment by health insurers, HMOs, and other actors are outlined briefly.
Genetically Defective Children: Emerging Legal Considerations
Authors: Shaw Margery W. 
Published: February 2021

AbstractDespite modern medical advances, births of genetically defective children still occur. The author outlines the problem of genetic disease, and describes the medical and legal advances that now make possible a reduction in its incidence. Then she cites—and briefly comments upon— some court cases brought by parents of genetically defective children against their physicians for allegedly failing to predict or to diagnose genetic defects in those children in time for the parents to exercise any procreative options such as sterilization, contraception, or abortion. In addition, the author speculates on various questions that may arise in future litigation in this area—among them, the question of whether or not courts someday will endow genetically defective children with a cause of action against their parents for bringing them into the world.
A Look at the Massachusetts Malpractice Tribunal System
Authors: McLaughlin Walter H. 
Published: February 2021

AbstractIn this Oration, the retired Chief Justice of the Massachusetts Superior Court offers some personal observations on the American medical malpractice crisis and examines the Massachusetts malpractice tribunal system, which is aimed at reducing the incidence of malpractice litigation that is either frivolous or involves simply an “unfortunate medical result” for which the health care provider should not be held accountable. First, the author relates some of his impressions of the evolution of the malpractice crisis and identifies its salient characteristics. Next, he provides a description and an evaluation of the Massachusetts tribunal system. Under that system, the plaintiff in any malpractice action must argue before a special tribunal—composed of a Superior Court judge, an attorney, and a surgeon—that his case raises a “legitimate question of liability.” If the tribunal finds that such a question exists, the plaintiff may pursue his case in the normal manner. But if the tribunal finds that the case involves “merely an unfortunate medical result,” and if the plaintiff still wishes to press his claim, he must, before proceeding, post a $2,000 bond, which is used to help pay the defendant’s litigation costs if the defendant prevails at the trial. The author offers data to support his contention that this tribunal system already is screening out a significant number of inappropriate malpractice claims. Nevertheless, he suggests that the system has substantial problems. He identifies those problems, and proposes methods for solving them.
Psychiatric Expert Witnesses: Proposals for Change
Authors: Needell James E. 
Published: February 2021

AbstractPsychiatric experts are now called more frequently than in the past to testify in courtroom proceedings. Often, however, their testimony leads, to non-productive "battles of the experts." This Note examines various plans that seek to minimize the conflicts in expert testimony due, not to legitimate psychiatric disputes, but rather to inaccurate or biased testimony offered by one or both psychiatrists. It concludes that either of two plans would be effective: the first provides for a panel similar to existing medical malpractice tribunals; the second mandates court appointment of an inde pendent expert to testify in addition to those called by adversaries.
Assuring ‘Detached but Passionate Investigation and Decision’: The Role of Guardians Ad Litem in Saikewicz-type Cases
Authors: Baron Charles H. 
Published: February 2021

AbstractThe author focuses this Article upon the aspect of the Saikewicz decision which determines that the kind of “proxy consent” question involved in that case requires for its decision “the process of detached but passionate investigation and decision that forms the ideal on which the judicial branch of government was created.” This aspect of the decision has drawn much criticism from the medical community on the ground that it embroils what doctors believe to be a medical question in the adversarial processes of the court system. The author criticizes the decision from an entirely opposite perspective, arguing that the court's opinion fails in not laying down guidelines that would assure a truly adversary process in Saikewicz-type cases. He agrees with the Saikewicz court that our democratic institutional structure and societal commitment to individual liberty require that persons not competent to consent for themselves to acts of euthanasia be protected by a process of “detached but passionate investigation and decision.” However, he points out that this ideal of the court system was not realized in Saikewicz itself and is not likely to be realized in other cases without reform of some of the procedures currently being employed by the courts in “proxy consent” cases. Drawing on previous articles that he has written in related areas, he then proposes a set of guidelines that he believes not only will remove existing procedural deficiencies, but also may reform some aspects of the existing system that have drawn criticism from the medical community.
Judicial Determination of the Sexual Identity of Post-Operative Transsexuals: A New Form of Sex Discrimination
Authors: Taitz Jerold 
Published: February 2021

AbstractTranssexualism is a condition in which an individual's psychological gender is the opposite of his or her anatomical sex. A “sex-change” operation can bring anatomical sex into line with gender, but it cannot create a new biological sex capable of procreation. The operation is expensive, dangerous and lengthy, yet in 1983 there were an estimated 6,000 post-operative transsexuals in the United States. Certain European countries have legislation recognizing the post-operative transsexual's new sex. Case law in the United Kingdom and the United States, however, prevent post-operative transsexuals from gaining legal recognition. The author does see some hope, however, for a change in the trend against recognition of transsexuals’ post-operative sex. This Article discusses the reasons behind this trend and concludes that the greater danger would be a consensus of medical opinion holding that sex-change surgery is unnecessary, questioning the very existence of post-operative transsexuals. Finally, the author calls for legislative action to remove judicially-imposed obstacles and to give legal recognition to the postoperative transsexual's new sex and identity.
Outcomes Assessment in Health Care Reform: Promise and Limitations
Authors: Mariner Wendy K. 
Published: February 2021

If the fundamental goals of the health care reform effort are to ensure universal access to an acceptable quality of health care at an affordable cost, then the threshold question for reform is: What health care services should be provided in an efficient, equitable system?Answering this question requires weighing a complex mix of medical and social policy factors, a process not attempted in this article. But the starting point for that process should be determining what health care services “work” and what they cost. Outcomes assessment holds considerable promise in finding answers to these subsidiary questions, because it is intended to assess the effectiveness of health care services, that is, what works and what does not work for patients. It holds promise, not only for improving the quality of care, but also for identifying unnecessary or wasteful practices that increase health care costs.
Redefining Quality by Reassigning Responsibility
Authors: Morreim E. Haavi 
Published: February 2021

Implicit in any discussion of quality in health care are ideas about responsibility: who is responsible to define quality, who is responsible to deliver it, and who is responsible when the quality of care is unsatisfactory. The thesis of this article is that due to economics, ethics, and law, we have placed these responsibilities almost exclusively on physicians, but that powerful economic changes now require a reallocation of the responsibilities of providers, patients, and payers in defining and delivering quality in health care.In the past half-century an extraordinarily generous, uncritical reimbursement system has empowered physicians to define and deliver quality that is interventionist and highly technological. Longstanding ethical precepts hold that physicians are responsible for their patients, and modern economic arrangements have encouraged physicians to focus on their patients’ welfare, virtually to the exclusion of costs or other competing considerations.
Quality Assessment of Ethics in Health Care: The Accountability Revolution
Authors: Wolf Susan M. 
Published: February 2021

Writing in 1988, Arnold Relman heralded the dawning of the “third revolution“ in medical care. The first revolution, at the end of World War II, had inaugurated an Era of Expansion, with an explosion of hospitals, physicians, and research. Medicare and Medicaid were passed, and medicine experienced a golden age of growth. Inevitably, according to Relman, this yielded to an Era of Cost Containment starting in the 1970s. The federal government and private employers revolted against soaring costs, brandishing the weapons of prospective payment, managed care, and global budgeting. Yet these blunt instruments of cost-cutting eventually produced concern over how to evaluate the quality of health care, to promote the good while trimming the bad. Thus Relman announced the arrival of the Era of Assessment and Accountability.This chronology helps explain the current importance of quality. Quality assessment and more recently, quality improvement techniques, occupy a central place in this new era.
Medical Malpractice Litigation: Do the British Have a Better Remedy?
Authors: Miller Frances H. 
Published: February 2021

AbstractMedical malpractice claims are filed nearly ten times more frequently in America than they are in Great Britain. British patients generally adopt a less adversarial stance toward medical malpractice than do American patients. This Article examines the British malpractice system, as compared with the American system, and explores the differences between the two, in terms of costs and fees, liability rules, statutory provisions, and judicial attitudes toward malpractice litigation. The Article also discusses British social and institutional factors, such as the “taint” of litigation and the National Health Service, and evaluates how these factors affect British malpractice litigation. The Article presents the alternative forums available to British patients in seeking satisfaction for their medical service complaints. The Article concludes with an evaluation of how these factors achieve the three societal objectives of malpractice litigation: reparation, emotional vindication and deterrence.
Patient Dumping in the Hospital Emergency Department: Renewed Interest in an Old Problem
Authors: Enfield Lisa M. , Sklar David P. 
Published: February 2021

AbstractAlarm about the adverse effects of transferring emergency patients for economic reasons has resulted in federal legislation aimed at curbing the practice. We review the history of common law hospital liability for denial of emergency care and analyze the federal legislation designed to restrict the transfer of medically indigent patients with emergency problems. We conclude that the currently proposed solutions to patient dumping will have limited effectiveness without more specific incentives for the provision of health care to the medically indigent.
Regulating Transfer and Use of Fetal Tissue in Transplantation Procedures: The Ethical Dimensions
Authors: Constantine Bell Nikki Melina 
Published: February 2021

For twenty years scientists have worked to find an effective treatment to ease the quivering, the stiffness, and the difficulty in controlling bodily movements which are the primary symptoms of Parkinson's disease. The disease can be treated with L-dopa, a drug that mimics the dopamine that coordinates neural transmission in the human brain, which Parkinson's sufferers have ceased to produce in sufficient quantities. The L-dopa, however, produces damaging side-effects and sometimes proves ineffectual. Researchers discovered in animal experiments that the effects of a laboratory-developed disease simulating Parkinson's disease could be mitigated using fetal brain tissue transplants, which produced the natural dopamine the animals’ cells failed to produce adequately.These experiments were replicated with human subjects, and fetal tissue transplants have shown great potential as a treatment for Parkinson's disease. Fetal tissue is ideal for transplantation because it is in a stage of primitive development in which it adjusts easily to a new environment.
Capitation, Advances in Medical Technology, and the Advent of a New Era in Medical Ethics
Authors: Malinowski Michael J. 
Published: February 2021

Health care is being capitated throughout the United States, and much of the spread of capitation is attributable to the efforts of insurers to contain costs. The present lack of comprehensive studies evaluating the impact of capitation on overall health care quality leaves vast room for speculation.Capitation does, however, carry a very fundamental certainty with broad implications. Whether the arrangement calls for a fixed sum for treating a particular ailment, a set fee for meeting all of an individual patient’s health care needs, or a standard charge for supplying all the medication for a specific condition, capitation sets limits. Because the health care costs for any given patient or condition are in reality zero-sum rather than fixed, capitation is about pooling patients and rationing. It involves denying services to some patients despite a general contractual commitment to coverage, presumably so that more patients can be covered or receive better care. The implications of capitation are even more significant when set fully in the context of the overall health care reform now underway. Simultaneously and comprehensively, health care is being managed, made for-profit, and consolidated.
“So Quick Bright Things Come to Confusion”
Authors: Capron Alexander Morgan 
Published: February 2021

In the past several decades, the problems facing those of us who labor in the vineyards of health policy and ethics have been the problems of success — first medicine's and then, though to a lesser extent, our own. By this I mean that it has been the remarkable fruits of biomedicine, from research to health care delivery, that have produced the rich harvest of ethical, social and legal issues that have drawn our, and society's, attention.In the basic science laboratory, scientists have developed means to splice pieces of DNA together, raising questions from workplace safety to the reengineering of homo sapiens. Of more immediate concern, tests for genetic susceptibility to disease in one's self and one's offspring have been developed, thereby generating questions about employment and insurance discrimination, selective abortion, and adverse impacts on self-identity and well-being.
Educated Guesses: Health Risk Assessment in Environmental Impact Statements
Authors: Harvey Pamela D. 
Published: February 2021

Environmental pollution threatens public health. The search for solutions has advanced the frontiers of science and law. Efforts to protect the environment and public health begin with describing potential adverse consequences of human activities and characterizing the predicted risk. The National Environmental Policy Act requires the preparation of environmental impact statements to describe the effects of proposed federal projects and provide information for agency decisionmakers and the public.Risks to public health are particularly difficult to quantify because of uncertainty about the relation between exposure to environmental contamination and disease. Risk assessment is the current scientific tool to present estimates of risk. The methodology has created controversy, however, when underlying assumptions and uncertainties are not clearly presented. Critics caution that the methodology is vulnerable to bias. This Note evaluates the use of risk assessment in the environmental impact statement process and offers recommendations to ensure informed decisions.
A Proposal For A Nonreinstatement Rule In Unfair Labor Practice Cases Involving Patient Abuse
Authors: Tully Clare T. 
Published: February 2021

AbstractNursing home discharges of employees based on patient abuse raise a difficult issue when the motivating factor for the disciplinary action is union activism. A tension is created between the rights of employees to engage in protected concerted activity and the rights of patients to quality care. In 1974, Congress passed the Health Care Institutions Amendments, which granted to non-profit health care workers collective organizing and bargaining rights substantially similar to those which workers in other industries had enjoyed for decades under the National Labor Relations Act. Congress intended to give health care workers only that degree of parity, however, which is compatible with the provision of high quality patient care. The agency charged with enforcing the Act, the National Labor Relations Board (NLRB), has failed to distinguish employee misconduct in industrial settings from patient abuse in health care institutions when fashioning remedies for discriminatorily discharged union activists. The NLRB typically has ordered the reinstatement, with back pay, of the patient abuser as the patient’s primary care-giver. This Article suggests that a front pay remedy is more appropriate to these cases because it protects the patient’s right to be free from abuse without sacrificing employee unionization rights.
Limits of Guardian Treatment Refusal: A Reasonableness Standard
Authors: Veatch Robert M. 
Published: February 2021

AbstractThe debate concerning the legal and ethical bases of guardian refusal of medical treatment on behalf of incompetent patients often ignores critical distinctions among types of patients and guardians. For example, patients who have expressed preferences regarding treatment while competent are distinguishable from patients who have always lacked the competency requisite to expressing a treatment preference. “Bonded guardians,” whose relationship with the patient preexisted guardianship, should have a different role in the decision-making process than “nonbonded guardians,” who were strangers to the patient prior to the guardian-ward relationship.This Article proposes criteria for guardian treatment refusal on behalf of incompetent patients. Under the model for guardian decision making presented here, bonded guardians should be preferred over nonbonded guardians, and bonded guardians should be allowed discretion to make treatment choices, limited only by a standard of reasonableness policed by the courts. The Author presents legal and ethical justifications for the bonded guardian's heightened role. Finally, he considers the proper roles of health professionals, hospital ethics committees, and judges in the decision-making process.