bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remarks on the Judge's Role and Moral Certainty
Authors: Kessler Gladys 
Published: June 2007

First, I am a trial judge on D.C. Superior Court—a court of general jurisdiction. Thus, my personal experiences and approach are grounded in the intense and heart-rending world of live testimony and real human beings—not the rarefied appellate atmosphere of cold transcripts and brilliant analytical arguments.To put some of my remarks in context, and to present a totally atypical situation which raises all the analytical issues of Cruzan, I would like to describe a real case—one that I actually tried—about 10 years ago, involving a committed patient at St. Elizabeths Hospital—a large local hospital for the mentally ill. I will call him Vladimir—he was a real person, not a faceless mental patient. Vladimir had escaped from the repressiveness and brutality of pre-Glastnost Russia—to the freedom of the West. Sometime after locating in America and working here, he became mentally ill and was hospitalized.
Cruzan: Facing the Inevitable
Authors: Bopp James , Marzen Thomas J. 
Published: June 2007

When the United States Supreme Court upheld the decision of the Missouri Supreme Court that it was not in the best interests of Nancy Cruzan to die of dehydration and malnutrition by withholding from her food and fluids provided by tube the result was deplored by many legal and popular commentators.The criticism suggested a wide range of values and reasoning that were reflected in the various briefs filed in the U.S. Supreme Court in support of reversing the Missouri court decision. The objections might be placed in three categories: the medical, the legal, and the ethical.The medical rationale for reversal of the Missouri Supreme Court categorized provision of food and fluids by tube as a “medical treatment” and, hence, subject to practices that pertain to forgoing other, more obvious forms of medical treatment, such as use of respirators or chemotherapy.
A Judge's Perspective: The New York Rulings
Authors: Wachtler Sol 
Published: June 2007

After I was named Chief Judge of New York State, a position previously occupied by one of the noblest of jurists, Benjamin Cardozo, I went up to look at my new chambers and there was my new desk—the desk that had been used by Benjamin Cardozo. And I said to a friend of mine, “Just think of it, I will be seated and be using and will have Benjamin Cardozo's desk.” And he said, “Yes, but remember, 50 years from today, it will still be Benjamin Cardozo's desk.” We have through the likes of Benjamin Cardozo inherited a jurisprudential history in New York State.The question that we now grapple with is a question which many states have had to face and the decisions from the state courts are diverse and often controversial. We were all waiting for the United States Supreme Court, that fountain of wisdom, to set the guidelines, so that we would have a standard to which we would look and adhere.
Between Isolation and Intrusion: The Patient Self-Determination Act
Authors: McCloskey Elizabeth 
Published: June 2007

Here's what was sitting on my desk on my first day of work for Senator Jack Danforth last summer:August 19Liz-Here is something you can start on when I am in Wyoming. Maybe you could begin pulling together some thoughts and material. Perhaps someone at YDS could give you some help. However, please don't attribute any conclusions to me as I have none.What are the ethics of extending the length of life?We cannot artificially end life (thou shalt not kill), but how about artificially extending life? Is that always good, sometimes good?Is it good to extend the life of a senile 90 year old who wears diapers? How about “neonatal care”—for a baby who would otherwise die? What's the difference in these two cases, or should we have a difference?In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?Is it “playing God” to make distinctions on the basis of quality of life? Do we owe a lesser degree of care to the comatose patient than someone else?
The Role of State Legislatures after Cruzan: What Can—and Should—State Legislatures Do?
Authors: Rouse Fenella 
Published: June 2007

In Cruzan, the Supreme Court held that the refusal of treatment is a constitutionally protected right and that the methods for permitting its exercise should be crafted by the laboratory of the states. In June 1990, when the court ruled, there already existed a large and complex body of law concerned with the refusal of treatment which differed, sometimes considerably, from state to state. Generally, withholding or withdrawing life-sustaining treatment has been accepted by the states, but different systems of justification have been used.Competent people are able to make decisions to refuse any form of medical treatment, regardless of their medical condition; competent people can also prepare written instructions describing the medical treatment they would want to receive in the future if incompetent, which have been endorsed by both state courts and legislatures.
Why I Don’t Have a Living Will
Authors: Lynn Joanne 
Published: June 2007

For a dozen years, my clinical practice has been largely with dying patients, my academic pursuits have focused on medical ethics, and my public service has been mostly at the interface of medicine and law. One would think that I would have “done the right thing” long ago and signed a living will. I have not. This essay is meant to illuminate my reasons. Some of my reasons may apply to others, and I will also mention some concerns that affect others but not me. However, I do not oppose the growth and development of advance directives. Rather, I hope to open the public and professional discussion of how to make decisions for incompetent adults in order to include more varieties of formal and informal advance directives and to force policy-makers to consider how to make decisions for incompetent adults who have no advance directives.As a physician, I do use advance directives, both formal and informal, with many patients in all of my clinical settings.
CDC Guidelines on HIV or HBV-Positive Health Care Professionals Performing Exposure-Prone Invasive Procedures
Authors: Gostin Larry 
Published: June 2007

The Centers for Disease Control published its long awaited guidelines for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients on July 12, 1991. The guidelines recommend voluntary HIV and HBV testing of all health care workers performing exposure-prone invasive procedures. Special safeguards are applicable to any worker who is infected with HIV or the most virulent form of hepatitis B—i.e., hepatitis B e antigen positive (HBeAg). HIV or HBsAg-positive health care workers should not carry out exposure-prone invasive procedures unless an expert panel has approved and provided individualized guidance, and the patient is informed about the HCW's serological status.Characteristics of exposureprone procedures include digital palpitation of a needle tip in a body cavity or the simultaneous presence of the worker's fingers and a sharp instrument in a poorly visualized or confined anatomic site.
Ethical Principles for the Conduct of Human Subject Research: Population-Based Research and Ethics
Authors: Gostin Larry 
Published: June 2007

Ethical principles for the protection of human subjects in clinical research are now well recognized, and rooted in the inherent worth and dignity of the individual.Respect for personsrecognizes people as autonomous agents and requires that their choices be observed. For persons who are not fully autonomous, the principle of respect for persons requires that they are protected from risks and adverse consequences of research, even sometimes excluded from research.Beneficence(do good) andnon-maleficence(do no harm) are complementary ethical principles that impose affirmative duties on researchers to maximize any benefits for subjects and minimize any risks. Thus, researchers must go beyond mere respect for a person's choices. The researcher must be vigilant to ensure that the subject receives all possible benefits and avoids all possible harms from participating in the research.
Confidentiality: The Protection of Personal Data in Epidemiological and Clinical Research Trials
Authors: McCarthy Charles R. , Porter Joan P. 
Published: June 2007

Lilienfeld and Lilienfeld have defined epidemiology as “the study of the distribution of a disease or physiological condition in human populations and of the factors that influence this distribution.” Epidemiology is an eclectic discipline, utilizing statistics, sociology, and biology of the study of disease populations. Epidemiological studies can help explain the etiology of a specific disease; they can evaluate the consistency of epidemiologic data with etiological hypotheses and provide a basis for developing or evaluating preventive procedures and public health practices.The consultation for the Development of International Guidelines for Epidemiological Research and Ethical Review Procedures assembled in Geneva in November 1990 offered basic principles that should apply to epidemiological and clinical research. The principles provide the basis for discussion here.Providing protection for the rights and welfare of two categories of research subjects in epidemiologic research must be a matter of serious concern to those who design, conduct and disseminate findings of epidemiological research.
Mistakes and Fraud in Medical Research
Authors: Friedman Paul J. 
Published: June 2007

Violations of the ethical canons of research have been reported with increasing frequency in recent years. Nowhere have the reported incidents been so numerous or so troubling or attracted so much Congressional attention as in biomedical research. Research ethics, once “something everyone agrees about,” has become the subject of disagreement now that issues of culpability and enforcement are demanding attention. How to distinguish mistakes from fraud has stopped being theoretically obvious and has become a practical problem.Defining culpable research misconduct has proved to be controversial. Good definitions are a prerequisite for intelligent discourse and sensible regulations. Regulations based on unclear or misdirected definitions stimulate resistance, hostility and evasiveness. The case in point is the definition of what it is that a research institution must investigate and report to the appropriate federal funding agency if allegations of misconduct are received.
The Morality of Physician-Assisted Suicide
Authors: Weir Robert F. 
Published: June 2007

In March, 1989, 12 physicians published an article on the provision of care to hopelessly ill patients. Unfortunately, many of the substantive points in that article received insufficient attention from readers because the authors call for appropriate, continually adjusted care for terminally ill patients was overshadowed by a portion of the document in which ten of the authors agreed that “it is not immoral for a physician to assist in the rational suicide of a terminally ill person.”In June, 1970, Jack Kevorkian, a retired pathologist in Michigan, gained international media attention by enabling Janet Adkins, a woman in the early stage of Alzheimer's disease, to terminate her life with the help of his “suicide machine.” The features of the case were so unusual that physicians, ethicists, and attorneys in health law who were interviewed by journalists were unanimous in judging this particular act of physician-assisted suicide deplorable.
Hospice Care as an Alternative to Euthanasia
Authors: Miller Robert J. 
Published: June 2007

The same concerns that have led society to consider euthanasia as an option for relieving the suffering of the dying led to the development of the hospice movement. How effectively has hospice care met these needs, and is there still a need for euthanasia? Is the hospice approach to death an alternative to euthanasia, compatible with euthanasia, or euthanasia in another form? Do those health care workers who are drawn to providing hospice care favor or oppose euthanasia?Hospice care developed out of a sense of frustration with the treatment of the dying, and as a reaction against the abuses of an impersonal high-technology approach to patients. There was institutional denial of death which made it impossible to integrate death into the lives of people. Due to neglect, many patients were under-treated with little attention paid to relieving pain or dealing with their or their families’ psychosocial needs.
Updating RU 486 Development
Authors: Baulieu Etienne-Emile 
Published: June 2007

RU 486 is a synthetic drug with antisteroid hormone properties, synthesized by the Roussel-Uclaf Company, Paris, France, which owns a world-wide patent for all uses.I have summarized the story of RU 486's discovery, testing and use in the Journal of the American Medical Association, in Science? and in a book entitled The Abortion Pill, also published in French as Génération Pilule.Based on antiprogesterone action, RU 486 was first approved in France for voluntary pregnancy interruption (VIP), within the framework of the abortion law, as a medical method to replace the instrumental technique in use when the law was passed in 1975. Registration of RU 486 was obtained in September 1988.
RU486 in France and England: Corporate Ethics and Compulsory Licensing
Authors: Boland Reed 
Published: June 2007

Prospects for the introduction of RU486 into the United States in the foreseeable future are not good. Despite the drug's proven value in inducing abortion safely and effectively in early pregnancy without the need of surgery or anesthesia and its potential value in the treatment of many other diseases, it has been held hostage by the controversy over abortion. Because of opposition to abortion from the current administration and the threat of boycotts by antiabortion groups, Roussel-Uclaf, the drug's manufacturer, has expressed its resolve not to become embroiled in the abortion debate and has postponed indefinitely plans to market RU486 in the United States.The contrast between this situation and that accompanying the introduction of RU486 into France and England, the two countries where it has so far been approved, is striking. Rather than blocking access to RU486, the governments of these countries moved forward expeditiously with testing and approval of the drug.
Ethics Committees and Due Process
Authors: Fletcher John C. 
Published: June 2007

Susan Wolf, in an important article on hospital or institutional ethics committees (IECs) and due process, writes:Ethics committees are in a due process wasteland. There is no indication that committees regularly offer patients any of the basic procedural protections such as notice, an opportunity to be heard, a chance to confront those in opposition, receipt of a written determination and a statement of reasons, and an opportunity to challenge that determination. Ethics corninittees may seek the decisive power of the Adjudicatory Model, while using the process of the Consultation Model. This is the worst of both worlds—the committee wields great influence over the treatment decision but accords no protection for the patient's rights.There are few data upon which to draw to disagree with Wolf's first claim about a due process “wasteland.” I suspect that it is mostly true, although one can observe, as I do, that Susan Wolf has omitted a great deal of evolution concerning ethics consultation in her article.
Do Those Who Cannot Speak Really Have a Voice?
Authors: Dew Betty 
Published: June 2007

Joseph Finelli, after a heart transplant, is being artificially maintained by medications and a gastrostomy tube (G-tube). He is not brain dead nor in a persistent vegetative state. In my role as court-appointed Guardian ad Litem (GAL-court investigator), it appears to me that Mr. Finelli is being treated against his stated goals and values. After applying the substituted judgment factors, I recommend the withdrawal of the medication which sustains his life. His family adamantly opposes my position.Joseph Finelli is a 57-year-old Italian-American Catholic husband and father of four adults. Mr. Finelli was an “extremely active” man. He enjoyed training dogs, hunting, running, and was an “avid” biker. Debilitating congestive heart failure eventually confined his activities to walking ten steps at a time. Surrendering his active life produced pronounced depression.
Physicians and Futile Care: Using Ethics Committees to Slow the Momentum
Authors: Brennan Troyen A. 
Published: June 2007

The subject of physician efforts to limit care by unilaterally withholding particular therapies, even if the patient, or the family of an incompetent patient, wishes continued care, plays an increasingly prominent role in discussions of clinical medical ethics. Some providers have described a professional duty to define the futility of care, and to act on the determination of futility even in the face of the patient’s, or a surrogate’s, resistance. This aggressive stance has gained intellectual momentum and may be percolating down into clinical practice.Given the history of the medical profession's diffident attitude toward patients’ rights and its reliance on well-meaning paternalism, the notion that doctors should determine futility and limit access to specific interventions must be carefully scrutinized. Indeed, the emergence of two other themes in health policy and ethics, in particular the living will/power of attorney initiative on the one hand and the open discussion of rationing care in Oregon on the other, tends to undermine the key rationales for physician control over futile care.
Recent Developments in Antitrust Law and Their Implications for the Clinton Health Care Plan
Authors: Jacobs Michael S. 
Published: June 2007

Although the details of the Clinton health care plan have yet to emerge from the continuing policy debate over the shape and size of the administration’s reform measures, one thing has become increasingly clear. Several recent developments in antitrust law will have important implications for what the plan will permit and how it will work.By all accounts, the broad outline of the administration’s plan revolves around the development of large and powerful consumer groups who, with the help of sophisticated, government-established intermediaries, will presumably purchase health care wisely and well. This alliance of massed consumer purchasing and government information-gathering will, it is hoped, produce a health care market more in competitive balance than the current version, which is widely regarded as dominated by powerful providers who dictate terms to small, uninformed buying groups.
Reproductive Freedom and Violence against Women: Where are the Intersections?
Authors: Heise Lori L. 
Published: June 2007

There isn’t much understanding in some marriages. My sister has six [children] and another has eight. I said to one of them that she shouldn’t have any more. And she said “What can I do? When my husband comes home drunk, he foxes me to sleep with him.” And that is what happens to a lot of women. And if the women don’t do it, the men hit them, or treat them badly. Or the men get jealous and think their wives are with other men.—Rene, a 29-year old Peruvian womanGender violence is a major yet often underrecognized obstacle to reproductive choice. In both the abortion rights movement in the United States and the reproductive health movement globally, the “enemy” of self-determination and choice is usually seen as imposing from the top down. In the North, it is the government—through the courts, the legislature, and bureaucratic rulemaking—that threatens to “take away” women’s reproductive autonomy. The image is one of the public sphere invading that which is private—of the state interfering with a woman’s right to control her own body.
Women in Clinical Trials: Are Sponsors Liable for Fetal Injury?
Authors: Sandomire Hazel 
Published: June 2007

Calls for the inclusion of women in clinical trials raise the obvious question: why have sponsors excluded them? The answer most often given is one tragically evocative word: Thalidomide. The tragedies of the children born with seal limbs because their mothers took this over-the-counter sleeping pill and cure for morning sickness showed that, contrary to previous perceptions, the placenta could not be depended upon to filter out toxins before they reached the fetus. The specter of birth defects spawned sponsors’ fears of a variety of catastrophes which contributed to closing the doors of clinical trials for women.This paper will not argue that the possibility of birth defects arising from the ingestion of an experimental drug does not exist. Sadly, scientists do not yet have the ability to predict which drugs will cause birth defects. Rather, it will argue that case law does not provide a basis for sponsor liability when a woman gives informed consent and the regulations governing clinical trials are followed.
Seek and Hide: Public Health Departments and Persons with Tuberculosis, 1890–1940
Authors: Rothman Sheila M. 
Published: June 2007

In 1882 Koch discovered the tubercle bacillus and transformed both the medical and the social history of tuberculosis and the experiences of those who contracted it. For the first time, the absence or presence of the bacillus made it possible to define, in Koch’s terms, “the boundaries of the diseases to be understood as tuberculosis.” And for the first time the sick became subject to oversight and discrimination.Prior to Koch’s discovery, tuberculosis, or as it was then called, consumption, was considered a hereditary and non-contagious disease, albeit a very deadly and persistent one. Over the first half of the nineteenth century, it was responsible for one out of every five deaths. It crossed all boundaries of geography, social class, age, and sex affecting residents in rural as well as urban areas, the prosperous as well as the poor, the young even more notably than the old, females more often than males. Physicians assumed a familial predisposition existed (as in the case of insanity); following the precepts of humoral medicine, they postulated that the disease originated in “irritations” whose sources were to be found in the interaction of an inherited constitution with a particular lifestyle and environment.
Recent Developments in Health Law
Authors:   American Journal of Law & Medicine
Published: June 2007

In American Dental Association v. Martin, the United States Court of Appeals for the Seventh Circuit reviewed a challenge to a rule of the Occupational Safety and Health Administration (OSHA). In December, 1991, OSHA passed a standard to protect health care workers from viruses transmitted by blood—bloodborne pathogens—including the hepatitis B virus (HBV) and the human immunodeficiency virus, the virus known to cause AIDS. Three health care organizations, whose members are dentists, medical personnel firms, and home health employers, petitioned the court to review OSHA's rule.The Occupational Safety and Health Act was passed to assure employees that they would have as safe and healthy a working environment as feasible. Congress sought to ensure this by vesting the Secretary of Labor for Occupational Safety and Health with the authority to promulgate mandatory safety and health standards. In promulgating standards concerning toxic materials or harmful physical agents, the secretary sets rules that most adequately assure that an employee will not suffer a material impairment of health or functional capacity while performing work-related duties.