Alice Noble

DNA Fingerprinting and Civil Liberties

The collection, retention, and use of forensic DNA has led to the rapid development of associated law and criminal justice practices. In a little over twenty years, DNA evidence and the science and technology undergirding it have become highly valued instruments in solving crime, convicting criminals, and exonerating the innocent. Questions of admissibility have largely been resolved with the adoption of rigorous standards for DNA analysis. State legislatures and Congress have answered these developments with incremental expansion of DNA databases. From an intial focus on felony sex offenses in the 1990s, there are now over forty states that collect DNA samples from all felons, while four states and the federal government permit inclusion of DNA profiles from certain arrestees. There has been concern, however, that technological and legal developments have outpaced measured consideration of the ethical, legal and social implications of this growing reservoir of genetic information and its uses. This symposium is designed to fill that gap, providing a balanced assessment of current policies and practices as well as an invaluable source of guidance for the development of future policies. The articles in this symposium were commissioned from national and international experts who represent wide-ranging viewpoints and experiences. The topics they address include privacy, database expansion, racial ethnic justice, forensic science and use of DNA in the courtroom, DNA sample retention after profiling, and secondary uses of DNA samples. This edition also represents the first detailed exploration of a number of topics, including the efficacy of DNA databases and DNA database searching for family relationships. The symposium has application to non-forensic uses of DNA, as it considers allowable secondary uses of biological samples. The following sections summarize the articles in this special edition. Risks to Privacy The special edition opens with a broad assessment of the impact of the expanding DNA databases on civil liberties by Mark Rothstein and Meghan Talbott. Few would argue with Rothstein and Talbott’s observation that we are entering the second stage of DNA forensics; a stage, the authors note, that could usher in a population-wide repository. Standing at a crossroads, this is an opportune time to assess the risks and benefits of our expanding regime of DNA testing and databasing to determine the wisdom of continued expansion in view of risks to privacy. In addition to the expanded inclusion criteria within database legislation, the authors examine expanding uses and consider the privacy implications of DNA in dragnets, familial and personal searches, as well as the expanded number of retained samples, and the secondary uses, such as genetic research, to which these samples may be put. The authors conclude that database inclusion and sample retention should be limited to individuals with prior convictions or against whom probable cause exists. Further commentary on these issues is provided by other symposium authors. Frederick R. Bieber develops Rothstein and Talbott’s concerns regarding the dearth of scientific, peer-reviewed data gauging the overall effectiveness of DNA databases in either crime prevention or solving. Both Bieber and Rothstein and Talbott point out the short-comings of the number of “cold hits” and “investigations aided” as measures of database effectiveness. In a thoughtful analysis of these and other potential measures, Bieber proposes a new methodology in measuring effectiveness. Of course, no one can doubt the power of DNA to aid the criminal justice system. However, more robust measures of effectiveness, such as those advocated by Bieber, would allow us to gauge the value of database expansion, prioritize the backlog of DNA evidence, and – significantly – more precisely weigh the benefit against any burden on civil liberties. Privacy concerns over DNA databases have led to numerous court challenges based on claims that compelled collection of DNA for inclusion in the database Alice A. Noble, J.D., M.P.H., is the Senior Health Law and Policy Analyst at the American Society of Law, Medicine & Ethics and is a member of the faculties of Boston College Law School and Brandeis University. introduction DNA Fingerprinting and Civil Liberties

Breastfeeding and the Affordable Care Act

Mothers who receive or qualify for the Women, Infants, and Children (WIC) program or have lower income are less likely to start and continue breastfeeding than their more advantaged counterparts. The Patient Protection and Affordable Care Act (ACA) requires employers to provide break time and space to express breast milk and requires insurance companies to cover breastfeeding support, supplies, and counseling at no cost to mothers. This ACA benefit does not extend to all Medicaid recipients or women in the WIC program. Legislative and regulatory efforts are needed to provide comprehensive coverage for all women and reduce disparities in breastfeeding.

Effect of the Affordable Care Act on Disparities in Breastfeeding: The Case of Maine

Objectives To evaluate the Affordable Care Act (ACA) breastfeeding provision and test whether changes in coverage affected women differently according to health insurance status. Methods We used the All-Payer Claims Database from Maine (2012-2014) to compare health insurance claims for lactation classes and breast pumps between women with private insurance and women with Medicaid (1) before the ACA breastfeeding provision, (2) after the provision came into effect, and (3) after health insurance expansion through the Marketplace. Results We found limited change in claims for lactation classes over the study period. By contrast, the number of claims for breast pumps among women with private insurance increased from 70 claims in the third quarter of 2012 to 629 claims 1 year later and 803 claims in the third quarter of 2014. Women with Medicaid had only 11 claims for breast pumps over the entire study period. Conclusions This 11-fold rise in claims for breast pumps by women with private insurance suggests that these women will likely increase breastfeeding initiation or duration; however, without additional support for women with Medicaid, disparities in breastfeeding may increase.