Charity Scott

Is Too Much Privacy Bad for Your Health? An Introduction to the Law, Ethics and HIPAA Rule on Medical Privacy

After years of Congressional debates and agency rule-making, the HIPAA health care privacy rule has finally become effective. Why did it take so long? Many of the issues which deadlocked Congressional attempts to pass federal privacy legislation reflect deep disagreements over how much individual privacy should be protected. On one hand, patients often believe that no one except their closest health caregivers should be able to see their medical records without their permission. On the other hand, many other people and entities, mostly strangers to the patient, believe they should have access to those records without having to ask permission. They argue that such relatively free access to individual health care information is good for the patient, good for other patients, and good for society - in other words, that too much privacy protection is bad for our individual and collective health. Indeed, society has often tolerated sacrifices in individual medical privacy in order to promote the public good. This article examines the ethical trade-offs that we have made between the benefits of privacy protection and the benefits of sacrificing it in the name of social welfare, such as advances in scientific research, protection of the public health, higher efficiency and better quality in the delivery of health care, and even improved law enforcement. It analyzes how these ethical trade-offs have been reflected in our laws, Congressional debates, and recent HIPAA privacy rule. It also examines several key issues which created the impasse in enacting comprehensive federal legislation, and which continue to be controversial as providers face the task of compliance. The article serves as a guide for legal and health care professionals who would like to be introduced to what the controversy over health care privacy has been all about and how the HIPAA rule has, at least for the time being, resolved some aspects of it.

Belief in a Just World: A Case Study in Public Health Ethics

This article offers a case study in Georgia on public health ethics and advocacy for public assistance programs. It explores the findings of a study by the National Center for Children in Poverty, entitled “How Belief in a Just World Influences Views of Public Policy,” in the context of overwhelmingly negative public reaction to a news story that had attempted a sympathetic portrait of a working-class married couple whose children were enrolled in PeachCare for Kids, a health insurance program for children that is Georgia’s version of the State Children’s Health Insurance Program. The NCCP study found that for respondents who had a strong belief in a just world, the more a hypothetical woman did to improve her situation, the less deserving they found her to be to receive public assistance. It was the opposite for respondents with a weak belief in a just world: the more she tried to improve her situation, the more deserving they found her. The NCCP study may help to explain why so many readers, despite the newspaper’s apparent attempt to put a sympathetic human “face” on the PeachCare program, found the family to be undeserving of it. By contrast, when Georgians were polled in more general terms about the program, respondents were highly supportive of providing PeachCare to families eligible under the current guidelines and even of expanding the program. This Georgia case study illustrates the NCCP’s conclusion that the “face” and the “context” given to a government aid program can impact the public’s support for it, either negatively or positively. Advocates who want to ensure a just distribution of health care to low-income families need to understand how differently “justice” may be perceived by different people.

Innovation in Higher Education: Lessons Learned from Creating a Faculty Fellowship Program

This concluding essay offers reflections on core components of the faculty fellowship program, its outcomes and results, and program design and administration. Amid the current calls for reform in legal and other professional education, the lessons we learned and perspectives we gained during this fellowship program may be relevant to any faculty members and university administrations that are seeking to create more effective and engaged professional and graduate school programs, whatever may be their subject-matter discipline.

How Well Do We Engage Our Students

Charity Scott I have a confession to make: I did not do all of my assigned reading when I was a law student. Actually, I almost never came to class prepared after my first year. I was immersed in pro bono legal aid work with the school’s legal aid bureau, and I had little time, except right before exams, to dig into the books. I usually showed up for class, however, to get a drift of the conversations and a sense of the territory of the course. And I took copious notes, which I later carefully translated for exam preparation. Thus it was that I discovered at semester’s end in my third year, while preparing for a federal courts exam, that the professor’s constant classroom references to Michigan, which I assumed to be a seminal court case that I had made a mental note to read, were actually to Mishkin.1 Times have not changed. A common observation in recent reports on the need for reform in legal education is that after the intense first year of law school, law students become increasingly disengaged. According to a recent Law School Survey of Student Engagement (LSSSE) report, while 40 percent of 1Ls said that they never came to class unprepared, only 23 percent of 2Ls and 16 percent of 3Ls reported that they never came to class unprepared (and surely some of them are fudging their answers – probably closer to zero percent of 3Ls never come to class unprepared). The amount of time students spend reading and studying drops way off as the years go by – from 30 hours a week for a typical 1L to 20 hours a week for a typical 3L.2 As health law professors, we teach the upper-level students, the ones who by all accounts are becoming less and less engaged in law school. How do we keep them engaged and motivated to learn? How do we encourage them to think more – more often and more deeply – about the issues in health law than they might have come to class prepared to think about? How can we foster a life-long habit of engaged thinking and learning for themselves that could last long after our classes are over? The following are some thoughts, drawn in part from the experiences of some of our most thoughtful colleagues who spoke at the 2007 Health Law Professors’ conference in Boston, as well as from the recent calls for reform in legal education.

Resolving Perceived Maternal-Fetal Conflicts Through Active Patient-Physician Collaboration

Mrs. Ford’s preemptive refusal to allow a cesarean delivery may seem to Dr. Raymond to put the patient’s wishes in conflict with her fetus’s welfare. This perceived potential for maternal–fetal conflict should be reframed as a potential conflict between physician and patient, which fortunately can likely be resolved through good communication and collaboration between them. Dr. Raymond and Mrs. Ford share common interests in a successful, healthy birth.

Interdisciplinary Contributions to Public Health Law

This session was created to display the value of interdisciplinary thought to the practice and teaching of public health. Through the extraordinary examples of four articulate, highly trained, and gifted individuals, the value of such training is demonstrated for the enhancement of both the individual and society. Each person describes how she or he has used the process of interdisciplinary learning, analysis, and action to enrich the substance of their personal and professional lives and the activities within their careers. Their “infectious” passion for what they do is so obvious that the audience cannot help but become personally engaged and excited. Through individual examples and stories, through discovery, analysis, science, humor, relationship-building, and values translation, each presenter briefly describes the particular path carved out and the impact that unique trail has had upon others-be they students, colleagues, or citizens in the community. Each person calls for a greater understanding of the use of interdisciplinary training and describes its resultant enhancement of the approach taken to problems faced, tackled, and resolved. One cannot help but be struck with admiration for the discipline displayed by these leaders as each uniquely pursued a dream and describes a career filled with satisfaction and pride. The listener is left with a sense of purpose and duty, “for the greater good,” and perhaps even an expectation that, “I, too, can respond to the challenge,” by enhancing my own knowledge base. Susan Allan