Kathy L. Cerminara

The Law and Its Interaction With Medical Ethics in End-of-Life Decision Making

The previous two articles in this series explored the historical and theoretical development of medical decision making from initial reliance on medical beneficence to a more recent emphasis on patient autonomy. The law of withholding and withdrawal of treatment has much in common with medical ethics. It is based on concerns about patient autonomy expressed by courts, legislatures, and the executive branch of the government. Legally, the patients right of self-determination has been based on a variety of sources ranging from state and federal constitutions to the common law of torts and from cases to statutes and regulations. Understanding the various sources of the law, the distinctions among those sources, and the interaction of the branches of government in this context assists in understanding the law itself. In our federalist system of government, significant legal variations can exist among the states, but although technically valid, excessive concern about compliance with the precise contours of each states statute when surrogate decision makers are engaging in bedside deliberations is unnecessary. Regardless of source or precise legal contours, the overall goal, which neither the physician nor the patients surrogate or proxy decision makers should forget, is to honor what the patient would want to have done. Physicians and attorneys will agree on that as a matter of both ethics and the law.

Therapeutic death: A look at Oregon's law.

Oregon voters approved the first American statute authorizing physician-assisted suicide, the Oregon Death With Dignity Act, in 1994. The authors of this article identify some positive and negative psychological effects of laws such as Oregons on patients. Generally, they conclude, on the basis of psychological theory and the available data, that laws such as Oregons benefit patients psychologically. Undoubtedly, however, there exist important possible antitherapeutic effects on patients, and the authors hope that discussion of both therapeutic and antitherapeutic consequences will stimulate future research by social scientists in this area.

Introduction To Regulating Innovation In Healthcare: Protecting The Public Or Stifling Progress?

The Supreme Court has allowed considerable judicial confusion to develop with respect to its “public forum” categories in First Amendment law. Because some courts have (reasonably) inferred that the “limited public forum” and the “non-public forum” are, analytically, one and the same, confusion persists as to the proper terminology and the number of “forum” categories. This short article explores those questions and suggests a resolution.The Supreme Court has allowed considerable judicial confusion to develop with respect to its “public forum” categories in First Amendment law. Because some courts have (reasonably) inferred that the “limited public forum” and the “non-public forum” are, analytically, one and the same, confusion persists as to the proper terminology and the number of “forum” categories. This short article explores those questions and suggests a resolution.

Daniel E. Dawes, 150 Years of ObamaCare (Johns Hopkins University Press 2016)

In the days leading up to the presidential election on November 8, 2016, Republican candidate, now United States President, Donald J. Trump repeatedly promised to repeal and replace President Barack Obama’s signature domestic accomplishment, the Patient Protection and Affordable Care Act (the ACA). It was unlikely, however, that either he or his supporters meant to repeal the most popular portions of the ACA, such as the prohibition of health insurers’ refusals to cover preexisting conditions or the requirement that health insurers cease risk-rating. Parents and young adults appreciate the ability to include children on parents’ health insurance policies until the age of 26. Businesses that invested time and effort in the development of vertically integrated, valuebased health care organizations almost certainly do not want to lose the financial advantages provided through the ACA’s authorization of accountable care organizations. In fact, once they recognized that “repealing and replacing” the ACA was not a simple matter, the president and Congressional Republicans cautioned that any change to the ACA would come slowly and not in wholesale fashion. Consistent with this position, health policy expert Daniel Dawes reminds us in this book that “[c]ontrary to statements made by opponents of the ACA, the majority of its provisions have long enjoyed bipartisan support.” An attorney, Dawes, now a professor at Nova Southeastern University’s business school, was at that time the executive director of health policy and external affairs at Morehouse School of Medicine. He also had founded and chaired the National Working Group on Health Disparities and Health Reform (the National Working Group), a conglomeration of organizations and

Clinical Trials: Legal Aspects and Consent

Clinical trials create both legal and ethical concerns, many of which overlap. This chapter focuses on informed consent of human research subjects, participation of special populations in medical research, medical research involving the mentally incapacitated, the use of placebos in human subject research, confidentiality of subject information, conflicts of interest in clinical trials, and research review committees.