An in-depth investigation of the influence that apprehension about litigation and legal liability exerts on ethical medical practice today.

The prevailing wisdom is that improving patient access to physician services is essential to promoting the public's health. This article suggests that, ironically, one effect of the 2010 federal health reform legislation may be to discourage physicians from serving the statute's intended beneficiaries, thereby exacerbating the access problem. The article examines several potential approaches to addressing this problem, comparing — from legal and policy perspectives — strategies based on legal conscription of physician services versus strategies that instead would rely on (...) incentivizing physician participation in serving otherwise access-impaired populations. The author argues in favor of the latter approach rather than one based on use of governmental force. (shrink)

The Patient Protection and Affordable Care Act of 2010 purportedly assures almost all Americans of the right to health insurance coverage. The long-term success of this legislation in improving the public’s health in the United States will likely hinge in no small part on the degree to which statutorily establishing a right to health insurance coverage translates into actual timely, meaningful access to health services, particularly physician services, for specific individuals.

Families frequently act as substitute decisionmakers for their older members who suffer from diminished mental capacity to make and express their own medical choices. Substitute decisionmaking takes on particular ethical and legal urgency within the nursing home environment, especially when choices concern potential medical treatment near the end of the nursing home resident's life. This article examines current legal mechanisms in the United States that enable a family to make substitute medical decisions, the ethical underpinnings of those mechanisms, and specific (...) ethical and legal considerations implicated by their application to the nursing home setting. The article offers advice to nursing home professionals, including physicians, in working with families as substitute decisionmakers. (shrink)

Empowering the elderly to make their own decisions regarding medical care is a noble social, political, and ethical cause; but society must guard against excesses that might ironically, deny the elderly their autonomy by forcing it upon them.

Thirty years ago when I, an attorney, took a tenure-track faculty position at an innovative, newly opened medical school, I was an oddity — truly, a stranger in a strange land. Today it is not uncommon for American medical schools to employ an attorney as a tenured or tenure-track member of its faculty. Over these last three decades, the educational roles and responsibilities of health law faculty who teach in law schools have become increasingly well defined, with numerous health law (...) courses and textbooks now generally accepted as part of the typical law school curriculum. However, the roles and responsibilities of attorney faculty members who teach in medical schools remain less clearly defined and likely are more individualized to the particular medical schools in which they teach. This essay explores some of the challenges and the opportunities which are given to attorney faculty members who teach in medical schools. (shrink)

Thirty years ago when I, an attorney, took a tenure-track faculty position at an innovative, newly opened medical school, I was an oddity — truly, a stranger in a strange land. Today it is not uncommon for American medical schools to employ an attorney as a tenured or tenure-track member of its faculty. Over these last three decades, the educational roles and responsibilities of health law faculty who teach in law schools have become increasingly well defined, with numerous health law (...) courses and textbooks now generally accepted as part of the typical law school curriculum. However, the roles and responsibilities of attorney faculty members who teach in medical schools remain less clearly defined and likely are more individualized to the particular medical schools in which they teach. This essay explores some of the challenges and the opportunities which are given to attorney faculty members who teach in medical schools. (shrink)

This paper reports on a mail survey of Jewish nursing homes nationally regarding their compliance with the federal Patient Self-Determination Act that became effective in December, 1991. Data is presented about the extent to which institutions' religious affiliation has influenced their advance directive policies and the procedures they have adopted to implement those policies. A content analysis of written advance directive policies used in Jewish nursing homes is presented also.