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Recent Developments in Health Care Law: Partners in Innovation

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Abstract

This article reviews recent developments in health care law, focusing on the engagement of law as a partner in health care innovation. The article addresses: the history and contents of recent United States federal law restricting the use of genetic information by insurers and employers; the recent federal policy recommending routine HIV testing; the recent revision of federal policy regarding the funding of human embryonic stem cell research; the history, current status, and need for future attention to advance directives; the recent emergence of medical–legal partnerships and their benefits for patients; the obesity epidemic and its implications for the child’s right to health under international conventions.

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Notes

  1. For a current list of relevant legislation by state, see Congressional Research Service 2008.

  2. The Dickey Amendment, prohibiting federal funding for “research in which a human embryo or embryos are destroyed,” pre-dated the advent of hESC research. The Dickey Amendment was first attached to the US Department of Health and Human Services appropriations bill, which provides NIH funding, in 1996, and has been re-enacted every year since. See The President’s Council on Bioethics (2004, Chap. 2).

  3. See notation of opposing views about President Bush’s policy among members of The President’s Council of Bioethics at footnote 1, The President’s Council on Bioethics, Chap. 2, and Appendix F, The Meaning of Federal Funding; see also discussion of a range of views in favor and opposed to President Bush’s policy in Murray (2001).

  4. For one set of polls on American public opinion, see The Pew Forum on Religion & Public Life, 2008, indicating that 51% of Americans polled in 2008 supported hESC research. The percentage in favor varied over the course of the polling, from a low of 43% in 2002 to a high of 57% in 2005.

  5. The case-by-case alternative was intended, in part, to address concerns that the 21 hESC lines approved under President Bush’s policy might be excluded from funding under the letter of the 2009 Guidelines’ new consent procedures. See Harris 2009.

  6. See response to the new policy by Richard Doerflinger of the U.S. Conference of Catholic Bishops in Vedantam (2009).

  7. See Scott (2000, pp. 257–258) (discussing the use of ‘ought’ to refer to ethics and the use of ‘must’ to refer to law).

  8. Advance directives address situations of those who are at one time competent and can indicate their health care treatment preferences in the event they become incompetent due to illness or injury. Situations involving patients who have never been competent or are children are not covered by advance directives. See Adrian and Levitan (2006, p. 31): “A person may be incompetent for a variety of reasons and circumstances. For example, the person may be under the age of 18, unable to understand the health care decision, or unable to communicate a health care decision. For whatever reason, if a person is incompetent, he or she cannot consent to medical treatment.”

  9. Cruzan by Cruzan v. Director (1990 at p. 269): “At common law, even the touching of one person by another without consent and without legal justification was a battery…This notion of bodily integrity has been embodied in the requirement that informed consent is generally required for medical treatment.” Cruzan at p. 270: “The logical corollary of the doctrine of informed consent is that the patient generally possesses the right not to consent, that is, to refuse treatment.”

  10. In re Quinlan, 355 A.2d 647 (N.J. 1976) at pp. 662–665 (unwritten constitutional right of privacy to refuse medical treatment).

  11. Cruzan by Cruzan v. Director (1990 at pp. 278–279) (constitutionally protected liberty interest includes right to refuse hydration and nutrition).

  12. While inclusion in the PSDA indicated federal support for advance directives, it also created confusion as some states’ statutes allow oral advance directives, but the PSDA defines an advance directive as a “written instruction.” See Sabatino (2006, p. 251).

  13. See Advance health care directive legislation 2009: AL, AK, CA, CT, DE, GA, HI, ID, KY, ME, MD, MN, MT, MS, NH, NM, ND, OK, OR, PA, UT, VT, VA, WV, and WY.

  14. See Advance health care directive legislation that includes a statutory form 2009: Nineteen state statutes include a form entitled “Advance Health Care Directive,” “Advance Health-Care Directive,” “Advance Directive for Health Care,” “Health Care Directive,” “Advance Directive,” or “Advance Medical Directive,” sometimes in combination with the state name (e.g. Utah Advance Health Care Directive, Georgia Advance Directive for Health Care). Five states with combined forms offer a separate living will or agent designation form or both in addition to the combined form (CN, MN, MO, OK, and WV).

  15. See Advance health care directive legislation 2009: AZ, AR, CO, DC, FL, IL, IN, IA, KS, MO, NE, NV, NJ, NC, OH, RI, SC, SD, TN, TX, WA, and WI.

  16. See Advance health care directive legislation 2009: LA, MA, MI, and NY.

  17. See Advance health care directive legislation that includes a statutory form 2009. E.g. Fla. Stat. Ann. § 765.203 (West 2009) (“Designation of Health Care Surrogate”); Nev. Rev. Stat. Ann. § 449.830 (West 2009) (“Durable Power of Attorney for Health Care Decisions”); 10 N.J. Forms Legal & Bus. § 24:108 (West 2009) (“Proxy directive—Designation of health care representative”); and Tex. Health & Safety Code Ann. § 166.164 (Vernon 2009) (“Medical Power of Attorney Designation of Health Care Agent”).

  18. Id., e.g., CA, GA, OK, and VT.

  19. Id., e.g., AK, CA, IA, and MS.

  20. For an account of a successful reform effort in Georgia, see Center for Law, Health & Society 2007.

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Acknowledgments

Jerri Nims Rooker gratefully acknowledges the excellent research assistance on state advance health care directive statutes provided by Heather Carter and Olga Dashevskaya. The co-authors, whose names are listed in alphabetical order, are academic affiliates of the Georgia State University Center for Law, Health & Society and thank the Center for its support. The Center <http://law.gsu.edu/clhs/> engages in interdisciplinary research, education, and community outreach to prepare future leaders in the legal and health professions.

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Berry, R.M., Bliss, L., Caley, S. et al. Recent Developments in Health Care Law: Partners in Innovation. HEC Forum 22, 85–116 (2010). https://doi.org/10.1007/s10730-010-9127-4

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