The second social construction of HIV disease has begun. In the first fifteen years of the HIV epidemic, many viewed the disease “as the modern plague.” Now, as the epidemic matures and new “miracle treatments" are heralded, the disease is beginning to conjure a very different set of images. Where once AIDS was dreaded as the inexplicable cataclysm of the end of the millennium, now, as the virus appears amenable to treatment, we are beginning to see the disease as something both preventable and controllable, no longer beyond human direction. And, where the disease was once synonymous with death, disability, and decline, we now witness stories of miracle recoveries and long-term survival. In the minds of many, the terminal disease has become the chronic disease; the dreaded plague has become but another social problem.

In most respects, the new social construction of HIV, emerging from the advent of potentially effective medical interventions, is a positive development.

Discovering the genetic basis of a particular disease is not only of great interest to the medical community; private health insurers are also anxiously awaiting the results of genetic linkage studies. Apart from the scientific value of DNA studies, the results of genetic linkage research are relevant to health care delivery in two principal ways. First, identifying the genetic origin of a disease may allow doctors to detect the disease earlier. If doctors know that an individual is genetically predisposed to a particular disease, then health care providers can increase screening efforts and watch for early symptoms. Second, if an individual has a genetic predisposition to a particular disease, health care providers may employ preventive or “prophylactic" measures to reduce or eliminate the risk of developing the disease or condition to which the individual is genetically predisposed. Genetic linkage studies will soon allow more individuals to learn of their own genetic predispositions to certain diseases. Currently genetic predisposition tests (both pedigrees of family history and DNA analysis) can indicate that an individual is at high risk for developing a disease.

Two recent circuit court decisions have reinvigorated the debate over the constitutional, practical and ethical ramifications of physician-assisted suicide. In Compassion in Dying v. Washington, the Ninth Circuit Court of Appeals held that a liberty interest exists in choosing the time and manner of one’s death. The court found this right to outweigh all asserted state interests, and concluded that, with respect to competent, terminally ill adults, Washington’s prohibition of assisted suicide violates the Due Process Clause of the U.S. Constitution. The ruling effectively strikes down laws against assisted suicide in all of the states in the Ninth Circuit.

In April 1996, in Quill v. Vacco, the Second Circuit Court of Appeals held that New York’s prohibition of assisted suicide violates the U.S. Constitution’s Equal Protection Clause.

Two competing public policies, an individual’s right to choice of medical provider and the need to reduce health care costs, have collided as the federal government and the states implement health care reform. During his first year in office, President William J. Clinton focused on health care reform; however, Clinton was unsuccessful in implementing his “Health Security Act" and national debate dissolved into partisan bickering. With the failure to establish a coherent national policy on health care, the states and private and public health care entities are reshaping the market. Simultaneously, the courts and administrative agencies entertain public policy arguments favoring choice or cost reductions.

Fee-for-service (FFS) medical care allows individuals to receive medical care from their provider of choice. Under the FFS model, individuals chose their health care provider, receive care, and the provider bills an indemnity insurance plan on the basis of service provided. The emergence of managed care organizations (MCOs) narrowed and, in some cases, eliminated this right to choose one’s health care provider.

Massachusetts recently became the first state in the United States to publish physician malpractice histories and hospital disciplinary records. On August 9, 1996, Governor William F. Weld signed the Physician Profile Act (Profile Act or Act) into law, making “profiles” of the Commonwealth’s approximately twentyseven thousand doctors available to the public. Under the Act, the Massachusetts Board of Registration in Medicine (Board) provides information on physicians’ insurance plans, specialties, training, honors, and malpractice histories over a toll-free telephone number, through the Internet and on CD-ROM.

The Act developed partially as a legislative response to a series of Boston Globe articles appearing in late 1994 which savaged the Board. Spotlighting a number of high-profile iatrogenic incidents, this highly charged series of articles, accompanied by a blistering editorial, alleged that some patients suffered substandard medical care at the hands of physicians who had been sued repeatedly for malpractice but never disciplined by the Board.