This article looks to the past to consider how government officials, health professionals, and legal authorities have historically framed racial disparities in birth and the lasting impact these explanations have had on Black birthing experiences and outcomes.

In the past ten years, the medical staff credentialing process has become a veritable antitrust minefield. The number of antitrust lawsuits brought by physicians and other health practitioners who have been denied medical staff appointment, reappointment, or whose clinical privileges have been terminated, restricted or otherwise diminished has escalated dramatically. Battles have been, and continue to be, waged in medical staff credentialing committees, hospital board rooms and, ultimately, in the courts over appointment and reappointment procedures, the criteria applied, and the procedures for hearings and appeals. Although aggrieved physicians also sue on other legal theories, antitrust lawsuits are particularly complex, expensive and time-consuming to defend and pose the risk of considerable monetary loss if a defendant is held liable. In addition, antitrust lawsuits may have deleterious public relations effects, impairing a hospital's reputation in the community and its credibility in its business dealings.

Only one of the Ten Commandments offers a reward. We should honor our parents, we are told, so that our days may be long. When the federal or state governments appeal to traditional religious and family values, however, we should look to the costs and not the benefits. In Hawaii, House Resolution 54 would seek to reinstate a relative responsibility law that was repealed in 1965; the immediate concern is to correct a $30 million shortfall in Medicaid. In Massachusetts, a pending bill, House Bill 1753, would make each “responsible relative” of a Medicaid recipient residing in a nursing home accountable for up to 25 percent of the amount paid, although the total collected from all responsible relatives must not exceed 100 percent of Medicaid payments. According to the bill, responsible relatives are spouses, natural and adoptive children, or natural or adoptive parents of blind or disabled children under 18.

Criticisms of the impersonal ways in which some physicians relate to their patients, as well as calls for the infusion of more compassion, empathy, and humanity into the delivery of medical care, have abounded in recent months, as physician-watching gains popularity as a major American sport. Various culprits have been ‘indicted” for current shortcomings in the humanistic quality of many physician/patient relationships: the traditional paternalistic orientation of the medical profession, the explosion in the scientific knowledge that physicians are expected to master, the growing importance and effectiveness of medical technology in diagnosing and curing disease, economic pressures, and the ever-present, anxiety-stimulating shadow of medical malpractice. Whatever its specific etiology, the too-prevalent concern for “curing” at the expense of “caring” among modern medical practitioners has been widely lamented in both professional and lay forums.

This conference comes together at a critical time for law, ethics, and medicine. The issues which come under attention are of the greatest variety, complexity, sensitivity, and urgency.

The topics span the whole of human life. They begin at a point before human life has commenced. The revolutionary developments of biology as they affect conception and the use and limits of reproductive and genetic techniques arrest our thoughts in section VI of this special issue of Law, Medicine & Health Care. The rationing of health care as it is made available to patients and the community is the focus of attention in section III. The subject of medical malpractice and the litigation which attends it where the patient or the family claim that things have gone wrong are considered in section II.

The new challenge of AIDS is discussed with its many faceted problems: medical, legal, and ethical. It is difficult now to remember the world before AIDS.

American hospitals are in turmoil, experiencing declines in community esteem, reductions in Medicare payments, pressure for cost control by employers and insurers, and internal conflict between managements and medical staffs. Each of these conflicts is simply another facet of an overall problem: American society's recently conceived notion that unlimited access to the best available health services constitutes a right. Americans have adopted this idea, however, without considering the economic consequences in an environment of rapidly advancing technology and an aging population. Costs have escalated rapidly, reaching ten and one-half percent of the gross national product; the health services system is in strong competition with other important societal segments for scarce resources. The money may not be running out, but a rather naive institution, the community hospital, has suddenly found itself in an environment for which it is ill-prepared.

Governmental licensure of health professionals has a long history, but significant federal intervention in hospital financing did not begin until after World War II with the advent of the Hill-Burton program, which provided funds for hospital expansion. Medicare introduced federal payment for hospital care provided to the elderly and used formulas for cost reimbursement in 1966.

The February 1985 issue of Law, Medicine & Health Care published excerpts from the Report of the Massachusetts Task Force on Organ Transplantation, along with a report by its chairman, Professor George Annas, and commentary by a number of esteemed scholars and practitioners who were generally complimentary of both the approach and substance of the work of the Task Force. We have thoroughly reviewed the Task Force Report and feel it necessary to take strong exception to a number of points, both procedural and substantive, raised there. In general, we are concerned that the Task Force Report perpetuates and reinforces a number of serious misconceptions about the issues surrounding transplantation that, in turn, lead to conclusions that are both inaccurate and misleading. This situation is most unfortunate be cause the complexities of the issues raised by transplantation require care ful scrutiny, especially where there are empirical data that clearly call into question these often strongly held predispositions. In the following sections we point out what we feel are the major shortcomings of the Massachusetts effort.

Biomedical research on advanced cryopreservation has spillover effects on innovation in the food and agricultural sector. Advanced biopreservation technology has three key domains of impact in the food system: (1) improving efficiencies in storage and utilization of gametes and organoids for plant and animal breeding; (2) isochoric methods for preservation of fresh food products; and (3) in biorepositories for storage of genetic resources for agriculturally significant plants and livestock species.

The recent flurry of antitrust litigation in the health care industry is forcing the courts to reevaluate the legality of existing health care institutions under the Sherman Antitrust Act. One type of institution that poses significant antitrust questions is the independent practice association (IPA), an arrangement which consists of a contractual relationship between subscribers, physicians and an IPA corporate entity. The physicians agree to provide medical services to the IPA's subscribers, who pay a flat rate. In exchange, physicians are reimbursed at rates usually established by a fee schedule.

The Health Maintenance Organization Act of 1973 requires that an IPA, like an HMO, must “assume full financial risk on a prospective basis for the provision of basic health services…” This ensures that the IPA bears the risk that the cost of the services it renders will not exceed the value of the premiums it collects, giving it an incentive to contain costs.

Consumer demand and federal support has caused the number of certified nurse-midwives to quadruple in the last decade, from 629 in 1970 to 2500 in 1982. Despite their record of reducing infant mortality and satisfying consumers, nurse-midwives are still an underutilized health resource. This article provides a brief history of nurse-midwifery. describes nurse-midwives’ education and current legal status, discusses obstacles to wider use of nurse-midwives, and examines the issues of safety and cost-effectiveness of nurse-midwifery practice.

The word “midwife” often evokes images of home births attended by “granny” or “lay” midwives who lack formal education in obstetrics. Yet, professionally educated nurse-midwives have practiced in this country since 1925, when an American nurse, educated in nurse-midwifery in England, came to the mountains of eastern Kentucky.

The goals of the federal and state antitrust laws and of the federal and state health planning laws often appear to be in conflict. The health planning laws encourage cooperation among providers of health care services and the sharing of facilities and services, based upon the premise that competition in the health care field has not succeeded in containing costs or adequately distributing resources. Generally, it can be said that the health planning laws, by establishing controls to prevent the unnecessary duplication of services, protect service monopolies. In contrast, antitrust laws are designed to prevent the establishment of monopolies which are able to control the supply of services. The antitrust laws are intended to promote a vigorous and competitive economy, in which businesses have a full opportunity to compete on the basis of price, quality and service. As a result of this conflict, those involved in health planning have become concerned about the legal environment in which they act.

In 1962, the Journal of law and Contemporary Problems devoted its entire winter issue to aging. The remarkable thing about that issue was that it had only one article that dealt with legal questions—and that with tax treatment of the elderly. The remainder of the issue contained articles dealing with the demographic and sociological characteristics of the elderly, currently held views and theories of aging and human development, and some special concerns from other disciplines like geriatric psychiatry.

In less than a generation, old age and the law has evolved into a field of study of consuming interest to legal scholars, practitioners, sociologists, and consumers. The Chicago-Kent Law Library established a special catalog of the law and aging in 1983. By 1987 (the year in which the last entries were made for the collection), the catalog had grown to over 500 pages. Earlier (1982) the Southern Culifornia Law Review published a similar catalog which was updated in 1984 and 1987.

On July 1, 1982, the United States Supreme Court issued its opinion in Mississippi University for Women v. Hogan, ruling that the “female only” admission policy of a state-supported nursing school violated the equal protection clause of the fourteenth amendment. The case has political and legal implications not only for nursing education, but for the nursing profession as well.

Joe Hogan, a registered nurse, worked as a nursing supervisor in a medical center in Columbus, Mississippi. In 1979, he applied for admission to the baccalaureate program at Mississippi University for Women (MUW) School of Nursing, located in Columbus. Although he met all of the school’s substantive admission criteria, Hogan was denied admission solely because MUW has, since its inception, admitted only females. The school’s policies would, however, permit him to audit nursing courses and to attend continuing ed,ucation courses.

The doctrine of informed consent, introduced by the courts in 1957, is but one of many legally imposed duties to disclose to arise over the last several decades. In myriad areas of everyday life, including medical decision-making, the law has come to require that a person or entity with presumptively superior information as to risks, contents, or consequences take affirmative steps to disclose that information at the time another individual is faced with a decision for which it might prove pertinent.

Such disclosure requirements underscore the values of individual liberty and self-determination that are at the core of our rights-based legal system. Rather than directly and more paternalistically regulating citizen behavior by, for example, simply prohibiting a given riskcreating activity, the State takes the less intrusive step of mandating that the individual be provided information that might affect her behavior.