In her recent article, “Evidence, Belief, and Action: The Failure of Equipoise to Resolve the Ethical Tension in the Randomized Clinical Trial,” Deborah Hellman gives a new twist to an old objection against clinical equipoise. Roughly, clinical equipoise is the requirement that there exist credible uncertainty in the expert medical community regarding the preferred treatment for a particular condition. This uncertainty is widely regarded as a necessary condition for enrolling participants in a clinical trial. The old objection is that clinical equipoise represents an overly permissive, and therefore morally unacceptable, mechanism for resolving the fundamental tension in clinical research between fidelity to the interests of the individual research participant, and fidelity to the statistical and scientific methods that are necessary to produce generalizable data in a reliable manner. Hellman's new twist on this objection utilizes some of the rudimentary architecture of Bayesian statistical theory to argue that clinical equipoise focuses our moral attention on the wrong issue.

Should Medicaid pay for supportive housing for homeless persons? After describing current limits on how states can use Medicaid funds to support housing, this article considers whether justice requires treating Medicaid recipients residing in nursing homes and Medicaid recipients needing supportive housing similarly.

Biobank-based research is not specifically addressed in Indian statutory law and therefore Indian Council for Medical Research guidelines are the primary regulators of biobank research in India. The guidelines allow for broad consent and for any level of identification of specimens. Although privacy is a fundamental right under the Indian Constitution, courts have limited this right when it conflicts with other rights or with the public interest. Furthermore, there is no established privacy test or actionable privacy right in the common law of India. In order to facilitate biobank-based research, both of these lacunae should be addressed by statutory law specifically addressing biobanking and more directly addressing the accompanying privacy concerns. A biobank-specific law should be written with international guidelines in mind, but harmonization with other laws should not be attempted until after India has created a law addressing biobank research within the unique legal and cultural environment of India.

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness (Summit) convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.

One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism.

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a profound impact on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver.

At the end of 1987, the insurance industry could breathe a sigh of relief. By a combination of good luck, astute planning, and nerve, life and health insurers had managed to impose HIV-testing requirements on insurance applicants while making few concessions to the gay community or insurance regulators. To a greater degree than almost anyone had thought possible, the insurers had deflected most of the expected health costs from the AIDS epidemic onto the nation’s taxpayers, and had taken steps to deny life or health insurance to anyone they considered to be at risk of AIDS.

The use of blood tests to determine if an individual is infected with the human immunodeficiency virus (HIV) that causes AIDS has been a matter of considerable controversy. Yet to date only a handful of states have restricted the use of HIV testing by companies offering life or health insurance.

The subject of screening stands at the intersection of medicine and public health and the law. Medicine is concerned about the care of the individual patient; public health focuses on maintaining and improving the health of entire populations. The law is concerned with the balance of rights and responsibilities, protecting society from errant individuals and protecting the individual from undue constraints of society.

In looking specifically at the questions of screening or testing for the Human Immunodeficiency Virus (HIV) it is useful to consider the meaning of the words “tests” and “screening” because many different terms are applied to these concepts — diagnostic testing, case finding, screening, surveillance, and so on. In all cases, medical tests have a common purpose: to provide information that sheds light on the probability that the disease of interest actually is present in the patient being tested.

A living will is a directive from a competent, seriously ill individual to medical personnel and family members regarding the treatment he wishes to receive when he becomes incompetent to make decisions for himself. It is important to remember that a living will is not necessary when an adult is competent and chooses to refuse treatment since it is clear that generally, an adult, whether critically ill or not, may refuse any treatment for any reason. A living will is applicable only when a previously competent patient is seriously ill and incompetent.

Recent concern about new medical technologies which can prolong the dying process without improving the quality of life has sparked interest in rhe living will. More than five million copies of sample living wills have been distributed throughout the country, often by churches and senior citizens groups. State governments have also responded to this interest; the first Natural Death Act was signed into law in California in 1976. Since then, thirteen states and the District of Columbia have passed similar legislation, sometimes referred to as right-to-die statutes (see table accompanying this column).

The escalating cost of health care has forced people to confront the possibility of rationing—forgoing beneficial care for patients so that the resources might be used either for other current or prospective patients or for entirely different things in life than health care. Rationing of some sort makes eminent sense, not just economically; only those who are fanatics about health and medicine would urge that everything possible be spent on health care for even the slightest marginal benefit. Yet actual rationing of health care is usually thought to exact high, or at least disturbing, ethical costs.

I will examine four of these costs here: (1) the sacrifice of physician loyalty to patients, (2) the substitution of misleading and discriminatory numerical measurements of medicine's human benefit for more sensitive qualitative judgments, (3) the unfair bite that rationing is likely to take first out of poor people's care before it affects wealthier patients, and (4) the general Substitution of public, group standards about life and health for the values and decisions of individuals.

This paper describes novel tobacco control laws passed in New York City in 2017. These laws are designed to improve the city's strategy of using price to decrease tobacco consumption, and over time, change the city's landscape by making tobacco less accessible.

In one of his few decisions addressing the interface of law and medicine, Oliver Wendell Holmes observed that, The patient has no more right to all the truth than he has to all the medicine in the physician’s saddlebag. He should only get so much as is good for him.

During the last 60 or so years, the question of how much medical information is indeed good for the patient has been the subject of innumerable lawsuits. From this plethora of litigation, a clear common law trend which favors maximum disclosure of information has become evident. Relying upon the fiduciary nature of the physician-patient relationship, the courts have imposed upon the physician a duty to inform a patient fully regarding the condition of his or her body. It is appropriate, therefore, to examine various exemplary case decisions in an effort to portray effectively the nature and scope of the physician’s rights and responsibilities in this context.

The acquired immunodeficiency syndrome (AIDS) has raised perplexing ethical and public policy dilemmas. Early in the epidemic, closing of bathhouses, testing blood donors for human immunodeficiency virus (HIV) infection, and notifying seropositive blood donors evoked passionate controversies. Current dilemmas include testing and using promising new treatments, notifying partners of seropositive persons, and, most recently, restricting the clinical activities of seropositive health,care workers who perform invasive procedures.

These dilemmas about HIV infection involve scientific judgments, cultural norms, and social values. In the HIV epidemic, public rhetoric and political pressure have been prominent. On the one hand, some persons have launched moralistic crusades against homosexuals and injection drug users. For these persons, AIDS symbolizes the breakdown of traditional family values and the social order. On the other hand, some advocates for persons with HIV infection have used confrontational tactics such as sit-ins and disruptive demonstrations.

Commercial surrogacy presents complex legal issues; the problems that it does not present are those of high tech reproductive medicine. All the new techniques for overcoming infertility, such as in vitro fertilization and the like, are medically complex but—as long as they involve a married couple and no third-party donors—legally simple. Surrogacy is so medically uncomplicated that it can be done without any physician involvement, but it is the most legally complicated means of providing a baby for an infertile couple.

From a time in England when fathers could sell their children into slavery to a day in which the legal system supposedly protects the best interests of the child, the common law increasingly respects the rights of children as individuals with constitutional rights and not as chattels of their parents. If the courts accept commercial surrogacy as a legitimate enterprise, it seems that we have again reverted to the concept of child as chattel.

By the beginning of 1988, nearly six hundred babies had been born through surrogate mothering arrangements. Although there have been a number of lawsuits concerning custody or challenging adoption laws that appear to prohibit payments to surrogates, the majority of surrogacy arrangements proceed without judicial involvement. Nevertheless, surrogate mothering has engendered considerable activity in state legislatures, as well as two bills in Congress to ban the practice (H.R.2433 and H.R. 3264) and hearings by the House Committee on Energy and Commerce and the Subcommittee on Transportation, Tourism, and Hazardous Wastes. Most recently, the Congressional Office of Technology Assessment (OTA) released a report, Infertility: Medical and Social Choices. That report included the results of a survey of surrogate-mother matching services active in the United States in late 1987.

Violations of the ethical canons of research have been reported with increasing frequency in recent years. Nowhere have the reported incidents been so numerous or so troubling or attracted so much Congressional attention as in biomedical research. Research ethics, once “something everyone agrees about,” has become the subject of disagreement now that issues of culpability and enforcement are demanding attention. How to distinguish mistakes from fraud has stopped being theoretically obvious and has become a practical problem.

Defining culpable research misconduct has proved to be controversial. Good definitions are a prerequisite for intelligent discourse and sensible regulations. Regulations based on unclear or misdirected definitions stimulate resistance, hostility and evasiveness. The case in point is the definition of what it is that a research institution must investigate and report to the appropriate federal funding agency if allegations of misconduct are received.

Most health professionals today would agree about the necessity of interdisciplinary health care for clients. The optimal division of labor, however, has been a source of concern if not outright disagreement.

Literature on “professional status” and on the interrelationships of health professionals abounds, possibly leading one to the impression that everything worth saying has already been said. However, developments in health care and in professional education are of a dynamic rather than of a static nature. For this reason alone a reconsideration of the roles and relationships of health care team members is justified from time to time.

Determining whether the health care system meets the needs of service recipients is only one important reason for studying role interactions.

Preemption is a powerful strategy used by special interest groups to undermine strong, local public health standards. Currently, 20 states in the U.S. have preemption ordinances in place related to clean indoor air initiatives. These preemption laws are the direct result of an ongoing and aggressive campaign of tobacco companies to thwart clean indoor air initiatives, which ultimately, according to tobacco industry internal documents, cause significant reductions in their annual revenues. Clean indoor air policies have arisen from a greater understanding of the documented health risks associated with exposure to secondhand smoke and action by local government (city councils, county commissions, and boards of health) to protect the public from these hazards. The efforts of the tobacco industry undermine local authority and seek to shift policy action to the state and federal levels, where the industry has greater political influence.

The Human Papillomavirus (HPV) vaccine burst onto the market and the legislative scene nearly simultaneously. Marketed as an amazing medical breakthrough, the vaccine GARDASIL prevents infection with four strains of Human Papillomavirus in nave populations; these four strains are responsible for 70% of cervical cancers and 90% of genital warts. Although most agreed that the vaccine was a wonderful medical advancement with the potential to save women's lives, there was strong disagreement about and a vocal public response to legislative attempts to require girls to receive HPV vaccines for school attendance.

The strong public response to HPV vaccine mandates partially stemmed from the sense that this vaccine is different from previously mandated vaccines because it attempts to prevent disease whose sole route of transmission is through sexual contact. Most other diseases covered by mandated vaccines are spread through the air, with little an individual can do in altering their behavior to prevent infection.