Injury and its prevention, like other areas of public health regulation, pose a number of interesting challenges to the theory of democratic self government. To understand these challenges, a good starting point is the Great Society era, when in a brief ten year period, major new agencies were created to promote safety in the workplace, the marketplace, and on our nation's highways—agencies like the Environmental Protection Agency (EPA), the Occupational Safety and Health Administration (OSHA), the Consumer Product Safety Commission (CPSC), and the National Highway Traffic Safety Administration (NHTSA).

The theory of injury that lay behind the new agencies was in sharp contrast to injury policy as pursued up to that time. The new public health and safety agencies were based on the idea that injury must be approached as an environment, not an individual, problem. The most articulate advocate of this view was William Haddon, Jr., the physician and injury researcher who became President Johnson's first head of NHTSA. Haddon argued for well over a decade for abandoning the view of injury as “accidents,” unpredictable and inevitable “acts of God.”

We presently are not really leaving withdrawal of treatment decisions to families and there are good reasons why we ought not to do so. To see why this is, we need to focus on what is special about PVS cases as opposed to other kinds of medical cases in which we are forced to make life and death decisions.

One thing which is very special about PVS is the fact that it is a condition which intuitively pushes us to rethink, once again, society's definition of “death.” We have already changed our definitions of death to include situations in which respiration and circulation continue but the “whole brain” is dead. Defining death to include irreversible PVS would merely require extending the definition to include situations where the brain stem is functioning but the neocortex is dead. There are, of course, obstacles to overcome in extending the definition in that fashion.

For a number of years, some non-physician health service providers have moved to secure status as independent, autonomous providers of health services. In addition, non-physician providers have sought, often through the state legislatures, eligibility to receive payment directly, on a fee-for-service basis, from private and governmental third party payers; alternatively, they have sought for their charges to be reimbursed to their patients by insurers on such a basis. The struggle for autonomy is related to, and is preliminary to, the struggle for access to, or eligibility for, payment through third party payment mechanisms.

The purpose of this article is to explore the implications of access to such payment in the current economic climate concerning the delivery of health services. The primary focus is on the nursing profession, in light of its continuing struggle to secure greater autonomy and to improve the economic rewards for nurses. The nursing profession is waging this struggle because it recognizes that gaining direct access to third party payment would increase the potential for economic success in developing private, independent nursing practices.

The focus of the abortion debate in the United States tends to be on whether and at what stage a fetus is a person. I believe this tendency has been unfortunate and counterproductive. Instead of advancing dialogue between opposing sides, such a focus seems to have stunted it, leaving advocates in the sort of I did not—You did too impasse we remember from childhood. Also reminiscent of that childhood scene has been the vain attempt to break the impasse by appeal to a higher authority. Thus, the pro-choice forces hoped they had proved the pro-life forces wrong by having had the Supreme Court of the United States decide in Roe v. Wade that a fetus is not a person for purposes of the fourteenth amendment. Now the pro-life forces are trying to prove the pro-choice forces wrong by passing legislation or a constitutional amendment that declares a fetus to be a person after all

The most remarkable thing about the U.S. Supreme Court's 1998 decision in Bragdon v. Abbott was that it was necessary at all. Seventeen years into the epidemic of the acquired immunodeficiency syndrome (AIDS), the Supreme Court, by a mere 5-4 majority, finally affirmed what most public health officials, health providers, and lawyers working with people with human immunodeficiency virus (HIV) believed all along: that individuals with HIV infection are entitled to the protections of antidiscrimination law, and that health care providers must respond to a patient's infection based on reason and science, not fear and prejudice. For individuals with HIV, and for those with other disabilities, the Court's ruling was a critical victory. But the very fact that the issues had to be decided by the Supreme Court and that only five justices joined the majority, shows the fragility of legal rights pertaining to HIV as well as the wide gulf between the perspectives of public health and those of public law.

Health information by its nature is personal and sensitive. At the same time, significant public value has resulted from research with health records about determinants of health and effective provision of health services. In Canada, certain legislation and processes have been established to balance the individual's right to privacy and the public good associated with analysis of health information.

My purpose is to describe privacy and confidentiality practices in Canada with respect to access to health data for research purposes. I provide an overview of the Canadian health care system and the legislative framework used to regulate research related to health information and Canada's major national data bases. Then I describe the confidentiality and privacy policies and procedures of Statistics Canada, of the Canadian Institute for Health Information (CIHI), and of health policy research organizations in three provinces. I conclude with comments on some current issues in health information in Canada.

During the past decade, Medicaid has experienced extraordinary growth, in both number of beneficiaries and total expenditures. Between 1988 and 1993, the number of Medicaid beneficiaries grew from 22 million to 32 million. While the number of Medicaid beneficiaries increased by 45 percent, expenditures increased by 145 percent, from 51 billion to 125 billion. Expressed in terms of its percentage of state budgets, Medicaid doubled from 10 percent to 20 percent over the same time period, to the point that it is currently the second largest budget item for most states.

Faced with unsustainable rates of program budget growth and serious concerns about the level of access and the continuity of care afforded by the Medicaid program, states have turned to managed care. Almost every state has introduced some form of managed care for a subset of their Medicaid beneficiary population. Twenty-three states have gone farther, and implemented, proposed, or are developing section 1115 waivers to overhaul their Medicaid programs. These waivers allow states to develop and introduce nonstandard approaches to benefits, eligibility, service delivery, and financing for the Medicaid beneficiary population.

This Article aims to show how the food industry has instrumentalized the right to freedom of expression to oppose innovative laws in Chile aimed at creating healthier food environments.

Public health law research reveals significant complexities underlying the use of law as an effective tool to improve health outcomes across populations. The challenges of applying public health law in practice are no easier. Attorneys, public health officials, and diverse partners in the public and private sectors collaborate on the front lines to forge pathways to advance population health through law. Meeting this objective amidst competing interests requires strong practice skills to shift through sensitive and sometimes urgent calls for action to address known threats to the health of individuals and the community. It also necessitates objective, timely information and national and regional legal support.

Most now recognize the inevitability of rationing in modern health care systems. The elastic nature of the concept of “health need,” our natural human sympathy for those in distress, the increased range of conditions for which treatment is available, the “greying” of the population; all expand demand for care in ways that exceed the supply of resources to provide it. UK governments, however, have found this truth difficult to present and have not encouraged open and candid public debate about choices in health care. Indeed, successive governments have presented the opposite view, that “if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone.” And they have been rightly criticized for misleading the public and then blaming clinical and managerial staffin the National Health Service (NHS) when expectations have been disappointed.

Attorneys regularly prepare advance healthcare directives for their clients. However, attorneys, lacking medical knowledge, are often considered ill-equipped to prepare such documents. While recognizing and respecting the fact that advance healthcare directives pertain to decisions about medical care, this article proposes that attorneys who prepare advance healthcare directives nevertheless provide a valuable service.

Data Safety and Monitoring Boards (DSMBs) were introduced in the 1960s to monitor data in clinical trials to ensure subject safety. It was thought important that DSMB members be experts in the field(s) of interest, but not otherwise involved in the study (e.g., sponsors and investigators) in order to maximize objectivity. Since then, the use of DSMBs has increased dramatically, and their scope has expanded to include scientific issues — in particular, to avoid bias that can result when trials are stopped early because of evidence that one treatment has greater efficacy or causes greater harm than another; or that no treatment is likely to do better than any other.

We have always had the ability to commit suicide or request euthanasia in times of serious illness. Yet these acts have been prohibited by the Christian tradition from early times. Some Christians, as they see relatives and friends kept alive too long and in poor condition through the use of current medical powers, however, are beginning to question that tradition. Are assisted suicide and euthanasia compassionate Christian responses to those in pain and suffering who face death? Or are they ways of isolating and abandoning them, of fleeing from Christian compassion, rather than expressing it?

The Committee on Medical Ethics of the Episcopal Diocese of Washington recently issued a report addressing assisted suicide and euthanasia. These matters cry out for religious contributions and perspectives, the Committee believes. The group recognizes that religious voices should not determine public policy, but believes they should be heard as we develop a social consensus about assisted suicide and euthanasia.

This article tests the impact of Walmart's corporate decisions to end the sale of handguns at its stores in 1994 and to discontinue the sale of all firearms at approximately 59% of its stores in 2006 before resuming firearms sales at some of those stores in 2011. Using a difference-in-differences framework, we find that that from 1994 to 2005 counties with Walmarts robustly experienced a reduction in the suicide rate and experienced no change in the homicide rate. These models suggest that Walmart's policy change caused a 3.3 to 7.5% reduction in the suicide rate within affected counties, which represents an estimated 5,104 to 11,970 lives saved over the studied period (425-998 per year). In contrast, Walmart's 2006 and 2011 decisions to discontinue and subsequently resume the sale of rifles and shotguns in many of its stores was not associated with a robustly measured effect on homicide or suicide rates. We do find evidence that Walmart's 2006 decision to reduce the number of its stores that sold firearms caused a statistically significant reduction in the suicide rate for counties in which Walmart did not subsequently resume firearms sales.

The rise in vaccine hesitancy in high-income countries has led some to recommend that certain vaccinations be made compulsory in states where they are currently voluntary. In contrast, I contend that legal coercion is generally inappropriate to address the complex social and psychological phenomenon of vaccine anxieties.