Discussions of medical malpractice seem to end up at either of two extremes: the trial lawyer's view that injured patients deserve compensation, with the treating physician the best source; and the doctor's view that such suits unfairly penalize judgmental errors while raising the costs of practicing medicine. The parties to this debate make different assumptions about the nature, purpose, and likely impact of malpractice suits; as a result, the issues are muddied rather than clarified. This article suggests that, viewed in light of recent studies of iatrogenic illness in hospital settings, malpractice litigation may help rather than hinder the quality of medical care delivered.

latrogenesis, defined as the undesirable side-effects of medical interventions, is not a new phenomenon. The major study undertaken by the Department of Health, Education and Welfare in 1973 noted that a substantial percentage of adverse medical outcomes occur as the result of treatment. Others have concluded that many surgical deaths are avoidable.

Recently a front-page article in the New York Times reported on a new method of blood-testing for paternity determination which is “revolutionizing the way courts determine the identity of a child's father in paternity cases.” The HLA (Human Leucocyte Antigen) test represents a significant advance over the standard red blood cell antigen tests for paternity. The large number of genetically determined factors in the HLA system makes it possible, by typing the blood of mother, child, and accused father, to either 1) rule out the possibility that the man could be the child's biological father in a large number of cases where the man is falsely accused; or 2) show that the accused man has a high probability of being the child's biological father, where the possibility of paternity has not been ruled out. Red blood cell typing, because of the much smaller number of factors examined, could only exclude a falsely accused male in a relatively small number of cases.

The 1974 health care amendments to the National Labor Relations Act (NLRA or the Act) have given rise to several significant developments in the case law. This article focuses on the subjects of appropriate bargaining units, the inclusion — or exclusion — of house staff under the NLRA, and, briefly, the special strike notice requirements under section 8(g) of the Act. These areas have been the subject of substantial controversy and conflict among the federal courts.

In 1947, the Taft-Hartley Act excluded from the term “employer” as defined in the NLRA, “any corporation or association operating a hospital, if no part of the net earnings inures to the benefit of any private shareholder or individual.” In 1974, Congress removed the exclusion for voluntary, nonprofit hospitals and added the new term “health care institution.” In so doing, it found “no acceptable reason why 1,427,012 employees of … non-profit, nonpublic hospitals … should continue to be excluded from the coverage and protections of the Act.

The term “nursing ethics” is controversial. Some insist that nursing ethics is a unique field posing issues that cannot be understood fully by adapting the professional ethics of physicians. They insist that the term “nursing ethics” connotes the uniqueness of the moral problems that nurses face in the health care setting.

On the other hand, others argue against the term. Some suggest that it is demeaning and has somewhat the connotation of watered-down ethics —the flavor of such textbook titles as anatomy for nurses or pharmacology for nurses Others critical of the term “nursing ethics” argue that there is really very little that is morally unique to nursing. The same ethical principles and the same moral issues emerge in the health care setting whether one is a physician, nurse or patient. This article puts forth the view that nursing ethics is a legitimate, if very limited, term referring to a field that is a sub-category of medical ethics.

A large part of the everyday practice of medicine consists of prescribing drugs for the purpose of curing or alleviating patient ills. In most cases, a drug must be approved for specific uses by the federal government before it becomes available to be prescribed by a physician. However, once a drug has received regulatory approval for a specific medical use, the physician may prescribe it for any purpose, approved or not. The prescribing of drugs for nonapproved uses is a common medical practice. This article discusses the informed consent implications raised by this practice, and argues that the physician should disclose to the patient the legal status of a drug prior to prescribing it for a purpose which has not been governmentally approved.

Relying upon the Constitution's Commerce Clause, Congress has vested jurisdiction over all “drugs” involved in “interstate commerce” in the federal Food and Drug Administration (FDA), a division of the Public Health Service (PHS) of the Department of Health and Human Services (DHHS).

Drugs are frequently used for purposes not included in the manufacturers’ package inserts which are approved by the Federal Food and Drug Administration (FDA). A current example involves the industrial solvent dimethyl sulfoxide (DMSO), which is approved for human use only for the treatment of chronic interstitial cystitis, but is reportedly widely sold for the nonapproved purpose of arthritis treatment. The placing of this product in the pharmacy for sale to consumers could constitute the basis for an action by FDA against the pharmacy. This article will discuss the potential legal ramifications when a pharmacist dispenses an approved drug for a nonapproved use.

The question of a pharmacist’s liability for dispensing approved drugs for nonapproved uses has not yet been litigated. Courts have, however, held physicians liable for improperly prescribing drugs for nonapproved uses, as discussed by Professor Kapp in the preceding article. The premise of this article is that the pharmacist is potentially liable, and that the basis of this liability may be analogized to that of the physician’s liability.

The use of the phrase “health care team” raises a number of philosophical questions — the fundamental one being whether it is appropriate to apply the word “team” to groups of health care professionals. This column will argue that answering that first question affirmatively will raise other ethical issues. For example, team rhetoric, drawn upon metaphors of athletic teams, is deceptive in the context of health care and can lead to incorrect concepts of the ethical responsibilities of the health care team and its members. Specifically discussed here will be the normative conflict between an individual’s loyalty to the health care team and that person's responsibility to “blow the whistle” on team members who have acted improperly.

One way to answer these questions is to use a general definition of “team” to determine whether there are any “teams” in health care based on that definition. Alternatively, one could look at several uses of the term outside the context of health care, and then see whether the health care situation is sufficiently analogous to these uses to justify the use of the term.