The decision whether or not to treat a newborn infant with a major birth defect or other life-threatening condition presents a multitude of medical, ethical and legal problems for all individuals involved. This is particularly true when the child’s prognosis, even with therapy, is uncertain or when treatment may result in or prolong a life fraught with substantial suffering. The proper roles of the physician and other hospital personnel, and especially of the child‘s parents, have yet to be fully or adequately resolved. Nonetheless, recent public awareness of isolated cases has made it clear that the status quo is not acceptable. The Committee on the Legal and Ethical Aspects of Health Care for Children (Children’s Committee) believes that hospitals and state agencies must do more to protect seriously ill newborns and to provide greater support—medical, psychological, and financial—to those in need.

On July 5, 1983. the Department of Health and Human Services (HHS) issued a revised version of its Proposed Rules for the so-called Infant Doe Regulations. The regulations are designed to prevent discriminatory denial of medical treatment to handicapped infants. An earlier version published last March had been struck down for procedural defects by Federal District Court Judge Gerhard Gesell. In the course of his opinion, Judge Gesell noted that the regulations touch upon one of the most difficult and sensitive medical and ethical problems facing society—the question of what, if any, life-sustaining medical treatment should be utilized to preserve the lives of severely mentally or physically defective newborn infants.

In his view not only were the original regulations procedurally flawed, but they also were substantively deficient. Arbitrary and capricious was Gesell's phrase to describe HHS's actions in establishing a toll-free 24-hour-a-day hotline on which anonymous tipsters could trigger an investigation of alleged nontreatment.

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.

This essay reflects my experiences as an open heart surgery patient. It also makes some comparisons of the roles of lawyers and doctors. The skills of the medical profession in pursuing the concept of preventive medicine have for more than three decades stirred my interest in developing the concept of preventive law.

As is my custom, aided by the good practices of my personal physician for a decade, I received an annual medical examination on Tuesday, June 8, 1982. The preliminary results were reported to me with the customary comment that I would receive the complete results in a few days. I did notice a slight downcast expression on the good doctor's face as he looked at the electrocardiogram, but I remained silent. The E.K.G. included a four-minute bicycle exercise. For most previous years, the exercise was the Master's two-step test so I did not have a good basis of comparison of this year's test with my previous E.K.G.s. I excused the slight difference that I felt this year on the basis that each year I am getting older.

Occupational health nurses exercise their professional skills in positions of enormous responsibility. An occupational health nurse works in industry or business, either alone or as part of a team, to ensure workers’ health and safety. Management is ultimately responsible for providing a safe and healthful work environment, and employs nurses and other professionals to provide health services for workers and to meet the mandates of the Occupational Health and Safety Act of 1970, which has imposed many responsibilities on employers and occupational health professionals.

Highly specialized professional nurses in recent years have gained recognition of their expanded responsibility, autonomy, and accountability. At the same time, an increased number of nurses have been named individually as defendants in negligence or malpractice actions. Occupational health nurses may become particularly vulnerable to a disproportionate number of malpractice suits, as a result of factors ranging from the independent setting in which occupational nurses work to the interplay of laws affecting workers and employers.