The articulation by a court of a new constitutional norm serves a valuable function: the right, as elaborated by judicial opinion, provides a standard for critically evaluating current social practices. The “right to refuse treatment,” that “newly created constitutional right of personal autonomy,” draws attention to the problems of institutionalized mental patients and their desires to make their own decisions to accept or reject drug therapies, particularly where severe side effects are involved. The enunciation of the right to refuse treatment, with its hard-edged overtones, forces us to look at the tension created by the conflict between institutional attempts to treat these patients, the sometimes antithetical desire of those within the institution to control them without regard for treatment impact, and the patient's desire to retain whatever control is left to him in such settings.

The right to refuse treatment-like its common law analogue in tort, informed consent doctrine-draws its roots from concepts of personal autonomy that pervade both tort doctrine and constitutional law.

An individual practice association (IPA) is a corporation or a partnership composed of physicians which contracts with health maintenance organizations (HMOs) to provide medical services to HMO subscribers. Since physicians typically practice independently, any agreement or arrangement among them may be perceived as an agreement of competitors. Hence, IPAs run the risk of challenge under the antitrust laws for activities such as price-fixing and the exclusion of physicians from membership.

Prior to the recent Supreme Court decision in Arizona v. Maricopa County Medical Society, it appeared that courts were willing to consider a variety of factors that distinguished antitrust cases concerning health care providers from antitrust cases in the commercial marketplace, and to find that conduct by providers did not constitute antitrust offenses. Indeed, an earlier article appearing in Law, Medicine & Health Care analyzed the lower court's decision in Maricopa and discussed the development of this trend.

The birth of Siamese twins to a Danville, Illinois physician and his wife on May 5,1981, renewed the recurrent debate on the morality, ethics, and legality of euthanasia for severely defective newborns. The twins, Jeff and Scott Mueller, were joined below the waist and shared the lower part of their digestive tract and three legs. Later studies revealed internal anomalies as well. At birth they were in critical condition, suffering from respiratory distress, and were not expected to survive more than a few days.

A note written by a nurse, and countersigned by Dr. Petra Warren, reading “do not feed in accordance with parents’ wishes” was entered on their hospital chart. Several nurses disobeyed the order and fed the infants. As the twins continued to live, against expectations, word of their birth spread. An anonymous caller informed the Illinois Department of Children and Family Services that they were being starved to death.

One of the central dilemmas in contemporary medical practice is determining how much information a patient needs to make an informed choice of medical care alternatives. On June 1, 1982, Texas began an experiment that requires specific information to be given to patients about to undergo selected medical procedures. The objective of this uniform disclosure is to reduce the threat of medical malpractice lawsuits based on a failure of informed consent. While this is of benefit to physicians, it is unclear whether patients’ needs for information, like the unfortunate guests of Procrustus, will be cut and stretched to fit an inflexible standard. This article reviews the antecedents of this approach to informed consent, the legal and philosophical problems involved in uniform disclosure standards, and the practical problems that uniform disclosure standards pose for health care providers.

The application of the antitrust laws to the health care field has generated intense debate over the last few years. Responsible for this debate in no small measure are the numerous health care antitrust cases that have reached and been decided by the United States Supreme Court. In the final weeks of the October 1981 term, the Court decided three such cases which should be of great interest to health care professionals. Although each involves a different point of law, collectively the decisions underscore the increasing amount of litigation that challenges joint conduct by health care providers, and the increasingly rigorous scrutiny that courts are giving such conduct under the antitrust laws.

The case that has received the most recent attention is Arizona v. Maricopa County Medical Society,’ which involved an alleged price-fixing agreement among physicians. Defendants were the county medical societies in Maricopa and Pima Counties in Arizona, and the foundations for medical care which each society had created.

The development of the medicolegal field in the United States has followed an uneven course, marked by successions of rich and fallow periods. By the beginning of the nineteenth century a number of universities had qualified professors of medical jurisprudence on their faculties, and the field appeared to be in full flower. Yet, in 1876. a well-known American medical professor and dean, Stanford Emerson Chaille, wrote with some bitterness of the deplorable state of medical jurisprudence in this country. Today, there is considerable interest in the field, but the comparative dearth of medicolegal instruction at medical schools remains an issue.

This article briefly traces the development in the United States of the medicolegal field, which for our purposes encompasses the legal questions concerning medicine and allied sciences Selected advances in education and publishing are highlighted; lastly, the article reviews those problems which appear to have prevented the full development of this field.

The judicial debate continues to rage over the right of a child born suffering from genetic impairments to recover on his own behalf against a physician or laboratory which failed to give his parents correct information about the defect. These “wrongful life” suits are brought by parents on behalf of their child, who in most cases is born suffering from mental or physical defects which could have been detected by genetic screening. In contrast, “wrongful birth” suits are actions brought by parents of a child born as the result of a defendant’s negligence, seeking damages for either the costs incident to the unwanted pregnancy and birth of a normal child, or the costs related to the unexpected birth and care of an impaired child.

New causes of action in tort law do not simply emerge, fully grown, like Athena from the head of Zeus. They develop as a result of a struggle between older case law on the one hand and the need to respond to an emerging problem on the other. This metamorphosis can be seen in many areas of jurisprudence, but most notably in the fields of products liability and medical malpractice litigation.

The explosion in products liability litigation, for example, is linked in part to the vastly increased proliferation of a variety of consumer goods and to new forms of marketing mechanisms for selling these goods, so that consumers are exposed to a wider range of risks. Medical malpractice litigation in the “wrongful life” area similarly reflects not only a change in social values toward abortion, but also changes in the perceived ability of medicine to detect and predict defects in the unborn fetus or the likelihood of such defects based upon the genetic history of the potential parents.