Anticipating unfair uses of genetic information.
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Corneal transplantation, the most common transplantation procedure done in the United States, requires access to a sufficient number of donor eyes. We examined how laws governing tissue donation affect availability of corneal tissue by reviewing records of the Lions Eye Bank of Texas, Houston, from 1961 through 1990 (43,696 eyes from 21,898 donors). Relevant Texas statutes included the Uniform Anatomical Gift Act of 1970, the Justice of the Peace/Medical Examiner Law of 1977, and the Routine Inquiry Law of 1988. Before 1970, the mean (+/- SD) number of donated corneas was 72 +/- 38 per year; enactment of each statute above was associated with increased mean annual donations of 215 +/- 87, 1329 +/- 562, and 1958 +/- 33 corneas, respectively. The Justice of the Peace/Medical Examiner Law yielded significantly younger donors (who died of trauma), and the Routine Inquiry Law increased the number of hospitalized donors. Data from this eye bank were compared with current state laws nationwide. Effective legislation is a means to meet national ophthalmic surgical needs.
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CONTEXT: Surveillance is a key component of the core public health function of health assessment. Systematic reporting by health care professionals and laboratories, which may vary by state law, statute, or regulation, continues to provide essential data for assessing public health. OBJECTIVE: To describe the state and territorial reporting requirements for diseases and conditions recommended for national public health surveillance. DESIGN, SETTING, AND PARTICIPANTS: Between May and August 1997, the state and territorial epidemiologists from all 50 states, in addition to New York City, Puerto Rico, and Guam, completed questionnaires indicating which diseases and conditions were reportable by health care professionals and laboratories in their jurisdictions. The surveys were subsequently updated to reflect reporting requirements current as of January 1, 1999. The overall response rate for the survey was 100% for US states and 90% overall, including the territories. MAIN OUTCOME MEASURE: State and territorial reporting requirements for diseases and conditions of public health concern. RESULTS: Of the 58 diseases and conditions recommended for national reporting, 35 (60%) were reportable in greater than 90% of the states and territories, 15 (26%) were reportable in 75% to 90%, and 8 (14%) were reportable in less than 75%. Nineteen of the infectious diseases were reportable in all of the states and territories that responded. CONCLUSIONS: Required reporting varies substantially by state or territory. Health care professionals are integral to public health efforts at the local, state, and national levels.
Statutes, regulations, and litigation are pivotal tools for creating conditions for people to lead healthier and safer lives. Law can educate, create incentives, and deter; mandate safer product design and use of property; and alter the informational, physical, or economic environment. This article defines public health law as the power and duty of the state to ensure conditions for people to be healthy and limitations on the state's power to constrain autonomy, privacy, liberty, and proprietary interests of individuals and businesses. The 5 essential characteristics of public health law discussed are (1) the government's responsibility to defend against health risks and promote the public's health; (2) the population-based perspective of public health, emphasizing prevention; (3) the relationship between government and the populace; (4) the mission, core functions, and services of the public health system; and (5) the power to coerce individuals, professionals, and businesses for the community's protection. JAMA. 2000;283:2837-2841
The Constitution allocates public health powers among the federal government and the states. Federal public health powers include the authority to tax, spend, and regulate interstate commerce. These powers enable the federal government to raise revenues, allocate resources, economically penalize risk behavior, and broadly regulate in the public's interest. States have an inherent authority to protect, preserve, and promote the health, safety, morals, and general welfare of the people, termed police powers. Police powers enable states to preserve the public health in areas ranging from injury and disease prevention to sanitation, waste disposal, and environmental protection. The Rehnquist Court has emphasized the limits of federal powers and the primacy of states in public health issues affecting local concerns. Finally, the Constitution safeguards individual interests in autonomy, privacy, liberty, and property. The Supreme Court often defers to public health authorities in matters of public health, but engages in strict scrutiny if government interferes with fundamental freedoms or discriminates against a suspect class. Provided that they act justly and reasonably to avert a serious health threat, the Court should cede to agencies the power to act for the communal good. JAMA. 2000.
Public health interventions need justification because they intrude on individual rights and incur economic costs. Coercive interventions can be justified in only 3 cases: to avert a risk of serious harm to other persons, to protect the welfare of incompetent persons, and, most controversially, to prevent a risk to the person himself/herself. This article proposes a systematic evaluation of public health regulation. The article recommends that public health authorities should bear the burden of justification and, therefore, should demonstrate (1) a significant risk based on scientific evidence; (2) the intervention's effectiveness by showing a reasonable fit between means and ends; (3) that economic costs are reasonable; (4) that human rights burdens are reasonable; and (5) that benefits, costs, and burdens are fairly distributed. The 3 articles in this series have sought to provide a fuller understanding of the varied ways in which law can advance the public's health. Public health law should be seen broadly as the government's power and responsibility to ensure the conditions for the population's health. As such, public health law has transcending importance in how we think about government, politics, and policy. JAMA. 2000.
The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.
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