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PubMed2003

Let the shoemaker stick to his last: a defense of the "old" public health.

The traditional forms of public health law were directed largely toward communicable diseases and other externalities, such as pollution, with negative health impacts. The more modern view treats any health issue that affects large numbers of individuals as one of public health, which would include such problems as obesity and diabetes. This paper examines the constitutional evolution of the public health principle from the narrower to the broader conception. It then argues that the narrower conception better defines the appropriate scope of coercive government intervention than does the broader definition, which could easily authorize interventions in economic affairs whose indirect effects are likely to reduce overall social wealth and freedom, and with it the overall health of the population.

Forecasting↗
PubMed2003

Competency to be executed and forced medication: Singleton v. Norris.

Singleton v. Norris is a decision by the Eighth Circuit Court of Appeals stating that forced psychotropic medication can be continued after the date of execution is set if the medication had been given previously to prevent the inmate from being dangerous in the prison setting under a Harper-type review. The defendant had argued that after the date of execution was set, it was no longer in his medical interests to continue the medication. In the decision, the majority held that the fact that an execution is in the offing does not alter the medical interests for which the medication had been prescribed, and physicians should just continue to treat the medical condition. This decision may raise ethics problems for physicians in such settings, because they may be in violation of the American Medical Association (AMA) Code of Ethics if the original override is dubious.

Arkansas↗
PubMed2003

The defence of therapeutic privilege in Australia.

Therapeutic privilege is a defence that excuses a medical practitioner or other health professional from complying with the requirements of full disclosure to a patient in circumstances where it is reasonably considered that such disclosure would be harmful to that patient's health or welfare. Although the concept originated in the United States, the defence has been applied in Australia, and was specifically endorsed as part of Australian law by the High Court in Rogers v Whitaker (1992) 175 CLR 479. However, there has been negligible application of the defence since that endorsement. This article examines the doctrine of therapeutic privilege in the present Australian medico-legal environment. After an examination of the concept and its three constituetent elements, the article canvasses the limited instances of judicial approval of the defence prior to Rogers v Whitaker. The author then analyses, by reference to reported and unreported case law, why the defence has been so narrowly interpreted since, such that it has come to occupy an almost untenable position in Australia's medical jurisprudence.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Unmanaged care: towards moral fairness in health care coverage.

Health insurers are generally guided by the principle of "actuarial fairness," according to which they distinguish among various risks on the basis of cost-related factors. Thus, insurers often limit or deny coverage for vision care, hearing aids, mental health care, and even AIDS treatment based on actuarial justifications. Furthermore, approximately forty-two million Americans have no health insurance at all, because most of these individuals cannot afford the cost of insurance. This Article argues that Americans have come to demand more than actuarial fairness from health insurers and are increasingly concerned by what I call "moral fairness." This is evidenced by the hundreds of laws that have been passed to constrain insurers' discretion with respect to particular coverage decisions. Legislative mandates are frequent, but seemingly haphazard, following no systematic methodology. This Article suggests an analytical framework that can be utilized to determine which interventions are appropriate and evaluates a variety of means by which moral fairness could be promoted in the arena of health care coverage.

Actuarial Analysis↗
PubMed2004

Forensic psychiatry and political controversy.

This article gives a U.K.-based perspective on the involvement of forensic psychiatry organizations in questions of political controversy. Medical professional bodies are fundamentally concerned to uphold good standards of clinical practice and patient welfare, and to uphold professional medical ethics. In our specialty, when acting as individual expert witnesses, we seek to serve the courts with objectivity and respect for the law. However, as members of our professional bodies we have a legitimate medical concern about how the law affects the mentally disordered as a class. We should articulate a collective view about what treating the mentally disordered justly and appropriately in the legal system means and should challenge the law when it fails to achieve this.

Federal Government↗