• Selected
• Entire List

Abstract:
Clinical depression is a serious medical problem in the older population. Although it is considered to be highly treatable, physicians and other health care professionals often are criticized for doing an inadequate job of recognizing, and then treating, depression in older persons. They are routinely exhorted to improve their performance by being more aggressive in recognizing and intervening with this clinical condition. Yet, the mandate to provide aggressive treatment of depression is not always uncontroversial. Rather, medical intervention for older patients may raise a number of challenging legal, as well as ethical, questions. Using a case example, this article outlines some of the salient legal issues implicated by an older person's right to be and act depressed and the exceptions to that right.

Abstract:
The conduct of biomedical research involving the participation of human beings implicates a variety of ethical concerns pertaining to such values as dignity, bodily integrity, autonomy, and privacy. These ethical concerns have been translated into a complex regulatory apparatus in the USA, containing specific legal provisions concerning such matters as participant safety, informed consent, and confidentiality. A topic of particular interest for pathologists is the handling of human tissue specimens that may be used for present, or stored for future, research purposes. This article examines the ethical and legal ramifications of obtaining and storing tissue samples for research purposes, with special attention to the issues of informed consent and confidentiality.

medical research, informed consent, confidentiality, ethics

Abstract:
This article examines the incongruity of two conceptualizations of aging in contemporary America: older persons as adults capable (with adequate support) of exercising a high degree of self-determination by designing and managing important aspects of their own publicly financed long term care, on the one hand, versus older persons as decisionally incompetent ninnies requiring paternalistic micromanagement of their public health insurance and retirement income benefits, on the other.

aging, elderly, healthcare, Medicare, retirement, Social Security

Abstract:
This article examines the topic of resident safety in long term care, concentrating particularly on nursing facilities. The article asserts that, although the LTC industry and its regulators may learn much from hospitals' extensive experiences and efforts in the patient safety realm, these lessons are fundamentally limited because of an array of important distinctions between acute care and LTC in the United States. These distinctions carry major implications for devising and implementing effective legal and non-legal strategies to achieve the highest degree of LTC resident safety consistent with all the other important social values we desire the LTC system to protect and promote.

safety, long term care, nursing homes, regulation

Abstract:
Closing the gap between knowledge and practice in the United States long-term care financing and delivery system is an important public policy goal. The author offers ideas about the significance of personal financial responsibility as a vital component of any appropriate strategy for moving the U.S. away from present long-term care practice that relies extensively on institutional placement, toward a financing and delivery paradigm that more heavily utilizes home and community-based long-term care services.

long-term care, nursing homes, home care, policy

Abstract:
Virtually all current residents of nursing homes in the United States have significant physical or mental problems requiring ongoing, competent medical attention. Physicians may be involved in the provision of medical care to nursing home residents in several different ways. This article reports on a research project involving a literature review, legal review, and the conduct of more than forty-five individual telephone and in-person conversations with key informants. The author attempts to identify and analyze the anxieties that physicians have about their own legal risks associated with nursing home involvement as either medical directors or attending physicians and how those legal anxieties may affect, positively or negatively, the quality of care and quality of life experienced by nursing home residents. The findings reported here form the basis for prescriptive recommendations for improving long-term care policy and industry practice.

nursing homes, medical malpractice, liability, long-term care

Abstract:
In anticipation of the escalating costs of long term care, consumers and the federal and state governments are engaging in a variety of strategies intended to preserve the financial solvency of the respective party. For the consumer, this may mean planning in a way designed to maximize one's potential future eligibility for government support, while the federal government tries to limit those planning activities inspired by public benefits considerations and the states attempt to recover their long term care expenses from the estates of deceased consumers whose long term care needs the state had earlier supported. All of these strategies have important and controversial public policy implications. The public policy debate surrounding these strategies ought to be ethically informed. This article sets out to identify and outline some of the main ethical questions engendered by individual Medicaid planning, on one hand, and state estate recovery efforts, on the other. It concludes that neither of these approaches to the challenge of long term care financing are very ethically palatable.

Medicaid, Long term care, Ethics

Abstract:
This editorial argues that many state statutes involving the foregoing of artificial nutrition and hydration (ANH), although generally well-intended, frequently exert the practical effect of clouding and confusing the legally permissible boundaries of end-of-life care and thus harming rather than helping the patient and those who must live through and carry on after the dying process. The author speculates about why the current state statutory landscape often adversely affects clinical practice and patients' rights regarding the use and limitation of ANH. Recommendations are offered for the correction or at least amelioration of prevalent present deficiencies in the inception, drafting, and interpretation and explanation of state ANH statutes.

Abstract:
This is a review of a recent book that sets out to develop and promote a new vision of law as an essential tool of public health. Part One of this volume explores Conceptual Foundations of Public Health Law. Part Two addresses in depth the conflict between public health actions and personal civil liberties, while noting that frequently these two considerations work synergistically rather than in opposition. In Part Three, Gostin presents an admittedly subjective account of public health law and proffers guidelines for the future of public health law that are driven by considerations of "consistency and uniformity of approach, mission and essential functions, powers, substantive limits, procedural limits, and protection against discrimination and invasion of privacy." The reviewer pronounces this book "a monumental contribution, from the discipline of law, to the multi-disciplinary and interdisciplinary theory and practice of public health." However, the reviewer notes the controversial nature of Gostin's advocating a carefully constrained and narrowly delineated interventionist role for government, at all levels, on behalf of the public's health when interventions may conflict with the civil liberties of distinct persons, while at the same time advocating an energetically activist government public health presence when the behavior of commercial enterprises is the subject of regulation.

Abstract:
The opening section of this article describes the present regulatory environment regarding human subjects research, followed by an overview of the Institutional Review Board (IRB) process. There then ensues an enumeration of some of the general criticisms of the current regulatory scheme that have been enunciated recently. Particular concerns about decisionally impaired persons as research subjects are then addressed, referring when applicable to the recommendations made by the National Bioethics Advisory Commission (NBAC) in its 1998 report on this subject and the implications of those recommendations for mental health professionals.

Abstract:
This is a review of a recent book that sets out to develop and promote a new vision of law as an essential tool of public health. Part One of this volume explores Conceptual Foundations of Public Health Law. Part Two addresses in depth the conflict between public health actions and personal civil liberties, while noting that frequently these two considerations work synergistically rather than in opposition. In Part Three, Gostin presents an admittedly subjective account of public health law and proffers guidelines for the future of public health law that are driven by considerations of "consistency and uniformity of approach, mission and essential functions, powers, substantive limits, procedural limits, and protection against discrimination and invasion of privacy." The reviewer pronounces this book "a monumental contribution, from the discipline of law, to the multi-disciplinary and interdisciplinary theory and practice of public health." However, the reviewer notes the controversial nature of Gostin's advocating a carefully constrained and narrowly delineated interventionist role for government, at all levels, on behalf of the public's health when interventions may conflict with the civil liberties of distinct persons, while at the same time advocating an energetically activist government public health presence when the behavior of commercial enterprises is the subject of regulation.

Abstract:
This article identifies and explores the possible impact of genetic science advances concerning Alzheimer's disease on legal standards delineating acceptable medical practice in the realm of predicting and diagnosing Alzheimer's disease, and on the potential liability exposure of physicians who care for patients who are now, or in the future may become, Alzheimer's disease victims. Specific issues addressed include: What obligation, if any, does a physician owe a patient to offer genotyping for Alzheimer's disease for predictive purposes? For diagnostic purposes? What are the informed consent ramifications of such offers? To what extent, if any, is there a duty on the physician's part to perform genetic testing for Alzheimer's disease in response to patient demand? What standards of care apply to the physician's communication of Alzheimer's-related genetic testing results to a patient? What confidentiality considerations apply to Alzheimer's disease-related genetic information about a patient, particularly if potential rights of third parties must be taken into account?

Abstract:
This article examines the prevailing paradigm shift in health care financing and delivery away from pervasive regulation toward greater consumer choice, with a focus on consumer choice and direction in the area of publicly funded health care and long term care services. Particular attention is devoted to consumer control by older and disabled persons, who comprise the population group most likely to be eligible for, and dependent on, public financing for these services. Objections to the paradigm shift from pervasive regulation toward the competitive marketplace are outlined and ultimately rejected in favor of an overall policy endorsement of more emphasis on consumer choice and control for older and disabled persons in this context. Finally, the article devotes substantial attention to identifying and analyzing the legal and practical implications of the marketplace paradigm shift for decisionally incapacitated older and disabled persons and their surrogates and advocates.

Abstract:
Decisions about admitting a mentally incapacitated person to a nursing home raise a variety of difficult legal, ethical, and public policy issues. A strategy for anticipating and addressing this contingency prospectively, by encouraging execution of formal advance planning directives while the individual is still capable, may mitigate some of the dilemmas associated with these issues. The author discusses the contours and feasibility of such a strategy, analyzing the possible uses of advance directives both for prospectively authorizing nursing home admission on one?s own behalf and for refusing such admission, or for placing explicit conditions on such admission, in advance of the time that the actual decision must be made.

Abstract:
The American nursing home industry is pervasively regulated today. This article suggests that current and future nursing home residents may best be served by examining the value of regulation with a healthy skepticism, rather than automatically assuming regulation?s superiority to other potential approaches that are aimed at the same ultimate goals. Specifically, this article reviews the relatively sparse, but nevertheless helpful, literature that examines the impact of nursing home regulation. The regulatory approach is subjected to the developing analytical lens of "therapeutic jurisprudence," which, in other contexts, has asked whether legal "reforms" truly help or hurt intended beneficiaries when all relevant factors are taken into account.