Medical-Legal Partnerships: Origins and Ethical Lessons
June 1, 2014
Nebraska Law Review, Vol. 93.3, March 2015, Forthcoming
This paper examines ethical conceptions of physician and attorney obligations during the course of providing treatment and representation to the indigent disabled. Within this context I argue that, despite the limited resources with which the lawyers and doctors who serve this community work, full compliance with ethical obligations is required. It is required not only by the codes governing physician and lawyer behavior but also by the realities of the adversary system: a system that low income disabled persons must access in order to obtain income and health care supports.
Further, within the specific context of disability benefits litigation, an historical analysis of social security and private disability decisions and trends reveals that the specific mechanism necessary to effectively advocate on behalf of the disabled is in fact the medical-legal partnership. This is precisely because the medical-legal partnership is what has been used by the Social Security Administration and private insurance companies to defend their internal decisions to deny benefits.
While relatively recent discussions about medical-legal partnerships come from advocates for the poor and underserved, in fact medical-legal partnerships originated with government and private sector advocates. As increasingly complex definitions of disability have been created and then codified by regulations on the public sector side and within insurance contracts on the private side, doctors who are used as consultants to review claimants’ evidence have had to be trained regarding the manner in which these definitions are to be applied to the evidence provided. In other words, the consulted have become the consulters and an interdisciplinary medical-legal partnership is effectively created. The result is that a claimant is often facing not only a more powerful, greater-resourced opponent but also one that presents what effectively is an interdisciplinary defense team.
In this manner, claims reviewers have successfully tipped the scales too far in their favor – rending the fabric of the already tenuous safety net for the disabled. To re-balance these scales and repair the safety net, I conclude with a call for an acceptance of ethically defined professional roles which encompass the obligation to create more similar partnerships in the future.
Number of Pages in PDF File: 44
Keywords: medical-legal partnership, medical ethics, legal ethics, interdisciplinary, low income disabled, disability income, disability insurance
Date posted: July 16, 2014 ; Last revised: October 25, 2014