This article explores the relationship between respect for individual autonomy and the law governing end-of-life treatment in the United States. It begins with a review of the law governing treatment decision-making for competent adults, incompetent adults, and children. It then turns to the issue of determining death. After that, the article discusses the limitations of the autonomy-based approach in addressing three areas of end-of-life law: “futile” treatment disputes, treatment decisions for incompetent patients, and access to physician-assisted death. It concludes that courts and other legal decision-makers will face pressure to consider the proper role of quality of life, cost, medical judgment, and patient vulnerability in determining end-of-life law.
This chapter explores the law’s response to conflicts between parents and medical professionals over medical treatment of children. It acknowledges that generally the law gives parents considerable leeway over how to raise children and will only allow intervention in cases where the parents cannot reach agreement over an issue or the parents are causing the child significant harm. The chapter explores why medical treatment might be seen as different from other issues concerning children—in particular because there are authoritative alternative decision-makers (doctors) who can claim to have greater expertise than parents. However, it is claimed that end-of-life cases tend to raise issues that are not solely medical and hence a dialogue between doctors and parents is essential to determine the child’s best interests.
This chapter examines how the congressional budget process influences health policy debates. It begins with an overview of the federal budgeting process and the role of health programs in the growth of federal spending over time. It considers three parts of the federal budget: discretionary spending, mandatory spending, and tax spending. It then describes the baseline used as a model to project the required spending of the federal government. It also discusses procedural and statutory limits to Congress’s ability to increase spending or cut taxes, including the “Pay-as-You-Go” (PAYGO) requirement and the use of scorekeeping to estimate the costs of new legislative proposals to make PAYGO limits workable. The chapter concludes with examples illustrating how the budget process influences legislative results, including the tobacco bill, the Sustainable Growth Rate in Medicare, and the Patient Protection and Affordable Care Act’s federal matching rates for its Medicaid expansion.
Dayna Bowen Matthew
This chapter discusses the existence of racial and ethnic discrimination in U.S. healthcare. It highlights the adverse effects on health outcomes of both the discrimination of the American slavery and Jim Crow eras, as well as the more subtle form of racism prevalent in healthcare today. It first contextualizes racism in American healthcare and the legacy of discrimination in medicine before turning to federally enacted legal instruments currently used to address discriminatory healthcare, along with their shortcomings. It then considers the Supreme Court’s response to contemporary trends in racial discrimination. It also suggests that Congress has been remiss in its responsibility to set the nation’s modern civil rights agenda and explains why. Finally, the chapter outlines concrete steps toward achieving nondiscriminatory healthcare delivery in America, mainly through legislative amendments to reform the existing civil rights law.
Manel Kappagoda, Lindsay Wiley, and Anne Pearson
This chapter argues that law and policy interventions can and should be used to prevent noncommunicable diseases, but some of the most effective strategies are impeded by political, cultural, and legal barriers. It reviews law and policy interventions—including mandated information disclosures and restrictions on marketing; taxation and pricing strategies; product and retailer regulation; licensing and zoning strategies; spending and procurement strategies; and indirect regulation through tort liability—that have potential to change behavior and protect health on a much broader scale than health education campaigns alone. Following the social-ecological model, this chapter addresses strategies for altering the information environment, the built environment, the marketplace, and the social norms that shape health behaviors, with particular reference to tobacco control efforts and initiatives that promote healthy eating and physical activity.
James G. Hodge Jr.
This article focuses on the extent to which laws, policies, and ethics are used to plan for, prevent, and respond to catastrophic events that may negatively impact the public’s health. It begins with a brief, historical background on emergency legal preparedness, particularly after the 9/11 terrorist attacks. It then considers legal classifications of varied types of emergencies and related public health powers, the practice of “legal triage” in real-time events, and the ethical allocation of scarce resources. It also examines the debate over liability protections extending to health care personnel and entities during emergencies, and discusses in conclusion the potential application of public health emergencies related to other risks to human health such as drug addiction, food contamination, or seasonal influenza.
Bioethics is the application of ethical principles to life’s biological choices. It has played a meaningful role in the intersection of sports and the law. As technology and science advance, bioethics is poised to even more dramatically influence how the various participants in the world of sports interact with the boundaries of law. To that end, this chapter explores the most critical bioethical issues in sports today. Those issues include the role of the team physician; the use of performance-enhancing pharmaceuticals, surgical techniques, and gene modification; and new advances in performance-tracking technologies. Finally, the chapter explores the ethics of watching violent contact sports knowing that participants may face a life after competition in a debilitating condition.
Rachel Rebouche and Scott Burris
This chapter examines the “social determinants of health”—the resources and conditions in our social and physical environments that influence exposure and vulnerability as well as immunity to proximate causes of acute or chronic illness and toxins or pathogens. It begins by explaining the social determinants of health, paying attention to the impact of race and ethnicity, low income, inequality, and education on health status and healthcare services. It then turns to the Patient Protection and Affordable Care Act (ACA) and its role in increasing equitable access to high-quality healthcare and in promoting improved integration of the health and healthcare systems. It also considers the ways in which the ACA may not succeed in adopting a social determinants approach. Finally, it reflects on how law can help create a “culture of health” based on established public health strategies and by addressing social determinants through structural reform.