Genetic enhancement in the twenty-first century: three problems in legal imagining

By what method should we resolve the ethical and public policy issues surrounding genetic enhancement: a utilitarian calculus, appeal to Scripture, application of neo-Kantian principles? In this Article, the author claims that, despite the diversity of our basic methodological commitments, we can advance our shared understanding of the issues surrounding genetic enhancement and come to agree upon certain central features as essential to any adequate method for resolving those issues. The author attempts to make modest headway on both fronts by engaging in "legal imagining." Legal imagining consists of examining hypothetical problems from the lawyer's perspective, the perspective of a caring, professional friend. This Article examines and discusses three problems in legal imagining.     

The new EMTALA regulations and the on-call physician shortage: in defense of the regulations

This Article examines the new Emergency Medical Treatment and Labor Act (EMTALA) regulations, focusing on the on-call provisions, in light of the practical realities of the on-call physician shortage. It provides an historical account of issues surrounding the delivery of emergency care by on-call physicians and the legal background of EMTALA insofar as it relates to on-call physicians. Ultimately, the author concludes that, although the current shortage of on-call physicians has caused hospitals to anticipate EMTALA liability and advocate for more specific regulations, a closer look reveals that hospitals' fears are overstated. As long as hospitals have proper procedures in place, the new regulations will not put them in violation of EMTALA.     

Images of health insurance in popular film: the dissolving critique

Several recent films have villainized the health-insurance industry as a central element of their plots. This Article examines three of those films: Critical Care, The Rainmaker, and John Q. It analyzes these films through the context of the consumer backlash against managed care that began in the 1990s and shows how these films reflect the consumer sentiment regarding health-insurance companies and the cost controlling strategies they employ. In addition, the Article identifies three key premises about health insurance in the films that, although exaggerated and incomplete, have significant factual support. Ultimately, the author argues that, despite their passionately critical and liberal tone, these films actually put forward solutions that are highly individualist and conservative, rather than inclusive and systemic.     

The clinical trial research participant as an inside trader: a legal and policy analysis

This Article examines whether a participant in a clinical research trial for a drug obtains material nonpublic information about the drug and its manufacturer or licensor and, if so, whether the participant may lawfully trade securities based on that information. This issue has been noted but not examined in depth in several articles in recent years. After an introduction to the federal law of insider trading and a discussion of relevant aspects of a supervised research trial, the Article concludes that, absent an agreement to the contrary, the participant would be free to trade securities based on any material nonpublic information learned in the trial. The author evaluates the extent to which the information is material and nonpublic and then presents the policy issues surrounding whetherthe participantshould be precluded from trading when in possession of material nonpublic information gained as a result of participation in the trial. While not resolving the competing policy considerations, including the value of allowing participants to make disclosure of their experiences in the trial before publication of the results in a peer reviewed journal, the Article presents an approach for preventing the misuse of material nonpublic information gained in the clinical trial context, by obtaining an agreement from the participant, and an agreement from the limited circle of persons to whom the participant should be allowed to make disclosure in any event (such as his personal physician and family members), that would render any trading by them unlawful under the federal law of insider trading.     

Kringen v. Boslough and Saint Vincent Hospital: a new trend for healthcare professionals who treat victims of domestic violence?

The plague of domestic violence is not being properly met by our medical and legal systems. The author, using the recent litigation in Kringen v. Boslough and Saint Vincent Hospital as a template, closely examines the various medical and legal issues that touch upon this area. The Article advocates for physicians to routinely be on the alert for signs of domestic violence, and to take actions to advance the safety of women who are seeking treatment for such injuries. The Article maintains that the increased use of screening protocols and procedures in this area is creating a new standard of care, and that enforcement of that standard of care by the judiciary will further advance the interests of battered women.     

Direct democracy and bioethical choices: voting life and death at the ballot box

Direct democracy, the political process that enables citizens to draft, circulate, and enact laws, has become the refuge for grassroots organizations seeking statutory validation in a legislative arena perceived to be unresponsive or unfriendly to their concerns. One group of citizens, advocates for physician-aid-in-dying, has recently emerged on the national scene, sponsoring state ballot initiatives in three states and pledging to continue their quest for legalization of physician-assisted death throughout the country. In this Article, Professor Daar examines the interplay between direct democracy and regulation of end-of-life decision making. This examination reveals that lawmaking of physician-aid-in-dying, is no less susceptible to the ravages of political wrangling than is representative democracy. Professor Daar argues that direct democracy is best utilized as a spur to legislative action rather than as a replacement for the study and compromise unique to legislating through representative democracy. In addition, the author advocates recognition of a constitutionally protected liberty interest in choices surrounding death, thus providing a threshold level of protection to all citizens, not just those whose lawmakers or citizens are motivated to codify this fundamental right.     

The conversion and settlement of Georgia Blue: are consumer groups still singing the blues?

As more Blue Cross/Blue Shield Organizations employ various means to convert to for-profit status, myriad issues arise concerning the proper treatment of assets that were accumulated during the not-for-profit years of such organizations. Moreover, state officials face pressure from all sides to assure that the conversion process is "fair." In the following Article, the author examines the conversion of Blue Cross and Blue Shield of Georgia to demonstrate the various conversion issues that arise under traditional legal principles--as well as the means by which that Blue employed newly enacted legislation to avoid many of the requirements that otherwise would have attended its conversion.     

Understanding the physician-owned specialty hospital phenomenon: the confluence of DRG payment methodology and physician self-referral laws

Physician-owned specialty hospitals have flourished in today's healthcare arena, but also have been the subject of a great deal of controversy. The author argues that the rise of specialty hospitals has been the result of a confluence of two healthcare policies: (1) skewed DRG payment methodologies and (2) the misapplication of exemptions to the Stark Law's ban on physician self-referral. This Article examines the aspects of these healthcare policies that have allowed for the explosion of specialty hospitals, as well as the arguments for and against the creation and need for specialty hospitals. The Article also analyzes the reform proposals to correct the Stark and DRG methodologies and how those proposals will affect both specialty and general hospitals.     

Managed care liability today: laws, cases, theories, and current issues

Managed care entities face numerous liability issues in today's changing healthcare environment. This Article provides the plaintiff with a comprehensive road map for navigating the many avenues of managed care liability. The author describes ERISA pre-emption provisions and suggests ways plaintiffs' attorneys can strive to narrow the pre-emption. The Article also provides in-depth analysis of each theory of managed care liability that has been litigated against managed care entities to date, and then goes on to explore state laws imposing liability on managed care entities, and how HMO liability is being reformed through legislative action. For plaintiffs' attorneys seeking the full spectrum of theories of managed care liability, or for defendants' attorneys wanting to remain updated on all potential claims to defend, this Article constitutes an extensive primer on the current issues.     

Hospital committee proceedings and reports: their legal status.

This Article examines the legal status of hospital committee proceedings and reports, focusing on how they may be used in a medicolegal context. Specific topics dealt with include the hospital medical staff in legal perspective, the concept of institutional responsibility, liability considerations arising from committee work, and the discovery and admissiblity of committee records in litigation cases. The author concludes that the danger of committee members facing liability for their activities is slight and that the fear that these reports and proceedings may be subject to discovery or be admissible into evidence in subsequent litigation is remote because candid and conscientious evaluations of clinical practices within every institution are essential and, therefore, public policy must encourage such evaluations by maintaining the confidentiality of committee activities.     

Legislation and Maintenance of Public Order and Civil Life by Occupying Powers

Article 43 of the 1907 Hague Regulations is a key provisionof the law of belligerent occupation. This essay examines howit has been understood by states and scholars, how it was developedby the Fourth Geneva Convention of 1949 and whether and howit was respected by the US and the UK during their recent occupationof Iraq. Under Article 43, an occupying power must restore andmaintain public order and civil life, including public welfare,in an occupied territory. Local legislation and institutionsbased upon such legislation must be respected by an occupyingpower and by any local authorities acting under the global controlof the occupying power. This general prohibition to change thelocal legislation also applies to post-conflict reconstructionefforts, including constitutional reforms, and changes of economicand social policies. The author examines the exceptions to theprohibition and assesses whether the widespread legislativeactivities by the occupying powers in Iraq fall under theseexceptions. He then analyses the question of whether the lawof military occupation ceased to apply in Iraq on 30 June 2004.It is also suggested that Article 43 applies to some peace operationsand provides a useful framework even for those peace operationsto which it does not formally apply.     

Legal audits and investigations: a key component of healthcare corporate compliance programs

In today's complex legal environment, healthcare organizations are increasingly implementing voluntary compliance programs as a means of avoiding severe penalties for violations of the law. The Office of the Inspector General has identified legal audits and investigations as key components of effective compliance programs. The author demonstrates the applicability of legal audits and investigations to healthcare organizations by examining the audit and investigation process from beginning to end. The author also examines the role of attorneys in legal audits and investigations, and explains how information communicated from the healthcare organization to its attorneys can be protected from disclosure. As this Article indicates, the monetary and human resource costs of such compliance audits and investigations are insignificant when compared to the potential costs of defending a legal action or paying monetary penalties.     

Rethinking the admissibility of medical treatises as evidence.

This Article examines the issues and questions which underlie the debate over the admission of "medical treatises" into evidence. The admissibility of this type of evidence is at issue most often in litigation involving complex medico-legal issues. This article outlines the evidentiary basis for admission of medical treatises and discusses the quality of medical treatises in an effort to determine what value to the fact-finder these treatises actually hold. The authors contend that there is an inherent untrustworthiness associated with medical treatises, but do not go so far as to suggest that medical treatises should never be admitted. The Article concludes that there is a need for greater caution in determining admissibility and recommends safeguards to better guarantee trustworthiness and reliability.     

The National Response Plan: a new framework for homeland security, public health, and bioterrorism response

This Article provides a detailed overview of the new National Response Plan (NRP) with a focus on its applicability to bioterrorism and other public health emergencies. The Article highlights critical policy and legal issues left unresolved by the NRP, and offers recommendations for the resolution of those issues. The author concludes that, although the NRP is not perfect, it represents a major advance in domestic incident management and provides regular opportunities for review and revision as we learn how to best coordinate the national response to major incidents. A close working relationship between the Departments of Health and Human Services and Homeland Security should enable a unified response to bioterrorism and other public health emergencies in support of state and local efforts.     

Private prosecution in Singapore: understanding locus standi and measures in place to minimise abuse

In Singapore, as is the case with other commonwealth countries, the general rule is that once any offence has been committed, it is for the state to prosecute the alleged offender. This explains why Article 35(8) of the Constitution provides that ‘[t]he Attorney-General shall have power, exercisable at his discretion, to institute, conduct or discontinue any proceedings for any offence’. Article 35(8) is reinforced by section 11 of the Criminal Procedure Code, which provides that ‘[t]he Attorney-General shall be the Public Prosecutor and shall have the control and direction of criminal prosecutions and proceedings under this Code or any other written law’. However, as is the case with other commonwealth countries, the public prosecutor in Singapore does not have an exclusive right to prosecute. In some circumstances other government agencies or private individuals may institute and have instituted prosecutions. The purpose of this article is to discuss the issues of locus standi to institute a private prosecution and the measures in place in Singapore to minimise abusing the right to institute a private prosecution. In discussing these issues, the author, where necessary, compares the Singapore position with that of other commonwealth jurisdictions and makes recommendations on how legislation could be amended in Singapore to address some of the challenges.     

Dagher redux: searching for the missing pieces

The most relevant question for any joint venture is, when does the relationship become a jointventure and not simply a price-fixing cartel? With respect to this question, this Article juxtaposes Texaco, Inc. v. Dagher, 126 S. Ct. 1276 (2006), against years of contrary precedent. In Dagher, the Court altered the seemingly settled foundation of antitrust law by changing its view on past holdings and abandoning the ancillary effects doctrine. The Article provides an outline of key holdings prior to Dagher, as well as a discussion of the issues that can arise as joint ventures are formed. Additionally, the authors examine how the decision altered the foundation of joint venture law in the United States. In particular, the Article exposes several important antitrust concerns relating to joint ventures that the Supreme Court did not address in Dagher. Perhaps the most perplexing issue of Dagher is whether the venture at issue would have survived analysis under the Federal Trade Commission's "continuum" approach.     

The birds,the bees,and the deep freeze: is there international consensus in the debate over assisted reproductive technologies?

This Comment traces assisted reproductive technologies from their historical beginnings in early artificial insemination techniques, through the revolutionary advent of in vitro fertilization two decades ago, and continues to current experimental procedures such as embryo twinning and cryopreservation of ova. It then examines the worldwide controversy surrounding clinical use of these technologies and international attempts to resolve these issues. The final focus is on whether or not a consensus exists within the international legal community on how to tackle the complex issues presented by recent advances in reproductive technology.     

Medical malpractice litigation: do the British have a better remedy?

Medical malpractice claims are filed nearly ten times more frequently in America than they are in Great Britain. British patients generally adopt a less adversarial stance toward medical malpractice than do American patients. This Article examines the British malpractice system, as compared with the American system, and explores the differences between the two, in terms of costs and fees, liability rules, statutory provisions, and judicial attitudes toward malpractice litigation. The Article also discusses British social and institutional factors, such as the "taint" of litigation and the National Health Service, and evaluates how these factors affect British malpractice litigation. The Article presents the alternative forums available to British patients in seeking satisfaction for their medical service complaints. The Article concludes with an evaluation of how these factors achieve the three societal objectives of malpractice litigation: reparation, emotional vindication and deterrence.