Conscientious objection in reproductive health care: Analysis of Pichon and Sajous v. France

This article explores the issue of conscientious objection invoked by health professionals in the reproductive and sexual health care context and its impact on women's ability to access health services. The right to exercise conscientious objection has been recognized by many international and European scholars as being derived from the right to freedom of thought, conscience and religion. It is not, however, an absolute right. When the exercise of conscientious objection conflicts with other human rights and fundamental freedoms, a balance must be struck between the right to conscientious objection and other affected rights such as the right to respect for private life, the right to equality and non-discrimination, and the right to receive and impart information. Particularly in the reproductive health care context, states that allow health professionals to exercise conscientious objection must accommodate this in such a way that its exercise does not compromise women's access to health services. This article analyses the European Court of Human Rights' decision on admissibility in Pichon and Sajous v. France (2001) and argues that a balancing approach should be applied in cases of conscientious objection in the sexual and reproductive health care context.     

Equity,access, and outcomes: The status of the art

A rationale for including analyses of outcome in evaluation of the impact and equity of changes in health care policy for the poor is presented. We first discuss problems in defining equity in and access to health care. Equity in access to health care requires equality of access only to those services that are believed to be efficacious. Three cost-containment strategies (restrictions in eligibility, coinsurance, and capitation) are then examined, and their limitations are discussed. Finally, directions for future research focusing on outcomes are suggested. Rather than using access to care to assess outcome, outcome is viewed as the framework for assessing access and equity.     

Hospice utilization: political, cultural, and legal issues

The provision of end-of-life care is considered a substantive part of nursing, and hospice is often considered the "gold standard" of optimal end-of-life care. Unfortunately, however, only an estimated 43% of patients eligible for hospice actually receive hospice services (Harrison, Ford, & Wilson, 2005). The purpose of this article is to describe the political cultural, and legal issues associated with the underutilization of hospice care. Specifically, this article will outline the policy issues for accessing hospice under Medicare and Medicaid, the cultural and social issues in hospice utilization, and the legal implications of these issues. In addition, this article will serve to offer initial solutions to the problems at hand in order to guide nurses in promoting effective, efficient, and realized access to hospice services.     

The constitutionality of current legal barriers to telemedicine in the United States: analysis and future directions of its relationship to national and international health care reform

The current health care crisis in the United States compels a consideration of the crucial role that telemedicine could play towards deploying a pragmatic solution. The nation faces rising costs and difficulties in access to and quality of medical services. Telemedicine can potentially help to overcome these challenges, as it can provide new cost-effective and efficient methods of delivering health care across geographic distances. The full benefits and future potential of telemedicine, however, are constrained by overlapping, inconsistent, and inadequate legal and regulatory frameworks, as well as the repertoire of standards imposed by state governments and professional organizations. Proponents of these barriers claim that they are necessary to protect public health and safety, and that the U.S. Constitution gives states exclusive authority over health and safety concerns. This Article argues that such barriers not only fail to advance these public policy goals, but are unconstitutional when they restrict the practice of telemedicine across state and national borders. Furthermore, the interstate and international nature of telemedicine calls for increasing the centralized authority of the federal government; this position is consistent with the U.S. Constitution and other governing principles. Finally, this Article observes that the U.S. experience bears some similarities to that of other nations, and represents a microcosm of the international community's need and struggle to develop a uniform telemedicine regime. Just as with state governments in the U.S., nations are no longer able to view health care as a traditional domestic concern and must consider nontraditional options to resolve the dilemmas of rising costs and discontent in the delivery of health care to their people.     

What is the goal of access to health care?

This article first examines the justifications for the goal of access to health care and the variations between health systems in their endorsement of individuals' rights to health care irrespective of income, ethnicity, age and other characteristics. It then examines the meanings of the goal of "access" to health care and considers four key dimensions--service availability ("having" access), service utilisation ("gaining" access), the relevance and effectiveness of services and equity of access. These dimensions provide a common framework that can be applied across countries and health systems and employed to assess the extent to which access to health care is actually achieved.     

Post-Apartheid Social Movements and the Quest for the Elusive 'New' South Africa

The South African Constitution guarantees justiciable socio-economic rights such as the rights to access to housing; to sufficient food and water; to social security and health care services. This 'transformative constitution' is meant to help rid the country of legacies of apartheid such as huge economic inequalities and entrenched poverty. The government's embrace of neoliberalism has, however, meant that these legacies have not only remained largely untreated but have also become entrenched. Poor communities have started organizing themselves in order to challenge the government's neoliberal policies as well as marginalization from structures of governance. This paper evaluates the nature of these 'social movements' as well as their impact on democracy and development.     

The Israeli Model for Managing The National List of Health Services in an Era of Limited Resources

In order to attain financial stability, equality, and quality of care, Israel placed its basic health insurance system under strict government regulation in the National Health Insurance Act (NHIA) of 1994. The act creates the National List of Health Services (NLHS), which outlines the minimal health services (including drugs and medical devices) that the four pre–exiting Sick Funds must supply to their members free of charge or for a relatively small defined co–payment
This article analyzes the mechanisms that update the NLHS to ensure the quality of health services provided to all citizens with respect to the constant developments in health technologies both for medical procedures and diagnosis, and for drugs.
The article's main conclusion is that Israel offers a unique model for explicit rationing. The process of updating the list of services leads to clear decision making at a national level, one which offers new technologies to all citizens by public funding each year within the limits of an allocated and defined budget. However, the Israeli model is far from perfect, especially as the act does not establish a defined mechanism for allocating an annual budget for updating the list. Therefore, the act cannot assure a health care system with the stability and certainty it requires.     

Nurse practitioner challenges to the orthodox structure of health care delivery: regulation and restraints on trade

Until recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse. This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners' dilemma.     

Obstacles to dependent health care access in Oregon: health insurance or health care?

In the 1980s, Oregon was one of a handful of "states that could not wait" for national health care reform. Oregon's chosen approach to reform was predicated on two widely accepted assumptions. First, universal access to health care is best achieved by universal access to health insurance. Second, universal access to health care could best be achieved, at least politically, by incrementally building upon the existing health care delivery and insurance system. This article questions both of these assumptions in light of Oregon's decade-long experience in trying to expand access to health care among its dependent population.     

Legal Constraints on the Use of Race in Biomedical Research: Toward a Social Justice Framework

This article addresses three questions concerning the legal regulation of the use of race as a category in biomedical research: how does the law currently encourage the use of race in biomedical research?; how might the existing legal framework constrain its use?; and what should be the law's approach to race-based biomedical research? It proposes a social justice approach that aims to promote racial equality by discouraging the use of "race" as a biological category while encouraging its use as a socio-political category to understand and investigate ways to eliminate disparities in health status, access to health care, and medical treatment.     

PERSONS WITH DISABILITIES AND THEIR SEXUAL,REPRODUCTIVE, AND PARENTING RIGHTS: AN INTERNATIONAL AND COMPARATIVE ANALYSIS

Despite important gains in human rights, persons with disabilities — and in particular women and girls with disabilities — continue to experience significant inequalities in the areas of sexual, reproductive, and parenting rights. Persons with disabilities are sterilized at alarming rates; have decreased access to reproductive health care services and information; and experience denial of parenthood. Precipitating these inequities are substantial and instantiated stereotypes of persons with disabilities as either asexual or unable to engage in sexual or reproductive activities, and as incapable of performing parental duties. The article begins with an overview of sexual, reproductive, and parenting rights regarding persons with disabilities. Because most formal adjudications of these related rights have centered on the issue of sterilization, the article analyzes commonly presented rationales used to justify these procedures over time and across jurisdictions. Next, the article examines the Convention on the Rights of Persons with Disabilities and the attendant obligations of States Parties regarding rights to personal integrity, access to reproductive health care services and information, parenting, and the exercise of legal capacity. Finally, the article highlights fundamental and complex issues requiring future research and consideration.     

The fundamental law that shapes the United States health care system: is universal health care realistic within the established paradigm?

In this article, the author draws from his own experience as a doctor in describing the issues the uninsured patient population faces. Pointing out that neither the U.S. Constitution nor case law provides a positive right to health care, the author describes the parameters of federal health care funding and ultimately concludes that universal health care cannot be fully achieved in the U.S.     

Gender Equality, Citizenship, and the EU's Constitutional Future

Abstract:  While gender equality has been a matter of some concern for EU law and policy makers over the past half century, this concern has tended, at least historically, to focus upon equal treatment in employment and has not yet materialised into the delivery of a broader package of civil, political, and social rights for women. Taking the concept of EU citizenship as a framework within which to view the promotion of gender equality, this article assesses the debate on the constitutional future of the EU. This is with a view to examining the possible amelioration of women's social position through the exploitation of opportunities that the constitutionalisation of EU law presents. Looking at women's citizenship through the lens of political rights to participate in the debate on the EU's future, together with examining substantive aspects of the Constitutional Treaty for their gender equality content, the article suggests that a more comprehensive endeavour by all institutional actors to engage in gender mainstreaming is needed in order to give effect to a broader form of equality between women and men.     

Levelling the EU participatory playing field: A legal and policy analysis of the Commission's public consultations in light of the principle of political equality

The EU Commission has a long tradition of consulting interested parties when formulating its policies. While the rationale, format and legal basis relied upon by the Commission when holding public consultations have changed over time, its systematic inability to make those consultations equally accessible to all affected parties has remained constant. This article discusses the extent to which such a consultation practice conflicts with the principle of political equality, as enshrined in Article 9 TEU. Given the Commission's unrestrained discretion regarding who, how and when to consult and the absence of corresponding participatory rights, it argues that the EU can no longer presume that all stakeholders—especially citizens and civil society groups—enjoy equal access to EU institutions. Rather, under a proposed substantive reading of the principle of political equality, it contends that EU institutions are procedurally required to ensure that everyone will effectively be given equal opportunities of access to the policy process. Only a series of structural, power‐shifting reforms—some of which are proposed in this article—may enable participation to become an autonomous form of legitimation of the Union.     

Access to health care for undocumented migrants: a comparative policy analysis of England and the Netherlands

The presence of undocumented migrants is increasing in many Western countries despite wide-ranging attempts by governments to increase border security. Measures taken to control the influx of immigrants include policies that restrict access to publicly funded health care for undocumented migrants. These restrictions to health care access are controversial, and evidence suggests they do not always have the intended effect. This study provides a comparative analysis of institutional, actor-related, and contextual factors that have influenced health care policy development on undocumented migrants in England and the Netherlands. For undocumented migrants, England restricts its access to care at the point of service, while the Netherlands restricts through the payment system for services. The study includes an analysis of policy papers and semistructured, in-depth interviews with various actors in both countries. Findings confirm the influence of such contextual factors as immigration considerations and cost concerns on health care policy making in this area. However, these factors cannot explain the differences between the two countries. Previously enacted policies, especially the organization of the health care system, affected the kind of restrictions for undocumented migrants. Concerns about the side effects of generous treatment of undocumented migrants on other groups played a substantial role in formulating restrictive policies in both countries. Evidently, policy development and implementation is critically affected by institutional rules, which govern the degree of influence that doctors and professional medical associations have on the policy process.     

The mental health service crisis of neoliberalism -- an antipodean perspective

Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.     

Access to mental health supports in England: crisis resolution teams and day services

Access to health care is a complex issue with multiple supply and demand side facets. Here just two issues are explored; the potential for access through availability and the actual access made as indicated by utilisation rates. These perspectives are explored for two mental health services, crisis resolution teams and day hospitals, both of which are recommended components for a comprehensive local mental health care service in England. The geographical spread of these services is considered alongside the level of provision and the extent of their use. Associations between availability and needs, and between use and needs are tested. Tracking resources from funding allocations to provision is also complex and issues around resource allocation are discussed.     

Decisions without consequences: cost control and access in state Medicaid programs.

States have implemented a number of strategies to provide services, pay providers, and control Medicaid spending. We test the effects of some differences in state Medicaid policies on program enrollees' access to and use of health care services. Logistic and OLS regression analyses of cross-sectional data indicate that these policies exert significant influences on enrollees' access to health services but have a weaker direct effect on their use of them. However, we find evidence that utilization is affected indirectly (through increased access) by state policy decisions. Somewhat surprisingly, Medicaid policies designed to contain costs by limiting utilization appear to affect neither access nor utilization. Medicaid enrollees have greater access to a private physician in states with higher physician reimbursement and additional Medicare insurance for their enrollees. Other nonpolicy variables with pronounced impacts on access to private office physicians include race and the availability of private insurance.