Webster and the fundamental right to make medical decisions

Members of the American Medical Association, the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Fertility Society, American Medical Women's Association, American Psychiatric Association, and the American Society of Human Genetics have submitted an "amici curiae" brief in support of the appellees of "Webster." The brief did not endorse or oppose the view that the state's interest in fetal health is compelling as fetal viability. Instead, the brief said that: 1) everybody has the right to make medical decisions without the state interfering "up to the point where the state's compelling interest arises;" and 2) even after a compelling interest comes up, state rules must go along with good medical practices. Because some provisions of the Missouri law were not consistent with good medical practice, these provisions were not constitutional. The fetal viability testing requirement would increase risks to the woman and fetus without providing substantial information on viability. The counseling ban would prevent doctors from giving necessary information to pregnant women so that they could make informed decisions. The 1st section of the brief discussed "the medical background of pregnancy and abortion." The earliest age at which a fetus can survive has remained unchanged since "Roe." The medical complications and adverse health effects are fewer from than from childbirth. Abortions have become safer. The brief said that the "right of privacy" is broad enough so that a woman could decide whether or not to end her pregnancy. In "Roe," the Court found that if a woman was going to make a choice about pregnancy, this was the same as other private decisions which are protected in the Constitution. Individual medical decision making is "deeply rooted" in US "history and tradition." Accepted principles are reflected in the fact that the patient has a right to make these decisions based on the "liberty component of the Due Process Clause." Section 188.029 of the Missouri Law would make a doctor do certain tests for fetal viability. They would have no medical value, in most cases, and put a risk on the health of the mother. It was not related to any goal of the state, and was, therefore, unconstitutional. Section 188-205 of Missouri law - which says a doctor can't consult unless the mother's life is endangered was also unconstitutional.     

The development of national medical care programs in the United Kingdom and Canada: applicability to current conditions in the United States

After a hiatus in the early to mid-1980s, a growing number of policy leaders, policy organizations, and citizen groups are advocating programs that ensure basic medical care for all. Although a large literature examines the applicability to the U.S. of national medical care programs that have been established in other countries from the perspective of operations and effectiveness, little attention has been given to the applicability of the experience of other nations in securing these programs. This paper examines the development of national programs in the U.K. and Canada and addresses two questions. First, what factors were critical to the establishment of the British National Health Service and the Canadian hospital and physician insurance programs? Second, how applicable are those factors to current conditions in the U.S.? The paper reviews the roles played by dislocations in society, by established models of state-sponsored medical care programs, by political institutions and leaders, and by the major medical sectors. It shows that the U.S., while differing in many particulars, presents several parallels to the U.K. and Canada. The paper argues that the current environment in the U.S. offers the nation the opportunity to develop at state or local levels government-sponsored programs that guarantee basic medical benefits to all. A new and powerful coalition, moreover, may in the coming years advance the cause of broader, more substantive change at the national level.     

Are disturbed and normal adolescents equally competent to make decisions about mental health treatments?

This study uses a structured vignette procedure to assess competency to make treatment decisions in two groups of adolescents, one at risk for institutional placement and the other a matched community sample. Scores on Factual Understanding (the ability to recall facts), Inferential Understanding (the ability to make inferences about those facts), and Reasoning (the ability to weigh risks and benefits of various treatment options and to make choices based on that reasoning) were compared. Results showed that while at-risk adolescents and their community, counterparts did not differ in their factual and inferential understanding abilities, the at-risk adolescents did significantly less well than the community adolescents in reasoning. This difference could not be fully explained by differences in verbal IQ. Girls, no matter what their risk status, scored higher than boys on the Reasoning scale. Implications for legal policies concerning adolescents are discussed.     

Privatization in the United Kingdom and economic regulation in the United States: Lessons in administrative law

The author would like to recognise Prof. Laksham Guruswamy, Faculty of Law, University of Durham, currently Visiting Professor of Law, University of Iowa, for the suggestions he contributed to this article.     

Developments in medical law in the United Kingdom in 2005 and 2006

This article highlights and summarises the key developments in medical law in the jurisdictions of the United Kingdom in 2005 and to April 2006. Topics are mental health and mental capacity, data protection, freedom of information and the impact on health data, the Human Tissue Act, genetic research databanks, Human Fertilisation and Embryology Act--Review of the legislation, consultations and related case law, developments in embryo and embryonic stem cell research, clinical trials and human subject research, medical futility, and physician assisted dying.     

Infectious disease surveillance in the United States and the United Kingdom: from public goods to the challenges of new technologies

Infectious diseases are a long-standing and continuing threat to health and welfare, with their containment dependent on national disease surveillance and response capacities. This article discusses infectious disease surveillance in the United States and the United Kingdom, examining historical national traditions for identifying and controlling infectious disease risks and how globalization and technical advances have influenced the evolution of their respective approaches. The two systems developed in different but parallel ways. In the United States, surveillance remained quite localized at the state level until the early twentieth century and still retains many of those features. The U.K. approach became centralized from the latter part of the nineteenth century and has principally remained so. In both cases, disease surveillance was traditionally conceived as a public good, where national or local authorities held sovereign rights and power to protect public health. With the increasing globalized nature of infectious disease, such notions shifted toward surveillance as a global public good, with countries responding in turn by creating new global health governance arrangements and regulations. However, the limitations of current surveillance systems and the strong hold of national interests place into question the provision of surveillance as a global public good. These issues are further highlighted with the introduction of new surveillance technologies, which offer opportunities for improved disease detection and identification but also create potential tensions between individual rights, corporate profit, equitable access to technology, and national and global public goods.     

Incentivizing professionals and patients: a consideration in the context of the United Kingdom and the United States

We are at the beginning of an era in which the pressure to secure the biggest possible "bang" for the health care "buck" is perhaps higher than it ever has been, on both sides of the Atlantic, and within the health policy discourse, incentives, for both professionals and patients, are occupying an increasingly prominent position. In this article, we consider issues related to motivating the professional and the patient to perform targeted actions, drawing on some of the evidence that has thus far been reported on experiences in the United Kingdom and the United States, and we present an admittedly somewhat speculative taxonomy of hypothesized effectiveness for some of the different methods by which each of these two broad types of incentives can be offered. We go on to summarize some of the problems of, and objections to, the use of incentives in health and health care, such as those relating to motivational crowding and gaming, but we conclude by positing that, following appropriate consideration, caution, and methodological and empirical investigation, health-related incentives, at least in some contexts, may contribute positively to the social good.     

Correlates of handgun carrying among adolescents in the United States

Weapon-related violence, especially the use of handguns, among adolescents is a serious public health concern. Using public-use data file from the adolescent sample (N = 17,842) in the 2008 National Survey on Drug Use and Health (NSDUH), this study examines the behavioral, parental involvement, and prevention correlates of handgun carrying. Overall, 3.1% of adolescents between the ages of 12 and 17 reported carrying a handgun in the past year. Results from a series of logistic regression models indicated that males, selling and using illicit drugs, were robustly associated with an increased probability of handgun carrying among adolescents. Furthermore, youth who carry handguns were significantly less likely to report a parent being involved in their lives and were significantly more likely to have encountered violence and drug prevention programming compared with youth who did not carry handguns. Implications of these results for prevention and policy are discussed.     

Inching toward incrementalism: federalism, devolution, and health policy in the United States and the United Kingdom

In the United States, the recently enacted Patient Protection and Affordable Care Act of 2010 envisions a significant increase in federal oversight over the nation's health care system. At the same time, however, the legislation requires the states to play key roles in every aspect of the reform agenda (such as expanding Medicaid programs, creating insurance exchanges, and working with providers on delivery system reforms). The complicated intergovernmental partnerships that govern the nation's fragmented and decentralized system are likely to continue, albeit with greater federal oversight and control. But what about intergovernmental relations in the United Kingdom? What impact did the formal devolution of power in 1999 to Scotland, Wales, and Northern Ireland have on health policy in those nations, and in the United Kingdom more generally? Has devolution begun a political process in which health policy in the United Kingdom will, over time, become increasingly decentralized and fragmented, or will this "state of unions" retain its long-standing reputation as perhaps the most centralized of the European nations? In this article, we explore the federalist and intergovernmental implications of recent reforms in the United States and the United Kingdom, and we put forward the argument that political fragmentation (long-standing in the United States and just emerging in the United Kingdom) produces new intergovernmental partnerships that, in turn, produce incremental growth in overall government involvement in the health care arena. This is the impact of what can be called catalytic federalism.