Navigating the minefield: legal ethics and healthcare law

Practicing law in the healthcare field is a daunting task due to the highly-regulated nature of the field and the increasing scrutiny of the conduct of industry providers, payors, and vendors. Attorneys must provide difficult opinions regarding matters with civil, criminal, and reimbursement implications and often are asked to represent multiple parties in healthcare-related settings. This article discusses some legal ethics issues for the healthcare practitioner and touches on some of the recent changes to the Model Rules of Professional Conduct, which were adopted by the American Bar Association's House of Delegates at its mid-February 2002 meeting. The authors conduct their analysis by applying the model rules to a number of hypothetical fact situations typical of those encountered in the day-to-day practice of healthcare law.     

Barcelona 2002: law, ethics, and human rights. HIV testing for peacekeeping forces: legal and human rights issues

In 2001, the United Nations Security Council established an Expert Panel to study the issue of whether the UN should institute HIV testing of peacekeeping personnel. This article, based on a 9 July 2002 presentation to the XIV International AIDS Conference (abstract TuOrG1173), reports on the findings of a paper prepared for the Expert Panel by the Canadian HIV/AIDS Legal Network. The paper examined whether it is permissible for the UN to implement mandatory HIV testing of its peacekeeping personnel, and whether HIV-positive UN peacekeeping personnel should be excluded or restricted from service on the basis of their HIV status or HIV disease progression. The article describes some of the court cases in which these issues have been considered; discusses the importance of analyzing such issues in the context of a human rights-based approach to the pandemic; and formulates a series of key principles for guiding UN decision-making. The article concludes that a policy of mandatory HIV testing for all UN peacekeeping personnel cannot be justified on the basis that it is required in order to assess their physical and mental capacity for service; that HIV-positive peacekeeping personnel cannot be excluded from service based on their HIV status alone, but only on their ability to perform their duties; and that the UN cannot resort to mandatory HIV testing for all UN peacekeeping personnel to protect the health and safety of HIV-negative personnel unless it can demonstrate that alternatives to such a policy would not reduce the risk sufficiently. In the end, the Expert Panel unanimously rejected mandatory testing and instead endorsed voluntary HIV counselling and testing for UN peacekeeping personnel.     

Economic and legal analysis of medical ethics

In the last decade, the antityrust authorities have stricken one after another of the ethical rules of professional societies. Underlying this pokicy is the widelyaccepted notion that ethics are simply devices designed by the professions to limit competition and thereby to benefit their pecuniary interests. The antitrust assault does not consider the longstanding, nearly universal consumer support for controls on the activities of certain professions. In this paper, the narrow view ofcompetition adopted by the courts is assailed. Focusing on the case ofrestrictions on interactions between physicians and other nonmedical health care providers, some procompetitive effects of medical ethics are analyzed. Generally, professional ethics can only change the form of competition but not eliminate it. A proper legal policy requires recognition of the consumer concern with the form of competition and therefore requires a careful balancing of the beneficial competitive effects against any attendant limits on intraprofessional competition.     

Post-mortem human reproduction: legal and other regulatory issues

Increasingly women are seeking to establish pregnancies using sperm retrieved from their dead or dying partners. This raises a number of issues of a broad nature, but is also of significance in terms of the relationship between regulatory mechanisms and private choices. This article reviews this relationship with specific reference to the United Kingdom position, but also taking account of case law and regulation in Australia, particularly in the State of Victoria.     

Prison administration in contemporary Japan: Six issues

Like all prison systems, the Japanese Corrections Bureau faces problems emanating from the host society and requiring competent managerial responses. This article illustrates that point by presenting six issues stemming from changes, both internal and external to the prison environment, that challenge administrators even in this stable society, which enjoys a relatively low crime rate.     

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.     

Ethical and legal issues in suicide research

Moralist, libertarian and relativist ethical positions concerning suicide and its prevention are presented in order to clarify premises upon which ethical issues in suicide research may be resolved. Ethical concerns are differentiated from legal considerations and the implications of the vulnerability of suicidology research participants are discussed. Specific issues that arise in design, choice of participants, interpretation, diffusion of results and evaluative research are treated. These include: experimental methodologies, obtaining informed consent, deception and disclosure, studying innovative and unproven interventions, unknown consequences of participation, rescue criteria, disclosure of information to third parties, research with special populations, risks in publicizing results and measuring the value of human life. When specific legal obligations are lacking, ethical premises concerning the acceptability of suicide and obligations to intervene may influence research protocols.