The need to know versus the right to know: privacy of patient medical data in an information-based society

"Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."(1) "Safeguards to privacy in individual health care information are imperative to preserve the health care delivery relationship and the integrity of the patient record."(2) As early as the fourth and fifth centuries B.C., Hippocrates contemplated the importance of medical information to the care and treatment of patients. His oath suggests that privacy of a patient's medical information creates the foundation upon which a patient reposes trust in his or her physician. While defining the earliest version of the physician-patient privilege, the oath does not envision the extent of modern day access to healthcare information. A patient's relationship with the modern healthcare delivery system often includes a team of physicians, nurses, and other clinical support personnel. This relationship extends beyond direct caregivers and may include healthcare administrators, payor organizations, and persons unfamiliar with a patient's identity, such as researchers and public health officials. Accessing a patient's medical information links these participants to the patient's healthcare delivery relationship. The Hippocratic Oath does not contemplate such broad access, nor does it contemplate the emerging privacy crisis resulting from the application of computer technology to medical record storage and retrieval. The combination of broad access, individual privacy rights, and computer technology requires a rethinking of measures designed to protect the realities of the modern medical information society.     

Candidate Character vs. The Economy in the 1992 Election

The outcome of the 1992 U.S. presidential election has been explained largely as a function of perceptions of George Bush's economic performance. The economy submerged questions about Bill Clinton's character, awarding the advantage to the Democrat. In this article, we evaluate the effect of economic evaluations along with character attacks on candidate support in the 1992 presidential contest. Claims that the economy submerged character have been somewhat exaggerated. But while character remains an important issue in presidential evaluation, its role in judging candidates cannot be taken at face value. We show that both economic evaluations and character judgments are highly politicized. The findings indicate that those protesting Clinton's character turned almost exclusively to Bush. Those protesting Bush's economic record turned to both Perot and Clinton. Still, the economy did not trump character. The troubles of both major party candidates fueled a strong protest vote that contributed to Perot's strong showing.     

Book reviews

Stephen Chan and Andrew J. Williams (eds), Renegade states: The Evolution of Revolutionary Foreign Policy (Manchester: Manchester University Press, 1994).

Adam Roberts and Benedict Kingsbury (eds), United Nations, Divided World. The UN's Role in International Relations 2nd edition (Oxford: Clarendon Press, 1993)

G. Hastedt and K. Knickrehm, (eds), Toward the Twenty‐first Century. A Reader in World Politics (New Jersey: Prentice Hall, 1994).

A. J.R. Groom and Margot Light (eds), Contemporary International Relations: A Guide to Theory (London: Pinter Publishers, 1994).     

A review of recent developments affecting COBRA rights

Due to the high cost of health care claims and COBRA's status as remedial legislation, COBRA has generated a significant amount of litigation in recent years. While the early COBRA decisions tended to broaden the law in order to provide a remedy to an otherwise uninsured qualified beneficiary, the recent trend in the case law has been to limit the expansion of COBRA rights based on a narrower construction of the statute. Even so, COBRA still represents a legal minefield for employers. As a result, a careful employer will minimize its exposure by monitoring changes in the law and its interpretation and making appropriate modifications to its COBRA documentation and administration. This article discusses some of the more significant recent changes in the law affecting qualified beneficiaries' COBRA rights--and therefore, employers' exposure.