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.     

Explaining “Pain and Suffering” Awards: The Role of Injury Characteristics and Fault Attributions

The present research explored factors thought to affect compensatory awards for non-economic ham (pain and suffering) in personal injury cases. Experiment 1 showed that the nature and severity of the plaintiffs injury had a strong effect on perceptions of the extent of harm suffered and on award amounts. The parties' relatively active or passive roles in causing the injury affected assessments of their degree of fault, but perceived fault had little influence on awards. Experiment 2 replicated with more varied cases the strong impact of injury severity on harm perception and on awards for pain and suffering. In both studies, the disability and the mental suffering associated with injuries were stronger predictors of awards than were pain and disfigurement.     

Reviews

Stephen Sestanovich (ed.), Rethinking Russia's National Interests. Washington, DC: Center for Strategic & International Studies, 1994, xii + 115pp., $14.95 p/b.

Neil Malcolm, (ed.), Russia and Europe: An End to Confrontation? London and New York: Pinter Publishers, for The Royal Institute of International Affairs, London, 1994, xi + 240pp., £35.00.

Douglas W. Blum (ed.), Russia's Future: Consolidation or Disintegration? Boulder, CO, San Francisco, CA & Oxford: Westview Press, 1994, 173pp., £33.50 h/b, £9.95 p/b.

Lynn D. Nelson & Irina Y. Kuzes, Property to the People. The Struggle for Radical Economic Reform in Russia. New York and London: M. E. Sharpe, 1994, xi + 268 pp., £48.00 h/b, £16.00 p/b.

Richard F. Kaufman & John P. Hardt (eds) for the Joint Economic Committee, Congress of the United States, The Former Soviet Union in Transition. Armonk, NY, York and London: M. E. Sharpe, 1993, xxiv + 1222pp.

Michael Jakobson, Origins of the Gulag. The Soviet Prison Camp System 1917–1934. Lexington, KY: The University Press of Kentucky, 1993, xiv+ 176pp., $28.00.

Paul R. Gregory, Before Command: An Economic History of Russia from Emancipation to the First Five‐Year Plan. Princeton; NJ: Princeton University Press, 1994, viii + 188pp., £30.00.

Helene Seppain, Contrasting US and German Attitudes to Soviet Trade, 1917–91. Politics by Economic Means. New York & Basingstoke: St Martin's Press and Macmillan, 1992, xiv + 349pp.

Graham Smith (ed.), The Baltic States: The National Self‐determination of Estonia, Latvia and Lithuania. London: The MacMillan Press Ltd, 1994, xii + 214pp., £40.00.

Jan Zaprudnik, Belarus: At a Crossroads in History. Boulder, CO: Westview Press, 1992, xxiii + 278pp., £11.95 p/b.

Dirk Kretzschmar, Die Sowjetische Kulturpolitik 1970–1985. Bochum: Universitatsverlag Dr N. Brockmeyer, 1993, xxvi + 873pp., DM89.80.

Jan Kubik, The Power of Symbols against the Symbols of Power; The Rise of Solidarity and the Fall of State Socialism in Poland. Pennsylvania, PA: University of Pennsylvania Press, 1994, xiv + 322pp., £38.00 h/b, £13.95 p/b.

Ljerka Fulgosi & Vlasta Vince‐Ribaric (eds), Hundred Testimonies: The Moving Accounts of Croatian Displaced Persons and War Prisoners. Zagreb: Society of Croatian Professional Women and INA Consulting, 1994, 196pp., $20.00.

Theodor Bergman, Gert Schaefer & Mark Seldon (eds), Bukharin in Retrospect. New York: M. E. Sharpe, 1994, xxv +251pp.     

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.     

Ethos,ideology, and partisanship: Exploring the paradox of conservative democrats

Despite the increasingly liberal cast of the national Democratic Party, self-identified conservatives continue to represent a significant segment of the party. At least 25 percent of Democratic identifiers considered themselves to be conservatives during the 1972–1988 period. This paper explores the puzzle of why significant numbers of political conservatives continue to identify with the Democratic Party. We argue that conservative Democrats relate to their party not because of political ideology, as do Republicans and to a lesser extent, liberal/moderate Democrats, but because of the symbolic values associated with the main groups in the party—what we refer to as party ethos. This proposition is examined by analyzing a new set of open-ended questions included in the 1988 American National Election Study probing citizens' images and assessments of the Republican and Democratic parties.The data utilized in this paper were made available by the Inter-university Consortium for Political and Social Research. The data forAmerican National Election Study 1988: Pre- and Post-Election Survey were originally collected by Warren E. Miller and the National Election Studies. Neither the collector of the original data nor the Consortium bears any responsibility for the analyses or interpretations presented here.