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.     

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.     

Black Cities/White Cities: Evaluating the Police

It is well known that African Americans and whites hold different views of the police, but nearly all of the previous research has been conducted in majority white settings. This research examines the relationship between race and evaluations of the police in majority black versus majority white contexts. Social dominance theory and the research on racial threat predict that when the racial majority changes, the relationship between race and attitudes toward police will change. We find that, in majority black contexts, the traditional relationship between being black and having negative evaluations of the police disappears, and it disappears because whites' evaluations of the police become more negative. Black evaluations of the police are relatively consistent across racial contexts. Also, white racial attitudes affect police evaluations in majority black contexts, but not in white contexts, while African American racial attitudes are inconsequential in both contexts. Furthermore, if a white citizen is victimized by crime in a black city, it has greater ramifications for evaluations of the police than if the victimization had occurred in a white city. All of this suggests that whites' views of the police may be more racialized than the views of African Americans.