Journal of law and health最新文献

Systemic discrimination in healthcare plagues marginalized groups. Physicians incorrectly view people of color as having high pain tolerance, leading to undertreatment. Women with disabilities are often undiagnosed because their symptoms are dismissed. Low-income patients have less access to appropriate treatment. These patterns, and others, reflect long-standing disparities that have become engrained in U.S. health systems. As the healthcare industry adopts artificial intelligence and algorithminformed (AI) tools, it is vital that regulators address healthcare discrimination. AI tools are increasingly used to make both clinical and administrative decisions by hospitals, physicians, and insurers--yet there is no framework that specifically places nondiscrimination obligations on AI users. The Food and Drug Administration has limited authority to regulate AI and has not sought to incorporate anti-discrimination principles in its guidance. Section 1557 of the Affordable Care Act has not been used to enforce nondiscrimination in healthcare AI and is under-utilized by the Office of Civil Rights. State level protections by medical licensing boards or malpractice liability are similarly untested and have not yet extended nondiscrimination obligations to AI. This Article discusses the role of each legal obligation on healthcare AI and the ways in which each system can improve to address discrimination. It highlights the ways in which industries can self-regulate to set nondiscrimination standards and concludes by recommending standards and creating a super-regulator to address disparate impact by AI. As the world moves towards automation, it is imperative that ongoing concerns about systemic discrimination are removed to prevent further marginalization in healthcare.

The Center for Disease Control and Prevention (CDC) has reported that the use of assisted reproductive technology (ART) has doubled over the past decade. In vitro fertilization (IVF) is the most prevalent form of ART. During IVF, a woman's eggs are extracted, fertilized in a laboratory setting, and then implanted in the uterus. Many IVF procedures use eggs or sperm that were stored using a process called cryopreservation. A recent survey reported that cryopreservation consultations increased exponentially during the coronavirus pandemic, rising as much as 60 percent. It is estimated that more than one million embryos are stored in cryopreservation facilities throughout the United States. As the use of cryopreservation increases, so too does the possibility that stored reproductive material will be lost or destroyed. Recently, over 4,000 cryopreserved human embryos inadvertently were destroyed at University Hospitals Fertility Clinic in Ohio, and 3,500 eggs and embryos were destroyed when a cryopreservation tank recently malfunctioned at a fertility clinic in California. When reproductive material is lost or destroyed, the aspiring parents; primary harm is emotional; it is non-pecuniary in nature. The emotional harm is particularly extreme in cases where the loss destroys a couple's only hope of becoming parents. Despite the severity of the emotional harm suffered due to the loss, aspiring parents often are left without a clear legal basis to recover emotional disturbance damages. Although emotional disturbance damages are rarely awarded for breach of contract, the article explains why such awards are justified based on the current trend in contract law, as exemplified by Restatement (Second) of Contracts section 353 and posits that clinics and ART professionals are aware at the time of contracting that emotional disturbance is particularly likely in the event of a breach. Scholars have noted that tort damages for emotional harm often are unavailable when reproductive material is lost or destroyed, because the emotional harm is not parasitic to a physical injury, nor can aspiring parents overcome the traditional barriers to NIED recovery because they neither were in the "zone of danger" nor were they bystanders at the time of loss. Therefore, for aspiring parents who reside in traditional barrier jurisdictions, breach of contract damages may represent their only hope to recover for emotional harm. This article posits that ART clinics and professionals have actual or constructive knowledge of plaintiffs' particular reason for storing reproductive material--namely, to achieve a later pregnancy--at the time of contracting, so as to support consequential damages for emotional disturbance. This knowledge of the contract's purpose, coupled with the nature of the transaction and the surrounding circumstances, put ART clinics and professionals on notice at the time of contracting that emotional disturbance is particularly likely to result from a bre

I investigate the constitutionality of hard state border closures in the United States as a prophylactic response to a pandemic. This type of border closure prevents people from entering a State, except for exempt travelers, a category that includes, for example, military, judicial and government officers, and people granted entry on compassionate grounds. Those allowed to enter usually have to then go through a quarantine regime before being released into the community. During the COVID-19 pandemic, no State has attempted such closures. However, epidemiological experts suggest that, in comparison to other border and non-border measures, such closures are more effective. Given the World Health Organization prediction of more pandemics in the foreseeable future, it is imperative that the constitutionality of such hard closures is investigated. I use structural analysis to argue that a recent challenge to hard border closures in Australia suggests that, under a strict scrutiny review, the Supreme Court is likely to uphold such closures in the United States. While actual implementation requires investigating issues that go beyond a constitutional analysis, these findings highlight the need for a wider conversation around a federal goldilocks zone when responding to the next pandemic.

Effective July 1, 1972, California's Lanterman-Petris-Short Act (LPS Act) set the precedent for modern mental health commitment procedures in the U.S. named after its authors, State Assemblyman Frank Lanterman and State Senators Nicholas C. Petris and Alan Short, the LPS Act sought to "end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorder"; to "provide prompt evaluation and treatment of persons with mental health disorders or impaired by chronic alcoholism"; and to "guarantee and protect public safety." Despite citing to these articles of intent, the LPS Act violates its own legislative intent through its inclusion of "gravely disabled" in its enforcement of involuntary psychiatric hold designations (also known as "5150 designations"). First, police officers are not required to make a medical diagnosis of a mental health disorder at the time of a 5150 designation; the broad scope of "gravely disabled" increases the number of persons police officers can involuntarily transport, increasing the likelihood of inappropriate and involuntary commitment of persons with mental health disorders. Second, the broad scope of "gravely disabled" produces an onslaught of 5150-designated persons (whether improperly designated or not) being sent to LPS-designated hospitals with limited resources (e.g., lack of beds and psychiatric staff); this results in patients waiting for an inordinate amount of time for a psychiatric evaluation and/or a hospital bed. Third, it is unclear whether the LPS Act sought to provide protection for the mentally ill or to provide protection from the mentally ill in its guarantee of protecting "public safety"; the inclusion of "gravely disabled" in 5150 designations indicates that the LPS Act provided the public with a duplicitous means of removing the mentally ill, impoverished, and houseless from the streets under the guise of "public safety." This Paper suggests the following to help remedy the effects of implementing the broadly defined "gravely disabled" in 5150 designations: (1) Remove "gravely disabled" from the 5150 criteria; (2) integrate the community with mental health advocacy efforts by creating outreach and education programs; and (3) implement a client-centric approach to interacting with persons with mental health disorders through restorative policing and the establishment of a restorative court.

The momentous public outcry for police reform is the result of police encounters ending fatally, which is notably sixteen times more likely for individuals suffering from mental illness in the United States. These horrific incidents highlight the systemic failings of traditional police departments training and its failure to provide officers with the necessary skills to de-escalate crisis situations involving the vastly overrepresented mentally ill population involved in the United States justice system. This article demonstrates that effective police training involving crisis intervention and de-escalation techniques equip police officers with knowledge and skills that enable them to contrive more positive outcomes for all involved. With a particular focus on Ohio, this article highlights the significant discrepancy between ideal police training and current Ohio requirements, which glaringly fail to require continual police officer training. The article ultimately proposes that the Ohio legislature pass a bill that both requires police officers to complete increased training programs in de-escalation and crisis intervention while providing departments with the necessary funding to make implementation possible. By implementing the proffered recommendations, the State of Ohio has the opportunity to contrive more positive police encounters with mentally ill individuals and the wider community.

Perhaps the best way to understand early-Twenty-First Century state and federal cannabis law in the United States is to examine the relevant history. Justice Oliver Wendell Holmes, Jr.'s statement is apropos: "[A] page of history is worth a volume of logic." This article begins by discussing the early history of cannabis and its uses. Next, the article examines the first state and federal marijuana laws. After a brief comparison of alcohol prohibition to cannabis prohibition, this article addresses cannabis laws from the 1920s to the early 1950s. Then, the article takes up the reorganization of the federal drug regulatory bureaucracy since its inception. Addressing the current era of cannabis laws and regulations, this article recounts how marijuana became a Schedule I drug. The discussion then turns to changing social attitudes towards cannabis as reflected in presidential politics and popular culture. Starting with the late-1990s, this article describes the development of state and federal cannabis laws and policies up to the present day.

On July 24, 2019, the Parliament of the United Kingdom passed an act that included an amendment requiring Northern Ireland to implement recommendations from the Committee on the Elimination on Discrimination Against Women. The amendment required Northern Ireland to repeal the 1861 abortion act and requires the decriminalization of abortion. The law went into effect on October 22, 2019, since the Northern Ireland power-sharing government (Stormont) did not reconvene before October 21, 2019. Since the law did go into effect, it gave women the right to obtain abortions under the CEDAW recommendations; however, when the Northern Irish government (Stormont) reconvenes, it can recriminalize abortion. They made this attempt when Stormont under DUP leadership reconvened briefly on January 11, 2020 before the official Brexit the next day. This Note argues that abortion should be legal in Northern Ireland regardless of whether the new legislation from British Parliament ever went into effect or gets overturned by the Stormont legislature because of several treaties and domestic decisions from the Supreme Court in Belfast and the new regulations made in accordance with the amendment need to meet the standards of the CEDAW recommendations.

In 2019, the United States saw the single largest outbreak of measles in recent history. The measles crisis has prompted state legislative bodies to face a seemingly impossible dilemma: eliminate both religious and philosophical exemptions to mandatory school vaccination statutes or sit by idly and allow measles to continue to run its course. As of June 2019, five states have neither religious nor philosophical exemptions to their mandatory vaccination statutes. This Note argues that states should remove all religious and philosophical exemptions to compulsory vaccination statutes. The 2019 measles outbreak demonstrates that the anti-vaccination movement poses a legitimate risk to the health of the masses, especially to the most vulnerable members of our communities. If individuals continue to opt out of compulsory vaccination requirements, diseases that were eradicated decades ago will undoubtably return to the absolute detriment of those unable to protect themselves.

In light of the confusion invited by applying the label "de-identified" to information that can be used to identify patients, it is paramount that regulators, compliance professionals, patient advocates and the general public understand the significant differences between the standards applied by HIPAA and those applied by permissive "de-identification guidelines." This Article discusses those differences in detail. The discussion proceeds in four Parts. Part II (HIPAA's Heartbeat: Why HIPAA Protects Identifiable Patient Information) examines Congress's motivations for defining individually identifiable health information broadly, which included to stop the harms patients endured prior to 1996 arising from the commercial sale of their medical records. Part III (Taking the "I" Out of Identifiable Information: HIPAA's Requirements for De-Identified Health Information) discusses HIPAA's requirements for de-identification that were never intended to create a loophole for identifiable patient information to escape HIPAA's protections. Part IV (Anatomy of a Hack: Methods for Labeling Identifiable information "De-Identified") examines the goals, methods, and results of permissive "de-identification guidelines" and compares them to HIPAA's requirements. Part V (Protecting Un-Protected Health Information) evaluates the suitability of permissive "de-identification guidelines," concluding that the vulnerabilities inherent in their current articulation render them ineffective as a data protection standard. It also discusses ways in which compliance professionals, regulators, and advocates can foster accountability and transparency in the utilization of health information that can be used to identify patients.

The United States has failed its citizens who suffer from severe and persistent mental illness (SPMI). Homelessness is one of the most obvious manifestations of this failure. The combination of a lack of effective treatment, inadequate entitlement programs such as Social Security Disability Insurance (SSDI), and subpar housing options form systemic barriers that prevent people suffering from mental illness from being able to obtain adequate housing. Cultural beliefs within the United States regarding who is homeless and what homelessness means also play a significant role in the development of positively impactful social welfare programs. Part II of this Note reviews the history of treatment for persons with SPMI--specifically how that treatment has evolved, the history of federal policies regarding SSI, SSDI and housing, and societal beliefs regarding homelessness and mental illness that have impacted policymaking decisions. Part III looks at these same areas from a current perspective and addresses the current issues and some possible solutions. Part IV discusses how lack of effective treatment, poor disability programs, and the need for better housing options work together to form systemic barriers for people with SPMI. Part IV also address how the cultural beliefs in the United States regarding people who have SPMI and are homeless serve as an independent barrier to policy change. Ultimately, this Note argues that homelessness is a product of system failures rather than individual factors.