American Journal of Law & Medicine最新文献

Multiple states have enacted statutes to govern procedures when a state seeks to execute a person who may be incompetent to understand why s/he is being so punished, an area of the law that has always been riddled with confusion. The Supreme Court, in Panetti v. Quarterman, sought to clarify matters, ruling that a mentally ill defendant had a constitutional right to make a showing that his mental illness "obstruct[ed] a rational understanding of the State's reason for his execution."However, the first empirical studies of how Panetti has been interpreted in federal courts painted a dismal picture. Only a handful of defendants have ever been successful in federal courts in seeking to enforce the Panetti ruling, and the authors of this abstract have characterized the relief ostensibly offered by that case as nothing more than an "illusion" or a "mirage" in a federal context. The issues of believability of experts, allegations of malingering, and "synthetic competency" dominate these decisions.In this paper, we seek to expand this inquiry to determine (1) how defendants in state courts seeking to assert Panetti claims have fared, and (2) the extent to which state statutes have made any meaningful difference in the way such cases have been decided. We also investigate the significance of the fact that the caselaw in this area has totally ignored the teachings of the school of legal thought known as therapeutic jurisprudence and offer some conclusions and recommendations (based on therapeutic jurisprudence principles) that, if implemented, can (at least partially) ameliorate this situation.

This Article analyzes the 2021 judgment of the Supreme Court of Pakistan in the case of Mst. Safia Bano v. Home Department, Government of Punjab. The case has garnered significant local and international attention due to the Court's ruling that a death sentence may not be carried out on a defendant who has a mental illness. Setting the case against the backdrop of Pakistan's Islamic and colonial contexts, this article argues that the Supreme Court has reshaped the insanity defense in Pakistani law by placing the determination of a defendant's mental state mainly in the hands of medical professionals. However, the Court's reliance on medical professionals and the subsequent downplaying of the "moral capacity" element of the insanity defense-a determination of law made by courts-has created an obstacle for courts to punish offenders more stringently in future cases due to the popular belief that mental health professionals are ill-equipped to answer broader questions of justice for victims and society. The article recommends that this issue can be remedied by establishing an objective legal test for insanity that considers Islamic law, Pakistani precedent, and advances in medical science.

Artificial intelligence (AI) is being tested and deployed in major hospitals to monitor patients, leading to improved health outcomes, lower costs, and time savings. This uptake is in its infancy, with new applications being considered. In this Article, the challenges of deploying AI in mental health wards are examined by reference to AI surveillance systems, suicide prediction and hospital administration. The examination highlights risks surrounding patient privacy, informed consent, and data considerations. Overall, these risks indicate that AI should only be used in a psychiatric ward after careful deliberation, caution, and ongoing reappraisal.

This Article seeks to synthesize academic research on home healthcare workers during the COVID-19 pandemic to understand how their workplace challenges were magnified. Crisis communication researchers note that a crisis provides both opportunities and threats for growth. This Article argues that many of the issues that have impacted home healthcare workers have always been present, but the pandemic allows policy makers the ability to see them clearly because the pandemic brought a spotlight to the issues that home healthcare workers face on a daily basis. Consequently, the author employed a narrative analysis of the literature concerning home healthcare workers during the pandemic to understand how the pandemic exacerbated structural issues that led to an increase in mental health difficulties for this population. By understanding how the pandemic exacerbated mental health issues, policy makers can craft solutions that can withstand the next public health crisis which will undoubtedly impact the most disenfranchised.

In June 2022, in Dobbs v. Jackson Women's Health, the U.S. Supreme Court overturned the precedent set by the 1973 decision in Roe vs. Wade, leaving access to abortion to be regulated by each state, rather than a U.S. constitutional right. Some states are setting gestational age limits, beyond which point only under certain circumstances can an abortion be obtained. Other states are banning abortion outright (regardless of gestational age) unless an "exception" is met. Certain states include an exception for abortion when a woman's physical health is at risk if they continue the pregnancy, but, at the same time, do not provide an exception for women whose mental health is at risk (a "mental health exception").Mental health conditions that develop, continue, or are exacerbated during pregnancy may be manageable or treatable, and women may want to continue their pregnancy even while experiencing such conditions. However, the absence of a choice to terminate their pregnancy as a result of these mental health conditions means women who are unable to successfully manage or treat their mental health during pregnancy have no choice but to experience the impact on their mental health - and reconcile any resulting impact on the fetus.This article will discuss the role a mental health exception plays in state abortion statutes by analyzing the impact of pregnancy on mental health and resources available to support those who experience mental health impacts during pregnancy while, simultaneously, advocating for the inclusion of a mental health exception in state abortion laws.

Many people who experience opioid use disorder rely on Medicaid. The high penetration of managed care systems into Medicaid raises the importance of understanding states' expectations regarding coverage, access to care, and health system performance and effectively elevates agreements between states and plans into blueprints for coverage and care. Federal law broadly regulates these structured agreements while leaving a high degree of discretion to states and plans. In this study, researchers reviewed the provisions of 15 state Medicaid managed care contract related to substance use disorder (SUD) treatment to identify whether certain elements of SUD treatment were a stated expectation and the extent to which the details of those expectations varied across states in ways that ultimately could affect evaluation of performance and health outcomes. We found that while all states include SUD treatment as a stated contract expectation, discussions around coverage of specific services and nationally recognized guidelines varied. These variations reflect key state choices regarding how much deference to afford their plans in coverage design and plan administration and reveal important differences in purchasing expectations that could carry implications for efforts to examine similarities and differences in access, quality, and health outcomes within managed care across the states.

Many insurers exclude coverage for transgender individuals. Litigation challenging these exclusions has increased. Most of these cases successfully advance equality claims by arguing that trans exclusions discriminate based on sex. That is, procedures performed on patients for reasons unrelated to gender affirming care are being denied to transgender individuals. There are, however, limitations to this argument. First, some courts may construe care narrowly and hold that some procedures are unique to gender affirming care that have no analog in other contexts. Second, a court that is hostile to the sex discrimination argument might hold that the denial does not arise from sex discrimination, but rather, because of the kind of diagnosis at issue. Further, the sex discrimination argument might force transgender individuals into making claims based on a binarized gender identity which may not conform with their lived experience.Claims based on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) can address these shortcomings. This Act prohibits insurers from discriminating against mental health diagnoses-for example, procedures that insurers cover because of medical or surgical diagnoses should also be covered if indicated for mental health diagnoses. Gender dysphoria is a recognized mental health diagnosis. Transgender individuals seeking gender affirming care arising from gender dysphoria can thus claim that exclusions of coverage violate the MHPAEA. Some transgender individuals might raise concerns that such an approach would lead to increased medicalization of trans identity. However, an MHPAEA claim would only appear in cases where a transgender individual is voluntarily submitting themselves to medical assistance in order to advance their own autonomy.

When federal district court Judge Carlton Reeves penned his opinion in U.S. v. Mississippi,¹ the case that seemed poised to overhaul Mississippi's suffering mental health system, he began with the story of Ms. Melanie Worsham, a mental health patient, also a certified peer support specialist. Ms. Worsham works to help those like herself who suffer with lifelong serious mental illness (SMI) to "overcome the obstacles that might be getting in their way of living the life they want to live." She also assists those with SMI by aiding in "navigating the system, to find resources, and then just being moral support."².