In one of his few decisions addressing the interface of law and medicine, Oliver Wendell Holmes observed that, The patient has no more right to all the truth than he has to all the medicine in the physician’s saddlebag. He should only get so much as is good for him.

During the last 60 or so years, the question of how much medical information is indeed good for the patient has been the subject of innumerable lawsuits. From this plethora of litigation, a clear common law trend which favors maximum disclosure of information has become evident. Relying upon the fiduciary nature of the physician-patient relationship, the courts have imposed upon the physician a duty to inform a patient fully regarding the condition of his or her body. It is appropriate, therefore, to examine various exemplary case decisions in an effort to portray effectively the nature and scope of the physician’s rights and responsibilities in this context.

The resurgence of tuberculosis in the United States is due, in part, to the dismantling of large-scale treatment systems that were a critical part of the disease control effort for the better part of the twentieth century. As the number of cases grows, clinicians, politicians, public health officials and community advocates have grappled with the difficult problem of building systems to care for infected people that are consonant with current knowledge and beliefs about quality care. As an example, the United Hospital Fund’s 1992 report, The Tuberculosis Revival: Individual and Societal Obligations in a Time of AIDS, discussed policies to guarantee adequate treatment that protects patients’ civil rights, needs for special facilities for care of TB patients, and the special problems faced by infected prisoners. This thoughtful report highlighted many areas of social policy that require further examination.

Consider the thought experiment offered at the conference that generated this collection of essays: in this fantasy, face transplants are safe and effective. A young woman is the victim of a devastating accident. A face transplant will enable her to live a completely normal life. But, say she is African American, or Asian. Would it be ethically permissible to allow her to take the face of a Caucasian woman? Or, say you have a child with a muscle wasting disorder. Would it be permissible to alter his muscle repair system so that he not only does not have the genetic variation that causes the disease, but he has the capacity for enhanced muscular strength, beyond that of his peers, such that he could become a big league pitcher?

A serious risk associated with some treatments for infertility is multiple birth pregnancy. The term “supernumerary pregnancy” aptly conveys the idea of too much or too many in this context: too many fetuses developing in the womb to secure a reasonable probability of a good outcome for each. A supernumerary pregnancy can occur, for example, when infertility is treated by the aggressive use of ovulation-stimulating hormones. If pregnancy is then achieved either naturally or artificially, or if large numbers of eggs are retrieved, fertilized in vitro, and then transferred to the uterus in a single cycle, the risk of supernumerary pregnancy is increased. Egg donation coupled with artificial insemination, or straight embryo donation, followed in each case by the transfer of more than two or three embryos to the uterus can also increase the risk for supernumerary pregnancy.

Transgender and gender diverse (TGD), Black, and Latinx communities have long borne a disproportionate share of the U.S. HIV epidemic, yet these same key demographics are continually underrepresented in national PrEP prescriptions. Black, Latinx, and TGD individuals are also more likely to be uninsured, meaning that a proposed federal program to cover PrEP for people without insurance could provide significant benefit to potential PrEP users from these populations. However, coverage of PrEP costs alone will not end disparities in uptake. This commentary provides additional context and recommendations to maximize effectiveness of a national PrEP program for TGD, Black, and Latinx populations in the US.

In the past two decades, courts and scholars have grappled with the appropriateness of pre-abortion disclosures mandated by the state. Statutes requiring physicians to recite a specific script, often detailing potential psychological “risks” of choosing to terminate a pregnancy, have proliferated nationwide over the past decade. Opponents of such laws have sometimes characterized the requirement of a procedurespecific disclosure as unnecessary and unique to the abortion context. In recent years, however, state legislatures supportive of abortion rights have legislated procedure-specific mandatory disclosures in the context of assisted reproduction and other health care procedures with reproductive health impacts.

In 1946, Tom Brock spent part of his summer dumping mustard gas bombs off a barge into the Atlantic Ocean. Brock was a civilian employed by the United States Army Transport Service in Charleston, South Carolina. His job was to dispose of surplus bombs and drums filled with mustard gas. Sulphur mustard, commonly called “mustard gas,” can take several forms: a liquid, a solid, or a vapour. Mustard gas, named for its mustard-like color and smell, is a vesicant that is toxic to humans and causes blistering and burns, affecting the lungs, eyes, and skin. Brock recalled that he and the soldiers enjoyed watching the occasional bomb explode as it sunk into the water. “We thought it was fun,” explained Brock. “I was 18 or 19 years old. We weren’t scared. We didn’t fear any explosive. We thought we were immortal.” Later that summer he was required to guard a barge of bombs that were leaking mustard gas, which looked to him like hot molasses. Due to the known health risks, Brock was told to wear a protective suit and gas mask. However, it was a hot day so he loosened the straps around his legs. As a result, enormous blisters developed, swelling out like a balloon from his toes to his knees. His summer job was no longer fun as he experienced firsthand the health hazards of exposure to mustard gas.

While human rights law has evolved to provide guidance to governments in realizing human rights in public health emergencies, the COVID-19 pandemic has challenged the foundations of human rights in global health governance. Public health responses to the pandemic have undermined international human rights obligations to realize (1) the rights to health and life, (2) human rights that underlie public health, and (3) international assistance and cooperation. As governments prepare for revisions of global health law, new opportunities are presented to harmonize global health law and human rights law, strengthening rights-based governance to respond to future threats.

The recent Minnesota case of In re Emergency Guardianship of Albert Barnes illustrates an emerging class of cases where a dispute between a family proxy and a hospital over “medical futility” requires legal resolution. The case was further complicated by the patient’s spouse who fraudulently claimed to be the patient’s designated health care proxy and who misrepresented the patient’s previously expressed treatment preferences. Barnes demonstrates the degree of significant administrative and institutional support to the health care team, ethics consultants, and futility committees that is required when a futility dispute escalates to the need for judicial resolution. An institutional futility policy, especially one that is endorsed by other regional medical centers and organizations, is an important foundation for a hospital that seeks judicial support in a dispute over medical futility in end of life care.

This paper highlights the need to apply an equity lens when assessing the impact of preemption and related legal doctrines on community health. Community autonomy to set and pursue public health priorities is an essential part of achieving health equity. Unfortunately, the priorities of organized industry interest groups often conflict with health equity goals. These groups have a history of successfully using law to limit community autonomy to pursue public health measures, most notably through preemption and related legal doctrines. We examine this phenomenon using two examples. First, we look at dental association efforts to block the spread of dental therapists in Indian Country. Native dental therapists have been improving the oral health of native people in Alaska for over a decade; yet the national and state dental associations have sought with mixed success to leverage state and federal laws to hinder other tribal governments from utilizing these providers. We compare these efforts with a restaurant association-led movement to limit what municipal governments can do to address food-based health inequities, focusing on a “model” ALEC bill that started in Ohio. Finally, we discuss how municipalities and Tribes are fighting back and continuing to pursue health equity for their communities.

Proposed changes to the Common Rule would require publicly funded researchers to disclose whether a subject's biospecimens could be used for commercial profit and whether the subject will share in those proceeds. Disclosing commercial interests will inform research participants that their tissue may have commercial value, a possibility that those individuals might not have previously considered. The proposed changes may then provide people with an opportunity to negotiate commercial rights in their biospecimens despite the well-accepted legal precedent that individuals maintain no interests in their excised tissue.

A medical profession which did not seek improved means to conquer disease would be condemned for dereliction of its duty, Members of the public will not accept the current state of the medical arts as finite but feel justified in expecting the development of more effective therapies for illness, and the promotion of improved means of preventive care.

With this assertion, the distinguished academic, Bernard Dickens, places research firmly in the domain of the public interest. Foster agrees, saying that, “[t]o improve medical care as much as we can, if not to perfect it, means that we have to accept the need for research.” Giesen adds a further emphasis to the search for medical advancements, saying that “freedom of research and scientific inquiry is, in itself, an important aspect of open societies.“

That cacophony you hear is coming from the growing number of commentators addressing ethical, social, and policy issues raised by nanotechnology. Like many novel technologies that disturb the status quo, nanotechnologies raise questions about the adequacy of oversight systems; the extent to which the technologies push legal, moral, and political boundaries; and ultimately, the implications for human health and well-being. Because nanoscale techniques and products challenge our ways of thinking about biology, physics, and chemistry, nanotechnology forces us to reconsider accepted wisdom on toxicity, mutagenicity, contamination, biocompatibility, and other interactions among humans, the environment, and technologies. The sheer scale and reach of nanotechnologies demands institutions, collaborations, and conventions that can cross-link knowledge across organizations, disciplines, and locales. If ever there was an occasion to rethink the limits of disciplinary-specific knowledge, norms about regulatory processes, and societal implications of new technologies, nanotechnologies provide the opportunity.

E-cigarettes, sometimes referred to as ENDS (Electronic Nicotine Delivery Systems), include a broad range of products that deliver nicotine via heating and aerosolization of the drug. ENDS come in a variety of forms, but regardless of form generally consist of a solution containing humectant (e.g., propylene glycol or glycerol), flavorings, and usually nicotine (some solutions do not contain nicotine); a battery-powered coil that heats the solution into an aerosol (usually referred to as vapor) in an atomizing chamber; and a mouthpiece through which the user draws the vapor into the mouth and lungs. The devices may be closed systems containing prefilled cartridges, or open systems, where the user manually refills a 1-2 ml. tank with solution. What started as closed-system cigarette-shaped devices marketed as an adjunct for smoking cessation, has transitioned rapidly to literally thousands of hip and funky-designed open-system hookah pens, vape pens, and modifiable devices. For younger people, these forms are the “in” thing, while traditional cigarette-shaped devices are “out.”

A substantial portion of biomedical R&D is publicly funded. But resulting medicines are typically covered by patents held by private firms, and priced without regard to the public’s investment. The Bayh-Dole Act provides a possible remedy, but its scope is limited.

What has happened to death? Why is this subject—virtually taboo in social and even in medical conversations a few decades ago—now so much a matter of debate in public policy settings, especially the courts? Four factors are primarily responsible, in my view. The first two—changes in the locale of death and development of ever more sophisticated forms of life-support—are by now familiar. Of growing significance are two further factors: increased fear of liability and the polarization of decisions about life-support as those decisions get swept up (at least in the United States) in the ferocious battles between freedom-of-choice and right-to-life supporters.

This paper attempts to analyze these four factors and, I hope, to uncover some of the confusion they have produced. I will then argue that despite consistent judicial endorsement of the right of competent adults to decide what medical care they wish to receive—even if they decide to forgo life-sustaining treatment, that is, to die—legal (like medical) attitudes are in fact ambivalent.

As part of a multifactorial approach to address weak incentives for innovative antimicrobial drug development, market entry rewards (MERs) are an emerging solution. Recently, the Duke-Margolis Center for Health Policy released the Priority Antimicrobial Value and Entry (PAVE) Award proposal, which combines a MER with payment reforms, transitioning from volume-based to “value-based” payments for antimicrobials. Here, the PAVE Award and similar MERs are reviewed, focusing on further refinement and avenues for implementation.

The Institute of Medicine (IOM) has returned the problem of medical error to the top of the health-care agenda. Its report that 44,000 to 98,000 patients die each year as a result of medical errors in American hospitals has renewed scholarly interest in health system quality control. In To Err Is Human, the IOM provides a vivid picture of a health-care system riven with serious quality problems. It calls for systems-based error-reduction methods borrowed from other high-risk industries and forcefully argues against the traditional tendency to assign accountability primarily to individual physicians. Most errors, the IOM argues, can be successfully addressed by engineering systemic fail-safe protections against the inevitable failings of human actors.

The chair of the ethics committee of a major medical center agonized over how he, as a physician, and his organization should deal with Initiative 119, which, if passed, would legalize physician involvement in active, voluntary euthanasia in Washington State. In the end, he said, he could not vote for aid-in-dying because, “However much I want to reduce suffering, I myself just couldn’t do it to one of my patients.” He spoke of a personal distaste for the potential act, of a profound desire not to have to do it. It was not an ethical argument, but an honest and compelling expression of feelings.

Why can’t this sincere man do it, even for patients who request such aid? In a 1991 poll, taken in Washington State prior to the vote on Initiative 119, 49 percent of the physicians surveyed supported the initiative, but 75 percent did not want to participate in aid-in-dying.