I want to begin by making the fundamental point that the question is not whether decisions to end human lives ought to be made but, rather, who makes these decisions, and on the basis of what principles or values. For the fact is that such decisions are already being made, and inevitably must be made, in modern hospitals.

For almost any life-threatening condition, modern medical technology can now delay the moment of death. Death will often not occur until and unless the decision has been made to withhold or withdraw life-sustaining treatment. In other words, when and how a patient dies is increasingly the outcome of a deliberate human decision. Such decisions—not to resuscitate a terminally ill patient, not to continue to sustain the life of a permanently comatose patient. or to withhold antibiotics from the deaf and blind octogenarian—are all instances of the intentional termination of life and, if done for the patient's sake, are cases of passive euthanasia.

It is Recommended … That it be recognized by all organizations and associations concerned with smoking and health that the campaign against smoking is political and economic in character and requires decisions based on political and economic factors.

The only way we know today to stop cancer is to stop smoking. …

In his introduction to this symposium, “Religions and Cultures of East and West: Perspectives on Bioethics,” Dr. Robert Sade defined its purpose as follows: “The objective of [our] discussions…is to explore the limits of enhancement technologies in light of what makes us essentially human, in the view of world-wide cultures and religions.”

These issues would seem to be at the cutting edge of any informed deliberation concerning the merits of “human enhancement” technologies. For instance, the issue of how “what makes us essentially human” affects our reflection on issues of technological “life enhancement” is raised in a 2007 book by Harvard professor Michael J. Sandel, The Case Against Perfection: Ethics in the Age of Genetic Engineering.

Expanding buprenorphine access in the United States requires evidence-based decision-making that considers both the drug's potential dangers and its potential benefits. Risks associated with buprenorphine misuse and diversion highlight the need for careful, ongoing evaluation during each stage of increased access.

Sexual assault cases are challenging for both the patient and provider, particularly given the emotional and logistic overlays in the majority of these cases. In this article we offer sexual assault programs information and areas for consideration when developing a policy addressing sexual assault examinations on patients who are either incapacitated or otherwise unable to consent to examination. This information is based on our experience in creating and implementing such a policy for our program. We also offer the written policy and associated consent form that we designed (see Figures 1 and 2).

The protocol manual for sexual assault medical forensic examinations authored by the Department of Justice actually recommends that each and every sexual assault nurse examiner (SANE) program have “internal policies based on applicable jurisdictional statutes governing consent for treatment of vulnerable adult patients. In cases of adolescents, the jurisdictional statutes governing consent and access to the exam should be followed.“

Physicians and institutional providers face expanding liability exposure today, in spite of state tort reform legislation and public awareness of the costs of malpractice for providers. Standards of practice are evolving rapidly; new medical technologies are being introduced at a rapid rate; information is proliferating as to treatment efficacy, patient risk, and diseases generally. Tort standards mirror this change. As medical standards of care evolve, they provide a benchmark against which to measure provider failure. The liability exposure of physicians is affected by (1) the generation of data, including outcomes data usable to profile physician practice, and statistical data that allows for predictions as to treatment efficacy, and patient prognosis; (2) obligations to inform patients and third parties of risk created by contagious disease and other sources of harm; (3) obligations of physicians to disclose risks that the provider creates for the patient; (4) obligations to disclose conflicts of interest arising out of the practice setting; and (5) duties arising from new epidemiological knowledge.

While the global threat of Ebola Virus Disease (EVD) in 2014 was concentrated in several West African countries, its effects have been felt in many developed countries including the United States. Initial, select patients with EVD, largely among American health care workers (HCWs) volunteering in affected regions, were subsequently transported back to the states for isolation and treatment in high-level medical facilities. This included Emory University Hospital, which sits adjacent to the federal Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

The first domestic case of EVD occurred in late September in Dallas, Texas. Additional exposures of two HCWs generated an array of legal issues for state and local public health authorities, hospitals, and providers. Consideration of these issues led to extensive discussion among lawyers, public health practitioners, and other attendees at a late-breaking session on EVD and Legal Preparedness at the 2014 National Public Health Law conference. In this commentary, session presenters from CDC and Emory University share their expert perspectives on legal and policy issues underlying state and local powers to quarantine and isolate persons exposed to or infected with Ebola, as well as facets of hospital preparedness underlying the successful treatment of patients with EVD.

As I write, I hear that Dr. Jack Kevorluan has delivered another victim to the emergency room of his local Michigan hospital. Why do physicians and terminally ill patients feel we need to change the law with respect to assisted suicide when a rogue pathologist, who has been stripped of his medical license, is allowed to pursue his appetite for providing his clients with inhalation treatments of carbon monoxide gas? If no court will convict this outlaw, what makes the physicians and patients who brought Compassion in Dying v. State of Washington and Quill v. Vacco fear that any court would ever convict a licensed physician of assisting in a suicide when he/she writes one of her established patients a prescription for a short-acting barbiturate? Moreover, it is not even clear that laws against assisted suicide in most jurisdictions were ever intended to apply to the actions of licensed physicians. Nonetheless, the plaintiffs in the Second and Ninth Circuit Courts of Appeals were clearly seeking some kind of redress, some kind of protection from potential legal claims they feared might be made against them.

A half century ago, American family lives did not differ markedly by class or region; children were born to married parents, shotgun marriages helped keep the nonmarital birth rate low, and women stayed home unless economics forced them into the workplace. In that era, the Utah Supreme Court cited New York cases in addressing non-marital cohabitation and family reforms that started in California swept much of the country in short order. While we know that our halcyon memories of those years cloak substantial conflict, we did sweep much of it under the rug; politicians, judges, religious leaders, and even family sit-coms in those years expressed remarkable agreement about family aspirations.

The treatment of severely handicapped newborns was, for a long time, an issue of concern only to medical practitioners and involved parents. Recently, however, it has drawn the interest of a much broader constituency. Philosophers, lawyers, politicians, and the clergy, as well as public interest groups, are but a few of the groups enmeshed in the controversy over whether all handicapped infants must be treated aggressively, regardless of their physical or mental condition. Similarly, the dispute has expanded beyond academic journals and medical rhetoric. The United States Department of Health and Human Services has issued several versions of regulations concerning the care of handicapped infants (the latest proposing voluntary Infant Care Review Committees to supplement federal and state review mechanisms).

Anyone who has ever prepared a college of nursing catalogue has had to engage, if only briefly and superficially, in the development of a philosophy of nursing. I would like to carry that activity a little further here in order to propose and develop a particular philosophy of nursing.

I will describe what could be called the self care philosophy. But an important distinction must be made at the outset. “Self care” usually suggests the lay revolt against professional care; often, self care is billed as an alternative to rather than a philosophy of professional health care. What then do we mean by self care as a philosophy of nursing? The philosophy is this: that nursing have as its primary ideal active assistance to individuals, families, and communities in the development and exercise of their autonomy in health matters. The concept of self care, or patient autonomy, involves two dimensions, action and agency, and the nurse provides assistance in both of these. Self care action is the health behavior that is performed.

In 1882 Koch discovered the tubercle bacillus and transformed both the medical and the social history of tuberculosis and the experiences of those who contracted it. For the first time, the absence or presence of the bacillus made it possible to define, in Koch’s terms, “the boundaries of the diseases to be understood as tuberculosis.” And for the first time the sick became subject to oversight and discrimination.

Prior to Koch’s discovery, tuberculosis, or as it was then called, consumption, was considered a hereditary and non-contagious disease, albeit a very deadly and persistent one. Over the first half of the nineteenth century, it was responsible for one out of every five deaths. It crossed all boundaries of geography, social class, age, and sex affecting residents in rural as well as urban areas, the prosperous as well as the poor, the young even more notably than the old, females more often than males. Physicians assumed a familial predisposition existed (as in the case of insanity); following the precepts of humoral medicine, they postulated that the disease originated in “irritations” whose sources were to be found in the interaction of an inherited constitution with a particular lifestyle and environment.

Direct reimbursement by insurers for the services of nurses and nurse practitioners is a primary goal of many state and national associations of nurses. Direct reimbursement means either that a nurse is paid directly by the insurer for nursing or nurse practitioner services rendered, or that the patient is reimbursed for costs incurred for those services. The issue is important to nurses for several reasons.

First, reimbursement allows rhe consumer of health care a wider choice of types of providers from whom to purchase care. As a practical matter, if an insurer does not reimburse for the care rendered by one type of professional, patients are likely to seek care from another whose services are paid by health insurance. The General Accounting office, for example, has lited restrictive third party reimbursement practices as one of the obstacles impeding the wider use of nurse-midwives. Second, some types of health care are less expensive when rendered by a nurse or a nurse practitioner; reimbursement thus can provide quality care at a lower cost. Third, reimbursement is a form of recognition that practice styles are changing. In 1983, West Virginia became the first state that explicitly reimburses for care provided by “nonsalaried duly licensed registered professional nurses engaged in private nursing practice or partnership.”

Lawsuits alleging malpractice in psychiatric diagnosis or treatment, once rather rare, appear to be growing in number. The low incidence of such claims in the past has been attributed to the difficulty of proving the applicable standard of care and a causal relationship between the breach of the standard of care and the alleged injury, the patient's reluctance to publicize his psychiatric history, the patient's inability either to formulate cleat expectations for the results of treatment or to assess the results, and the belief that the success of psychotherapy depends to a great extent on the cooperation of the patient.

Nonetheless, the number of claims against psychiatrists is rising, in part because of a more open attitude about psychiatric treatment coupled with increased expectations of its efficacy. Other factors which may be contributing to this trend are the emphasis on mental patients rights in recent court decisions and the popular literature, the emergence of legal doctrines finding new legal duties arising out of the therapist-patient relationship, and the publication of several sizable verdicts in suits based on psychiatric malpractice.

In the mid-1970s the alarming state of nursing home care in the United State was dramatically exposed by the Subcommittee on Long-Term Care of the special Committee on Aging of the United States Senate, which released a series of papers collectively entitled Nursing Home Care in the United States: Failure in Public. Simultaneously a plethora of media investigations, exposés in the popular literature, scholarly articles, and state commission reports condemned conditions in nursing homes and called for reform. These investigations and reports uniformly demanded more rigorous government regulation of nursing homes. In response, in the late 1970s and early 1980s, virtually all of the states adopted some form of nursing home reform legislation. The federal government also adopted regulations mandating oversight of long-term care facilities participating in the Medicare and Medicaid programs.

The goal of this paper is to present a succinct overview, from a clinician’s perspective, of the importance and implications of research on heart failure in African Americans. It first gives a brief outline of the rationale and results of the African-American Heart Failure Trial (A-HeFT), which showed evidence for the effectiveness of fixed-dose combination of isosorbide dinitrate and hydralazine (ISDN/Hyd), marketed as BiDil (NitroMed Inc.), in this population. Finally, it underscores the necessity of treating African Americans with evidence-based medicine given that humanistic physicians and other clinicians strive to provide holistic treatment to their patients.

Most researchers and clinicians recognize the difficulty with utilizing race as a category for inclusion in trials. While race lacks any true biologic definition, it is potentially beneficial as a consideration in clinical studies, based on prior evidence of certain potential differences across self-identified racial/ethnic groups in morbidity and mortality and responses to medicine. Even though use of race as a classification is a problematic distinction, it should not be ignored. If clinical trials demonstrate significant improvement with targeted treatment in African Americans, clinicians should not withhold life-saving drugs that result from such studies.

The flu has an interesting history with respect to health care rationing in the United States. Consider that just about two years ago, the American public faced a shortage of influenza vaccine. Dire predictions were made about how many people might perish, and rationing protocols were created. However, many of the rationing protocols were ignored. Luckily, that flu season did not result in the horrible fatalities that were predicted. For these reasons, problems of health care rationing around issues of the flu were postponed, rather than resolved.

Over the last year, the public has focused its anxious attention on the possible avian influenza pandemic. Last week I noticed that at least once each day I heard mention in some discussion or another of the threat of this disease becoming easily transmissible from human to human.

The law applicable to genomics in the United States is currently in transition and under debate. The rapid evolution of the science, burgeoning clinical research, and growing clinical application pose serious challenges for federal and state law. Although there has been some empirical work in this area, this is the first paper to survey and interview key scientific and legal stakeholders in the field of genomics to help ground identification of the most important legal problems that must be solved to successfully integrate genomics into clinical care. The respondents in this study identified a wide range of interconnected issues, focusing specifically on the need for clear guidelines about how to use these data, fear of liability for those who use these data, and the need to protect patients from use of this information particularly by insurers, while endorsing data sharing. Developing legal strategies to support appropriate use of genomics now and in the future clearly will require making trade-offs, taking into account the full complexity of this legal ecosystem.

On May 7-9, 2012, obesity prevention leaders, including public health professionals across federal, state and local levels, policymakers and decision makers, community leaders as well as researchers engaged in policy, systems and environmental (PSE) efforts related to obesity prevention, convened at the Weight of the Nation (WON) conference in Washington, D.C. In recognition of the growing interest in the relationship between the food system and public health, and obesity in particular, organizers of the WON invited leading experts from multiple disciplines to work as a committee to plan five sessions related to these topics. These experts decided to expand the focus of the sessions to include public drinking water systems and to organize sessions with the goal of identifying solutions to create a healthy, sustainable, and equitable food and water system. This paper presents the key themes, challenges, and potential solutions and discussed within the Food and Water System: Agriculture, Access and Sustainability track (hereinafter referred to as the “Food and Water System Track”).