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conceptions that involve anyone but the couple under treatment. Many states have specific laws on artificial insemination that specify that the donor father has no legal rights. However, if a couple wants to choose their own donor or to arrange a contract pregnancy, the laws are not as clear. Custody fights and criminal charges of baby selling are known problems with these arrangements. The control of infectious and genetic diseases must also be considered. The use of any tissue from a third party requires that the physician have a complete genetic history and that the donor be tested for infectious diseases as would an anonymous donor. The presence of contracts or sperm donation laws may not prevent the parties from ending up in a court case or a custody battle. Even without legal entanglements, the social dislocations may be considerable. A man may believe that he can be indifferent when the child is only a theoretical possibility and find that he cannot keep away from the child when he or she is born. The mother and her husband may also have ambivalent feelings. It is very difficult to accept paternity as an abstraction or as a legal concept when all the people involved know one another well. The use of banked sperm from an unidentified donor is legally safer than using a chosen donor. The anonymous donor has been screened for disease and has relinquished any right to the child conceived. The donor is unlikely to know who his biologic children are, and in general he is barred from making any legal claim to them. Conversely, the child is cut off from important information about the biologic parent’s medical and psychiatric history. f) Genetic Disease Standard of care requires reasonable screening of any prospective sperm donor for genetic disease. This is true whether accepting donations to a sperm bank or accepting a donation for a specific woman. This screening should include testing when indicated. The availability of easy, inexpensive testing for sickle cell trait, for instance, makes this test mandatory for all prospective donors who are Black. The fact that the woman has chosen the donor does not relieve the physician of the responsibility for using reasonable care. Many people are unaware of any genetic disease they may carry. The patient and the donor have a right to expect that proper precautions are taken. g) Infection Control The increase in severe sexually transmitted disease in the general population has made this a paramount consideration in artificial insemination. Virtually any venereal disease can be transmitted by fresh or processed semen. There have been cases of infection with HIV through artificial insemination. In such a case, there could be costly suits on behalf of the infected woman and on behalf of the baby if it is also infected. There are medical standards for screening donors and treating specimens to 575
prevent the spread of disease, and these should be followed carefully. The current recommendation on HIV control requires that the donor be tested for HIV when the semen is collected. The semen is then frozen for six months. The donor is tested again at the end of the six months. Only after this second test is negative can the semen be used. [ACOG Committee Opinion 109. Maximizing Pregnancy Rates Resulting from Donor Insemination with Frozen Semen. April 1992.] h) Unmarried Couples There is an ethical debate over whether fertility technology should be available to unmarried couples. This is not an issue for techniques that correct physiological or psychological conditions that impair fertility, when the patient then conceives through intercourse with a self-selected partner. Although the physician may not approve of the behavior, just as he or she might disapprove of premarital sex in general, the physician has no right to impose his or her values on the patient. It does become an issue when physicians are asked to do procedures such as in vitro fertilization or artificial insemination. Although many physicians believe that marriage should not be a precondition to artificial insemination or in vitro fertilization, there is a societal policy, expressed through various laws, against having children outside of marriage. Most state laws on artificial insemination by donor (AID), which is the usual request, are written in terms of a married couple. It is not clear whether any of these laws forbids the artificial insemination of an unmarried woman. They do, however, leave a child born of AI outside of marriage in a legal limbo. In some states, specific statutory authorization was necessary to permit AID. Without the statutory authorization, AID contravened state laws on adultery or fornication. If an authorizing law is written solely in terms of a married couple, then AID of an unmarried woman might violate fornication or adultery laws. Given that laws against fornication and adultery are constitutional, the constitutional right of reproductive freedom may not extend to unmarried couples. State civil rights laws requiring married and unmarried persons to be treated in the same way might imply that an unmarried person is entitled to AID or in vitro fertilization. Conversely, since in most states a married woman cannot be artificially inseminated without her husband’s permission, equal treatment might also mean that AID is not available without a husband. Physicians who choose to offer AID and in vitro fertilization to unmarried persons should seek legal advice to ensure that they do not violate any state laws. They should be meticulous in both infectious and genetic disease investigation. This is a controversial area. Physicians may be involved in highly publicized lawsuits if the couple decides to break up and the donor contests paternity. C. A Structured Approach to Obstetric Care Most obstetric malpractice is due to medical system failures rather than 576
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Public Health Law Map - Beta 5.7 I.
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1942.] The English statutory and co
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health or individual health officer
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actions through the district attorn
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3. The Judicial Branch The federal
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consumer protection, such as requir
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With these exceptions, most litigat
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the court in Los Angeles might allo
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subject matter and may also have in
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2. Implementing ADR The major benef
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III. Tort Claims against Private Pa
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cannot be proved, but it is clear t
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uterus, triggering a miscarriage. T
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first were passed immediately after
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years. If the practitioner violates
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defendant’s conduct or (for the d
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proving a case against a physician
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e important for their adult medical
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emoving the plantar wart. This emph
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Blake BL. Sgt. Friday, Dr. Welby, a
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Walter C, Richards EP. Keeping junk
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earning capacity. b) Medical Expens
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simple as installing wheelchair ram
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cases do not give rise to injury-re
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medical costs from the lawsuit. Som
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compilation of legal principles. It
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traditional sense. Fetal heart moni
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oxygen saturation. When saturation
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1993;56:12-14. King JY. Practice gu
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are handled through an administrati
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U.S.C. § 1491. As such, the Court
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waiving immunity provide the only m
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against the United States in federa
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A discretionary function is an act
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deviant sexual conduct by an Air Fo
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The government can be liable under
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decision of the hospital officials
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constitutional rights have been vio
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case basis. The critical element in
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allegedly defective product was a m
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that state law is displaced if it i
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adopted. Therefore, Congress may au
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alleged. The “color of state law
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Importantly, the DeShaney analysis
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In the context of public health, on
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Also, immunity from suit is preserv
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The mere fact a private corporation
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1. Absolute Immunity Absolute immun
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prisoners were infected with HIV an
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against physicians who sold prescri
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The key distinction between crimina
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it almost impossible for practition
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forced to give hair samples, blood
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medical care practitioner does not
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assume that a hospital has an incen
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fined not more than $25,000 or impr
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charitable, religious, or philanthr
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(2) The Everyone-Does-It Defense De
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automatically invoke attorney-clien
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The Federal government, and several
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e of no benefit to the community, t
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activities of the large professiona
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Some of these provisions, such as t
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not support the scheme to reduce ho
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(1) Sentencing Guideline Standards
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did not provide full information ab
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5. If an employee chooses not to re
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documents until the court had made
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Frech HE III, Danger KL. Exclusive
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1998;29:16-18. Stahl DA. Consolidat
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tampering. b) Search Warrants If th
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defense lawyers to fight claims tha
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a) Service of Process One distressi
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provide as little speculation from
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place for the deposition. Each part
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should include a signed release by
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juries will disregard scientific ev
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the jury may be out of the room for
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entered the patient’s description
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the information being presented is
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are situations where what is genera
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test so generously that it also gav
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defendant’s failure to render the
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fees may be construed as attempting
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Fish R, Rosen P. Physicians should
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$150,000 to fight a case that could
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case; rather, it encourages the att
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were below the acceptable standard
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A. Establishing Agencies For its fi
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local level because the employees a
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dispute before the court. The lawye
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c) The Goldberg Rights Persons whos
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the cost of butter. A public intere
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standards and who agree to complian
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a) Agency Interpretation of Law All
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Johnson JA. Court limits board of m
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persons—business law, constitutio
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5. Corporate Employers and Institut
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prohibited the attorney from asking
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supervising the work. A more fundam
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medical problems. Whether it is can
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for buying insurance is that it pay
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Lawyers working on a contingency do
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Review deposition summary: 30 Novem
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of an effective preventive law plan
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ibes were in the form of consulting
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detailed summaries of important doc
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A very important part of the invest
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cases. Houston Bar Assoc. 1996;34:2
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state civil rights laws and health
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must carry out these actions correc
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c) Informal Consultations One of th
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on relinquishing care and follow-up
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The manufacturers of emergency kits
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equire a consultation before certai
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any differences of opinion between
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to refer a patient to such an insti
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help the patient deal with the insu
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diagnostic interest to the physicia
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attendant duties. When they exercis
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physician must be notified at once.
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to find a specialist willing to see
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physicians, a recent U.S. Supreme C
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The law requires a physician to pro
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proper diagnosis. The physician los
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possible, the letter should be sent
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states than in others.) The best ra
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Medical licensing agencies and medi
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If there is a physician-patient rel
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(1) In general If any individual (w
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subject to a civil money penalty of
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condition described in paragraph (1
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(A) Placing the health of the indiv
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may not transfer the individual unl
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sent by certified mail, return rece
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Berlin L. Communication of the sign
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evaluation of distance medicine tec
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consent: reducing conflicts with pa
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) Children in the Emergency Room A
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such as cancer should be withheld f
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eing challenged over their good- fa
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would not require that the risk be
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usual in the community, and in othe
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consent to risks of the treatment b
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) Reasonable-Patient Standard This
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candidates for treatment if their u
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prospective reimbursement systems r
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The child’s legal status should b
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litigation. Most states allow a phy
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should be reported to the child pro
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mental suffering and injury. 5. No
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ensure that all other participants
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(1) The research involves no more t
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different dialects but with differe
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to consent to medical care. Convers
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person. The power of attorney may b
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eligious reasons. Parents may refus
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life-support technologies, patients
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use every possible avenue to prolon
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decision? The court found that Miss
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Cruzan really dead? Justice Rehnqui
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discussed in terms of the patient
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) Following the Patient’s Wishes
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Few termination of life-support cas
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than any element of human behaviora
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Law Policy. 1997;361. Brody, H. Com
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Furthermore, a physician who withdr
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Cunningham N. Fear and informed con
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Invest Radiol. 1996;31:109-113. Nic
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interests test. J Leg Med. 1991;12:
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esearch subjects: proposed guidelin
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1994;8:19-27. Silverman HJ. Ethical
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Insurance Portability and Accountab
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physician, just as the records of c
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and if the patient is the victim of
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Disabilities Act (ADA) limits an em
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that is part of routine medical car
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A description of each purpose of th
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services to the medical care provid
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Access to the records is subject to
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Use appropriate safeguards to preve
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when they were designing research s
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such as an antitrust or false claim
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contain, the potential for harm in
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identification of abnormal findings
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Anything that indicates special tre
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put in the chart to document that t
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keep personal notes, and often the
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night unless she has a serious conc
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difficult to authenticate, unless t
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225. Smith J. Good medical records
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The legal consequences of the corpo
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to set up their own practices or wo
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California. Independent Contractor:
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physician fail to obtain a proper i
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When a physician recommends unneces
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Because employers attempt to limit
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utilization review organization den
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to influence a treating doctor’s
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important if the employee injures a
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these rules vary greatly from state
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If, as frequently happens, the pati
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eviewed completely by the supervisi
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protocols become generic documentat
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the physician is directly supervisi
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a. Penicillin V potassium 250 mg q.
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they hospitalize or refer a patient
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patient’s right of privacy should
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Medical students are often enthusia
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unauthorized practice of medicine.
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staff knows that the orders are onl
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is injured by a fellow workers’ n
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limited due process restrictions on
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agreeing to reimburse the MCO for a
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collective action, a close reading
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Med Soc. 1996;148:341-343. Maurer W
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Fiesta J. Delegation, downsizing an
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XIV. Peer Review and Deselection HI
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the development of new legal theori
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juror’s perspective, peer review
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to deal fairly with citizens, these
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5. There is an overriding national
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a) Notice of a Right to a Hearing T
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equest, to the physician or practit
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subchapter. Information about malpr
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the standards set forth in the Act,
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2. The Problem of Bias Until recent
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from general disclosure, but it sho
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do cost-cutting that the physicians
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Med. 1997;18:521-538. Maguire D. Te
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Introduction All medical care pract
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we are due for another worldwide ep
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include nurses, dentists, veterinar
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marital disharmony. In the classic
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criticisms of the cost of contact t
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diseases such as the Marburg or Ebo
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organized, powerful political lobby
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homosexual activists and the religi
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eligion or conscience. Thus, he can
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high, amounting to several dollars
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1. Birth Certificates Normally the
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caused or contributed to by infecti
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D. Law Enforcement Reporting Every
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campus police. The campus police de
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the law enforcement authorities are
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when they are acting as officers of
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eporting practices. J Emerg Med. 19
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Starr P, Starr S. Reinventing vital
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October;51:132]. J Am Med Womens As
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laws governing air and water pollut
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the widespread occurrence of tooth
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within the power of the judiciary t
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[specify fluoridation measure at is
Page 507 and 508:
Still other arguments center on all
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(Wash. 1955); Rogowski v. City of D
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adverse effects would occur was arb
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Kaul v. City of Chehalis, 277 P.2d
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Introduction There are special cons
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Under no circumstances should medic
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patients about high-risk behavior a
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arrier method that is only 70% effe
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injectable contraceptive that lasts
Page 525 and 526: that HIV is less of a threat than a
Page 527 and 528: for procedures affecting reproducti
Page 529 and 530: funded services to coerce a person
Page 531 and 532: The person who obtains the consent;
Page 533 and 534: The recognition of personal privacy
Page 535 and 536: medically necessary: On their face,
Page 537 and 538: Although abortion is still a surgic
Page 539 and 540: The presumption of legitimacy was a
Page 541 and 542: Unfitness is also narrowly defined
Page 543 and 544: consistent with public health and s
Page 545 and 546: constitutional protections or feder
Page 547 and 548: information in violation of confide
Page 549 and 550: Mary Sue’s ova were successfully
Page 551 and 552: But the rule does not contemplate t
Page 553 and 554: as not to violate this prohibition.
Page 555 and 556: committed before she knows the stre
Page 557 and 558: 1. Adoption 2. Family Planning and
Page 559 and 560: Soderberg H, Andersson C, Janzon L,
Page 561 and 562: Hum Reprod. 1992;7:1029-1033. Snowd
Page 563 and 564: condition. This conflict can take t
Page 565 and 566: eaching a level of 1 per 11 births
Page 567 and 568: who has finally conceived after thr
Page 569 and 570: should be sure that she understands
Page 571 and 572: The treatment of infertility poses
Page 573 and 574: disorder should not be helped to co
Page 575: Choosing a sperm donor can be legal
Page 579 and 580: problems before they cause accident
Page 581 and 582: Beyond a structured prenatal care s
Page 583 and 584: patient’s decisions. The patient
Page 585 and 586: covered in signs that ask women if
Page 587 and 588: decisions not to use medical interv
Page 589 and 590: lifesaving care. Many physicians ig
Page 591 and 592: profound differences in the underly
Page 593 and 594: midwife’s skills and judgment, as
Page 595 and 596: who might sue on her behalf or on t
Page 597 and 598: contraception, but contraception ha
Page 599 and 600: One example has been the developmen
Page 601 and 602: Marshall BM. Ethical issues in assi
Page 603 and 604: 1995;115:39-43. Greely HT. Genetic
Page 605 and 606: 3. General Obstetrics Abrams FR. Co
Page 607 and 608: King NM. Informed consent and the p
Page 609 and 610: XIX. Occupational Medicine and Disa
Page 611 and 612: and balances inherent in having gen
Page 613 and 614: putative illness, requesting an exc
Page 615 and 616: compensation system. The company ma
Page 617 and 618: In some circumstances, the union ma
Page 619 and 620: ethical obligations concerning the
Page 621 and 622: Records concerning voluntary employ
Page 623 and 624: employee’s health status.” In t
Page 625 and 626: films shall be preserved in their o
Page 627 and 628:
Employees may also have a financial
Page 629 and 630:
available information on the proper
Page 631 and 632:
lood tests that are medically neces
Page 633 and 634:
hospital. Both the medical care pro
Page 635 and 636:
Section 504 was a remedial statute
Page 637 and 638:
or recurrent, that the key word was
Page 639 and 640:
government officials investigating
Page 641 and 642:
incorrect, so this area of the law
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is to ensure that patients have eno
Page 645 and 646:
problems. The Court also reiterated
Page 647 and 648:
the medical problems have affected
Page 649 and 650:
normal eyes and kidneys and no peri
Page 651 and 652:
not constitute a disability. The pa
Page 653 and 654:
workplace, their legal status is no
Page 655 and 656:
hepatitis A, the onset of the disea
Page 657 and 658:
(2) The nature and severity of the
Page 659 and 660:
Many diseases are spread by insects
Page 661 and 662:
eporting duties that apply to the c
Page 663 and 664:
9. Bloodborne Pathogens All workpla
Page 665 and 666:
this includes all types of medical
Page 667 and 668:
clinics or home health visits. An i
Page 669 and 670:
Purtilo RB. Ethical issues in the h
Page 671 and 672:
Disabilities Act: a decision analys
Page 673 and 674:
occupational accidents and diseases
Page 675 and 676:
1998;13:241-272. Pollack R. Update
Page 677 and 678:
legislation, set minimum standards
Page 679 and 680:
hearing seems to be rooted in the l
Page 681 and 682:
ates among drug addicts. Beyond the
Page 683 and 684:
Team physicians’ duties are to th
Page 685 and 686:
first aid and training programs are
Page 687 and 688:
equired by the school is not accept
Page 689 and 690:
interfere with getting the child pr
Page 691 and 692:
4. Handicapped Children Handicapped
Page 693 and 694:
1996;35:237-242. Cheng TL, Savageau
Page 695 and 696:
Med Sci Law. 1995;35:45-47. Mitten
Page 697 and 698:
handling prisoners in a burns unit.
Page 699 and 700:
legislation. The FDA, DHHS, HCFA, a
Page 701 and 702:
of a lower court to a higher, appel
Page 703 and 704:
assaulted will bring a legal action
Page 705 and 706:
anesthesiologists and nurses with i
Page 707 and 708:
Negligence to consider the plaintif
Page 709 and 710:
declaratory judgments about the con
Page 711 and 712:
Durable Power of Attorney ensurance
Page 713 and 714:
fiduciary relationship, as is the r
Page 715 and 716:
Hearsay Rule Testimony of what anot
Page 717 and 718:
In Loco Parentis Literally, in the
Page 719 and 720:
to dangerous products such as drugs
Page 721 and 722:
filing of all official documents. I
Page 723 and 724:
Perjury The willful act of giving f
Page 725 and 726:
had that reasonable person been in
Page 727 and 728:
RICO The common abbreviation for st
Page 729 and 730:
person seeks damages or other legal
Page 731 and 732:
appropriateness. Vacate When a cour
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