Reproductive tourism as moral pluralism in motion.
Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the louder the call for international measures to stop these movements. Three possible solutions are discussed: internal moral pluralism, coerced conformity, and international harmonisation. The position is defended that allowing reproductive tourism is a form of tolerance that prevents the frontal clash between the majority who imposes its view and the minority who claim to have a moral right to some medical service. Reproductive tourism is moral pluralism realised by moving across legal borders. As such, this pragmatic solution presupposes legal diversity. (+info)
Health care reform and social movements in the United States.
Because of the importance of grassroots social movements, or "change from below," in the history of US reform, the relationship between social movements and demands for universal health care is a critical one. National health reform campaigns in the 20th century were initiated and run by elites more concerned with defending against attacks from interest groups than with popular mobilization, and grassroots reformers in the labor, civil rights, feminist, and AIDS activist movements have concentrated more on immediate and incremental changes than on transforming the health care system itself. However, grassroots health care demands have also contained the seeds of a wider critique of the American health care system, leading some movements to adopt calls for universal coverage. (+info)
The tenuous nature of the Medicaid entitlement.
Although Medicaid is regarded as a federal entitlement program, nowhere does the Medicaid statute explicitly recognize a federal right of action to enforce recipients' rights. Arguably, the Supreme Court, rather than Congress, first recognized the right of Medicaid recipients to protection of federal law. A controversial 2001 federal court decision, however, called into question the continuing existence of federally enforceable Medicaid rights. Although this decision has been reversed, it illuminates the tenuous nature of the Medicaid entitlement, as do recent Supreme Court decisions narrowing federal rights. Congress should amend the Medicaid statute to ensure the rights of Medicaid recipients. (+info)
Confidentiality and the duties of care.
Doctors have an ethical and legal duty to respect patient confidentiality. We consider the basis for this duty, looking particularly at the meaning and value of autonomy in health care. Enabling patients to decide how information about them is disclosed is an important element in autonomy and helps patients engage as active partners in their care. Good quality data is, however, essential for research, education, public health monitoring, and for many other activities essential to provision of health care. We discuss whether it is necessary to choose between individual rights and the wider public interest and conclude that this should only rarely be necessary. The paper makes some recommendations on practical steps which could help ensure that good quality information is available for work which benefits society and the public health, while still enabling patients' autonomy to be respected. (+info)
Chevron v Echazabal: public health issues raised by the "threat-to-self" defense to adverse employment actions.
In June of 2002, the US Supreme Court upheld a regulation that allows employers, under the Americans with Disabilities Act, to make disability-related employment decisions based on risks to an employee's own personal health or safety. Previous judicial decisions had allowed employers to make employment decisions based on the threat that a worker's medical condition posed to others but had not addressed the issue of risk posed to an employee's health by his or her own disability. The authors comment on the potential effects of the court's decision for occupational health practitioners charged with assessing the degree of risk and harm of a particular workplace environment and for public health efforts aimed at curbing workplace injury and sickness. (+info)
Workers' liberty, workers' welfare: the Supreme Court speaks on the rights of disabled employees.
On June 10, 2002, a unanimous US Supreme Court rejected the claim by Mario Echazabal that he had been denied his rights under the Americans with Disabilities Act when Chevron USA had refused to employ him because he had hepatitis C. Chevron believed that Echazabal's exposure to hepatotoxic chemicals in its refinery would pose a grave risk to his health. This case poses critical questions about the ethics of public health: When, if ever, is paternalism justified? Must choice always trump other values? What ought to be the balance between welfare and liberty? Strikingly, the groups that came to Echazabal's defense adopted an antipaternalistic posture fundamentally at odds with the ethical foundations of occupational health and safety policy. (+info)
Chevron v Echazabal: protection, opportunity, and paternalism.
The Supreme Court, in Chevron v Echazabal, ruled that risks to a disabled worker, if established by an individualized medical assessment, can disqualify the worker from protections offered by the Americans with Disabilities Act (ADA). This decision rejected the antipaternalist position of ADA advocates that workers with disabilities should be able to determine, through their own consent, the risks they will take. Such strong antipaternalism may not be compatible with the underlying justification for the protection of workers against health hazards. Stringent regulation of workplace hazards involves restricting the scope of consent to risk. Resolution of this conflict will depend on more careful examination of the degree to which individualized medical assessments avoid stereotyping and bias. (+info)
Harlem health care, a look back. An interview with Edward A. Nichols, MD/pediatrician. Interview by George A. Dawson.
Our goal in this series of interviews is to provide a historical record, of sorts, and to highlight persons of African American ancestry who are health care professionals in Harlem, New York. Today, Harlem is undergoing a second cultural renaissance, and in this milieu, doctors are active contributors as providers of health care and, therefore, must be reckoned with as the proverbial backbone to any community change, be it positive or negative. In this instance, we judge the changes occurring in Harlem, for the most part, to be positive. Our inaugural interview is with Dr. Nichols, a longtime member of the National Medical Association and a pediatrician who has practiced in Harlem for well over 25 years. (+info)