(Institute for the feeble-minded, Lincoln, Ill. / Library of Congress)

Brittney Poolaw and the Long Tradition of State-Sponsored Control of Women and Their Fertility

By Lauren Breslow

On October 5, 2021, a 20-year-old Native American woman, Brittney Poolaw, was convicted by an Oklahoma jury of manslaughter for the death of her 17-week-old, non-viable fetus.

Her conviction stands as a modern recapitulation of the historical violations that women, especially Black and Brown women, have endured regarding their fertility.

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Doctor Holding Cell Phone. Cell phones and other kinds of mobile devices and communications technologies are of increasing importance in the delivery of health care. Photographer Daniel Sone.

Toward a Broader Telehealth Licensing Scheme

By Fazal Khan

Evidence generated during the first year the COVID-19 pandemic has called into question the need for many of the telehealth restrictions that were in effect prior to the pandemic.

The question many policymakers are asking now is: which of the telehealth regulatory waivers enacted during the pandemic should become permanent?

My forthcoming article proposes that the federal government use its spending power to incentivize states to adopt a de facto national telehealth licensing scheme through state-based mutual recognition of licensing and scope of practice reforms through a Medicaid program funding “bonus.”

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Photo of doctor's exam room.

Using Health Justice to Identify Inequities Experienced by Employees with Disabilities

By Katherine Macfarlane

Disability discrimination negatively impacts the health of people with disabilities, yet disability law often overlooks discrimination’s health consequences. A health justice framework does not. It recognizes that discrimination impacts health, and then goes a step further, highlighting how legal systems are complicit in perpetuating health injustice. That wider lens better captures the lived experiences of those who experience discrimination, including people with disabilities.

My own work explores disability law’s insistence that disability be confirmed through medical examination. Without confirmation from a health care provider, disability does not exist, and reasonable accommodations need not be provided. A health justice framework has deepened my understanding of the harm those encounters impose. Identifying the full scope of the harm people with disabilities endure is the first step toward dismantling the systems that cause it.

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Pulse oximeter used to measure pulse rate and oxygen levels in use on a person's finger.

‘I Can’t Breathe’: Racism in Medical Technology

By Aziza Ahmed

When Black Lives Matters (BLM) activists say “I can’t breathe,” they are acknowledging that breathing is not simply biological — it is enabled or disabled by law and politics. They are right.

In fact, the legal and political environment shapes and legitimates the very tools we use to monitor our capacity to breathe.

The racial justice uprisings and the COVID-19 pandemic have inspired advocates, scholars, and researchers to examine the assumptions about race that have embedded themselves into these tools — the medical technologies we use to measure if, and how, a person is breathing and absorbing oxygen.

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Emergency room.

Truth and Reconciliation in Health Care: Addressing Medical Racism using a Health Justice Framework

By Amber Johnson

Healing processes, such as the truth and reconciliation process, can operationalize the three components of the health justice framework — community empowerment, structural remediation, and financial and structural supports — to address the trauma of medical racism. Structural remediation and institutional change is a long and slow process; however, changing the way we interact with each other — through healing processes — can lead to swift, radical changes. Consider, for example, interpersonal racism in patient/provider health care interactions.

Interpersonal racism in patient/provider interaction can determine whether a patient’s needs are met, and can be the deciding factor between survival or death. From communication between a provider and a patient, to diagnosis and treatment, to follow-up care and pain management, the patient/provider interaction is integral to obtaining access to quality health care. When interpersonal racism is at play, the quality of care is substandard and health outcomes are negatively impacted.

Interpersonal racism is one aspect of patient/provider interaction(s) that has massive implications for health outcomes, and it is also one that hospitals and medical staff have the direct agency, resources, and time to change. But this must be done at least partially on an individual level — neither patients nor providers can eradicate racism without acknowledging the truth of the harm caused and healing from the harm.

Acknowledging the truth may be achieved through a truth and reconciliation commission (TRC), a process whereby parties who have been harmed and parties who have caused harm are able to share their experiences and revise ahistorical narratives, so that they reflect the truth and seek justice in the form of reconciliation, reparations, or some form of resolution.

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Map of remote execution requirements for advance directives.

Advance Care Planning in an Online World: State Law Activity and Challenges Since COVID-19

By Nikol Nesterenko, Jonathan Chernoguz, and Sarah Hooper

Advance care planning — the process by which an individual documents their wishes for health care in the event that they become incapacitated — has become particularly urgent during the COVID-19 pandemic.

However, individuals that wish to engage in advance care planning, and specifically to document their plans in a written form (i.e., advance directives), have faced significant hurdles due to legal execution requirements. State advance directive law often requires or presumes live, in-person witnessing or notarization, actions which were prohibited by social distancing orders or simply unsafe during the pandemic.

In this piece, we summarize the state of remote execution requirements for advance directives before and during the COVID-19 pandemic. Broadly speaking, while many states took some action in this regard, most did not enact comprehensive changes, and therefore failed to meaningfully facilitate remote execution of advance directives.

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Gloved hand holding medical rapid test labeled COVID-19 over sheet of paper listing the test result as negative.

How Long COVID Is Forcing a Reckoning with the Neglect of Post-Infectious Chronic Illnesses

By Colleen Campbell

While post-viral illnesses are not new, they have been considerably neglected by the public health, medical, and scientific communities. This invisibility has, in many ways, been constructed by institutional neglect and medical sexism.

The COVID-19 pandemic is now causing a reckoning with this institutional neglect. This is because COVID Long Haulers and patient advocates for the chronically ill are forcing an unprecedented recognition for these chronic complex diseases.

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Doctor working with modern computer interface.

To Set the Price Tag for Telehealth, First Understand Its Value

By Mary Witkowski, Susanna Gallani, and David N. Bernstein

As the economy reopens, a debate has emerged about whether to continue supporting telehealth and digital practices, or whether to return to pre-pandemic practices, practically relegating telehealth solutions and digital interactions to lower-value exceptions to traditional medical care.

The next set of regulatory and payment policies will likely set the trajectory for how digital health is integrated into the overall care model. We suggest that rather than making these policy decisions based on incremental thinking relative to historical pricing of in-person care, they ought to be based on an assessment of how they generate value for patients.

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