On Monday, September 16, the Petrie-Flom Center’s Health Law Policy and Bioethics Workshop will host Kimani Paul-Emile of the Fordham University School of Law. Paul-Emile’s presentation is titled “Beyond Title VII: Rethinking Race, Ex-offender Status And Employment Discrimination In The Information Age.”
All meetings of the Workshop are free and open to the public. You can download Paul-Emile’s paper and view the full schedule of upcoming workshops here.
Perhaps surprisingly to some, Colombia has come much further along the path towards universal coverage than many developed countries in the world, including the US. Most of this progress happened precipitously starting in the early 1990’s: while in 1993 fewer than 5% of people in the lowest income quintile had access to any health care that was not paid for entirely out-of-pocket, by 2011 over 85% were covered by a social security system that provides access to a basic package of health benefits. Although there are persisting problems in terms of the effectiveness of coverage, many of us would argue the progress has been real and frankly impressive. But none in Colombia would deny that there is still much room for improvement, and that the government has inexcusably failed to take advantage of numerous opportunities over the past two decades to make those improvements.
These failures led to a landmark decision on the part of the Constitutional Court in 2008, which through its jurisprudence in the T/760 decision of 2008 adjudged the right to health to be a fundamental constitutional right, thereby permitting that specific demands by citizens be submitted for constitutional judicial review through the tutela protection writ (the Colombian version of the amparo). The decision has been seen by many as a trail-blazing approach to protecting the fundamental rights of the most vulnerable individuals in Colombia from the effects of persistent negligence on the part of the Government.
Art Caplan has a new opinion piece at MSNBC.com discussing the ethical issues raised by heiress Huguette Clark’s sometimes enormous gifts to the medical workers who cared for her while she lived in a New York hospital for over 20 years — despite being in good health.
[…] Clark’s favorite private duty nurse, Hadassah Peri, received more than $31 million in gifts during 20 years of service, including enough money to buy five homes, jewelry and other luxuries. Clark gave lavishly to Peri’s husband and children, too.
Other caregivers also got gifts, although not in those amounts. Still others got nothing. Was it ethical for those who got gifts to accept them?
Clark’s personal staff members were not the only ones with an eye on her fortune. The hospital where she lived pushed hard to get Clark to make a substantial gift, using their development staff to try to pry a promise from her, the book reports.
In 2004, Dedman and Newell write, hospital officials threatened Clark with having to move from her beloved room if she did not make a contribution of $125 million to forestall the sale of the building.
So what is the ethical deal?
Read the full article here.
Want to know more about the ethics of aid? Want to hear the inspiring talk that’s convinced students across the northeast to take global poverty seriously? Join Harvard High-Impact Philanthropy for our first talk of the semester with ethicist Larry Temkin! RSVP here for
Global Poverty: Why Should We Care?
a talk by Larry Temkin
Thursday, September 12
8 PM
Science Center E
Each year, millions of children die from readily preventable causes. This raises an obvious and poignant question. What, if anything, should our reaction be to the apparent fact that each one of us could easily prevent the deaths of many innocent people who are not responsible for their unfortunate plight?
Larry Temkin is a professor of philosophy at Rutgers. He holds a Ph.D. from Princeton and is the author of “Rethinking the Good: Moral Ideals and the Nature of Practical Reasoning” (OUP, 2012) and “Inequality” (OUP, 1993). He has received seven fellowships and eight major teaching awards.
The lecture will take place in Harvard’s Science Center, Hall E (in the basement), and will be followed by a Q&A period.
This lecture is also the kick-off event for our Philanthropy Fellowship, a new program this year. Fellows will attend talks and private dinners/receptions with many speakers on effective altruism, including Princeton ethicist Peter Singer, Skype co-founder Jaan Tallinn, and cosmologist Max Tegmark. At the end, we’ll pick a cause that we think is important and raise funds for it ourselves, to be matched by an anonymous donor. To apply, fill out this short application by Sunday, Sep. 15!
As debates surrounding genetic patent rights begin to settle, new questions and disputes have started to emerge around insurance coverage for genetic testing. For the first time, a U.S. health insurance provider (Cigna) has decided to require evaluation by an American Board of Medical Genetics or American Board of Genetic Counseling certified counselor before covering the costs of genetic testing, including genetic tests for susceptibility to breast and ovarian cancer (e.g., BRCA1 and BRCA2). Cigna specifies in its new coverage policy statement, which goes into effect on September 15, 2013, that coverage for such testing will require recommendation by a certified genetic counselor based on pre-test individual evaluation, pedigree analysis, and intent to engage in post-test counseling.
By mandating genetic counseling prior to testing, this requirement aims to reduce unnecessary tests and to increase the efficiency and efficacy of health risk management and service delivery. Earlier this week, however, the American Society of Clinical Oncology (ASCO) took aim at Cigna’s policy, claiming that it can “negatively impact the care of cancer patients by serving as a barrier to the appropriate use of genetic testing services.” At least four key considerations appear to underpin ASCO’s apprehensions about Cigna’s new policy.
By Ching-Fu Lin
In a congressional letter last month, 76 House Members urged United States (US) Trade Representative Michael Froman to push for strong and enforceable sanitary and phytosanitary (SPS) measures in the proposed Transatlantic Trade and Investment Partnership (TTIP). SPS measures – which have been viewed as an area with very little room for convergence between the two sides – cover animal health, plant health, and food safety law and regulation. The differences are evidenced by previous politically salient disputes over hormone-treated beef, genetically modified organisms (GMOs), and more recently, ractopamine in pork. Indeed, given the cultural and institutional divergences between the US and the European Union (EU) food safety regulatory systems, many doubt the possibility that TTIP can come up with an SPS chapter (or an SPS-Plus chapter) that strikes a proper balance between public health and international trade.
As noted by some commentators, given the relatively low tariffs between the EU and US, the chief focus will center upon reducing non-tariff barriers to trade in numerous sectors, including agricultural products, biotechnology, and food safety regulation. The Food and Drug Administration (FDA) has also established a special public health and trade team within its Office of International Programs to take a more active role in the negotiation. Yet the negotiation over such a “sensitive” area has been considered unpromising—transatlantic deadlock, cooperation failure, and several deal breakers (especially regarding GMOs)—because the differences in food safety regulation between the US and EU seem not only significant but also persistent.
However, the outlook may not be as pessimistic as the common understanding.
Anonymity is not just an aspect of privacy and recognizing their difference reveals a powerful and poorly understood set of legal tools for facilitating and controlling the production of public goods. This is the central claim of my newest article (SSRN draft available here).
Three examples illustrate the scope of the under-explored ways in which anonymity is currently used in our law.
These varied uses of anonymity in our law—as a right when purchasing land, a requirement in voting, and a trigger than extinguishes rights in biomedical research—may appear to be unrelated. But I argue that they are in fact all part of a cohesive and previously unrecognized class of rules that use anonymity not to protect privacy, but rather to incentivize or control the production and circulation of information and other socially desirable goods. Read More
By Scott Burris
A new documentary from the HIV Justice Network gets the views of researchers on the impact of HIV criminalization. Call it Evidencer-Based film-making. It premiered last night at the US Conference on HIV and can be seen here. made by Edwin Bernard and Nick Feustel, it captures the issues and what we know in 30 minutes of interviews with some excellent researchers.
On a personal note: sometimes, you know, people who are, you know, being filmed at, you know, the end of the day are, you know, not always as eloquent as, you know, they would like.
By Scott Burris
I am not disputing the value of properly trained health professionals acting as gate-keepers to potentially dangerous drugs. And I am not taking on here the question of which health care professionals should be allowed to prescribe which drugs, though that is an important question on which the states vary quite a bit. Right now, though, there are at least three examples of important, even life-saving medicine that is being kept from people who need it because of rigid (or rigid interpretations of) state prescribing law, and the inability of the FDA to move quickly when its labeling no longer seems to meet the public interest:
1) Epinephrine (in epi-pens) to treat severe allergic reactions. Here’s a good story about that, highlighting a tragic case in which a child died because a school nurse would not or could not use epinephrine that had been prescribed for a different child. The story reports that 30 states now allow “undesignated” epinephrine to be used in these cases, but only four require it – and 20 still prohibit it.
2) Naloxone to prevent death from drug overdose. Naloxone is the standard treatment to reverse opioid overdose. People usually suffer OD far away from a doctor, but often in the presence of someone who could administer naloxone by simple intramuscular injection or intranasal spray. This year there has been quite a bit of legislative activity to break down this barrier to life-saving treatment, including a new bill passing both houses in California this week. But only 16 states and the District of Columbia have acted so far.
3) Expedited partner therapy for treatment of STDs. It takes at least two people to get an STD, or prevent one, but often only one partner is seeing the doctor. EPT gives the patient an extra prescription or dose for the partner. According to the CDC, this is still illegal in six states and not clearly legal in 9, the District of Columbia and Puerto Rico.
There is evidence for the safety and effectiveness of all these practices, and has been for years. Why does it have to take so long for state prescribing rules, or FDA labels, to change? We need a faster mechanism for keeing prescribing rules consistent with current practice and evidence. This is, after all, a matter of everyday life and death.
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