Health care law and ethics in a nutshell / Mark A. Hall, Ira Mark Ellman, David Orentlicher.
2011
KF3821 .H353 2011 (Map It)
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Details
Author
Title
Health care law and ethics in a nutshell / Mark A. Hall, Ira Mark Ellman, David Orentlicher.
Published
St. Paul : West Pub. Co., 2011.
Call Number
KF3821 .H353 2011
Edition
Third edition.
ISBN
9780314209870
0314209875
0314209875
Description
xxx, 463 pages ; 19 cm.
System Control No.
(OCoLC)729348021
Bibliography, etc. Note
Includes bibliographic references and index.
Series
Record Appears in
Added Author
Table of Contents
Preface
v
Glossary of Terms and Acronyms
ix
Table of Cases
xxiii
pt. I
THE FUNDAMENTALS OF HEALTH CARE DELIVERY AND FINANCE
ch. 1
Health Insurance Coverage and Regulatory Reform
3
A.
The Crisis in Health Care Spending and Coverage
3
1.
The Dimensions of the Crisis
3
a.
The Spending Crisis
3
b.
The Coverage Crisis
5
2.
The Causes of the Spending Crisis
8
a.
The Structure of Traditional Insurance
9
b.
The Incentives for Patients
9
c.
The Incentives for Providers
12
d.
The Incentives for Insurers and Employers
13
e.
Traditional Medicare Reimbursement
15
f.
Managed Care and the Structure of Health Insurance
17
B.
Insurance Coverage Reform
19
1.
Socialized Medicine and the British System
20
2.
Single Payer, Canadian-Style Insurance
21
3.
Employer or Individual Mandates
24
4.
Incremental Alternatives
26
5.
Managed Competition
27
C.
Interlude: Economic and Regulatory Theory
30
1.
The Need for Health Care Rationing
30
2.
The Ethics of Health Care Rationing
33
a.
Rationing Criteria
33
b.
Rationing Decision Makers
36
3.
The Economics of Health Care Rationing
41
a.
Free Markets vs. Government Controls
41
b.
Economic Theory
44
D.
Cost Containment Reforms
48
1.
Reducing the Scope of Insurance
48
a.
Practical Problems
48
b.
Disability Discrimination and Other Legal Problems
50
2.
Rigorously Reviewing the Necessity of Care
55
3.
Reforming Provider Payment
60
a.
Medicare Prospective Payment
61
b.
Capitation Payment and HMOs
67
4.
Public Utility Regulation
72
E.
Recapitulation
74
ch. 2
The Treatment Relationship
75
A.
Duty to Accept and Treat Patients
76
1.
Doctors
77
a.
The "No-Duty" Rule
77
b.
Formation of the Treatment Relationship
79
2.
Hospitals
81
a.
The General Duty to Provide Care
82
b.
Access to Emergency Care
84
1.
Common Law and Statutory Rights
84
2.
The Emergency Medical Treatment and Active Labor Act
86
(a).
Screening
87
(b).
Treatment and Stabilization
90
(c).
"Preventive" Dumping
91
3.
Doctors Within Health Care Organizations
92
4.
Wrongful Denials: Antidiscrimination Law and Refusal to Treat
94
a.
Title VI: Race and Ethnicity
94
b.
Disability Discrimination
95
1.
Protected Class
96
2.
Core Provisions
98
5.
Other Bases for a Duty to Treat
102
a.
Constitutional Rights of Access
102
b.
Patients' Rights
104
6.
Terminating the Treatment Relationship
105
B.
The Legal Content of the Treatment Relationship
109
(1).
The Fiduciary Core of the Treatment Relationship
109
(2).
Confidentiality
110
a.
The Duty to the Patient
111
(1).
Common Law Protections
112
(2).
Statutory Protections
112
b.
The Duty to Protect Third Parties and the Limits of Confidentiality
115
(1).
Statutory Duties to Report
115
(2).
Common Law Duty to Protect Third Parties
117
(a).
Basis of the Duty: "Hazard" or "Special Relationship"
118
(b).
Foreseeable Plaintiffs
121
(c).
Discharge of the Duty to Protect
122
3.
Informed Consent
124
a.
Classic Doctrine
126
(1).
Risk: What Information Must Be Shared?
126
(2).
Negligence: Measuring the Physician's Conduct
127
(3).
Causation
130
(4).
Exceptions to the Duty to Disclose
130
b.
Conflicts of Interest and Fiduciary Principles
131
c.
Emerging Applications of Informed Consent
133
4.
Modifying the Terms of the Treatment Relationship
136
pt. II
THE LEGAL STRUCTURE OF HEALTH CARE DELIVERY
ch. 3
Hospital Structure and Regulation
140
A.
Hospital and Facility Regulation
141
1.
Licensure, Certification, and Private Accreditation
141
2.
Certificate of Need Laws
145
B.
Hospital and HMO Medical Staff Issues
151
1.
Medical Staff Structure and Staff Selection Process
151
2.
Economic Credentialing, Exclusive Contracts, and Institutional Control
155
3.
Insurance Deselection and Managed Care Contracting
158
4.
Hospital Medical Staff Disputes
161
a.
Introduction
161
b.
Theories of Judicial Review
163
c.
The Scope of Judicial Review
167
5.
Physician Membership in Managed Care Networks
173
6.
Peer Review Confidentiality and Immunity
175
a.
State Peer Review Confidentiality Statutes
175
b.
Federal Peer Review Immunity
176
C.
Labor and Employment Law
178
1.
Labor Law
179
a.
Patient Care Concerns
179
b.
Physician Unions
180
2.
Employment Law
184
a.
Wrongful Discharge
184
b.
Covenants Not to Compete
185
ch. 4
Antitrust Law and Health Care
187
A.
Introduction
187
B.
Antitrust Boycott Law
188
1.
The Conspiracy Requirement
189
2.
Medical Staff Boycotts as Restraints of Trade
191
a.
Avoiding Per Se Illegality
191
b.
Avoiding Trial on the Merits
196
3.
Exclusions From Managed Care Networks and Illegal Tie-ins
198
4.
The Patient Care Defense
201
5.
The Interstate Commerce and State Action Defenses
205
C.
Price Fixing and Vertical Restraints Involving Insurers
207
1.
Price Fixing in Provider Networks
207
2.
Monopolization by Insurers
213
3.
McCarran-Ferguson Exemption
216
D.
Merger Law
217
ch. 5
Complex Transactions and Organizational Forms
223
A.
The Corporate Practice of Medicine
224
1.
The Doctrine's Rationale
225
2.
The Doctrine's Survival
228
B.
Insurance and HMO Regulation
229
1.
State Solvency Laws
229
2.
Managed Care Regulation
231
3.
Federal Insurance Reform
234
C.
ERISA Preemption
235
D.
Charitable Tax Exemption
242
1.
The Basis for Tax Exemption
243
a.
Hospital Services
243
b.
Other Health Care Institutions
245
2.
Inurement to Private Benefit
248
3.
Unrelated Business Income
250
4.
Hospital Reorganization, Diversification, and Conversion of Status
251
a.
Reorganization and Diversification
251
b.
Conversion to For-profit Status
253
E.
Referral Fee Prohibitions
257
1.
Sources of Law
257
2.
Earned Versus Unearned Fees
259
F.
Summary
262
pt. III
ETHICAL ISSUES IN PATIENT CARE DECISIONS
ch. 6
Defining Death and Transplanting Organs
268
A.
Defining Death
268
1.
Cardiopulmonary Criteria
269
2.
Neurological Criteria: Whole Brain Death
270
3.
Neurological Criteria: Upper Brain Death
273
B.
Organ Procurement and Allocation
276
1.
Procurement of Organs
278
a.
Organ Donation
278
b.
Donation and the Definition of Death
280
c.
Mandates, and Novel Rules, for Organ Procurement
282
2.
Allocation of Organs
287
a.
Waiting Lists and UNOS Distribution
288
b.
The Ethics of Allocation Policies
290
ch. 7
The Law and Ethics of Withholding Medical Care and Assisting "Suicide"
294
A.
The Traditional Ethical Distinctions
298
1.
Acting Versus Failing to Act
298
2.
Withholding Versus Withdrawing Treatment
300
3.
Active and Passive Euthanasia
303
4.
The Doctrine of Double Effect
309
5.
Ordinary Versus Extraordinary Treatment
310
6.
Conclusion
313
B.
The Competing Principles of Personal Autonomy and Beneficence
314
C.
The Currently Competent Patient
317
1.
Paternalism and the Limits of Autonomy
317
2.
Determining Decisionmaking Capacity
319
3.
Examples of Decisionmaking With the Competent Patient
324
4.
The Constitution and End-of-Life Decisions
338
D.
Patients Lacking Decisionmaking Capacity
349
1.
Patients With Advance Directives
349
a.
Living Wills
350
b.
Durable Powers of Attorney
351
2.
Once-Competent Patients Without Advance Directives
353
3.
Never-Competent Patients
367
4.
The Seriously 111 Child, Including the Newborn
374
a.
The General Framework of Child Protective Laws
374
b.
The Special Case of the Newborn
381
E.
Denying "Futile" Treatment to the Patient Who Requests It
393
ch. 8
Selected Issues in Reproductive Medicine
400
A.
Assisted Conception
400
1.
Artificial Insemination by Donor (AID)
400
a.
Basic Rules
400
b.
Use by Lesbian Couples
403
2.
Surrogate Motherhood, Egg Donation, and In-Vitro Fertilization
405
a.
Surrogacy Contracts Under Traditional Law
406
b.
Gestational Surrogacy and Changing Law
414
3.
The Status of Stored Embryos
418
4.
Genetic Medicine
421
B.
Maternal-Fetal Conflict
429
1.
Forced Treatment and Fetal Surgery
431
2.
Fetally Toxic Maternal Behavior During Pregnancy
441
Index
453