Legal regulation of certain types of medical

practice.

Bioethics

Bioethics is a branch of normative ethics. It deals with ethical problems that arise in the context of medicine and biomedical sciences. Abortion (cf.

abortion), euthanasia (cf. euthanasia), organ transplants, genetic manipulation, cloning, the

physician-patient relationship, biomedical research with human subjects, animal rights (cf. animal

rights), and justice in the distribution of healthcare services are some of the main areas of bioethical

concern.

In fact, bioethics has developed into a kind of “profession” and acquired some degree of social authority either to make

decisions within the law, to create new legal norms, or to interpret the law. This professionalization has been criticized and, to some extent, the critics are right. Bioethics seems to be increasingly playing in our secularized society the same

role that religion played earlier (cf. Engelhardt 2002). Be this as it may, nothing could be further from my purpose than

depicting bioethics as a monolithic body of truths. Bioethics is an incipient discipline, which shares its epistemic

weaknesses and its rather erratic methodology with ethics, and in general with philosophy. The significance of bioethics for the law consists simply of its capability to highlight the fact that we cannot make central social choices concerning

biomedical sciences by appealing solely to the law or to medicine. They are issues of genuine ethical concern.

Despite the trendy nature of cloning and other hot issues, there are numerous ways in which the knowledge that practicing physicians have about medical ethics and law can have a more direct impact on the type and quality of care that the average patient receives. In order to provide medical care in an ethical and humane way, physicians need to be better educated about specific aspects of ethical medical practice and learn to think critically about the increasingly complex world of medical practice. Routine bioethics education for medical students and resident physicians, and continuing medical education for practicing doctors, are the best ways to accomplish this goal.

Risk management is an issue that concerns most physicians, improving doctors’

knowledge of medical law can help them better understand and estimate risks, as

well as learn where they may be unconsciously overestimating certain risks

in ways that have negative effects for patient care. Thus, law and ethics are

inevitably intertwined in clinical medicine.

Practical application of bioethics concepts is essential for the well-being of both patients and physicians. The integration of bioethics into clinical medicine through the practice of “clinical ethics” is a major part of many bioethicists’ jobs. This usually occurs in at least two ways, first by educating physicians-in-training, and second, by conducting clinical ethics consultations, which have both an educational role and are designed to assist with a particular ethical problem in a clinical setting. In this setting, the bioethicist provides services that assist specific patients and their families, as well as health care providers. By modeling good clinical ethics practice, bioethicists can teach physicians ways to better perform these functions.

The role of lawyers and risk managers are closely linked in many health care institutions. Indeed, in some hospitals the Risk Manager is an attorney with a clinical medicine background. There are,

however, important distinctions between law itself and risk management.

Law is the established social rules for conduct; a violation of law may create criminal or civil liability.

Risk Management is a method of reducing risk of liability through institutional policies/practices.

Risk Management is guided by legal parameters but has a broader institution specific mission. It

is not uncommon for a hospital policy to go beyond the minimum requirements set by the

legal standard. When legal and risk management issues arise in the delivery of health care, there may be ethical

issues, too. Conversely, what is originally identified as an ethical problem may raise legal

and risk management concerns.

Intercalating in Bioethics and Medical Law is a fantastic opportunity to explore lots of different areas in your own way. If you’re used to doing sciences as most medics are

and fancy some time to study something completely different then I’d recommend it. The law component is

really interesting and the bioethics component gives you the space to study different theories and use these to examine ethical issues of your own choice. While there is not much teaching (about 5 lectures/seminars per week in the first 1 and a 1/2 terms and then only 2 per week the rest of the year) there are regular essays and presentations to keep you busy but as it is all topics of your own choice, this is

often less tedious than expected.

In the course of practicing medicine, a range of issues may arise that require consultation from either a lawyer, a risk

manager, or an ethicist. The following discussion will outline key distinctions between these roles.

The role of lawyers and risk managers are closely linked in many health care institutions. Indeed, in some hospitals the Risk Manager is an attorney with a clinical medicine background. There are, however, important distinctions

between law itself and risk management. Law is the established social rules for conduct; a violation

of law may create criminal or civil liability.

Law is derived/expressed through:

-federal and state constitutions

-federal and state statutes (ex. Revised Code of WA.)

-federal and state regulations (ex. WA. Administrative Code)

-federal and state case law (individual lawsuits-decisions at

appellate level.)

Risk Management is derived from law and professional

standards and is expressed through institutional

policies/practices.

Medical Ethics is derived/expressed through:

-law

-institutional policies/practices

-policy of professional organizations

-professional standards of care, fiduciary

obligations

Law and medical ethics are both dynamic and are in a constant state of change, i.e., new legislation and court

decisions occur and medical ethics responds to challenges created by new technology, law or other

influences. To locate information about what the law on a particular topic is or to get copies of statutes,

regulations or case law you may need to go to a law library. There are also legal search tools available on the

Internet. Another potential resource are medical journals which frequently have articles on ethical issues

which mention relevant legal authority.

The Medical Crisis and the Need for

Radical Procapitalist

Reform

• For decades the cost of medical care has risen relative to prices in general and relative to people's incomes. Today [1994] a semi-private hospital room typically costs $1,000 to $1,500 per day, exclusive of all medical procedures, such as X-rays, surgery, or even a visit by one's physician. Basic room charges of $500 per day or more are routinely tripled just by the inclusion of normal hospital pharmacy and supplies charges (the cost of a Tylenol tablet can be as much as $20). And typically the cost of the various medical procedures is commensurate. In such conditions, people who are not exceptionally wealthy, who lack extensive medical insurance, or who fear losing the insurance they do have if they become unemployed, must dread the financial consequences of any serious illness almost as much as the illness itself. At the same time, no end to the rise in medical costs is in sight. Thus it is no wonder that a great clamor has arisen in favor of reform – radical reform – that will put an end to a situation that bears the earmarks of financial lunacy.

• Such a reform has been proposed by the Clinton administration. The essence of its plan is to control the rise in medical costs by a combination of controlling the various prices charged by the providers of medical care and the kinds and quantities of medical care that they can provide. In the plainest language, the Clinton administration's proposed solution to the problem of ever rising medical costs is price controls and rationing. [This applies to all proposals for government-mandated cost controls, including, of course, those of the present, Obama administration. There is simply no way for the government to limit medical costs except by limiting the prices and/or kinds and quantities of medical care provided.]

Capitalism

Capitalism • Capitalism is an economic system in which trade, industry and the means

of production are controlled by private owners with the goal of making profits in a market economy. Central characteristics of capitalism include capital accumulation, competitive markets and wage labor. In a capitalist economy, the parties to a transaction typically determine the prices at which assets, goods, and services are exchanged.

• The degree of competition, role of intervention and regulation, and scope of public ownership varies across different models of capitalism. Economists, political economists, and historians have taken different perspectives in their analysis of capitalism and recognized various forms of it in practice. These include laissez-faire capitalism, welfare capitalism and state capitalism; each highlighting varying degrees of dependency on markets, public ownership, and inclusion of social policies. The extent to which different markets are free, as well as the rules defining private property, is a matter of politics and policy. Many states have what are termed capitalist mixed economies, referring to a mix between planned and market-driven elements

Ayn Rand

• Ayn Rand was born in St. . Petersburg, Russia , February 2, 1905 . With six years she learned to read, and two years later she covered her first fictional hero in a French magazine for children - and thus captures the fictional pattern that accompanied her through life. As a result, at the age of nine years decided that it will deal with literary career . In opposition to the mysticism and collectivism of Russian culture , young college student wanted to be a writer for as European style , especially after meeting with Viktor Hugo , the creator who most impressed her .

• In his school was an eyewitness to two revolutions : February Revolution , which supported and the Bolshevik Revolution , which condemned the very beginning. To avoid fighting her family moved to the Crimea , where she finished high school. However, the final victory of communism resulted in the complete confiscation of the pharmaceutical industry gained in her father's wealth and long periods of starvation. Since that time, the dream of an ambitious girl has become America . Young writer on the history of the United States learned in the last year of high school and took her for a model country of free people .

• After returning from the Crimea got on to the University of St. Petersburg , where she studied philosophy and history. Graduating in 1924 experienced a fall of academic freedom and university takeover by the Communist bandits. Living in a communist reality became her increasingly unbearable , so highly appreciated Western culture , which for her was a form of escape . Rand fascinated the Viennese operas and western films and theater arts . Her long passion for cinema made in 1924 got to the National Institute of Cinematography , where she studied screenwriting . It was a time when she released her first publication : a booklet about the actress Pola Negri and a brochure entitled " Hollywood has : American Movie City" (1926 ) .

• In 1925, he received permission to go to relatives in the United States. Although assured the Soviet authorities that her visit would be short , Rand was determined to never go back to Russia. Came to New York in February 1926 . She spent the next six months with her relatives in Chicago , and received an extension of his visa and moved to Hollywood to pursue a career as a writer.

Human Rights

• general - are valid all over the world and everyone is entitled

• natural - everyone is entitled from birth• inalienable - they can not be waived• inviolable - exist independently of government and can

not be by her freely adjustable• natural - apply regardless of their confirmation by the

state• indivisible - all are integral and interdependent whole

Declaration of the Rights of Man and of the Citizen in 1789

Human Law in Medicine

1. Protection of human dignity: • In Article 1 confirms the protection of the

dignity and identities of all the people and guarantees to every person - without discrimination - respect for its integrity and rights in the use of biology and medicine.

2. The principle of the primacy of person: • In biomedicine, especially in research in this

field, there may be a conflict between the interests of the individual (individual person) and the interests of society as a whole. Convention puts the interest of the individual above, proclaiming the principle of the primacy of the person. So you can not carry out research at the expense of the man.

3. The principle of equitable access to health: • The principle of equitable access to health

care means such access, which is consistent with the medical needs of a specific person. Health care is understood here broadly as: diagnostic procedures, preventive, curative and rehabilitative.

The Future of Bioethics Law

and How It May Affect Medical

Care

• While many lawyers may not be familiar with the intricacies of bioethics, the study is a very important and substantive issue that directly affects the public as it relates to medical discoveries and health care costs. In a roundtable discussion sponsored by the American Bar Association Special Committee on Bioethics and the Law titled “Hot Topics in Bioethics,” experts William Allen, director, Program in Bioethics, Law and Medical Professionalism, University of Florida and Robyn Shapiro, partner at Drinker Biddle in the Health Practice Group, led and facilitated debate on current trends in the field, as well as legal and ethical issues.

• One issue up for debate during the panel program was the yet-to-be-determined federal court decision in the case Association for Molecular Pathology v. U.S. Patent and Trademark Office. The fundamental question of the case is whether or not the patenting of genes is legal, in other words, can genes be separated from a DNA sequence in a manner that can be deemed, “new and useful” to the extent that a patent can be issued.