The Weight of Stigma

Many health care providers, both implicitly and explicitly, perpetuate stigma in their treatment of patients classified as obese. While medical professionals understand that a one-size-fits-all approach to treatment is ineffective, patients classified as obese are frequently offered limited treatment options that fail to account for their unique needs. Access to a range of effective treatment options has historically been limited, but new GLP-1 receptor agonist medicines like Wegovy (semaglutide) and Zepbound (tirzepatide), have shown incredible promise in addressing the obesity crisis. Unfortunately, these transformative drugs are costly, in high demand, and not widely covered by insurance, rendering them inaccessible for many Americans. This Article reviews the history of weight loss medications, emphasizing how past problems have fueled skepticism toward obesity treatment while reinforcing societal stigma against overweight individuals. Medical understanding of obesity has evolved from an issue of personal responsibility to a recognized disease, yet stigma persists. GLP-1 receptor agonist medicines have the potential to reduce structural barriers, including stigma, that deter individuals classified as obese from seeking necessary medical care. However, their effectiveness in addressing these barriers depends on expanding access. GLP-1 receptor agonists will not be universally effective, so enhanced provider education on comprehensive obesity management remains paramount. Effective medicines with strong safety profiles are an important first step, but to improve outcomes and reduce obesity stigma, physicians must adopt individualized, multi-faceted treatment plans for patients classified as obese

Teaching Client Counseling in the Shadow of Homelessness

Working with clients at risk of, or experiencing, homelessness teaches personal and professional humility like few other experiences in law school or the practice of law. Yet such sensitive work also provides an opportunity for law students to develop both a keener understanding of their own professional identity—with its capacities and limitations—and critical counseling skills. This essay draws upon experiences gained in three distinct law school projects that work with clients at risk of, or experiencing, homelessness. After providing a brief overview of each project, the essay will explore methods used for training and supervising students during their counseling sessions, as well as techniques used for facilitating feedback and debriefing with students. The essay concludes by encouraging other instructors to include counseling housing-insecure clients into their courses, whether they teach a doctrinal or experiential class, given the benefits that accrue to students and clients alike

Tackling the Next Public Health Crisis: Lessons Regarding Long-Term Care from the COVID ERA

This paper reviews multiple ethical and clinical issues during the COVID era affecting long-term care. The authors are members of one of many long-term care COVID task forces[1] that emerged in multiple jurisdictions to address a pandemic emergency. This paper applies the pandemic ethics literature that informed healthcare providers during COVID and recommends adjusting health messaging and communication that may shift responsiveness in the next public health crisis. [1]. Kentucky Cabinet for Health and Family Services Long-Term Care Advisory Task Force (in alphabetical order): Muhammad Babar, MD, MBA, MSc, CMD, SNF medical director; Belinda Beard, BS, RN, Division Director, Health Care Facilities, Office of the Inspector General, KY Cabinet for Health and Family Services; Allen Brenzel, MD, Medical Director, KY Dept for Behavioral Health, Developmental and Intellectual Disabilities and Associate Professor, Psychiatry, College of Medicine, University of Kentucky; Sherry Culp, CSW, KY Long-Term Care Ombudsman; Andrea Flinchum, MPH, BSN, RN, CIC, FAPIC, Manager, Healthcare-Associated Infection/Antibiotic Resistance Prevention Program, KY Dept for Public Health; Victoria Elridge, MS, OTRL, Commissioner, KY Dept for Aging and Independent Living; Eric Evans, Associate State Director, Advocacy and Outreach, AARP-KY; Christian Furman, MD, MSPH, AGSF, Health and Aging Policy Fellow (2022-2023), Medical Director, Trager Institute/Optimal Aging Clinic, and Professor, Geriatric and Palliative Medicine, School of Medicine, University of Louisville; Mary Haynes, MSN, MS, RN, LNHA, President, Nazareth Home, Inc.; Leslie Hoffmann, MEd, Deputy Commissioner, KY Dept for Medicaid Services; Keith Knapp, PhD, MHA, CNHA Associate Clinical Professor, Department of Health Management & Policy, University of KY College of Public Health and Senior Advisor, Adult Programs, Office of the Secretary, KY Cabinet for Health and Family Services; Laura Morton, MD, CMD, Associate Clinical Professor, Dept of Geriatric and Family Medicine, School of Medicine, University of Louisville and SNF medical director; Adam Mather, MHA, RN, LNHA, Inspector General, KY Cabinet for Health & Family Services; M. Sara Rosenthal, Professor and Founding Director, University of Kentucky Program for Bioethics, Departments of Internal Medicine, Behavioral Science and Pediatrics and Founding Director of the Markey Cancer Center Oncology Ethics Program; Kevin B. Spicer, MD, PhD, MPH, Medical Officer, Healthcare-Associated Infection/Antibiotic Resistance Prevention Program, KY Department for Public Health; Waqar Saleem, MD, CMD, FAAFP, Assistant Clinical Professor, Dept of Family and Geriatric Medicine, School of Medicine, University of Louisville and SNF medical director; Pam Smith, RN, Division Director, KY Dept for Medicaid Services; Mackenzie Wallace, JD, Director of Public Policy, Alzheimer’s Association of Kentuckiana; Kathleen Winter, PhD, MPH, Director, Division of Epidemiology and Health Planning and Assistant Professor, College of Public Health, University of KY [hereinafter KY LTC Task Force]

Bail-ing Out of Cash Bail: Navigating the Pretrial Fairness Act and Illinois’ Cashless Frontier

Cash bail, once a tool intended to ensure appearances in court, has evolved into a system that disproportionately incarcerates marginalized and economically disadvantaged communities. This national reckoning with the failures of the cash bail system necessiates a critical reevaluation of pretrial justice in the United States. Calls for bail reform have been ringing across the nation and Illinois has answered. This note critically examines the Pretrial Fairness Act (PFA), a landmark reform in the Illinois SAFE-T Act which abolishes cash bail and restores the presumption of innocence to pretrial detention decisions in Illinois. In response to the systemic inequities of the American cash bail system which unfairly targets marginalized communities, the PFA seeks to rectify these disparities representing a transformative shift in pretrial practices. This note traces the historical origins of cash bail in America, highlighting the economic disparities inherent within the system. It also provides a detailed analysis of the legislative history of the PFA, its key provisions, and the Illinois Supreme Court’s affirmation of its constitutionality. This note continues to explore the PFA’s potential efficacy by comparing it with other similar reforms across the United States and analyzing data regarding the PFA’s implementation. Through this lens, this note casts its eyes to the future for potential legal challenges and assesses whether the PFA can serve as a national model for bail reform to construct a better, more equitable pretrial system

Peer Feedback Skills: A Negotiation Teaching Imperative

Critical feedback, especially among peers, is difficult to give well but can be taught. Alternative Dispute Resolution (ADR) and Negotiations teachers can not only teach negotiation and facilitation skills affecting substantive outcomes but also equip students with the confidence and competence to engage well with critical feedback—a skill readily transferrable into any conflict resolution context. In this study, the author engaged a classroom intervention designed to improve peer feedback quality in an undergraduate negotiation course. The intervention included increasing transparency of what makes effective feedback and supplying a video recording of students’ negotiation performance prior to engaging in peer feedback, as well as ensuring at least twenty-four hours of rest time before engaging in feedback. The results revealed that the interventions significantly affected overall feedback quality, with students in the intervention group giving more effective than ineffective feedback while those in the control group gave almost equal amounts of effective and ineffective feedback. Students were also more often willing to tell a peer they exhibited close-mindedness rather than open-mindedness, suggesting increased ease of providing critical feedback. The intervention also improved timeliness of assignment completion. Furthermore, students in the intervention perceived and self-reported greater abilities to give constructive feedback following the course, finding the video playback particularly helpful

The Curious Case of Religious Accommodation

The COVID-19 pandemic sparked newfound interest in—and scrutiny of—religious accommodation law due to the proliferation of lawsuits by workers who sought exemptions from their employers’ vaccine mandates. This piece contributes to the burgeoning conversation around workplace religious accommodations by examining the evolution of the law from its origin in 1972 to the present. The law’s development has not followed a straight line, but rather is marked by triumphs and defeats, advances and setbacks, that defy conventional explanation. If the topsy-turvy development of religious accommodation law has taught us anything, it is to expect the unexpected. But what seems clear is that the future of religious accommodation law is less likely to be shaped by politics than it is by other influences, including demographic and cultural changes, the shift away from formal religious affiliation and toward individual spirituality, and, perhaps most critically, by how courts interpret Title VII’s undue-hardship defense in the wake of the U.S. Supreme Court’s recent bombshell decision in Groff v. DeJoy

Teaching Foundational Mediation Principles in a First-Year Lawyering Skills Program

This article asserts that foundational mediation principles and skills can successfully be taught in a first-year lawyering skills program. At the University of Kansas School of Law, we have included an instructional mediation module in our first-year course for many years. The module contains substantive instruction on alternative dispute resolution, active learning exercises, a mediation simulation, and a reflective oral report. Our module could be adapted to other first-year courses or to upper-level experiential and doctrinal courses. This article explains the learning goals of our mediation module and the module’s various components in detail. It explains the module’s many benefits and points out the potential disadvantages and challenges of adding a similar module to existing curriculum

Integration of Mediation Skills as Required by the Nextgen Bar Exam

The National Conference of Bar Examiners (“NCBE”) developed the NextGen Bar Exam to more actively test a broad range of foundational lawyering skills. The timing of the rollout will take several years with the final adoption date in 2028. The formatting of the questions will change, and the “Integrated Questions Set,” where examinees answer a series of questions about a given scenario, seems to be the hallmark of innovation. The NextGen Bar Exam will also include a performance task where examinees will draft a memorandum, legal brief, letter, or similar document. Faculty striving to adapt to the new assessment requirements of the NextGen Bar can introduce mediation and negotiation skills into their courses. Skills taught in alternative dispute resolution courses that can be incorporated into existing curriculum include reflexive listening and reframing questions, identifying the positions versus interests of the parties, understanding conflict handling modalities, and BATNA versus WATNA. For instance, faculty can integrate NextGen Bar Exam Foundational Skills when discussing lease agreements in a contracts class by identifying the strengths and weaknesses of a client’s position based on relevant legal rules and standards. First-year curricular classes and upper-division classes alike will have hurdles and time constraints for the integration of NextGen Bar skills. However, integrating NextGen Bar concepts does not have to be daunting. It could be as straightforward as a fifteen-minute conversation discussing each side’s positions and interests after watching a scenario video and reviewing a simplified lease agreement

Whose “Best Interests”? Concerns About the Use of Fiduciary Framing in Long-Term Care Decisions

As part of reimagining America’s long-term care system, this article will explain how today’s system is, in many ways, the logical extension of historical presumptions that are foundational to our understanding of family, medical, and organizational governance as “fiduciary” in nature. More specifically, much of our current language (operating in someone’s “best interests,” acting consistent with their “substituted judgment” if now incapacitated) and jurisprudence (parens patriae, trusts, guardianships, conservatorships, and corporate governance) descends from centuries of equity and law centered on the management of property, not people or health. This legal framework is firmly rooted in English statutes, court opinions, organizational charters, and treatises that anticipated or addressed questions of incapacitated property owners and mismanagement of property and assets that are held in trust, whether in the form of an estate, trust, or corporation. Because of the “other-regarding” nature of these concerns, these matters have been overwhelmingly heard in courts of chancery and equity rather than courts of law (which were centered on the reasonable, autonomous man). A look at this history highlights underlying presumptions of: (1) personal and family wealth (typically in the form of real property), (2) incapacitated people (or “objects of charity”) for whom feoffees, trustees, guardians, conservators, or directors make all decisions, and (3) unpaid, enslaved, or underpaid caregivers. These presumptions (and the fiduciary framework built upon them) encourage us to look past the day-to-day reality of those with long-term care needs and the millions of underpaid and unpaid caregivers who keep our neighbors, friends, and loved ones clean, clothed, fed, and engaged. We need to replace these antiquated tools with framing that more accurately reflects the reality of chronic illness and the need for sustainable caregiving

Pharmaceutical-Telehealth Confederacies

Access to prescription pharmaceuticals has historically been controlled by a physician’s pen. As a result, pharmaceutical companies spend billions of dollars on advertising and promotion to mitigate this barrier: first and primarily, to physicians and other prescribers, and more recently, to the general public through direct-to-consumer advertising. The success of these promotional efforts can be seen in greater prescribing of costly brand-name medicines, even in settings where lower-priced generic alternatives exist. Brand-name prescriptions now make up only 10% of all prescriptions written yet account for 87% of drug spending. Despite these substantial returns on investment, companies continue to seek opportunities to drive lucrative brand-name spending. In 2024, Eli Lilly & Co. and Pfizer, Inc., introduced direct-to-consumer services LillyDirectTM and PfizerForAllTM, aimed at largely circumventing the traditional role of physician-as-gatekeeper. LillyDirect and PfizerForAll engage in direct-to-consumer advertising, directing interested consumers to confederate telehealth companies and profiting when those telehealth prescribers in turn write prescriptions for the referring manufacturers’ costly brand-name drugs. These pharmaceutical-telehealth confederacies threaten patient safety and may increase health care costs by driving the inappropriate prescribing of costly drugs over cheaper alternatives. Four U.S. Senators inquired about the relationships between the two pharmaceutical companies and their telehealth groups to identify potential violations of the federal Anti-Kickback Statute (AKS). The U.S. Department of Health and Human Services Office of the Inspector General has also raised concerns regarding arrangements between physicians and telemedicine companies when providers are compensated for each prescription written. Likely by design, LillyDirect and PfizerForAll may evade AKS scrutiny by conducting transactions outside federal insurance programs. Yet the idea that drug companies can promote, prescribe, and dispense medications directly to patients with few gatekeepers and limited regulatory oversight seems inherently problematic. This Article evaluates the nature of these pharmaceutical-telehealth confederacies while offering solutions for reigning in their more egregious practices