Newsgathering in Light of HIPAA

This short piece examines the interaction between the Health Insurance Portability and Accountability Act (HIPAA), a federal law designed to protect the privacy of individuals’ health information, and state Freedom of Information (FOI) laws, which are designed to ensure public access to government documents. It describes three recent cases from different states that addressed difficult issues about where and how to draw the line between the public’s right to know and individuals’ rights to keep their medical information secret. It concludes that questions about the interaction of state FOI laws and HIPAA should be guided by the framework suggested in HIPAA regulations for understanding the interaction between HIPAA and the federal Freedom of Information Act. State courts and agencies should therefore use the provisions in state FOI laws that regard medical privacy to inform decisions about information requests from citizens and the media

Legal Age

How old are you? This deceptively simple question has a clear answer in the law, which is a number measuring the amount of time that has elapsed since birth. However, as scientists discover various biomarkers of human aging and individuals openly embrace more fluid identities, this chronological definition will soon have to compete with biological and subjective alternatives. Legal scholars have previously examined the role of age in the legal system, but they have done so assuming a chronological definition. This is the first Article to examine critically the antecedent question of how we should define legal age after one has reached adulthood. The stakes for this definition are high. Age is ubiquitous in the legal landscape, appearing in the Constitution, antidiscrimination statutes, criminal laws, and public benefits programs. This Article normatively assesses the chronological, biological, and subjective conceptions of age, examining how well they improve the accuracy of the legal system, impact administrative costs, promote autonomy interests, and further antisubordination goals. It then charts three potential paths forward for legal age: abolishing age as a meaningful legal category for adults, particularizing the definition of legal age based on context, and reforming the chronological status quo through the calibration of existing age-based law

A System for Interactive Assessment and Management in Palliative Care

The availability of psychometrically sound and clinically relevant screening, diagnosis, and outcome evaluation tools is essential to high-quality palliative care assessment and management. Such data will enable us to improve patient evaluations, prognoses, and treatment selections, and to increase patient satisfaction and quality of life. To accomplish these goals, medical care needs more precise, efficient, and comprehensive tools for data acquisition, analysis, interpretation, and management. We describe a system for interactive assessment and management in palliative care (SIAM-PC), which is patient centered, model driven, database derived, evidence based, and technology assisted. The SIAM-PC is designed to reliably measure the multiple dimensions of patients’ needs for palliative care, and then to provide information to clinicians, patients, and the patients’ families to achieve optimal patient care, while improving our capacity for doing palliative care research. This system is innovative in its application of the state-of-the-science approaches, such as item response theory and computerized adaptive testing, to many of the significant clinical problems related to palliative care

The Business of Employing People with Disabilities: Four Case Studies

This exploratory study examines employer attitudes towards people with disabilities in the labor market. Through in-depth, semi-structured interviews with senior management, human resources staff, directors of diversity, and hiring managers at four corporations, it pinpoints reasons why businesses chose to hire people with disabilities, investigates the perceived benefits and barriers to hiring people with disabilities, and identifies strategies for successfully hiring and retaining workers with disabilities. It fills a gap in examining the attitudes and decision-making processes of U.S. companies that have been leaders in hiring people with disabilities, as well as delving into the special issues of small businesses that may lack exposure to disability employment. It closes with directions for future studies that could extend our understanding of employment of people with disabilities

The Price of Palliative Care: Towards a Complete Accounting of Costs and Benefits

The costs and benefits of hospice and palliative care have recently received attention for many compelling reasons. First, the cost of medical care over a lifetime is largely expended near the end-of-life. The impending demographic bulge of aging baby boomers will only heighten concerns about costs. Second, hospice and palliative care have been offered as potential vehicles for reducing late-in-life spending. Third, palliative care has gained legitimacy as a distinct medical specialty, having as it does a characteristic philosophy, specialized skill sets, and specific service delivery needs. This philosophy of care is consistent with and, to some degree, builds on the philosophy of care that geriatrics also promotes. In this article, currently accepted standards for cost-benefit analysis of health care interventions are outlined, and a framework to evaluate palliative care within these standards is provided. Recent publications on the economic implications of palliative care are reviewed, which are only the ‘‘tip of the iceberg’’ of the potential costs and benefits. Using this framework, the authors offer guidelines for performing comprehensive cost-benefit analyses of palliative care and conclude that many of the issues beneath the surface may be substantial and deserving of closer scrutiny. Methods for gathering relevant cost-benefit information are detailed, along with potential obstacles to implementation. This approach is applicable to palliative care in general, including palliative care for elders