Whose Patient Am I, Anyway? How New Economic Threats to Continuity of Care Can Undermine the Doctor / Patient Relationship

New structures for the financing and delivery of health care and serious efforts to control costs all create tensions in the relationship between doctors and patients and heighten the need for clarification of that relationship. We all want to maintain the traditional sense of a personal, caring, trusting relationship between doctor and patient. However, economic incursions into that relationship threaten to make it a thing of the past. This paper explores these issues

Pesticide Toxicity, Human Subjects, and the Environmental Protection Agency\u27s Dilemma

Should humans be used as subjects in research designed to determine the toxicity of pesticides? If so, under what conditions should they be used? If not, why not, given that human subject testing is common in research studies designed to determine the safety and efficacy of drugs? Should the EPA seek, or even accept, the results of such research in formulating the evidentiary base it uses in making decisions about pesticide registration? This article does not propose to answer these questions, but to illuminate the process by which they are addressed and offer some suggestions about how other such questions might be addressed in the future

At the End of Life

The reflections of a philosopher who spent a summer as an observer in a major teaching hospital

Is Law the Prescription That Can Cure Medicine?

Now medical care has been transformed. We recognize that the human organism is a complex interaction of many different systems-respiratory, circulatory, neurological, digestive, and so on. Some of them can fail and create both problems and opportunities we did not formerly have. One of the opportunities we now have is that we can keep people alive who in an earlier era would not have survived. And one of the problems we now have is also that we can keep people alive who in an earlier era would not have survived. Some of them are kept alive with such diminished capacity that we are not sure that on the balance it is what we ought to do. Indeed, often we have the capacity to keep people alive who are sure themselves that it does them no benefit. That one possibility transforms the relationship between physicians and patients. Instead of patients hoping that medical intervention can do for them some part of what they want, patients now confront the question, How much of what doctors can do do I want done? That is a new kind of question, and it has changed the distribution of decisional authority. Some cases of physicians wanting to do more than the patients want done have even lead to litigation

How Many Times Do I Have to Tell You?!: EPA\u27s Ongoing Struggle with Data from Third-Party Pesticide Toxicity Studies Using Human Subjects

This article addresses EPA\u27s current and historic policy struggle regarding the position the Agency should take with respect to pesticide toxicity studies done by third parties in their attempts to register pesticides. Chemical companies often conduct these studies, or seek third-parties to do so, and submit the results to EPA in support of applications for pesticide registration. Although EPA had a high level joint Science Advisory Board/FIFRA Science Advisory Panel make recommendations to it on this subject in 1999, last year EPA asked the National Academy of Sciences to conduct additional, almost certainly duplicative review. Specifically, EPA has asked the NAS to review the complex scientific and ethical issues posed by EPA\u27s possible use of third-party studies which intentionally dose human subjects with toxicants to identify or quantify their effects, essentially the same charge the EPA issued to the 1999 panel

If Your Grandfather Could Pollute, So Can You: Environmental Grandfather Clauses and Their Role in Environmental Inequality

When this country was struggling over voting rights, it adopted what are now called grandfather clauses to exclude certain groups from the democratic process. Although various types of laws excluded people from voting, a man could vote if his grandfather had been allowed to vote. [FN3] Applied to modern environmental laws, a grandfather clause, in essence, says, if your grandfather could pollute, so can you. In the environmental arena, these laws make it much easier for companies or municipalities to expand older, existing facilities than to create new ones. They also make it significantly more difficult for opponents to shut down an existing facility than to block the siting or construction of a new one. But most troubling for the environmental justice movement, which in part seeks to distribute environmental risk more equitably, grandfather clauses make it difficult to reduce the risk presented by polluting facilities currently located in low-income minority communities. This Article examines the language and operation of specific provisions that amount to grandfather clauses in the Resource Conservation and Recovery Act (RCRA), the Clean Air Act, land use and zoning law, and certain state provisions. It illustrates how each of these systems of environmental regulation allows older polluting facilities to remain in operation, subject to less stringent regulation than is applicable to new facilities, thereby inflicting greater amounts of pollution on the neighborhoods in which they are located. This Article discusses the reasons lawmakers use grandfather clauses both in general and in environmental laws. It discusses the role of fairness in arguments for the creation of grandfather clauses, and in arguments for reducing or eliminating the benefits and protections they confer on older sources of pollution. Finally, it proposes some suggestions for eliminating grandfather clauses, or reducing or amortizing grandfathered benefits. This Article demonstrates that eliminating or reducing grandfathered protectionism can lead to the cleaning up or shutting down of polluting facilities, and potential environmental improvement for communities

One Piece of the Puzzle: Why State Brownfields Programs Can\u27t Lure Businesses to the Urban Cores without Finding the Missing Pieces

U.S. EPA, state legislatures, and state administrative agencies have invested considerable time and money resources to encouraging urban renewal through the redevelopment of contaminated urban properties, called brownfields. These efforts attempt to induce businesses to clean and redevelop brownfields by reducing the numerous environmental barriers to redevelopment, such as the enormous cost of clean-up and threat of immeasurable liability. In this Article, I argue that environmental barriers to redevelopment, although important, are but one piece of a complicated urban redevelopment puzzle. The other pieces, largely missing from existing efforts to encourage redevelopment of brownfields are non-environmental factors, such as size and location of candidate sites, infrastructure issues, and the relative obsolescence of existing structures. These non-environmental factors influence businesses\u27 decision-making and operate as important barriers to redevelopment. Because existing brownfields redevelopment programs fail to focus on these missing pieces, they cannot succeed substantially in encouraging urban renewal