Access to Health Care in Texas: A Patient-Centered Perspective

Access to health coverage in Texas is, and continues to be, an urgent policy issue. This article provides an overview and evaluation of the primary state- or local-based and private financial means through which Texans gain access to health care, and offers suggestions to the Texas Legislature to help improve coverage access

The 25th Anniversary of the Baby Doe Rules: Perspectives from the Fields of Law, Health Care, Ethics, and Disability Policy

A highly publicized and controversial case involving the withholding of medical treatment from a “Baby Doe” with Down syndrome gave rise in 1984 to the federal law known as the Baby Doe Rules, which went into effect the following year. The law conditions the grant of federal funds for any state’s child protective services program on the state’s assurance that it can respond to reports of medical neglect, which may include the withholding of medical treatment from disabled infants with life-threatening conditions. Leading scholars and practitioners from the fields of health care, law, ethics, and disability policy who are experts in the field of neonatal medicine and decision-making involving very premature and other medically at-risk infants gathered to provide thoughtful commentary and debate on the occasion of the 25th Anniversary of the Baby Doe Rules. The Georgia State University Law Review will publish a symposium volume on the topic in Fall 2009

The 25th Anniversary of the Baby Doe Rules: Perspectives from the Fields of Law, Health Care, Ethics, and Disability Policy

A highly publicized and controversial case involving the withholding of medical treatment from a “Baby Doe” with Down syndrome gave rise in 1984 to the federal law known as the Baby Doe Rules, which went into effect the following year. The law conditions the grant of federal funds for any state’s child protective services program on the state’s assurance that it can respond to reports of medical neglect, which may include the withholding of medical treatment from disabled infants with life-threatening conditions. Leading scholars and practitioners from the fields of health care, law, ethics, and disability policy who are experts in the field of neonatal medicine and decision-making involving very premature and other medically at-risk infants gathered to provide thoughtful commentary and debate on the occasion of the 25th Anniversary of the Baby Doe Rules. The Georgia State University Law Review will publish a symposium volume on the topic in Fall 2009

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Privacy, Confidentiality, and Autonomy in Psychotherapy

I. Introduction II. The Concepts of Privacy and Confidentiality ... A. Background and Overview ... B. Privacy ... 1. Law ... 2. Economics ... 3. Anthropology ... 4. Philosophy ... 5. Psychology ... 6. Summary: Core Concepts of Privacy ... C. Confidentiality III. Privacy and Confidentiality in Law ... A. Constitutional Law ... B. Tort Law ... C. Privilege Law ... 1. In Re Lifschutz ... 2. Caesar v. Mountanos ... 3. Tarasoff v. Regents of the University of California IV. Privacy and Confidentiality in Psychotherapists\u27 Professional Ethics Codes ... A. Overview of Ethics Codes ... B. Form and Content of Confidential Information ... C. Occasions for Disclosure ... D. Consent and Notice of Limitations of Confidentiality ... E. Summary V. Privacy and Confidentiality in the Therapeutic Relationship ... A. Psychotherapy ... B. The Psychodynamics of Privacy and Confidentiality in Psychoanalysis VI. Conclusio

Oral History of William "Bill" J. Winslade

This interview with William “Bill” J. Winslade, PhD, JD, PhD, was conducted by Suzanne Snider on March 28 and March 29, 2023 in Friendswood, Texas as part of Moral Histories: Voices and Stories from the Founding Figures of Bioethics, an oral history project of the Johns Hopkins Berman Institute of Bioethics. Prof. Winslade was born in 1941. He is the James Wade Rockwell Professor of Philosophy of Medicine at the Institute for Bioethics and Health Humanities, University of Texas Medical Branch at Galveston; Distinguished Visiting Professor of Law and Associate Director for Graduate Programs, Health, Law, and Policy Institute at the University of Houston Law Center; and an elected Fellow of The Hastings Center. His areas of expertise include psychodynamics of medical practice, traumatic brain injuries, bioethics and the law, and clinical ethics.On Day 1, Prof. Winslade speaks about his childhood in Illinois and his undergraduate career at Monmouth College, where he completed a double major in philosophy and economics. He describes his transition to the philosophy department at Northwestern University, where he received his PhD in 1967. Prof. Winslade discusses how the interdisciplinary approach and connections to international visitors he experienced enriched his education. Prof. Winslade mentions his experience teaching philosophy at University of Maryland in the late 1960s before enrolling at UCLA School of Law. He narrates an early childhood brain injury and explores this as inspiration for his eventual research focus on traumatic brain injuries later in his career. Prof. Winslade states his position in favor of patient autonomy as an ethics consultant and in the context of end-of-life decisions particularly. During his time at UCLA, Prof. Winslade discovered his commitment to psychodynamics and pursued his PhD in psychoanalysis, which he completed in 1984.Prof. Winslade recounts his collaboration with Albert Jonsen and Mark Siegler on the book Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine (1982). He understands this book as a practical complementary guide to Tom L. Beauchamp and James F. Childress’ Principles of Biomedical Ethics, which Prof. Winslade describes as more theoretical. Prof. Winslade explains the four box method for assessing clinical ethics issues. Prof. Winslade discusses his move from UCLA to the University of Texas Medical Branch (UTMB) in Galveston, Texas, which allowed him to work within one department dedicated to bioethics rather than across many as had been the case at UCLA. Prof. Winslade offers a definition of bioethics. He narrates his professional and personal relationship to Dax Cowart, a burn survivor whose case raised questions about individual decision making and the right to die. Prof. Winslade briefly describes his experience with teaching.On Day 2, Prof. Winslade returns to traumatic brain injuries, mentioning a case which inspired him to write his book The Insanity Plea: The Uses and Abuses of the Insanity Defense (1983). He discusses the case of Dennis Thorpe, a 70-year old man who refused physician’s recommendations to amputate his gangrenous foot. Thorpe only accepted this treatment once the judge ruled the amputation as necessary; Prof. Winslade shares his reflections on this outcome as a lesson in the influence of authority and trust.Prof. Winslade shares his personal views against boxing and his professional ambivalence towards boxing as a sanctioned sport; he subsequently addresses ambivalence as a valid stance on ethical issues. He talks about three patients he treated as a practicing psychoanalyst at UCLA whose recovery from grief inspired his current project that centers on Freud’s Mourning and Melancholia.Prof. Winslade emphasizes the importance of psychoanalytic education in medical school. He mentions his consultation work for legislators in relation to a law that would allow voluntary castration for sex offenders in Texas, and describes his relationships with three people who were castrated under this law as well as their outcomes. Prof. Winslade distinguishes his role as a consultant during his time on the ethics consultation services at UTMB and UCLA as a facilitator to support patients’ own decisions, rather than a decision-maker. Prof. Winslade briefly discusses the ethics of working as a consultant for private companies, his work with the Children’s Organ Transplant Association, and privacy and confidentiality in psychoanalysis. Prof. Winslade concludes the interview by acknowledging the involvement of clinical ethics consultants in bioethics conversations.This interview may be of interest to those wishing to learn more about the field of bioethics; clinical ethics; regional histories of bioethics (Texas); bioethics, law, and psychoanalysis; work in prisons; and traumatic brain injury