K. Cerminara, F. Pizzetti, Watcharin H. Photangtham
{"title":"Schiavo Revisited? The Struggle for Autonomy at the End of Life in Italy","authors":"K. Cerminara, F. Pizzetti, Watcharin H. Photangtham","doi":"10.2139/SSRN.1477957","DOIUrl":"https://doi.org/10.2139/SSRN.1477957","url":null,"abstract":"Politically strident debates surrounding end-of-life decisionmaking have surfaced once again, this time across the Atlantic in Italy. Eluana Englaro died early this year after a prolonged court fight, causing the international press to compare her case to that of Theresa Marie Schiavo, who passed away in 2005 in Florida after nearly sparking constitutional crises on both state and federal levels. In many respects, the facts of Ms. Englaro’s case are similar to Schiavo, but a close analysis of Englaro leads to the surprising conclusion that the Italian Court of Cassazione in that case actually enunciated a broader, stronger right to make end-of-life decisions than has the United States Supreme Court thus far in America. The parallels between Englaro and Schiavo have not solely been judicial, however. In a number of ways, despite the breadth of the judicial decisions in Englaro, institutional differences seem to be leading Italy down a different path in the Parliament than the United States has taken through its several legislatures. Despite the introduction of advance directive legislation in Parliament, it seems as if Italy’s path toward patients’ preserving robust end-of-life decisionmaking power even in incompetency lies not through that body in the future but through that body’s past actions. If the current proposed legislation fails, it is possible that patients and the courts can build upon the groundwork the courts have established through the Italian constitution in combination with the statutory tool of the amministratore di sostegno to secure robust patient autonomy near the end of life.","PeriodicalId":289061,"journal":{"name":"Marquette Elder's Advisor","volume":"342 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124222483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Choices for Care: Consumer Choice and State Policymaking Courage Amid Medicaid’s Shifting Entitlement to Long‐Term Care","authors":"Tracy Bach","doi":"10.2139/SSRN.1443237","DOIUrl":"https://doi.org/10.2139/SSRN.1443237","url":null,"abstract":"In Choices for Care: Consumer Choice and State Policymaking Courage Amid Medicaid’s Shifting Entitlement to Long-Term Care, Professor Bach analyzes a leading state program intended to encourage the delivery of care in the home and community, thereby avoiding admission to nursing homes. Choices for Care, Vermont’s Medicaid Demonstraion Waiver program, has clearly enabled more Vermonters to receive health care in their homes. After its first two years, it is seen as a model by other states and the federal government. But Bach questions the results. She argues that CFC is reshaping the landscape of long-term care providers, with resulting industry effects both intended, on nursing homes, and unintended, on home health agencies. Moreover, she observes that the initial success in shifting care away from institutions does not provide a clear answer to the cost trade-off between nursing home and home and community-based care. To date, Vermont has not shown that CFC has solved the overall long-term care spending problem. Likewise, the question of whether expanding home and community-based services for those on the eligibility edge successfully staves off their eventual admission to a nursing home is still an open one. Finally, the demographic question about the home care provider pool underlines the fact that the experience of CFC, as a very small state experiment, might be hard to replicate in other states. In this article, Bach puts the CFC results into the perspective of long-term health care system design.","PeriodicalId":289061,"journal":{"name":"Marquette Elder's Advisor","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116874647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Funding a Grandchild's College Education","authors":"R. Kaplan","doi":"10.2139/SSRN.285002","DOIUrl":"https://doi.org/10.2139/SSRN.285002","url":null,"abstract":"This article considers various techniques that grandparents might use in helping fund their grandchildren's college education. The techniques analyzed include outright gifts, college savings bonds (both state and federal), prepaid tuition plans, so-called section 529 college savings plans, and education IRAs. Each technique is analyzed from the following perspectives: income taxation, gift and estate taxes, control over the funds, eligibility implications for Medicaid long-term care benefits, and impact on needs-based financial aid.","PeriodicalId":289061,"journal":{"name":"Marquette Elder's Advisor","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2001-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115908381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}