American Journal of Law & Medicine最新文献

{"title":"Leveraging the Power of Federal Procurement to Increase the Employment of People with Significant Disabilities.","authors":"Chai Rachel Feldblum","doi":"10.1017/amj.2025.10092","DOIUrl":"https://doi.org/10.1017/amj.2025.10092","url":null,"abstract":"<p><p>The employment of people with disabilities lags significantly behind the employment of people without disabilities. This article addresses the traditional means for increasing the employment of people with significant disabilities, primarily through anti-discrimination law and affirmative action efforts. It then argues that another effective means for increasing such employment is to expand and modernize an existing federal program that designates certain federal procurement contracts to employers that hire a required percentage of people with significant disabilities.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"568-598"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Defense of Using Medical Practice Guidelines Defensively: A Response to Stewart and Peck.","authors":"Mark A Hall","doi":"10.1017/amj.2025.10087","DOIUrl":"https://doi.org/10.1017/amj.2025.10087","url":null,"abstract":"<p><p>The American Law Institute (ALI) recently approved its first ever Restatement of Medical Malpractice law. One Restatement subsection embraces the position that an authoritative clinical practice guideline, if admissible and sufficiently relevant, can be prima facie evidence of a provider's compliance with the standard of care. This article responds to a forceful critique of that position by two of the Restatement's advisors, who are nationally esteemed members of the plaintiff's bar. They argue that caselaw does not support this provision, that it is unsound public policy, and that the provision is unfair because it does not afford the same prima facie proof status to plaintiffs' use of practice guidelines.This article addresses each of those critiques. It starts with the observation that, at bottom, this opposition is fundamentally at odds with the primary governing principle of professional liability, namely, that professional standards have greater force in medical liability cases than do industry standards in general negligence cases. Because professional standards determine professional negligence, a relevant clinical practice guideline that speaks with authority for a relevant segment of medical professionals, if admissible, should be sufficient to support a jury finding of non-negligence for a doctor who complies.The same conclusion does not apply, however, when a plaintiff presents a single relevant guideline that a physician failed to follow, for the simple reason that it is often the case that more than one approach can reasonably apply to a given clinical situation. Also, guidelines often set ideal rather than minimal standards. Thus, this provision's differential effect is not fundamentally unfair. Instead, it flows directly from a plaintiff's burden of establishing professional negligence, much like numerous other conventional legal rules can affect opposing sides of a case differently.As accomplished advocates, it is no surprise these authors have made the strongest possible case against any enhanced legal status for defensive use of exculpatory practice guidelines. Thoughtful inspection and reflection reveal, though, that their analysis significantly misstates or over-states the Restatement's position, and so their attacks are mostly misdirected. If this Restatement's position were truly as radical or poorly considered as these authors portray, the ALI likely would not have adopted it. Nevertheless, engaging with this critique can better elucidate reasons that courts might view this Restatement provision as well-considered.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"555-567"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training by Travel: Medical Education for OB/GYN Residents after <i>Dobbs</i>.","authors":"Rachel Rebouché","doi":"10.1017/amj.2025.10086","DOIUrl":"https://doi.org/10.1017/amj.2025.10086","url":null,"abstract":"<p><p>After <i>Dobbs v. Jackson Women's Health Organization</i>, the United States Supreme Court decision that overturned <i>Roe v. Wade</i> in 2022, OB/GYN residents' access to abortion training, which is required in all accredited programs, has come under pressure. To receive the foundational training doctors in the field need, many residents in ban states travel to out-of-state programs where abortion is legal. But demand is high, travel for multiple weeks is expensive, and the capacity to train at host sites is limited.Training by travel could have ripple effects for the quality of patient care. As the number of OB/GYNs continues to decrease, newly-trained providers will have different, and arguably diminished, skills in delivering not just elective but also medically necessary abortion care. And as exceptions for life and health become how legal, procedural terminations take place in one-third of the United States, there is no guarantee that the doctors in those states will feel comfortable providing that care.This article explores the residency training provided today, providers' and institutions' navigation of abortion bans, and what changes in residency programs might mean for patient care in the coming years. Part I surveys the landscape of abortion law after <i>Dobbs</i>; even the strictest bans contemplate instances when abortion is medically required and legally permitted. Part II summarizes the pre- and post-<i>Dobbs</i> expectations for abortion training for OB/GYN residents, describing how graduate medical education has changed for residents in ban states. Part III assesses shorter and longer-term effects of a system that relies on travel and simulation (the use of models) or is out of compliance with national accreditation standards. Part IV concludes with potential paths forward that depend on state and national organizations supporting and funding the networks of health care professionals that facilitate training across the country.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"433-451"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Bench to Bedside: Governing Health Care Artificial Intelligence (AI) through a \"True Lifecycle Approach\".","authors":"Barry Solaiman","doi":"10.1017/amj.2025.10091","DOIUrl":"https://doi.org/10.1017/amj.2025.10091","url":null,"abstract":"<p><p>This paper addresses the comprehensive regulation of artificial intelligence (\"AI\") across its entire lifecycle in the health care sector. It builds on a proposal for a True Lifecycle Approach (\"TLA\") to address governance gaps across three phases of AI and expands the framework with detailed practical insights for governing health care AI, drawing on pioneering examples from Qatar, Saudi Arabia, and the United Arab Emirates (\"UAE\") as models for global implementation. Beginning with the research and development phase, it highlights the urgent need for robust guidelines and certification processes to ensure that AI technologies are developed in compliance with ethical and safety standards. Moving into the approval stage, the discussion explores how AI systems can be effectively regulated under existing medical device frameworks, emphasizing the need for tailored regulations that consider the unique challenges posed by AI. Finally, the paper delves into the deployment of AI in clinical practice, examining the gaps in current laws and the need for a coherent and consistent regulatory framework that can adapt to AI advancements. The paper argues that the existing legal structures are inadequate, often inconsistent, and fail to address the complexities of AI in health care. It argues for a broader regulatory approach focused on patient safety throughout the AI lifecycle.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"452-478"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity and Social Care in Medicaid through Community Care Hubs.","authors":"John V Jacobi","doi":"10.1017/amj.2025.10089","DOIUrl":"https://doi.org/10.1017/amj.2025.10089","url":null,"abstract":"<p><p>Medicaid serves vulnerable populations that experience deep health inequities and significant health-related social needs. In recent years, reforms to Medicaid have sought to respond to those needs, with mixed results. Value based payment methods, which in theory link payment to outcome metrics, are emerging in commercial insurance markets and can be adapted to the needs of Medicaid programs and their beneficiaries. These methods seek to tie payment for services to the forging of connections between medical and social care including housing supports and nutrition services for vulnerable populations. This paper describes the merits and some pitfalls of the attempt to turn Medicaid from its roots as a medical insurance program to a broader health insurance program. It describes the benefits of employing community care hubs - intermediaries between community-based organizations and large payers and hospital systems - as a way to spur the move to social care in Medicaid. It also addresses some of the barriers to this move, including the perceived danger of \"medicalizing\" society's failures and the apparent turn by the current federal administration away from commitment to health equity.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"517-534"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whose Burden Is It Anyway? A Comprehensive Proposal to Reshape Food Safety Review by Treating Food as Medicine.","authors":"Katya S Cronin","doi":"10.1017/amj.2025.10088","DOIUrl":"https://doi.org/10.1017/amj.2025.10088","url":null,"abstract":"<p><p>With more than sixty percent of U.S. adults struggling with at least one diet-related health condition, the relationship between nutrition and public health has never been clearer. Indeed, for the first time in over a century, food has a prominent place on the national political stage and is one of the exceedingly few issues that has garnered bipartisan support. The recent rise in popularity of \"Food Is Medicine\" initiatives, which seek to provide medically tailored or healthy meals to vulnerable populations, underscores the critical importance of food to public health. Yet, while \"Food Is Medicine\" is shifting the insurance, business, and nutritional landscape, the Food and Drug Administration (\"FDA\") - the primary regulator in charge of both food and drug safety - treats food as anything but medicine. Known and unknown food additives, color dyes categorically banned in other countries, chemicals leaching from paper and plastic, and environmental toxins and pathogens all contaminate our food and sicken children and adults alike. All the while, the FDA acts as if it were powerless to fulfill its mission of protecting the public from unsafe food.In a time when the political will to reform our food system and rid it of harmful chemicals and ingredients is high, this article offers a blueprint for how to do so in a scientifically grounded, legally consistent, and lasting manner. Starting from the basic premise that food can be medicine, the article explores ways to bring food safety review closer to the much more demanding safety process for pharmaceuticals. Part I defends the premise that food is every bit as important to human health as medicine - both for good and for ill - and posits that food safety should be regulated just as much as (even if not in identical ways to) the safety of medical drugs. Parts II and III offer a comparison between the rigors of drug safety review, albeit with its own set of problems, and the laxity and at times utter lack of food safety review. Finally, Part IV advances a comprehensive package of both legislative and regulatory reforms, all designed to shift the <i>de facto</i> burden of proving the safety of food ingredients from the overtaxed FDA and the overburdened consumers to food manufacturers.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"393-432"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking the Financialization of Healthcare.","authors":"Jacqueline Fox","doi":"10.1017/amj.2025.10090","DOIUrl":"https://doi.org/10.1017/amj.2025.10090","url":null,"abstract":"<p><p>Financialization of healthcare drains our current system of resources it needs to provide care. It occurs when money is siphoned off for private profit through mechanisms such as rent seeking, gamesmanship, and exploitative price setting. This is not an ethically neutral activity, and the people profiting in this way ought to justify why they are entitled to this money, given the foreseeable negative effects what they are doing has on people's health. This important problem is masked by current accounting methods and healthcare billing methods, which need to be changed to allow for a more transparent assessment of what is really occurring.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"535-554"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Gift That Keeps on Giving: Medicaid as a Crucible of Public Goods.","authors":"Robert I Field","doi":"10.1017/amj.2025.10085","DOIUrl":"https://doi.org/10.1017/amj.2025.10085","url":null,"abstract":"<p><p>Medicaid has been called the \"workhorse\" of the American health care system, but one would hardly see that in the tenor of political debates. The Program perennially faces political headwinds that at times build to hurricane force with proposals for dramatic structural changes and spending cuts, most recently the draconian cuts enacted by Congress in 2025. In 2024, Medicaid covered more than seventy million Americans, and another ten million were covered by its companion program, the Children's Health Insurance Program. As formidable as these numbers are, the Program's impact runs much deeper, affecting the lives of almost everyone in the United States. It serves as an essential support for the entire health care system and, in doing so, helps to sustain almost every hospital, nursing home, and a range of other providers. This support, in turn, generates population-wide benefits that can be seen as public goods on which everyone relies, whether they realize it or not, that the private sector could not provide. These include peace of mind from knowing there is access to inpatient hospital care, emergency rooms, and long-term care when needed, protection from public health threats, improved health care based on continual innovation, greater social stability, enhanced economic productivity, and reduced health inequities. As devastating as proposals to shrink Medicaid would be for millions of low-income Americans who rely on it for access to health care, these repercussions would cause hardship for almost everyone.This article explains Medicaid's role in sustaining the overall health care system, the nature of the public goods it produces in doing so, and the widespread harm that would be caused were these public goods to be diminished. By characterizing public debates in this way, the Program's supporters could reframe political discourse as a matter of universal self-interest.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 3-4","pages":"479-516"},"PeriodicalIF":0.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146206452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Corporatization as a Catalyst for Wellness Legal Partnerships.","authors":"Barbara J Zabawa","doi":"10.1017/amj.2025.10067","DOIUrl":"10.1017/amj.2025.10067","url":null,"abstract":"<p><p>The increasing presence of private equity investment in physician practices reveals that current health law practice sites such as in-house, corporate law firms, and Medical Legal Partnerships (MLPs) are ill equipped to address patient harm from health care corporatization. A new type of health law practice is needed to address the adverse impact health care corporatization is having on health care purchasers (primarily employers and patients) and physicians. I label this new health law practice the Wellness Legal Partnership (WLP), modeled after the Medical Legal Partnership (MLP). WLP lawyers can look to systems leadership theory, lawyer fiduciary duties, and health justice frameworks as guides to combat the adverse impacts of health care corporatization. WLPs would work best rooted in corporate health and wellness benefit settings, and they would improve patient wellbeing using a three-fold approach of individual advocacy, organizational change, and systemic change.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 2","pages":"252-285"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statutory Thickets and Drug Shortages: Accumulating Legislation as an Underlying Cause.","authors":"Jonathan J Darrow, Erin R Fox, Timo Minssen","doi":"10.1017/amj.2025.10065","DOIUrl":"10.1017/amj.2025.10065","url":null,"abstract":"<p><p>Over the past three decades, the U.S. health care system has experienced numerous shortages of commonly-used older medicines that are both off-patent and inexpensive. Commentators seeking to explain shortages have often pointed to manufacturing quality and low profit margins as principal causes. These proximate causes, however, do not explain why there was a sudden and dramatic increase in shortages between 2007 and 2012, when shortages almost tripled from 154 to 456, or why they have persisted at similar levels into the 2020s despite repeated efforts to address them. This Article posits that low prices and quality problems derive from underlying shifts in the market environment, and that these shifts in turn are largely the result of Congressional legislation. The role of such well-intentioned legislation over the past fifty years is evaluated, including the 1984 Hatch-Waxman Act, the 2003 Medicare Modernization Act, the 2012 Generic Drug User Fee Act, and the 2015 Bipartisan Budget Act. The analysis reveals these laws have inadvertently squeezed profitability out of the generic drug market and thereby served as a true root cause of many drug shortages. Also considered are the potential effects on drug shortages of more recent legislation, including the 2021 American Rescue Act Plan and the 2022 Inflation Reduction Act.</p>","PeriodicalId":7680,"journal":{"name":"American Journal of Law & Medicine","volume":"51 2","pages":"179-216"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"社会学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}