Legal Landscape Affects Practice of Medicine
|Feinberg School faculty member Katie Watson, JD, discusses recent U.S. Supreme Court cases of special interest to physicians.|
Katherine (Katie) L. Watson, JD, lecturer in the Medical Humanities & Bioethics Program at Northwestern University’s Feinberg School of Medicine, says the legal landscape affecting the practice of medicine is changing in ways most citizens may not recognize. In a recent presentation called “Life, Death, Drugs, and Politics: Two Years of the Expanding Federal Role in the Regulation of Medicine,” she briefly described relevant recent pieces of legislation and three key U.S. Supreme Court cases. These laws and case rulings and the current administration’s conservative policies are shaping the legal environment, she said.
The first event Dr. Watson cited was President Bush signing a bill passed by Congress on March 21, 2005, allowing federal intervention in the Terry Schiavo case. This famous case involved end-of-life issues in which the wishes of Schiavo’s parents differed from those of her husband. The federal courts ultimately confirmed the decision of the Florida state courts, but allowing any federal court interference in that type of state court decision represented a unique federal intervention.
On April 22, 2005, the Department of Health and Human Services issued a memo announcing what it called “proactive enforcement” of the Born-Alive Infants Protection Act of 2002. Until then, federal enforcement had been lacking.
Two Supreme Court cases, Gonzales versus Raich, decided on June 6, 2005, and Gonzales versus Oregon, decided on January 17, 2006, litigated the limits of the federal government’s ability to essentially overturn state laws about physician prescribing. In the Raich case, the Supreme Court allowed federal policy to trump California’s approval of medical marijuana, but in the Oregon case, it rejected the Attorney General’s attempt to punish physicians who followed Oregon’s law regarding prescribing for physician-assisted suicide.
The most recent case Dr. Watson described was Gonzales versus Carhart, decided on April 18, 2007. In a 5-4 decision, the Supreme Court reversed its course on abortion, upholding the federal Partial-Birth Abortion Ban Act by a single vote. Watson described this act as the first law that the court has found constitutional banning a type of abortion on moral grounds. The banned procedure, known medically as intact dilation and extraction, involves removing an intact fetus from the patient’s uterus, as opposed to the more common dismemberment technique. When enacted, members of Congress stated that this procedure too closely resembled infanticide. This vote shifted emphasis toward fetal life and away from medical judgments about women’s health because, unlike all previous abortion jurisprudence, the ban was upheld without a health exception.
More changes in Supreme Court rulings are projected due to the retirement of Justice Sandra Day O’Connor last year. Samuel A. Alito took her seat. Anthony M. Kennedy, called “the new swing justice,” wrote the decision in Gonzales versus Carhart.
After her presentation, Dr. Watson facilitated a discussion among the physician audience members, who clamored for more time. Several avidly volunteered their own medical practice experiences and insights. For instance, Lee Smith Jr., MD ’51, of North Manchester, Indiana, spoke about hospice care and terminal treatment as it is practiced in his state. William J. Frable, MD ’59, of Richmond, Virginia, talked about community standards versus state and federal standards as they relate to end-of-life care. James J. Hansen, MD ’67, of Spearfish, South Dakota, asked about the relevance of the U.S. Constitution, which delegates to states all powers not specifically granted to the federal government. Attendees stayed after the presentation to continue their lively debates, clearly interested in the future implications of federal involvement in medical practice.