Public Health Law Midterm

John Snow

London had a cholera outbreak and people first thought it was caused by “bad air”

Snow got a list of the people who had died from cholera and looked at where they lived

He found that they all lived around a specific pump

People who did not drink from the pumps were not getting sick

When they took the handle off the pump, the cholera outbreak ended

This laid the foundation for modern day epidemiology

Primary Prevention

stop diseases from happening in the first place

Secondary Prevention

detect and treat diseases when symptoms are manageable and less dangerous

Tertiary Prevention

focus on managing existing diseases and minimizing their complications

Statutes and Ordinances

The express intent of legal branches

They provide agencies authority to make and oversee regulations

Regulations

Agency-made rules that implement the letter and intent of statutes

Prescribe the standards that people must follow in otder to be lawful

Often more technical and detailed than statutes

Executive Orders

Issued by the president and directs the actions of federal agencies

Can spring from emergency powers and extend beyond the government to the people

Case Law

Made by the courts interpreting the Constitution when ruling on disputes

Legal Etiology

The study of legal practices that cause disease and injury

Legal Prevention and Control

Legal practices serving as interventions for disease

Policy Surveillance

tracking of policies that are important to health

Law Making Process

Law Making → Laws/Interventions → Legal Practices → Changes in Environment and Behavior → Population Health

Bioethics

Ethical issues brought by biomedical advancements

Clinical Ethics

Ethical issues in clinical practice

Research Ethics

Protection of research subjects and scientific integrity

Public Health Ethics

Practical decision making to support mandate

Stepwise Procedure

Analyze, Evaluate, and Justify

Belmont Principles

Autonomy, Beneficence & Non-Maleficence, and Justice

Autonomy

Informed consent and privacy protection

Protect those with diminished autonomy

Beneficence

Maximize benefit and minimize harm

Justice

Equal access

Fair distribution of burdens and benefits

HIPAA

Health Insurance Portability and Accountability Act

Protects patient health information while allowing for the flow of information when needed for ensuring the quality of care

What information does HIPAA apply to?

Protected Health Information and Individually Identifiable Health Information

Exceptions for HIPAA

Treatment, Payment, Operations

Legal Epidemiology

The scientific study and deployment of law as a factor in the cause, distribution, and prevention of disease

Legal Mapping

a process for capturing important features of laws and for identifying how they vary across jurisdictions

Aims to translate the qualitative legal data into something more quantifiable

10th Amendment

Reserves power that was not given to the federal government to the states

Enumerated Powers

Tax Power

Spending Power

Commerce Power

War Power

Supremacy Clause

The Constitution is the supreme law of the land

Preemption

When the law of a higher level of government invalidates the law of a lower level of government (Federal > State > Local)

Ceiling Preemption

When a lower level of government is prevented from passing or enforcing any laws or regulations for an area

Floor Preemption

When a lower level of government can regulate some parts of an issue, even when a higher level already has a law in that area

Express Preemption

when a federal or state government expressly says that it would preempt a lower level government’s law

Implied Preemption

when a federal or state government does not explicitly say that it preempts a lower level law, leaving the interpretation up to the courts

Field Preemption

when a higher law is so comprehensive that there is no “space” for the lower level law to regulate that activity

It is implied that the higher law would occupy that field

Conflict Preemption

when it is impossible to comply with both standards, causing the lower law to fall

Vacuum or Null Preemption

when legislators chose not to enact regulations in a particular field but then forbids lower levels of government from doing so

leaves gaps where states can’t regulate

Punitive Preemption

higher laws not only preempt lower laws, but also punish local governments that try to enact or enforce preempted laws

Police Powers

Implied powers that the states get, not explicitly mentioned in the Constitution

• Promote the public health and general well-being of the community

• Enact and enforce laws for general welfare 

• Regulate private rights in the public interest

• Protect the rights of one person from violation by another person

Jacobson v Massachusetts

Smallpox outbreak, Cambridge government passed an ordinance that required everyone to get vaccinated or pay a fine

4 people refused and then appealed their case up to the Supreme Court

Their case hinged on the 14th Amendment’s guarantee of due process protections and its limits on the power of the state

The Supreme Court sided with the state → the law was within the power of the state

This authority is to be referred to as a police power

Police power must be held to protect the public health

Government has the authority to choose the means by which the state can protect itself

4 standards for Constitutional Limits on Police Power

Necessity: measures must be necessary to address the health threat

Reasonable Means: measures must have a reasonable relationship to the goal

Proportionality: the burden of measures shouldn’t exceed the benefit

Harm Avoidance: measures should not cause harm

4 Steps for Ethics

1. Application: Use of ethical principles to guide decision making when facing practical problems in public health

2. Content: Ethical principles, (rules, norms, and values) relevant to the practice of public health

3. Stepwise procedure: Orderly process of identifying, analyzing and addressing ethical issues and challenges in public health

4. Standard practice: Commitment to ‘upstream’ ethics, i.e., to bake ethics into public health’s DNA so that an ethics-in-all-policies approach becomes integral to public health practice

14th Amendment

Put express limits on states to not infringe upon individual rights

Home Rule

state laws that gives local governments the autonomy to govern themselves

Dillon’s Rule

local governments have only those powers that are explicitly granted or implied from a specific grant of authority

Local governments have limited authority and can only do what states let them do

Due Process

places limitations on how the government can act on the people within its jurisdiction

5th Amendment

protects citizens from self-incrimination, guarantees due process, and protects property rights

only applied to the federal government

Modern Req. for Procedural Due Process

a notice of a hearing before an impartial tribunal

Procedural Due Process

did the government follow fair procedures when taking away rights?

Substantive Due Process

is the government’s reason for taking away rights justified and constitutional?

Focuses on the underlying rights that are being protected by the procedural requirements