This is an introductory course in public health law and ethics. While a goal of government is to protect and support the health of the public, implementation of health policies may infringe on the rights and liberties of individuals, including businesses. This conflict is sometimes characterized as “private interest versus public good.” This course explores the inherent tension between promoting public health and protecting the legal and ethical rights and interests of individuals. The course focuses on the legal foundations of the American public health system and resulting ethical dilemmas that must be reconciled when the interests of the larger community may be at odds with those of individuals. This course examines key elements of the U.S. legal system that govern and influence public health, including the U.S. Constitution, federal and state laws, administrative law and judicial decisions.
Course Outcomes
Each week, you will have discussions related to public health cases.
Each student is expected to post at least three times (one initial post, and two peer responses) each week in response to forum questions on that week’s topic. Because this is an online course, the online discussion portion is an important way to exchange ideas with your classmates. Students will be graded on their participation and effort of their posts. Please be familiar with the course material (readings/lectures) before posting each week.
Your grade in this course will be determined by the following criteria:
Assignment | Points |
---|---|
8 Discussions (5 points each) | 40 points |
4 Written Assignments (15 points each) | 60 points |
Total | 100 points |
After reading DeShaney (1989) and the 2013 Georgetown Law Review article by Bahrenburg, write an initial post identifying at least two (2) pros and two (2) cons of legal holdings that individuals are not entitled to constitutional protection against harm occasioned by private persons, even when some state action is involved. Also identify two (2) specific public health-related reasons why constitutional protections should be extended and two reasons why they should not, using specific public health examples. Explain your reasoning, incorporating information from the course readings.
Respond to two (2) of your peers. Identify specific examples that either support one or more of their positions or rebut them. Remember, legal skill requires understanding and sometimes advocating for either side of an issue! Be specific in your responses.
Find three (3) recent (within 3 years) examples of federal regulatory action- relating in some way to public health – that exhibit the kind of paternalism described by Professors Sunstein and Thaler (pg. 252 et seq in your text). For each example, explain how the regulation requirement(s) “nudge” individuals or populations or corporations toward better behavior, better health, or a better outcome for oneself or others. For each of your 3 examples, provide a full explanation of the agency involved, the regulatory requirement, and how it operates as a paternalistic ‘nudge’. You can get ideas from reliable, credible, unbiased news sources (e.g. Kaiser Health News, NPR) or from non-partisan think tank organizations (e.g. Urban Institute, The Rand Corporation, Kaiser Family Foundation).
Respond to two (2) of your peers. For one or more of the examples provided, can you identify any more effective ways that the agency might achieve the “nudge” toward the desired policy outcome? Are there any populations or communities for which the policy action nudge might be ineffective or counter-productive? If so, explain your views and support them with references to credible, reliable sources.
Additional reading for assignment: FF v. State of NY, 65 Misc 3d 616 (2019)
Jacobson v. Massachusetts (pg. 146 in your text) is the seminal case on the state or local government’s power to regulate to protect the health of the public. Write a summary of the facts and the legal holding in that case (a template will be provided) and, using the Jacobson court’s language, write a 1200-1500 word paper explaining how the principles outlined in Jacobson are (or are not) relevant in the current cases on non-medical vaccination exemptions, including the case in the assigned reading, FF v. State of NY.
The Daubert v. Merrell Dow Pharmaceuticals case (pg. 282-285 in your text) highlights the issue of the extent of scientific knowledge that can be used as evidence to demonstrate the defendant’s knowledge of health risks. Write an initial post discussing comparisons between, for instance, the evidence (or lack thereof) of vaping health risks (now that we have over 30 deaths and rising) with that of opioid misuse health risks? How much scientific evidence should be necessary for legal liability? Consider the teachings of Jacobson in your posts. What about the Juul litigation? See Vaping Giant Juul Settles Lawsuit, Will Not Market To Teens And Children or antimicrobial resistance resulting from antibiotic overuse in humans and livestock?
Respond to two (2) of your peers. Do you agree or disagree with their assessment of the state of scientific evidence on the health issues they discussed, or the level of evidence that does or should support limits on individual or organizational behavior or trigger legal liability? Why or why not? Be sure to fully explain your position using legal principles from the course readings.
Closely read Professor Mariner’s essay (text, pgs. 379-384) and listen to this NPR story on big data from health apps
Using (and referencing!) what you have learned about civil and criminal legal proceedings, and reflecting on Prof. Mariner’s essay, discuss the pros and cons of third parties (e.g. health systems, insurers, internet providers) being required to turn over patient data. Consider and apply the concepts of necessity and proportionality. Should we be more concerned about our own privacy or more focused on the larger benefits of using big data for public health purposes? Why or why not? In your post, include a discussion of the pros and cons of our current lack of government regulation of the use of health data by Big Tech (refer to N. Terry’s essay on pgs 388-392 of the text).
Respond to two (2) of your peers. Which of their pro/con arguments most resonate with you and why (be specific)? What is your view about whether a third party’s obligation to surrender your health data to the government amounts to a “seizure” under the Fourth Amendment? As a patient, could you protect yourself and still access care? How or how not?
Additional reading for this assignment:
JAMA (2019) The Opioid Crisis and Corporate Responsibility
Read the attached article and review the content in Chapter 7. Write a 1200-1500 word paper discussing the primary lessons from major litigation on public health issues. Address the benefits and potential limitations or risks of litigation against manufacturers, distributors, and/or service providers. Consider who are the stewards of the public’s interests. Who should the beneficiaries be and how can court orders or court-approved settlements protect the interests of the public and address the harms suffered by individual people (e.g. sick people, families of people who have died)? You should consider these issues as they relate to public health threats beyond the opioid crisis (e.g. harm from environmental contamination, unsafe products).
Learning Outcomes
The regulation of commercial speech by governments and the extent of protection afforded commercial entities is still an evolving area of the law. Using specific language in the court rulings on tobacco warnings, alcohol price advertising, salt and sugar warnings, and the discussion on marijuana advertising discussed in the Lewis & Clark Law Review article, compare the relative harms to the public (resulting from allowing unregulated speech) and the harm to commercial entities (resulting from restrictions on speech). Be sure to consider the impact on economic activity — which is also a driver of wellbeing (i.e. jobs and income are social determinants of health).
Respond to two (2) of your peers. Comment on your peers’ analyses; have they considered all the angles? Do you agree or disagree with their analyses and why or why not? Be specific and cite specifics from the relevant court opinions we have read.
People with special needs are particularly vulnerable during emergencies when there is no electricity, internet access, and when the availability of home care services is likely to be disrupted. Review this policy statement from the American Academy of Nursing. Identify and discuss the competing rights and responsibilities, including those of governments (federal, state, and local), those of the provider organizations, and those of the residents and family members. What are the most critical legal issues, and how can they be balanced with the economic issues faced by nursing homes and assisted living facilities? After 12 nursing home residents died during Hurricane Irma in 2017, former Florida Governor, Rick Scott, issued an Emergency Order after, requiring nursing homes to have back-up power. This was met with industry resistance (and litigation) and, in 2019, many nursing homes remain non-compliant.
Respond to two (2) of your peers. What can you add to both sides of this argument — the government (public health) side, and the industry side? How would you convince nursing home owners that compliance is the “right” thing? Should there be government subsidies or other support? If so, what and why?
Additional reading for Assignment (and re-read pgs 392-406 of text):
Hodge, J., et al (2017) Top Takeaways from the Common Rule Amendments
This written assignment is in two (2) parts, reflecting two of the substantive changes to The Common Rule in 2017 governing human subjects research.
Part 1 (+/- 750 words) – In your own words, explain why the US Dept. of Health and Human Services (Office for Human Research Protections) differentiated public health research and public health practice. Discuss the pros and cons and the risks and benefits of the prior and current rule on this issue.
Part 2 (+/- 750 words) – Given the current state of genetic science, discuss the constitutional privacy considerations at issue in the use of biospecimens. Explain the reason for The Common Rule change on this issue in the context of legal principles of privacy. What are the benefits to patients and what are the burdens on public health surveillance? Use examples other than the newborn screening statutes from the text (pg 400).
Closely read Sheila Foster’s account of the environmental affronts to the residents of Chester, Pennsylvania (text pgs 593-600) and apply the concepts of a relational perspective of public health ethics discussed in the Baylis article. How did local relationships (including the state and local political context) impact the initial success, but later failure of the CRCQL’s resistance efforts? If “social justice is concerned with fair access to social goods such as rights, opportunities, power and self-respect” (Baylis, pg 203), in what ways were the residents of Chester granted or denied access to these social goods?
Respond to two (2) of your peers. What can you add to their analyses? What are the strengths and/or weaknesses of their discussion points? Do you agree with their application of the social justice concept in this public health context? Why or why not? Be specific.
Since this is a short week, use the discussion forum this week to discuss the issues in the Week 8 written assignment. Debate with one another based on public health ethics principles outlined in the text and accompanying readings. For instance, you might ask one another: How can older people provide input into health care organization policies? How can they be more empowered to advocate for their health and wellbeing? How should public health and health care organizations better attend to the dignity and diversity of older patients? How can we achieve reduced levels of paternalism and protectionist attitudes toward older patients and provide more decision-making autonomy and self-determination? How can public health professionals contribute to creating a less-ageist society?
Respond to two (2) peers. Use the response posts as an opportunity to deepen your analysis of the case questions.
Additional reading for assignment:
Review Case 11b in Coughlin Chapter 11. Write a 1200-1500 word paper that answers the questions at the end of the case. Be sure that your paper is organized according to the case questions and you integrate the concepts from the course content readings and from the Coughlin chapter and the Marckmann paper. These concepts include such issues as autonomy in decision-making, public perception of risk, and impact on equity (this is not the full list!).
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Questions? Visit the Student Support Public Health page
UNE's Student Academic Success Center (SASC) offers a range of free online services to support your academic achievement. Writing support, ESOL support, study strategy and learning style consultations, as well as downloadable resources, are available to all matriculating students. The SASC also offers tutoring for GPH 712 Epidemiology, GPH 716 Biostatistics, GPH 717 Applied Epidemiology, GPH 718 Biostatistics II, and GPH 719 Research Methods. To make an appointment for any of these services, go to une.tutortrac.com. For more information and to view and download writing and studying resources, please visit:
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The American Medical Association Manual (AMA) of Style, 11th edition is the required writing format for this course. Additional support for academic writing and AMA format is provided throughout the coursework as well as at the UNE Portal for Online Students.
Online resources: AMA Style Guide
The College of Professional Studies uses Turnitin to help deter plagiarism and to foster the proper attribution of sources. Turnitin provides comparative reports for submitted assignments that reflect similarities in other written works. This can include, but is not limited to, previously submitted assignments, internet articles, research journals, and academic databases.
Make sure to cite your sources appropriately as well as use your own words in synthesizing information from published literature. Webinars and workshops, included early in your coursework, will help guide best practices in APA citation and academic writing.
You can learn more about Turnitin in the guide on how to navigate your Similarity Report.
Please review the technical requirements for UNE Online Graduate Programs: Technical Requirements
Course surveys are one of the most important tools that University of New England uses for evaluating the quality of your education, and for providing meaningful feedback to instructors on their teaching. In order to assure that the feedback is both comprehensive and precise, we need to receive it from each student for each course. Evaluation access is distributed via UNE email at the beginning of the last week of the course.
Students are responsible for submitting work by the date indicated in Brightspace.
Quizzes and Tests: Quizzes and tests must be completed by the due date. They will not be accepted after the due date.
Assignments: Unless otherwise specified, assignments will be accepted up to 3 days late; however, there is a 10% grade reduction (from the total points) for the late submission. After three days the assignment will not be accepted.
Discussion posts: If the initial post is submitted late, but still within the discussion board week, there will be a 10% grade reduction from the total discussion grade (e.g., a 3 point discussion will be reduced by 0.3 points). Any posts submitted after the end of the Discussion Board week will not be graded.
Please make every effort ahead of time to contact your instructor and your student support specialist if you are not able to meet an assignment deadline. Arrangements for extenuating circumstances may be considered by faculty.
The policies contained within this document apply to all students in the College of Graduate and Professional Studies. It is each student's responsibility to know the contents of this handbook.
Please contact your student support specialist if you are considering dropping or withdrawing from a course. The last day to drop for 100% tuition refund is the 2nd day of the course. Financial Aid charges may still apply. Students using Financial Aid should contact the Financial Aid Office prior to withdrawing from a course.
The University of New England values academic integrity in all aspects of the educational experience. Academic dishonesty in any form undermines this standard and devalues the original contributions of others. It is the responsibility of all members of the University community to actively uphold the integrity of the academy; failure to act, for any reason, is not acceptable. For information about plagiarism and academic misconduct, please visit https://www.une.edu/studentlife/plagiarism.
Academic dishonesty includes, but is not limited to the following:
Charges of academic dishonesty will be reviewed by the Program Director. Penalties for students found responsible for violations may depend upon the seriousness and circumstances of the violation, the degree of premeditation involved, and/or the student’s previous record of violations. Appeal of a decision may be made to the Dean whose decision will be final. Student appeals will take place through the grievance process outlined in the student handbook.