Health Care Law and Ethics in a Nutshell
Authors:
Hall, Mark A. / Orentlicher, David
Edition:
4th
Copyright Date:
2020
20 chapters
have results for health care law
- These are exciting but challenging times in which to study health care law. Traditionally, the exclusive focus of health care policy was on advancing the state of medical science. Over the past generation, however, two new concerns have begun to dominate the health care policy agenda: the cost of and access to medical treatment. Limiting incessant inflation in health care spending for the bulk of the population covered by insurance and finding ways to afford health care coverage for the medically indigent are issues of paramount importance in the decisionmaking of law makers, medical practitioners, and health care institutions. These issues were brought to a head a decade ago in Congress’ enactment of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act or ACA). Over that decade, the ACA survived repeated challenges both in Congress and in the courts, yet pressing issues of medical costs and access remain acute in health care public policy, law, and ethics.
- So that the reader may acquire a deeper understanding of these new legal challenges, Chapter 1 explores the policy and economic environment that shape the agenda for contemporary health care law and ethics. Chapter 2 then looks at the areas of legal doctrine that directly affect a patient’s right to receive health care, and the structure and content of the doctor-patient relationship.
- The fundamental reorientation in perspective caused by the shift in focus from advances to restraints demands a thorough rethinking of traditional legal doctrine from the ground up. Legal precedents rooted in the expansionist medical care system of the post-war era sometimes no longer make sense in an era when the controlling public policy is to limit or allocate governmental and private health care spending. For example, perhaps malpractice law should take account of the economic costs as well as the medical risks of treatment decisions. Or perhaps antitrust, tax and corporate law should be take more account of health policy concerns in determining how medical institutions are structured and operated. In the field of bioethics, perhaps the law still has not found the right balance among patient autonomy, professional prerogative, and institutional integrity.
- THE FUNDAMENTALS OF HEALTH CARE DELIVERY AND FINANCE
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Preface 3 results
- Scholars debate whether health care law is a coherent intellectual field. Some call it a “chaotic, dysfunctional patchwork” of doctrine, whereas others believe the field coheres around the essential features of medicine and how they systematically shape and change generic law. Despite this unresolved debate, there is a good deal of consistency about the content of health care law courses taught not only in law schools, but also schools of medicine, public health, and health care administration. Typically, these courses divide into three or four distinct subject areas. Historically, “law and medicine” courses were dominated by the subject of medical malpractice and public health law. These subjects remain important, and are the topic of other books in the Nutshell series. But they no longer are the dominant focus of the field. Modern health care law courses also include two areas that developed rapidly and extensively over the past generation (or two): the corporate, regulatory, and...
- Part I of this book contains foundational chapters that are relevant to any course in health care law. It capsules the legal and policy issues of health care funding, access, and reform, and it explores the legal structure and content of the doctor-patient relationship. The dramatic growth of health care spending and efforts to contain spending lead to both innovations and tensions in the business of health care. Part II addresses the legal issues that result from these structural and economic forces. Part III moves from these “macro” issues to the ethical dilemmas that arise in individual patient decisions, and covers most of the topics addressed by law school courses in bioethics.
- Most schools teach the financial and structural issues of health care delivery in a separate course from the bioethical puzzles, often through different instructors. Other instructors are more generalists who combine elements of both these areas with the traditional medical malpractice topics into a successful overview course. To maximize our respective talents, we have divided primary authorship responsibilities along these same lines (Hall—Chapters 1–5; Orentlicher—Chapters 6–8). Also, we owe a large intellectual debt to our colleague, Ira Mark Ellman, who had primarily responsibility for the bioethics chapters in prior editions. Working together on this book has persuaded us, however, that this tripartite field of law has many common themes that can and should be integrated into a more coherent whole. To that end this book is a small step.
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Chapter 4 Antitrust Law and Health Care 43 results (showing 5 best matches)
- This chapter explores four branches of health care antitrust law; group boycott challenges to a hospital’s or HMO’s exclusion of physicians from the medical staff; the price-fixing ramifications of health insurance and provider networks; vertical restraints and monopolization charges against HMOs; and merger doctrine as applied to various health care ventures.
- The cloudy law on this question might appear to place hospitals and doctors in an intolerable dilemma: tort law forces them to review the competence of medical staff members, but antitrust law’s opaqueness regarding non-economic justifications for physician exclusions appears to make quality-of-care defenses legally risky. This appearance is misleading, however. It is patently wrong to conceive of economic motives and quality of care as mutually opposed considerations in hospital staffing decisions. Indeed, from the hospital’s perspective, the two are Indeed, for decades quality competition was virtually the sole force that drove the entire health care sector. Therefore, quality of care concerns factor directly into the procompetitive side of the rule of reason balance.
- Each of these contested issues reveals that courts are taking an active role in setting antitrust policy for the health care industry. By doing so, courts for a time were much less deferential to the FTC and DOJ than they typically are in antitrust matters. During the 1990s and 2000s, there were repeated expressions of judicial annoyance at treating health care just like any other industry, and insistence that the enforcement agencies recognize the unique attributes of health insurance and medical care rather than rely on general economic theories. More recently, however, courts have started to recognize the competitive harms that may be resulting from consolidation in the health care industry.
- The federal antitrust laws have prompted one of the most burgeoning areas of health care litigation in modern times. Prior to 1980, antitrust challenges to the health care industry were almost unheard of. It was thought that the antitrust laws did not apply to the learned professions and that health care is an inherently local activity not subject to federal jurisdiction. The Supreme Court exploded both of these myths in the mid-1970s. In
- Initially, most health care merger law focused on hospitals rather than physicians. More recently, however, consolidation in the physician market is receiving increased antitrust attention. This consolidation is occurring in two significant ways beyond merely physicians expanding the size of their practice groups. First, hospitals increasingly are purchasing physician practices, to form larger, vertically-integrated delivery systems. Second, even when physicians remain independent, they are affiliating with each others and with hospitals more actively in order to form, via contract, “accountable care organizations.” So far, there has been only limited litigation over the principles that govern these various physician affiliations, but to date those decisions have analyzed them under similar principles that apply to hospitals. See, e.g.,
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Chapter 2 The Treatment Relationship 94 results (showing 5 best matches)
- Any treatment of health care law faces the daunting task of deciding which topics to present and in what order. Health care law, as it has developed over the past four decades, has become an unwieldy collection of disparate areas of doctrine and public policy. Accordingly, some lawyers and scholars maintain there is no unifying structure or core set of ideas that qualifies this as a coherent and integrated body of legal thought and professional practice, other than the happenstance that each topic involves doctors, hospitals, or health insurance in some way. We agree this field has not yet jelled in the way that classic first-year subjects have, but we nevertheless see interlaced throughout these disparate topics several organizing principles or themes that potentially explain not only what makes these disparate parts cohere, but also why that coherence distinguishes health care law from other bodies of law.
- One of these of organizing themes, and perhaps the most prominent, is the set of attributes that make the medical enterprise uniquely important or difficult in the legal domain. Health care law is about the delivery of an extremely important, very expensive, and highly specialized professional service. If anything distinguishes health care law, it must be the unique aspects of the treatment encounter viewed from both sides of the doctor-patient relationship. Health care law in each of its branches must take account of the phenomenology of what it is
- Two closely related laws, both of which apply to a wide range of activities beyond health care, are of rapidly growing importance in this field: Section 504 of the Rehabilitation Act of 1973 ( ). HIV/AIDS first drew attention to the application of disability law to health care and HIV cases continue to arise and receive coverage, but the application of disability discrimination law to health care is considerably broader.
- These pragmatic accommodations have created a degree of uncertainty in abandonment law. Because this body of law is based on an implied contractual undertaking and on notions of fiduciary responsibility, its precise limits are not firmly set. Consequently, the case law in different states offers conflicting indications of whether simple notice of treatment termination is sufficient, or whether instead the law requires health care providers to arrange for a substitute source of care.
- have been true at one time (the older case law seems to say so, but it is not without ambiguity), this general “no duty” rule unquestionably is not the law now. Hospitals and other health care institutions, in contrast with physicians, operate under numerous sources of law (both statutory and court created) that prohibit the arbitrary refusal to admit patients.
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Chapter 1 Health Insurance Coverage and Regulatory Reform 100 results (showing 5 best matches)
- The vertical scale is the dollar value of health care (either its benefits or its costs). The horizontal scale represents abstract units of health care (days in hospital, doctor visits, drugs, x-rays, etc.). The “Benefits” curve shows the increment in societal health benefits that result from changes in the quantity of health care provided. Thus, at point A, when little health care is being provided, health care is very productive: there is a large return on each additional resource devoted to medical treatment. At some place down the line, though, we reach a point (B) of diminishing returns where additional health care expenditures rapidly become much less productive. As the line crosses the horizontal axis (point C), we reach the area of totally unproductive care, and below the axis is counterproductive treatment that produces a net medical harm (D).
- These increases in spending might be celebrated as a great American success story if we believed they produced commensurable benefits. After all, nothing is more treasured than our health; why shouldn’t we spend as much as possible to enhance it? There are three responses to this observation. First, all spending is inherently a trade-off because we can always spend on something else instead. While our health is surely an important priority, it simply is not true that people always treat health as more important than competing values. We see this every day, not only when we smoke, drink, or eat excessively, but also when we drive to work or we read a book rather than exercise. Second, even if we focus on our health as the overriding value, we must realize that there are other ways to promote health than through medical care. In the words of one prominent health policy analyst, “once a reasonable minimum level of care is provided, factors other than medical care—diet, lifestyle,...health
- Although the Affordable Care Act made reduce the underlying costs of health care. To secure the support or avoid the opposition of key provider interest groups, the Obama administration refrained from imposing new controls on the price of medical care. Thus, the crisis in medical costs continues to make it difficult to extend comprehensive coverage to everyone. Therefore, the first task of health care policy is to understand the causes and possible solutions to the relentless inflation that has gripped health care spending over the past generation. After that, we will look at proposals for making access to health insurance more comprehensive.
- The marginal benefits curve is in essence a societal demand curve for health care because it tells us, at each level of production, how much society would be willing to spend on the last unit of service. If we then draw a hypothetical “Societal Costs” line to represent the marginal costs of the societal resources consumed by increasing units of health care, the optimal system would operate at the intersection of the two curves (O). (The cost curve is flat because of the simplifying assumption that each unit of health care has the same cost.)
- Therefore, this sort of analysis cannot generate a precise dollar amount for how much we should spend on any aspect of health care. Nevertheless, it establishes that an optimal health care system avoids spending money not only on unproductive or counterproductive care but also on beneficial care that is nonetheless more costly than it is worth—what might be called marginally unproductive care. One way to evaluate various proposals for containing costs, both regulatory and market-based, is whether they are capable of generating wise decisions about which beneficial treatments are not worth their costs.
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Chapter 3 Hospital Structure and Regulation 69 results (showing 5 best matches)
- A more specialized regulatory regime that exists in most states requires hospitals and other health care institutions to obtain a certificate of need (“CON”) from a government agency before constructing new facilities, purchasing major medical equipment, or instituting new health services. CON laws arose from the National Health Care Planning and Development Act of 1974, which required states to adopt CON regulation in order to receive certain federal health care funding. In 1987, though, Congress became disenchanted with the CON regulatory approach (for reasons explained below) and repealed the federal mandate, leaving states free to depart from the federal model. Consequently, a number of states have scrapped their CON laws entirely and a number of others have substantially loosened their regulatory reigns. Still, CON has a significant presence in the majority of states and is expected to remain as a permanent fixture in the health care regulatory apparatus for some time to come.
- CON laws are designed to curb these excesses by requiring hospitals and other health care facilities (such as nursing homes, ambulatory surgery clinics, and home health agencies) to demonstrate a need for new projects that involve a substantial expenditure. The exact expenditure thresholds and project descriptions vary widely from state to state, but generally speaking the amounts involved must be $1 million or higher.
- The prototypical health care institution is the general, acute care, medical-surgical hospital. Hospitals come in many shapes and sizes. Most are private and non-profit, although many are run by government entities or owned by investors. Some are quite small, with 50 beds or less; others are 1000-bed behemoths. Community hospitals offer more basic services such as routine child birth and simple operations while major medical centers and teaching hospitals strive to have the most comprehensive and state-of-the-art programs and technology available. Other hospitals specialize in only a limited range of medicine, such as mental health or cancer. Nevertheless, hospitals of all types share important common features. There are also common features among all medical institutions. Although we seldom mention nursing homes, home health agencies, diagnostic clinics, and ambulatory surgery facilities in this book, often times when we refer to hospitals we could equally well include these other...
- This chapter explores the basic legal environment in which traditional hospitals and other health care facilities are organized and operated. It addresses the bodies of law that are most familiar to health care lawyers, and for the most part it regards these facilities in their simplest structure. Although this chapter considers the obvious extensions of this basic legal doctrine to HMOs and other more complex ventures, most of the cutting-edge legal developments that respond to these innovative structures are taken up in the subsequent chapters.
- For these and other reasons, several studies have demonstrated that CON regulation has virtually no effect on health care investment or expenditures. This failure is due primarily to several shortcomings in the design and implementation of CON laws. Even as designed, CON laws are very limited in scope. First, they address only the major capital of health care; hospitals are still free to inflated—treatment patterns. Therefore, CON laws at best remove only the outer layer of fat, that is, the existing excess capacity; they are inherently incapable of reversing the built-in inflationary base of treatment intensity caused by the “Roemer cycles” of past decades. Moreover, CON laws are constitutionally incapable of eliminating increases in service intensity. With “need” as the
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- The pressures of the cost, coverage and reform described in Chapter 1 are pushing the health care industry to develop organizational forms and relationships that do not fit easily into preexisting legal categories. As a consequence, health care corporate and regulatory law remains a flourishing practice area that requires sophistication in subjects as diverse as antitrust, tax, licensure, and insurance regulation. The materials in the second part of this book examine these and other private and public law doctrine that have the greatest relevance to the unique legal problems presented by the structure and functioning of the contemporary health care delivery system.
- HEALTH CARE DELIVERY
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A Glossary of Terms and Acronyms 11 results (showing 5 best matches)
- ERISA: Employee Retirement Income Security Act of 1974—A federal statute that primarily regulates private pension plans, but also encompasses other employee benefits such as health insurance. It has tremendous importance for the regulation of health care delivery because of a sweeping provision that preempts many traditional sources of state law.
- HMO: Health Maintenance Organization—A health care organization that combines insurance and treatment functions in the same entity by providing all needed care for a lump sum annual payment.
- The literature of health care law, and especially health care financing, is filled with acronyms and specialized terminology. We have avoided these where possible, but they are sometimes necessary, for many concepts and agencies are better known by their acronym or specialized phrase than by their full name. To ease the burden on the reader new to the subject, the following list gathers the major acronyms and terms of art used in this book primarily in the first five chapters:
- Managed Care: Any system of health service payment or delivery arrangements in which the health plan or provider attempts to control or coordinate health service use to contain health expenditures, improve quality, or both. Arrangements often involve a defined delivery system of providers having some form of contractual relationship with the plan.
- ACA: Affordable Care Act (a.k.a. “Obamacare”)—A comprehensive reform of the individual health insurance market, a substantial expansion of Medicaid, and a significant body of additional requirements for group insurance.
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Chapter 5 Complex Transactions and Organizational Forms 63 results (showing 5 best matches)
- The Patient Protection and Affordable Care Act of 2010 (Affordable Care Act or ACA) comprehensively reformed how health insurance is designed and sold. This law:
- Hospitals are not the only health care institutions concerned with tax exempt status. Nonprofit health maintenance organizations (HMOs), outpatient clinics, and pharmacies have also sought to maintain exempt status. When confronted with these nonhospital health care services, federal and state tax policy tends to take a distinctly less welcoming attitude.
- of insurance” discussed above and it limits the extent of state regulation of health insurance to a significant extent. However, it cannot be overly stressed that ERISA preemption permeates the landscape of health care law and public policy. It has major impact in at least three distinct places: (1) malpractice actions against health insurers; (2) contract claims for the denial of payment under health insurance; and (3) state regulation of how health insurance is structured and sold. The focus here is primarily on the third component, but this section also provides an overview that is useful for the other two topics. Moreover, it cannot be overemphasized that ERISA preemption is capable of cropping up almost anywhere in health law. For instance, each of the following are potentially preempted: physicians’ contract actions against managed care plans that drop them from their networks; taxation of firms that assist self-insured employers in administering their health benefits; and state
- Under these rulings hospitals no longer have to provide any specific amount of health care free of charge to the poor in order to qualify under . This result is not entirely unprecedented. To be considered “charitable” under the tax code an organization need not necessarily be a charity in the everyday sense of assisting the poor. Many educational and scientific organizations exempt from tax and supported by tax deductible contributions provide no or few services to the poor; serving the poor has never been the only activity accepted as “charitable” under either the tax code or the traditional law of charitable trusts. The IRS consulted precedents from the law of charitable trusts to determine that advancing health provides a separate and sufficient basis for favorable tax treatment, apart from charity care. In essence, hospital care is treated like education—as being a
- The Supreme Court has stressed that the basic preemption provision, which reaches any state law that “relates to” an employee benefit plan, is to be construed very broadly. Prohibited state laws include both common law and statutory law. Thus, the Court has ruled that employer-sponsored HMOs cannot be sued under state statutory or common law for personal injury damages arising from their negligent limitation of medical care.
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Chapter 8 Selected Issues in Reproductive Medicine 70 results (showing 5 best matches)
- That said, there will be ways to promote the future child’s health that would entail a more onerous burden than that which the law would require of a woman with regard to her born children. In those cases we might reject a duty of care for the pregnant woman even if we believe that she owes some duty of care to her fetus for lesser burdens.
- Of course, the lack of a duty to aid is qualified in special relationships, such as the parent-child relationship. People do assume duties of care to their children. But even then, legal duties stop short of aid that would impose a risk to the parent’s health. So, for example, while parents must provide food and shelter to their children, they do not violate the law if they refuse to donate a kidney or stem cells from bone marrow or blood to save their child’s life. Carrying a pregnancy poses risks to the woman’s health and therefore goes beyond the level of duty that the law imposes on parents.
- she chooses to continue it to term. The law recognizes a duty of parents to promote the health of their children. Since harm to child health can occur before birth, we might extend the duty to promote child health to pregnant women. Or to put it another way, the “greater right” to abort a fetus doesn’t necessarily include the “lesser right” to harm a fetus that will be born.
- Another important principle lies in the prohibition against risking one person’s health for the benefit of another. For example, as discussed, even after fetal viability, states must permit abortions when necessary to protect the woman’s health. Consider also the example of living kidney donation. Because most people have two functioning kidneys, and a person can do nearly as well with one kidney as with two, living kidney donation is encouraged. Nevertheless, because there are risks to the donor’s health, the law does not require kidney donation.
- An obvious starting point to analyze these maternal-fetal conflict cases is abortion law. It is tempting to conclude that if a woman can abort her fetus before viability, she has no duties of care to the fetus before viability. Similarly, if a woman cannot abort her fetus after viability, she assumes duties of care to her fetus upon its viability.
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Table of Cases 15 results (showing 5 best matches)
Title Page 3 results
Chapter 7 End-of-Life Medical Decisions 88 results (showing 5 best matches)
- For more discussion, see Hall, Orentlicher, Bobinski, et al., Health Care Law and Ethics (9th ed. 2018) and Meisel and Cerminara, The Right to Die (3rd ed. 2010).
- Durable powers of attorney were created because under the common law, all agency power ceases when the principal becomes incompetent. With a “durable” power of attorney, the proxy’s agency authority survives the incompetence of the patient. Technically, durable powers of attorney for health care are actually “springing” powers of attorney. In other words, strictly speaking, a durable power of attorney takes effect while the principal is still competent and continues to have effect if the principal becomes incompetent. A springing power of attorney, on the other hand, does not take effect until the principal becomes incompetent. Despite the inaccuracy of the term, powers of attorney for health care are universally characterized as durable powers of attorney.
- As we saw in Chapter 2, patients possess the basic right of informed consent: Physicians and other health professionals may not provide care to a patient without first informing the patient about the care and its alternatives and obtaining the patient’s voluntary and competent consent to the treatment. If the patient must consent to treatment, it follows that the patient also has a right to withhold consent and refuse the treatment.
- Despite years of ethicists and courts rejecting the distinction between withholding and withdrawing, health care providers may feel very differently about the two acts. Some physicians believe it is less acceptable to withdraw care than to withhold it. These feelings are not surprising. It is hard not to feel responsible for a patient’s death when you turn off a ventilator and the patient dies within minutes. Accordingly, while patients have a right to refuse treatment, health care providers generally can decline to participate in the withdrawal of care and arrange for other providers who are comfortable with the withdrawal to carry out the patient’s wishes.
- States have begun to recognize a right to palliative care in their legislatures and courts. Florida, California, New York, and other states have passed statutes requiring physicians to advise terminally ill patients of their options for end-of-life care, including hospice care, and treatment to relieve pain and other symptoms. In addition to these statutory rights, patients may be able to recover damages from doctors and other health care providers for the failure to provide adequate pain relief.
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Index 49 results (showing 5 best matches)
Outline 31 results (showing 5 best matches)
Chapter 6 Defining Death and Transplanting Organs 21 results (showing 5 best matches)
- Laws and public policies that seek to procure more transplantable organs must balance the interests of donors, recipients, and the public health. In doing so, they confront a number of important and recurring dilemmas, including the proper role of financial incentives in motivating donations, the definition of death, the proper role of consent, and obligations to donate organs.
- Can organs not essential to a competent person’s life ever be taken against the person’s wishes? In the limited circumstances in which the question has arisen, the law has consistently prohibited such a step, even where the tissue is renewable and the procedure may be lifesaving. E.g., (discussed in Chapter 8.D.1). It is not permissible to risk one person’s health even to save another person’s life. Thus, for example, as discussed in Chapter 8, the government must permit abortion after fetal viability when necessary to protect the health of the pregnant woman. For an interesting argument defending the ethics of a law that would both compel everyone to be potential donors of renewable and non-essential tissues, and assure universal
- the likelihood of a successful transplant, including the expected length of the benefit (which in turn may depend, in part, on the recipient’s age and general health status);
- The National Organ Transplant Act of 1984 created the Organ Procurement and Transportation Network (OPTN), a private nonprofit entity, to oversee retrieval of organs and determine standards for their allocation. The United Network for Organ Sharing (UNOS) operates OPTN under contract with the Department of Health and Human Services (DHHS). UNOS is a membership organization that includes the country’s 58 organ procurement organizations (OPOs), transplant centers, and others.
- against contracting for the sale of a heart, lungs, liver, or both kidneys upon death, is justified on several theories. Supporters of the ban argue that a market approach would “commodify” the body in objectionable ways, undermine altruism, and (in the context of organ removal during life) encourage needy persons to take inappropriate risks for pay. Advocates of a free market approach argue in response that the current system inhibits needed expansion in the supply of organs, and that it is unjust to donors since recipients, physicians, and others all derive concrete benefits from the donors’ largesse, yet donors remain uncompensated in material terms. Some proposals would provide payment to family members of people who agree while alive to organ donation after their deaths, to avoid the concern of people putting their health at risk for money.
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- In Part III we shift our focus to issues that arise in individual patient care decisions. This Part addresses certain recurring ethical dilemmas that confront physicians and hospital administrators. We begin in Chapter 6 by looking at the problem of defining death, which is related to how organs are harvested and distributed for transplantation since the dead are a critical source of organ donations. A clear grasp of the definition of death is also important to understanding issues that arise in the termination of life-sustaining treatment, which is the subject of Chapter 7. Chapter 8 then shifts our attention to the beginning of life, examining the ethical dilemmas arising in two selected areas of reproductive medicine: advanced reproductive technologies, and maternal-fetal conflict. While Part III provides a comprehensive overview of the relevant law, it often goes beyond the law to survey the philosophical and policy debates that permeate these questions.
- CARE DECISIONS
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West Academic Publishing’s Law School Advisory Board 12 results (showing 5 best matches)
- Dean and Joseph L. Rauh, Jr. Chair of Public Interest LawUniversity of the District of Columbia David A. Clarke School of Law
- Professor of Law Emeritus, University of San Diego Professor of Law Emeritus, University of Michigan
- Professor of Law, Chancellor and Dean Emeritus University of California, Hastings College of the Law
- Professor of Law, Yale Law School
- Hostetler Chair in LawMichael E. Moritz College of Law, The Ohio State University
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- Publication Date: February 24th, 2020
- ISBN: 9781684676422
- Subject: Health Law
- Series: Nutshells
- Type: Overviews
- Description: Public policy responses to escalating medical costs and constrained access pose fundamental challenges to health care law. Profound medical advances also generate many ethical dilemmas. This authoritative discussion considers how law and ethics respond to these driving social, economic, and political forces of innovation, crisis and reform. Topics include health insurance reform, health care finance and delivery structures, treatment relationships, facility and insurance regulation, corporate and tax law, refusal of life support, organ donation, and reproductive technologies.
