Health, Law & Justice
Justice Brandeis Semester – Summer 2015
Instructors:
Sarah Elisabeth Curi, JD, MPH & Alice Noble, JD, MPH
Schedule:
June 1– August 7, 2015. 10 weeks, 12 credits
Typically our seminars will meet on Mondays and Wednesdays, while our experiential learning activities
will be occur on Tuesdays and Thursdays
Outline of Course Syllabus - subject to revision
Health, Law & Justice is an intensive, interactive, interdisciplinary 10 week long semester designed for students
interested in pursuing careers in the social sciences, law, medicine, politics, business and/or ethics as well as any
students curious to learn more about health care in the U.S. This JBS merges two highly participatory seminars with
experiential learning allowing students a unique opportunity to delve into some of the most contentious and profound
issues confronting our health care system and each of us, personally.
Together, we will explore the quest for a just health care system, including an in-depth consideration of the 2010
Affordable Care Act (“ACA”) and its implementation; legal and ethical questions surrounding the doctor-patient
relationship; and key bioethical concerns that challenge our concept of what it means to be a person. A central
question throughout Health, Law & Justice is how well our health care system supports an ethical framework for
patient care and patient-centered decision-making. Moreover, we will consider what constitutes a just health care
system while comparing our system and those of other developed nations.
Throughout the course, students will explore various perspectives of relevant stakeholders, including consumers,
patient advocates, legislators, academics, business leaders, physicians and other health care providers, and insurers. As
future leaders and global citizens, students will also be encouraged to delve into the question --“What is next --and what
is best--for health care in the United States?”
LGLS 114aj – American H ealth Care: Law & Policy
LGLS 131bj – Patient Autonomy:
Four years after the historic passage of the ACA, the
United States and our health care system is at a cross
roads. While the ACA seems to have weathered most of
the significant implementation challenges, even its most
ardent supporters acknowledge that the law provides only
a partial fix for our nation’s health care system. While
access should improve appreciably, particularly for those
who are currently uninsured, many will still remain without
access to needed care. Moreover, our costs are the highest
by far and the quality of our care is no better than that
found in these less costly nations. We will explore the
ACA, the events leading up to its passage, the policies the
law was designed to further, and its impacts so far.
At the heart of our evolving health care system are
the doctor and the patient. Related to the doctorpatient relationship are often complex issues related
to patient autonomy, life and death treatment
decisions, and the cost of and access to care. They
implicate questions of justice and the just
distribution of care, a key goal of health care
reform. We will explore ethical, legal, and social
issues (including end-of-life-decision making,
physician assisted suicide, procreative liberty,
cloning, and genetic therapies) from the micro level
of patient care at the patient’s bedside to the macro
issues of the health care system in which patient
care is delivered and financed.
Reform
Health, Law & Justice
Law, Medicine & Ethics
Justice Brandeis Semester – Summer 2015
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Block
One:
Block
Two:
Introduction
• Overview of the U.S. health care system: Cost,
Quality, and Access
• U.S. health care in the world: international
comparisons of Cost, Quality, and Access
• Overview of the ACA and its implementation
The ACA: Background, Goals, and Objectives
• Politics and policy of the ACA
• What is the ACA’s mission?
• What is it trying to fix?
Block Health Care as a “Right”
Three: • Physician’s duty to treat and legislative tempering
of the common law “no duty” rule
• Access: the role of private insurance
• Insurance market reforms of the ACA
• How insurance works
• Legal disputes between health insurers and
consumers
• Access to health care: the role of public programs
(Medicare and Medicaid), including Medicaid
expansion under the ACA
Block Quality care and medical liability of Physicians
Four:
and Health Care Institutions
• Medical malpractice and medical error
• Informed consent
• Direct and vicarious liability of hospitals and
managed care organizations
• Quality care and hospital and managed care
liability
• The impact of liability on provider and
organizational behavior
• The ACA and medical malpractice reform
Block Health Disparities and Legislative Approaches
Five:
to Overcoming Discrimination
• Historical perspective on racism and U.S. health
care
• Impact of racial, ethnic, cultural, and
socioeconomic variables on access to care
• The ACA and other legislative approaches to
overcoming health disparities
Block Patient-Centered Innovation
Six:
• Electronic health records (EHRs) and Electronic
medical records (EMRs)
• New models for care delivery, such as ACOs and
Medical Homes
Block NFIB v. Sebelius
Seven: • Health reform and individual liberties
• An analysis of NFIB v. Sebelius (2012)
Health, Law & Justice
Introduction
• What is Bioethics?
• What is Health?
• What is Autonomy?
Informed Consent & Truth
• The evolution of the legal doctrine of informed
consent
• Paternalism
• The role of truth
Major Ethical Theories
• Nihilism
• Kantian
• Utilitarianism
• Social Contract Theory
• Rights-based Ethics
• Natural Law Theory
• Communitarianism
• Feminist Ethics
• Aristotle (Virtue Ethics)
Decisional Capacity and the Right to Refuse
Treatment + Advanced Directives
• Capacity in practice
• The promise of advance directives (health care
proxies and living wills)
Choosing for Patients who Once had Capacity
Patient and Choosing for Patients who Never
had Capacity Patient
• Substitute decision making when patients lack
capacity
Personhood & Procreative Liberty
• What is personhood?
• To what extent do we/should permit people to
make their own decisions about reproduction?
Physician Assisted Death
• What is the state of the law in the US?
• What can we learn from other health systems?
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Block
Eight:
Block
Nine:
Block
Ten:
• What, if any, aspects of other models would be
useful/workable in the U.S.?
Reproductive Cloning and Therapeutic Cloning
• Emerging technologies – what limits, if any, are
ethical?
How Do They Do It? A Comparative Analysis of
U.S. and European Health Systems
• What we can learn from other health systems?
• What, if any, aspects of other models would be
useful/workable in the U.S.?
Toward a Just Health Care System
Just Distribution of Resources
• Drawing from all the course materials, including
• Drawing from all the course materials, including
their practicum experiences, students will reflect
their practicum experiences, students will reflect
on where we are four years into the ACA
on how we should make difficult decisions when
implementation and will explore options for the
faced with limited resources, asking how the
future, asking how the tools of law and ethics may
tools of law and ethics may be used to move us
be used to move us closer to the goal of a just
closer to the goal of a just health system
health system
Capstone on Health, Law & Justice
LGLS 98bj – Independent Research/Experiential Learning: Students will explore an array of complex issues in
depth during the seminars as well as in the “real world” as they attend public meetings or hearings and actively dialog
with stakeholders. We will examine the day-to-day issues faced by stakeholders in the midst of reform efforts. While
connecting theory and practice, students will take initiative and actively engage in structured assignments.
Throughout the semester, opportunities for experiential learning may include:
- Meeting with leaders in the Executive and Legislative branches of government
- Dialoguing with patient advocates and advocacy organizations as well as candidates and political campaign staff
- Observing court proceedings
- Visiting a community health center and other provider organizations
- Tracking pending legislation relating to course topics
Course Requirements: Health, Law &Justice will require thoughtful and active in-class participation, the preparation
of analytical positions papers based on true life examples, simulations based on hypotheticals, interactive group
projects and presentations, and a final exam for each base course. This coursework will be integrated with hands-on
fieldwork, reflection assignments, short papers, and a final “capstone” presentation. Examples of a “capstone”
include solution-oriented works such as the creation of a campaign commercial, the preparation of written/oral
testimony to a senate subcommittee, or the development of an advocacy piece for a nonprofit.
Students will be graded on the quality of their written work, class-participation, and in-class presentations as well as
their active involvement in the experiential learning activities.
Goals: During Health, Law & Justice, students will be challenged to:
1. Hone essential written and oral communication and advocacy skills through practical exercises and interactions
with stakeholder
2. Enhance knowledge of the challenges and opportunities regarding implementation of complex and controversial
policies and laws regarding our health care system, with a focus on exploring justice
3. Become better prepared for life after college or graduate school by engaging with diverse individuals and
professionals in their fields of interests
4. Forge relationships beyond university, thereby developing a broader network
5. With a focus on U.S. law and policy, assess how and why other countries take a different approach to address
similar problems
Health, Law & Justice
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