Georgetown University Law Center

About: Georgetown University Law Center is a based out in . It is known for research contribution in the topics: Supreme court & Global health. The organization has 585 authors who have published 2488 publications receiving 36650 citations. The organization is also known as: Georgetown Law & GULC.

MRIs and the Perception of Risk

Abstract: I. INTRODUCTION The most important safety decision concerning MRIs was to change the name of the procedure. In the late 1970s, the procedure known as nuclear magnetic resonance (NMR) became magnetic resonance imaging (MRI) because of the negative connotations the word "nuclear" invited.1 Since then, the use of MRIs has flourished. The procedure is now routinely conducted to make medical diagnoses and to study the brain functioning of healthy volunteers participating in research studies devised by, among others, neuroscientists and economists. There is nothing intrinsically wrong with changing a procedure's name to respond to a public perception of risk, especially when experts do not share that perception. Yet, while MRIs rarely injure patients or test subjects,2 there is reason to believe that they have important health and safety consequences not captured in standard informed consent forms. These concerns ironically involve perception of risk. On the one hand, unexpected incidental findings of clinically significant conditions in volunteer research subjects raise a host of ethical concerns. On the other hand, clinically irrelevant MRI findings sometimes lead to needless and dangerous interventions. In both cases, risk perception plays a role in understanding and dealing with the problem. The name change from NMR to MRI, however, will not exempt this procedure from difficult choices in the years ahead. The following takes a closer look at the role risk perception plays in the use of MRIs to study brain functioning. Part II begins by describing the history of nuclear magnetic resonance, a history that illustrates the way basic research led to unimagined practical applications decades later. Part III turns to the history of the name change, which includes a formal vote by the American College of Radiology to remove the word "nuclear" from the procedure to allay public fears.3 Part IV discusses the recent literature on the difficult problem of what to do when an MRI administered to a presumably healthy volunteer in a research setting reveals the possibility of a medical problem that may or may not be clinically relevant, but which will cause fear in either case. This problem-which has medical, legal and ethical dimensions-deserves the full attention of the research community. Finally, this article concludes with abrief summary of the legal implications of the risk perceptions of research subjects. II. HISTORICAL EMERGENCE OF NUCLEAR MAGNETIC RESONANCE The development of MRIs began with early twentieth century research on the quantum mechanical nature of the atomic nucleus.4 The story, in highly simplified terms, goes like this. In the 1930s, the physicist 1.1. Rabi, working at Columbia University, began to study the magnetic properties of atoms.5 He bathed lithium chloride molecules with magnetic fields and radio waves in a successful effort to induce and measure the resonance frequency that occurs when the nucleus absorbs energy from the radio signal that is equal to a particular change in its energy state.6 This technique enabled Rabi to learn a tremendous amount about how atoms are bound together and how their nuclei are affected by nearby atoms.7 In the 1940s, Edward Purcell at Harvard and Felix Bloch at Stanford, working independently, each developed ways to observe the magnetic resonance of the proton-the nucleus of the hydrogen atom-in liquids and solids.8 Rabi worked with isolated molecules. By working with solids and liquids, Purcell, Bloch, and researchers who followed, were able to probe the internal structure of a variety of materials, making it possible for chemists, biologists, and physicists to analyze the structure of molecules.9 The technique pioneered by Purcell and Bloch came to be called nuclear magnetic resonance (NMR). It was not until 1969 that Raymond Damadian, a physician at the Downstate Medical Center in Brooklyn, New York, began to do experiments designed to show that NMR could be used to probe living tissue for signs of disease. …

The "Gag Rule" Revisited: Physicians as Abortion Gatekeepers

Abstract: In this article, I explore this failure [of the therapeutic exception as a compromise device in federal abortion counseling regulations] with an eye toward its broader lessons about the social uses of medical discretion and the difficulty of achieving an abortion compromise in America. I begin by examining the legal underpinning beneath the widespread belief that the "gag rule" imposed a near-absolute ban on discussion of the abortion option. This conventional wisdom, I conclude, collapses on careful inspection. It fails utterly to account for the strong support to be found in the Title X regulations and their larger legal context for a therapeutic exception unconstrained by administrative or judicial definition. Next, I observe that this legal unboundedness would have empowered Title X clinic physicians (and perhaps others who do counseling) to exercise broad discretion over abortion access, under the rubric of medical indication.... By so doing, however, physicians would have become abortion gatekeepers. This would have raised difficult ethical and clinical questions about the extent to which medical judgment should be allowed to incorporate (and shield) socially-disputed moral choices. I briefly consider some of these questions, along with the countervailing appeal of preserving a measure of intimate freedom under medical cover. I then conclude by positing some connections between the moral infirmities of medical gatekeeping and the political failure of the therapeutic exception. I suggest, in essence, that this failure was ensured by a strong resonance between the exception's moral infirmities and the fears of the medical leaders, pro-choice activists, and abortion opponents who framed the public debate over the "gag rule." The potential breadth of the therapeutic exception went unrecognized and unexplored because professional and popular understanding of the abortion counseling regulations was molded by the activists who framed the debate...

Are There Cross-Cultural Legal Principles? Modal Reasoning Uncovers Procedural Constraints on Law

Abstract: Despite pervasive variation in the content of laws, legal theorists and anthropologists have often argued that laws share certain abstract features and even speculated that law may be a human universal. In the present report, we contribute cross-cultural data to this debate: Are there cross-cultural principles of law? Participants in eleven different countries (N = 3054) were asked whether there could be laws that violate certain procedural principles (e.g., laws applied retrospectively or unintelligible laws), and also whether there are any such laws—in a between-subjects design. Confirming our pre-registered prediction, people reported that such laws cannot exist, but also (paradoxically) that there are such laws. These results document cross-culturally and –linguistically robust beliefs about the nature of law which defy people’s conception of how legal systems function in practice.

“To Be a Good Lawyer, One Has to Be a Healthy Lawyer”: Lawyer Well-Being, Discrimination, and Discretionary Systems of Discipline

Abstract: In 2017, a National Task Force on Lawyer Well-Being comprised mostly of representatives from lawyer assistance programs (LAPs) issued a report recommending “modify[ing] the rules of professional conduct to endorse well-being as part of a lawyer’s duty of competence.” This Article evaluates one of the premises underlying the report’s recommendations: “[t]o be a good lawyer, one has to be a healthy lawyer.” A review of medical studies and evidence offered by LAPs and others in support of these claims indicates that there is no empirical evidence that substance use and other mental health disorders “are leading causes of malpractice suits and ethical disciplinary actions against attorneys.” Further, medical evidence strongly suggests that many lawyer well-being interventions currently being proposed offer little to no mental health benefits and are more likely to prevent than encourage treatment engagement. This Article then evaluates professional well-being (or wellness) policies, communications, and ideology, focusing specifically on discrimination based on mental health disorders and disabilities. It contends that lawyer well-being policies and communications are likely to result in biased appraisals of lawyers under the American Bar Association’s Model Rules of Professional Conduct 1.1, 1.16(a)(2), and 8.3(a), and act as a subterfuge for violating the Americans with Disabilities Act. It also discusses the potential for well-being policies to create and sustain hierarchy, and result in discretionary systems of discipline and social control over the private conduct of legal employees. Finally, it concludes with recommendations to reinforce the employment rights of legal employees; eliminate the role of LAPs and associated entities in providing education about mental health and well-being; improve protections from unwarranted mental health inquiries and evaluations; and reject lawyer well-being policies and derogatory rhetoric that put people with mental health disorders and disabilities down.

Passion and Reason in Labor Law

Abstract: The central debate within domestic labor law today revolves around whether existing union certification procedures promote or inhibit autonomous employee choice. Within that debate, both judges and commentators tend to embrace a model of the self and of the optimal conditions for autonomous choice that draws from both liberal political theory and rational choice theory. Most judges and commentators assume that individual workers’ preferences are exogenous and relatively static; that workers decide whether to support unionization by weighing its costs and benefits in light of their individual self-interest; that union organizing is basically a process of aggregating individual workers’ expressed preferences; and that workers’ autonomy is threatened not only by coercion, but also strong communal attachments to coworkers. This article criticizes that model on both empirical and normative grounds. Workers’ preferences towards unionization are not wholly exogenous, it argues, but rather are pervasively shaped by the law and by workers’ group identities. Similarly, organizing is not solely a process of aggregating preferences, so much as a process of building collective identity and solidarity - and therefore shaping workers’ preferences - often through disruptive and emotionally - charged collective action. Finally, such identity-shaping does not inevitably threaten individual workers’ autonomy. To the contrary, ideals of autonomy actually provide normative justification for such efforts insofar as they aim to equalize power between workers and management. This argument has implications both for ongoing debates over labor law reform, and for accounts of the relationship among law, identity, and social movements more generally.