Showing papers in "Washington Law Review in 1991"

Undefined experimental treatment exclusions in health insurance contracts: a proposal for judicial response.

Abstract: Health insurance contracts often exclude coverage for experimental treatments. No accepted definition of experimental treatment exists, however, and insurance contracts rarely define the term. Although experimental treatment exclusions are necessary and desirable, insurers may easily manipulate undefined exclusions to exclude treatments on inappropriate bases such as cost. Thus, courts should construe the term \"experimental\" narrowly and find treatments non-experimental if there is any demonstrated likelihood of their success. When standard chemotherapy failed to destroy thirty-five year old Pamela Pirozzi's breast cancer, her doctor recommended a recently developed treatment.' Her insurer refused to pay for the treatment, claiming it was experimental and thus excluded under her insurance contract.2 Pirozzi sued the insurance company. Because her health plan did not define \"experimental,\" 3 the court had to interpret what the term meant. Pirozzi, who was not expected to survive even a year without the treatment, had to wait three weeks4 for the completion of an expedited trial to gain coverage and begin treatment.' Dilemmas such as Pirozzi's are inevitable when insurers exclude experimental treatment but do not define the term. Most health insurance contracts6 exclude experimental treatment. 7 Health. insurers do this to avoid paying for unproven, fraudulent, or worthless treatments and to maintain their ability to offer an affordable product.' Experimental treatment exclusions are useful in achieving these objectives because physicians sometimes recommend new 1. Pirozzi v. Blue Cross-Blue Shield, 741 F. Supp. 586, 588 (E.D. Va. 1990). The recommended treatment was high-dose chemotherapy with autologous bone marrow transplant (HDCr-ABMT).

Valuation and International Regulation of Forest Ecosystems: Propects for a Global Forest Agreement

Abstract: Deforestation poses severe environmental problems for temperate and tropical regions world-wide. An international forest agreement is necessary to protect these forests. Previous international environmental agreements provide, at best, limited protection for endangered natural resources. To conserve the world's forests, an effective forest agreement must recognize the economic value of forest ecosystems. This forest agreement should define a twofold rule of responsibility: that states have a duty to protect forests located within their borders, and that other states that benefit from forests have a legal obligation to share in conservation costs. Deforestation is one of the world's most important environmental problems.1 The endangered forests are both ecosystems within a global biosphere and regions of human use and enjoyment.2 Airborne pollutants such as acid rain threaten the very survival of forests throughout much of Europe, the eastern United States and Canada.3 Urban encroachment, over-exploitation and conversion into timber stands also threaten temperate forest ecosystems.4 Although international attention has focused on the need to protect tropical forests, wetlands and other ecosystems,' no international agreement protects northern temperate forests. By failing to recognize environmental costs and non-timber forest values, market mechanisms 1. Kairiukstis, Forest Decline Background to the Problem, in FOREST DECLINE AND REPRODUCTION: REGIONAL AND GLOBAL CONSEQUENCES 3 (1987). See generally J. BRUNNEE, ACID RAIN AND OzoNE LAYER DEPLETION: INTERNATIONAL LAW AND REGULATION (1988). 2. Ecosystems are complex and evolved interdependent communities of plant, animal and microorganism species interacting with their environment. See generally THE TEMPERATE FOREST ECOSYSTEM (Y. Hanxi, W. Zahn, J. Jeffers & P. Ward eds. 1986). Forest systems recycle nutrients, recharge water and constitute habitat for a rich diversity of flora and fauna. Forests remove carbon dioxide from the atmosphere, thereby mitigating global warming. Forests also provide people with values and uses, including watersheds for fisheries and water supplies, trees for timber and wood pulp, and environments for recreation, tourism, and spiritual and aesthetic experiences. Forests are homelands for indigenous peoples. Thus, damage to forests threatens both global ecological processes and human values that depend on sustainable forests. See UNIFICATION OF EUROPEAN FOREST PATTERN RESEARCH (P. Schmidt, R. Oldeman & A. Teller eds. 1989); WORLD DEFORESTATION IN THE TWENTIETH CENTURY (J. Richards & R. Tucker eds. 1988). 3. See Kariukstis, supra note 1, at 3. Although not discussed here, air pollution severely threatens temperate forests. See generally J. BRUNNEE, supra note 1; INVENTORYING AND MONITORING ENDANGERED FoRESTs (P. Schmid-Haas ed. 1985). 4. See generally Jeffers, The Importance of Research in Temperate Forests, in THE TEMPERATE FOREST ECOSYSTEM 9 (1986). 5. See infra notes 62-65 and accompanying text. Washington Law Review hasten rather than slow deforestation. Thus, forest protection requires regulatory policies and alternative methods of assessing forest values. International economic pressures, uneven development of environmental law, and the global impact of the forest crisis require international regulation of forests. Because of interconnections among tropical and temperate forest nations, a global agreement should protect the forests in both regions. International legal principles and prior international agreements comprise the bases for international environmental law applicable to forest regulation. International legal principles address and define international environmental problems and solutions. In contrast, international agreements legally bind parties, creating both rights and obligations concerning the regulated global resources.6 These existing principles and agreements, however, are inadequate models on which to base an international forest agreement. Therefore, this Comment suggests some of the general contours and components of an effective international forest agreement. I. FOREST CRISIS AND THE NEED FOR