On July 5, 1983. the Department of Health and Human Services (HHS) issued a revised version of its Proposed Rules for the so-called Infant Doe Regulations. The regulations are designed to prevent discriminatory denial of medical treatment to handicapped infants. An earlier version published last March had been struck down for procedural defects by Federal District Court Judge Gerhard Gesell. In the course of his opinion, Judge Gesell noted that the regulations touch upon one of the most difficult and sensitive medical and ethical problems facing society—the question of what, if any, life-sustaining medical treatment should be utilized to preserve the lives of severely mentally or physically defective newborn infants.

In his view not only were the original regulations procedurally flawed, but they also were substantively deficient. Arbitrary and capricious was Gesell's phrase to describe HHS's actions in establishing a toll-free 24-hour-a-day hotline on which anonymous tipsters could trigger an investigation of alleged nontreatment.

Occupational health nurses exercise their professional skills in positions of enormous responsibility. An occupational health nurse works in industry or business, either alone or as part of a team, to ensure workers’ health and safety. Management is ultimately responsible for providing a safe and healthful work environment, and employs nurses and other professionals to provide health services for workers and to meet the mandates of the Occupational Health and Safety Act of 1970, which has imposed many responsibilities on employers and occupational health professionals.

Highly specialized professional nurses in recent years have gained recognition of their expanded responsibility, autonomy, and accountability. At the same time, an increased number of nurses have been named individually as defendants in negligence or malpractice actions. Occupational health nurses may become particularly vulnerable to a disproportionate number of malpractice suits, as a result of factors ranging from the independent setting in which occupational nurses work to the interplay of laws affecting workers and employers.

The decision whether or not to treat a newborn infant with a major birth defect or other life-threatening condition presents a multitude of medical, ethical and legal problems for all individuals involved. This is particularly true when the child’s prognosis, even with therapy, is uncertain or when treatment may result in or prolong a life fraught with substantial suffering. The proper roles of the physician and other hospital personnel, and especially of the child‘s parents, have yet to be fully or adequately resolved. Nonetheless, recent public awareness of isolated cases has made it clear that the status quo is not acceptable. The Committee on the Legal and Ethical Aspects of Health Care for Children (Children’s Committee) believes that hospitals and state agencies must do more to protect seriously ill newborns and to provide greater support—medical, psychological, and financial—to those in need.

This essay reflects my experiences as an open heart surgery patient. It also makes some comparisons of the roles of lawyers and doctors. The skills of the medical profession in pursuing the concept of preventive medicine have for more than three decades stirred my interest in developing the concept of preventive law.

As is my custom, aided by the good practices of my personal physician for a decade, I received an annual medical examination on Tuesday, June 8, 1982. The preliminary results were reported to me with the customary comment that I would receive the complete results in a few days. I did notice a slight downcast expression on the good doctor's face as he looked at the electrocardiogram, but I remained silent. The E.K.G. included a four-minute bicycle exercise. For most previous years, the exercise was the Master's two-step test so I did not have a good basis of comparison of this year's test with my previous E.K.G.s. I excused the slight difference that I felt this year on the basis that each year I am getting older.

The “medical malpractice crisis” in the 1970s involved not only a greater number of suits, but also the emergence of new sorts of claims against medical practitioners. One such claim was the wrongful birth suit, where parents sued their physician on their own behalf for negligence that resulted in the birth of an unwanted child. A related claim, wrongful life, involved a suit brought on behalf of a defective infant against a physician or laboratory that failed to give correct information about a potential defect to the parents. These claims have been the subject of much controversy for judges and commentators.

The debate over wrongful life suits involving “impaired” children continues. Courts in Michigan have recently rejected the wrongful life cause of action, while, in Washing ton, the action has been allowed. Some academic critics have also continued to oppose the wrongful life action. In a recent commentary in the pages of this journal, one critic wrote: “Wrongful life actions, by whatever name they may be called, accord with neither logic nor experience, and should not be allowed.”

Recent years have brought increasing pressure from the public and the courts for truly informed patient consents to medical treatment and surgical procedures. Many courts have recognized that a patient's signature on a consent form is no assurance that the patient has received sufficient information, much less that he or she truly understood the information. A Pennsylvania court articulated this principle this way: