When Eric Rosenthal graduated from the Law Center in 1992, he originally planned to take a job with Human Rights Watch. But while traveling in Mexico for a Minnesota human rights group, he happened to visit a psychiatric institution. The experience -which he describes in a recent article as "horrifying"-altered the course of his career.

With the Law Center's support, Rosenthal applied for a unique $25,000 fellowship, granted to people with a "grand idea for changing the world," he says. He won the fellowship and, with the money, founded Mental Disability Rights International. Today Rosenthal travels worldwide, investigating abuse of people with mental disabilities and trying to right the wrong.

One of many law alumni committed to working in the non-profit sector, Rosenthal credits his experiences at Georgetown with helping him to shape a career that brings together his dual interest in mental disability law and international human rights. Two of his most influential professors, he recalls, were Chai Feldblum, director of the Federal Legislation Clinic and an expert in disability rights law, and Gregg Bloche, a physician as well as a lawyer.

They and other faculty in the health law program are at the heart of Georgetown's nationally recognized program. Each of the five full-time professors at the Law Center who specialize in health law-Judith Areen, Gregg Bloche, Lawrence Gostin, Patricia King, and Kevin Quinn-contributes particular interests and experiences. King, Areen, and Quinn focus most of their attention on bioethics. Gostin and Bloche deal primarily with public health and health care policy issues, both domestic and international.

The program's scope is significantly broadened by the teaching and scholarship of faculty members who focus on other disciplines that touch on health law. In her work with disability rights, for example, Feldblum handles issues of great importance to health law professionals. Professor Steven Goldberg, an expert in science, law, and religion, writes and speaks about the ethical concerns raised by the mapping of the human genome. Professors Richard Lazarus, Lisa Heinzerling, and Hope Babcock, experts in environmental law, frequently explore the ways in which the environment affects the health of social groups. Because health law by its nature is very diverse, the multiple perspectives of the faculty enhance its study at Georgetown and make possible innovative academic projects.

The Law Center offers several special opportunities for studying health law. One is the joint program in law and public health. This four-year program provides graduates with two degrees, the Juris Doctorate from Georgetown and a Master of Public Health from Johns Hopkins School of Public Health and Hygiene, one of the nation's leading schools of public health. At the graduate level, the Law Center offers a Greenwall Fellowship in Health Policy and Bioethics, with opportunities for participants to teach and study at both the Law Center and Johns Hopkins. In addition, there are opportunities for students and faculty to work with the Kennedy Institute of Bioethics at Georgetown University and the Georgetown Institute for Health Care Research and Policy.

The Managed Care Revolution

The Hippocratic Oath commits doctors to placing the interests of their patients before all other concerns. For centuries physicians have striven, with varying degrees of success, to meet this goal. In recent times, their efforts have been complicated by soaring medical costs and the emergence of managed care.

Physician loyalty to patients-and the quest for efficiency in health policy-are topics that deeply concern Professor Gregg Bloche. With managed care organizations seeking to restrain costs, the government must sometimes step in on behalf of patients and the public interest, Bloche says. At other times, the market may serve this purpose. "What can we rely on markets to do and what role should government play?" Bloche asks in his teaching and his writing.

Bloche teaches health law and policy, an anchor course in the health law field. The course explores ways in which medical care is provided and paid for in our society. Among the topics addressed are government regulation of the medical marketplace, patient choice and privacy, and racial discrimination.

Professor Bloche is engaged in a variety of research projects in this field as well. With a three-year, $250, 000 investigator award in health policy research from the Robert Wood Johnson Foundation, he is examining policies related to the managed care revolution. He has written extensively on the topic and frequently offers commentary in the media. In a 1999 article in the Journal of the American Medical Association, Bloche took up the complex problem of divided physician loyalty that managed care presents. And, in a recent amicus brief written for a Supreme Court case, Bloche and others examined the highly charged issue of rewarding physicians financially for withholding care. The brief concludes that such incentives are inevitable-but argues that they must be subject to regulatory limits.

At the upperclass level, Bloche also teaches (with Professor Carlos Vázquez) a research workshop on international human rights. Students in the course frequently choose to explore the intersection of health and human rights. When Eric Rosenthal participated in this workshop, he explored medical documentation of torture and the killing of detainees. Soon after, Bloche invited him to author an article on the ways that principles of international human rights law might protect people with mental disabilities. Rosenthal's pathbreaking article (written with adjunct Professor Leonard Rubenstein) was published in a special issue of the International Journal of Law and Psychiatry.

Bloche's interest in the interface between health and international human rights has animated his pro bono work as a board member and active participant in the work of Physicians for Human Rights, one of the recipients of the 1997 Nobel Peace Prize. He has also served as an advisor to South Africa's Truth and Reconciliation Commission, the World Health Organization, the American Association for the Advancement of Science, and other national and international bodies. Recently, he raised funds for an international collaborative effort to develop standards of conduct for health care organizations and professionals in settings at risk for human rights abuse. "When things go terribly wrong abroad it ought to matter to us as fellow human beings," Bloche says. "We can also learn how things might go wrong in our own country."

The Revolution in Genetics Legislation

Just six months into the 21st century, scientists engaged in the dizzying task of mapping the three billion bits of chemical information in the human genome announced that they had effectively completed the task. Although the map of the human genome that now exists is still rough, it represents an enormous achievement, one that will radically affect medical care and many other aspects of human life in the years and decades to come. The field of genetics will be "more responsible than any other single factor in influencing future generations," says Professor Lawrence Gostin.

Gostin has worked in public health for more than 20 years and is the author or co-author of more than two dozen books, most recently a comprehensive text on American public health law. The book, Public Health Law: Power, Duty, Restraint, will be published by the University of California Press in November 2000. The press will also publish Professor Gostin's Public Health Law and Ethics.

Gostin began his career in England, where, as legal director of the National Association for Mental Health, he drafted a large portion of the country's mental health legislation.While there, he successfully argued several cases before the European Commission and Court on Human Rights. Among the advisory committees Gostin serves on are those of the World Health Organization, the Centers for Disease Control, and the National Academy of Sciences. He is a "leading light" in the field of mental health law, says Eric Rosenthal. "His work has been an inspiration."

In recent years, Gostin has begun examining the legal and ethical issues surrounding the genetic revolution. Scientists' increasing capacity to identify human traits and diseases through genetic testing, he says, raises highly sensitive issues of privacy, discrimination, and access to appropriate medical treatment. For example, there already exists an "inchoate genetic database for every American," consisting of the traditional "heel-stick" blood samples taken at birth. Theoretically, officials could obtain a wide range of genetic information on almost every citizen of the United States from these tiny samples, known as Guthrie cards. Federal agencies frequently ask Gostin for advice on how these and other genetic data bases-and the potential information they contain-should be handled.

To develop a legal framework to assist in answering such questions, Gostin in 1998 secured a $1.2 million grant from the National Institutes of Health to analyze legislation regulating the use of genetic information. The project, Genetics Legislation: Syntax, Science, and Policy, will take three years to complete. As its principal investigator, Gostin heads a team of scholars, including Professor Patricia King and Dean Judith Areen from the Law Center, and Professors James Hodge and Nancy Kass from Johns Hopkins School of Public Health and Hygiene. Professor Robert Oakley, director of the Law Center library, is also a member of the advisory committee. The group is the first to undertake a comprehensive analysis of genetics legislation and make recommendations for future state and national policy that both protects individual privacy and encourages scientific research.(See below for a detailed description of grant activities.) In addition to scholarship and public service activities, Gostin is a talented educator. He regularly teaches health and legal reasoning, a first-year elective. Topics covered in the class include health care, bioethics, and epidemiology. In discussions, students explore volatile issues such as the rights people have at death and mandatory notification of partners of HIV-positive individuals. Gostin constantly encourages students to think more deeply about these topics. "He really makes us look at things from a lot more angles than we usually would," notes one of Gostin's current students.

What is Right?

"Bioethics is a multidisciplinary field," says Patricia King, Carmack Waterhouse Professor of Law, Medicine, Ethics, and Public Policy. "It evolved from concern about the moral, legal, and social implications of innovations in the life sciences and in health care." King, who has been a faculty member for more than twenty-five years, has wide-ranging interests in the field, which she helped to pioneer in the early 1970s. She served on the first national bioethics commission established to study and make recommendations to protect human subjects of medical research, an experience that proved indelible.

King's fascination with bioethics and her insights into the field have placed her at the heart of public policy development in this area. For example, in the 1980s, she was a member of the President's Commission for the Study of Ethical Problems in Medicine and the NIH Recombinant DNA Advisory Committee. In the 1990s, she was a member of the Ethical, Legal, and Social Issues Working Group of the Human Genome Project and co-chair of the NIH Embryo Research Panel. King has also earned a seat on some of the most prestigious boards and organizations in the country concerned with health and medicine. Among these are the Hastings Center, the Henry J. Kaiser Family Foundation, and the governing Council of the Institute of Medicine, a part of the National Academy of Sciences.

King's public policy interests inspire her scholarly interests, among them a focus on the fetus in law and medicine. Her scholarship in this area looks at ethical and legal issues inherent in scientific research on fetal tissue, human embryos, and human pluripotent stem cells-undifferentiated human cells that have the ability to develop into most of the specialized cells of tissue in the human body. King has also examined the rights and obligations of pregnant women and fetuses in the contexts of reproductive decision making, assisted reproductive technologies, clinical research, AIDS, and fetal therapy. More recently, King has turned her attention to examining bioethical dilemmas through the lens of race for insights that such a perspective can bring to the development of law and policy.

"I have come full circle," King says. Her appointment to the first national bioethics commission was due to her background in federal civil rights enforcement and the controversy that erupted with the public disclosure of the infamous Tuskegee Experiment. The experiment was a Public Health Service study of syphilis in black men in Macon County, Alabama, which began in 1932 and lasted for 40 years. "Now is the time to meld insights from feminist theory and critical race theory with all that I have learned about bioethics." Critical race theory emerged from the assumption that blacks and other racial and ethnic minorities are treated unfairly by the legal system and other social institutions.

"The health care system, just like the legal system, is in dire need of this critical examination," King says. She points to "the growing public awareness of long-standing disparities between whites and minority Americans in health status and access to health care and coverage" and anticipates "concentrated development of policies and programs to reduce these disparities." King is currently focused on looking at how these issues manifest themselves in genetics. She is particularly intrigued by the ways in which genetic information can be used-and misused-in connection with racial and ethnic minorities. She worries that the barrage of information emerging from the effort to map and sequence the human genome will burden rather than benefit African-Americans.

Professor and Dean Judith Areen has also dedicated much of her career to issues involving ethics in medicine. At Yale Law School, she studied with Dr. Jay Katz, a noted medical ethics expert. The experience triggered Areen's lifelong interest in the field. With Patricia King, she developed a seminar on law, medicine, and ethics, taught regularly at the Law Center by both full-time and adjunct faculty members. She is also co-author, with King, Goldberg, and Gostin, of a casebook, Law, Science, and Medicine, now in its second edition. In her scholarly writing, Areen has explored legal issues raised by human gene therapy, organ donation, the AIDS epidemic, and consent to withhold medical treatment.

Areen's interest in bioethics and public health led her to establish, with her colleague Dr. Ruth Faden, executive director of the Bioethics Institute at Johns Hopkins University, a joint degree in law and public health. The four-year program offers law students access to graduate work in public health, normally available only to those with backgrounds in science or health. Students working toward the joint degree first complete one year of law school at Georgetown, then for 11 months attend Johns Hopkins School of Hygiene and Public Health in Baltimore, earning the master's portion of the degree. They return to Georgetown for two more years to complete their law degrees.

The program provides a superb foundation for a wide range of public health careers. Graduates have taken positions in government, with private firms specializing in public health law, and in non-profit agencies. "The design of the program is ideal," says Eric Gorowitz, JD/MPH '94, one of the first graduates of the joint-degree program. "The first year of law school helps you to think about the public health curriculum from the perspective of someone who knows a little bit about how the law works. The second year at Hopkins broadens your perspective; you go back to law school and can then think about the next two years of courses from a public health perspective." Since earning his dual degree, Gorowitz has worked in the private sector, litigating breast implant cases for a law firm, and with non-profit organizations focusing on the issue of gun control.

Many of Professor Kevin Quinn's interests parallel those of King and Areen. But Quinn, a Jesuit priest and moral theologian as well as a legal scholar, brings a unique perspective to the field. Quinn's goal is to reveal to future lawyers the moral values that inform law. He regularly teaches a law, medicine, and ethics seminar. He has written extensively in the field, on such topics as the allocation of health resources, the Human Genome Project, assisted suicide, and cloning.

In his classes, Quinn asks students to probe their consciences on the topics considered. Given the subject matter and the possibility for multiple viewpoints, the discussions are spirited. An argument can be made in favor of cloning for instance, based on the notion that individuals have a moral right to reproduce. One benefit of cloning, then, is that it creates another option for infertile couples who might otherwise not be able to have children. There are strong arguments against cloning, of course: cloning threatens a person's right to be unique; it is a violation of the natural order of things; it is morally repugnant. In Quinn's view, there is no single answer to difficult questions such as these.

"What I bring to the study of bioethics is three interests: law, social policy, and moral theology," Quinn says. In his recent scholarship, Quinn has been probing the limits of "liberal society," which bases its values on individual rights rather than aiming for what he terms the "political common good." The liberal viewpoint, Quinn believes, limits America's ability to achieve comprehensive health care reform. In a recent article published in the Southern California Law Review, Quinn explores these concepts and suggests that striving for the "political common good is a workable alternative that America's health policy makers should try now."

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