Worksite drug testing.
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Biomedical subjects
Publications and source records attributed to L Gostin.
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Genetic discrimination is detrimental to public health programs, as well as to society generally. Advances in genetic testing and screening, accelerated and prompted by the Human Genome Initiative, increase society's ability to detect and monitor chromosomal differences. These technologies and their resulting genomic data will enhance medical science, but may also encourage discrimination. Although few employers or insurers currently utilize genetic screening, testing or data, rising employee benefit costs and market forces create powerful incentives for usage. Current municipal, state and federal laws, including the Americans with Disabilities Act (ADA), may not sufficiently protect employees and insureds from genetic discrimination. While municipal and state protections should not be overlooked, the ADA's sweeping scope may currently provide the most comprehensive safeguard. Federal laws banning discrimination on the basis of race or sex might also successfully redress some forms of genetic discrimination. Genetic technologies' advent necessitates efforts to rectify state and federal statutory coverage gaps, strictly regulate employers and produce comprehensive guidelines regarding its use.
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Medical practitioners often feel obligated to use all available procedures to sustain patients' lives. A review of case law indicates, however, that practitioners who abate treatment that is contrary to people's known preferences or current best interests act legally and in accordance with the highest professional standards. In the case of Nancy Cruzan, the Supreme Court delegated to the states the determination whether to respect the rights of nonautonomous patients to die with dignity. States should enact creative laws to encourage families and physicians to discuss final care, and assist people in making clear and simple statements about their preferences.
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The worldwide AIDS epidemic has posed an extraordinary array of ethical and legal challenges. The work presented here reviews three issues at the heart of the matter: discrimination against HIV-infected people, the limits of confidentiality, and the exercise of coercive government powers to limit spread of the disease. Because the authors are most familiar with the U.S. experience, the review deals primarily with the history of the epidemic in the United States and public responses to it in that country.
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