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PubMed1996

Psychosocial assessment of organ transplant candidates and the Americans with Disabilities Act.

The use of psychosocial criteria to assess candidates for organ transplantation may violate the Americans with Disabilities Act (ADA). The ADA prohibits discrimination on the basis of disability or on the basis of eligibility criteria that disproportionately affect persons with disabilities. When organ programs deny access to a person because of schizophrenia, they are denying an organ on the basis of disability. When organ programs deny access to a noncompliant person, they are denying an organ on the basis of an eligibility criterion that is more common in persons with coexisting disabilities like mental illness. Accordingly, both of these denials may violate the ADA. However, the ADA recognizes that it often is appropriate to take a person's disability into account when allocating organs for transplantation. There is a legitimate social interest in allocating organs in a way that maximizes medical benefit, and a person's disability may compromise the benefit that the person will receive from a transplant. It is likely that courts will interpret the ADA to permit denials of organs or lower waiting list priorities for persons with disabilities as long as predictions of diminished benefit are based on scientifically valid criteria, the assessment of candidates is individualized and not based entirely on generalized predictors, and the transplant program undertakes reasonable steps like psychological counseling to compensate for an organ candidate's coexisting disability.

Persons with Disabilities↗
PubMed2004

Outcomes of shelter use among homeless persons with serious mental illness.

OBJECTIVE: The purpose of this study was to examine the extent to which the use of case management services predicted public shelter use among homeless persons with serious mental illness after the termination of Access to Community Care and Effective Services and Supports (ACCESS), a five-year outreach and case management program. METHOD: The sample consisted of 475 Philadelphia ACCESS program participants. Client-level interview data and case manager service delivery records that were collected during the ACCESS intervention period were linked with administrative data on public shelter use for the 12-month period after the ACCESS program was terminated. By using Cox's proportional hazards model, multivariate analyses were conducted to test how the characteristics of the participants and the intensity of case management service use affected the rate of the first entry into a public shelter. RESULTS: Homeless individuals with serious mental illness who were younger, were African American, had fewer years of schooling, and had longer shelter stays during the ACCESS intervention period were more likely to enter shelters in the 12 months after the ACCESS program ended. Although use of vocational and supportive services was associated with a lower probability of shelter entry, use of housing assistance was associated with a higher probability of shelter entry. CONCLUSIONS: The study found that the total number of case management service contacts was not significantly associated with residential outcomes. Rather, the use of specific types of services was important in reducing the use of homeless shelters. These findings suggest that case management efforts should focus on developing vocational and psychosocial rehabilitation services to reduce the risk of recurrent homelessness among persons with serious mental illness.

Adult↗
PubMed1988

R. v. Morgentaler, 28 January 1988.

The appellants, physicians who had set up a clinic to perform abortions, were charged with conspiracy with intent to commit abortions contrary to Section 251(4) of the Canadian Criminal Code. Section 251(4) prohibits abortions being performed upon women who have not obtained a certificate from a therapeutic abortion committee of an accredited or approved hospital. On appeal of a lower court decision ordering a new trial for the appellants after a jury had acquitted them, the Supreme Court held (two justices dissenting) that conditioning the performance of an abortion upon certification by an abortion committee violated the right of security of the person contained in Section 7 of the Canadian Charter of Rights and Freedoms. The five justices in the majority wrote three separate opinions which pointed out, variously, that Section 251 imposed unnecessary procedures and restrictions, restricted access to hospitals, caused delays, resulted in physical, psychological and emotional risk to the woman, and forced some women to carry a fetus to term against their will.

Abortion, Induced↗