Now showing items 21-40 of 259

    • E Pluribus UNOS: The National Organ Transplant Act and Its Postoperative Complications

      Gross, Jed (2013-03-03)
      Thanks to George Orwell's dystopian novel, the year 1984 became a cultural reference point in Cold War America. When January of that iconic year finally arrived, Apple rolled out the Macintosh personal computer with an arresting Super Bowl advertisement, assuring viewers that "1984 won't be like Nineteen Eighty-Four." As the introduction of new technologies generated excitement and apprehension in the mid-1980s, increasingly sophisticated organ transplantation practices seemed to embody the promise and the perils of medicine's future. Orwell's novel remains a cultural touchstone in the twenty-first century, having outlived its immediate political context, and the first Macintoshes, though today considered technological dinosaurs, ushered in the era of personal computing. The National Organ Transplant Act of 1984 (NOTA) likewise left a cultural imprint that would transcend its immediate historical context. The Act's motives, its text, and even its name have largely receded from the public's consciousness, to the extent that they ever were a part of that consciousness. The human organ allocation system that it spawned, however, supplies the news and entertainment media with a steady stream of inspirational stories, suspicious incidents, and ethical conundrums. Amid a persistent scarcity of transplantable organs, salient aspects of organ allocation in the United States-patients waiting for transplantable organs, shocked next-of-kin being asked to consent to the donation of loved ones' organs, institutional protocols for allocating available organs, and the ban on organ purchases--continue to draw academic and public scrutiny. Policyoriented scholars are increasingly revisiting established features of the NOTA system, especially the provision of NOTA that prohibits commerce in human organs, and proposing various modifications. But before this renewed critical interest can develop into an informed policy discussion, a more complete understanding of what NOTA was intended to do, and what it actually ordained, is needed.
    • Does Being a Repeat Player Make a Difference? The Impact of Attorney Experience and Case-Picking on the Outcome of Medical Malpractice Lawsuits

      Harris, Catherine; Peeples, Ralph; Metzloff, Thomas (2013-03-03)
      Empirical analyses explaining litigation outcomes are not often attempted either in legal scholarship or in the sociology of law. There are studies focusing on conversation analysis in mediation, but few other empirical issues in litigation have been examined in depth. In addition, there is little theory addressing the causes of litigation outcomes in legal scholarship. Similarly, there are few micro-level studies or theories in the sociology of law, other than that of Donald Black, that address the litigation process. There are several reasons for the dearth of studies. Determining outcomes of actual, filed civil cases is difficult, tedious, and time-consuming. There are few databases from which samples may be drawn in a systematic way. Cases must be identified. Court records must be found, read, and abstracted. Critical information about cases is often not a part of the court file. For example, official court records seldom state whether a monetary settlement was reached, and, if so, the terms of that settlement. Instead, court records merely indicate either that the court rendered a judgment or dismissed the case. Why the case was dismissed, or on what terms the case was dismissed, is seldom disclosed. Nonetheless, there is a great need for the insights to be gained from empirical studies based on court records supplemented by additional sources such as archival data, questionnaires, and interviews. Such studies could lead to a richer understanding of the conflict resolution process as it is conducted in the civil court system. The work of Miller and Sarat provides an example. More than twenty-five years ago, Miller and Sarat described the litigation process in the larger context of what they called the "dispute pyramid," with layers of grievances, claims, disputes, filings (involving lawyers), court filings, trials, and appeals. They discussed the process of case attrition, and noted that this attrition may be pronounced. The result resembles a pyramid, with only the most durable cases rising through each layer to reach the top. The shape of the dispute pyramid varies by type of case, but what all these pyramids have in common is that very few cases survive to the apex-a pattern supported by considerable empirical evidence. Many, but not all, cases settle for money being paid to the plaintiff. Other cases are simply dropped prior to trial without any money being paid to the plaintiff. Thus, a successful plaintiffs lawyer must have the ability to select cases that are likely to settle or, if a trial occurs, that are likely to result in a plaintiff's verdict.
    • Health Courts: An Extreme Makeover of Medical Malpractice with Potentially Fatal Complications

      Chow, Emily (2013-03-03)
      United States citizens spent $5267 per capita on health care in 2002, nearly $2000 more than any other country, with annual spending reaching $1.6 trillion. Yet quality and availability of medical care continue to be concerns, and medical malpractice litigation is frequently blamed for rising consumer costs and skyrocketing physicians' malpractice premiums. With physicians abandoning medical specialties with high malpractice premiums like neurosurgery, and obstetrics-gynecology residencies reaching only 65% capacity for the medical school class of 2004, there is a growing consensus within the medical community that current efforts to resolve the "medical malpractice crisis" are failing. The debate has spawned a variety of actions, including implementing noneconomic damage caps, physician walkouts, and the firing of a hospital staff member whose spouse's law firm had a malpractice group. A surgeon from South Carolina has even attempted to obtain the American Medical Association's (AMA) support for his grassroots approach of refusing treatment to malpractice lawyers, their families, and their employees: "[it is] analogous to hitting the lawyers with a 2-by-4. Now we have their attention. Now maybe we can make some progress." In fact, there has not been much progress in medical malpractice reform, especially as compared to the technological advancements in medicine over the last thirty years. Malpractice became "medicine's most serious crisis" for the first time in 1975, when many commercial insurers struggled to provide adequate coverage for physicians. Despite the cyclical onset of several of these crises, the traditional tort system remains the primary tool for victims of malpractice seeking compensation.
    • A Human Rights Approach to Routine Provider-Initiated HIV Testing

      Rajkumar, Rahul (2013-03-03)
      This Article describes the ethical, legal and public health implications of routine HIV testing - that is, testing such that individuals receive a routine offer of an HIV test whenever they come into contact with the health care system. In recent months, the consensus in favor of voluntary testing has yielded to a debate over whether efforts to curb the spread of HIV and to treat individual patients themselves would benefit from health care providers initiating testing. This Article first describes the history of HIV testing policy in the United States and internationally. It outlines the arguments in favor of routine provider-initiated testing and responds to objections that have been raised in the literature. Finally, it describes a proposal for an ethical routine testing regime that is consistent with human rights principles as well as U.S. and international statutes and case law on testing. This Article also proposes model legislation that addresses the issues of counseling, confidentiality, and informed consent in the context of routine-offer HIV testing.
    • Pathways Across the Valley of Death: Novel Intellectual Property Strategies for Accelerated Drug Discovery

      Rai, Arti; Reichman, Jerome; Uhlir, Paul; Crossman, Colin (2013-03-03)
      Most therapeutic interventions produced by pharmaceutical firms take the form of small molecule drugs, which are mass produced at low marginal cost and ingested orally. Drug therapies typically work by affecting the activity of human proteins, known in the industry as targets, that have been implicated in disease pathways. Thus far, medical science has identified safe and effective therapies for only a few hundred of the estimated 3000 protein targets in the human genome that are potentially susceptible to a drug. Moreover, pharmaceutical firms have encountered major obstacles in producing fundamentally new small molecule drugs, especially those that work against new targets. According to one report, an average of only three drugs that act on novel targets have reached the market annually in recent years. This highly visible problem has attracted commentary in scholarly articles, government white papers, and the popular press. Government agencies, such as the National Institutes of Health, and industry insiders, have also recognized that one of the most serious pitfalls involves the difficulty of moving across the so-called "valley of death" that separates upstream research on promising genes, proteins, and biological pathways from downstream drug candidates. For example, an upstream finding that a given protein is differentially expressed in individuals with a particular disease may suggest that the protein merits further investigation. However, much more work (especially medicinal chemistry) is necessary to determine how good a target the protein really is and whether a marketable drug candidate that affects the activity of the protein is likely to be developed.
    • Proxy Consent to Research: The Legal Landscape

      Saks, Elyn; Dunn, Laura; Wimer, Jessica; Gonzales, Michael; Kim, Scott (2013-03-03)
      When an adult suffers from a disorder that impairs his or her capacity to consent, may another person enroll that individual in research? The answer, it appears, is not a simple "yes" or "no," but rather "it depends." The lack of clear legal answers to this question has significant ramifications for the conduct of important research on disorders that affect many individuals. A growing population in our country suffers from illnesses that may affect decision-making, such as dementia, mental retardation, or, in certain instances, severe neuropsychiatric disorders. To illustrate this point, consider Alzheimer's disease ("AD"). As the most common cause of dementia, the current and projected impact of AD is immense. An estimated four to fifteen million people are expected to suffer from Alzheimer's disease by the year 2047. Beyond the quantitative impact of AD, the personal and relational costs of the disease are staggering. Patients in later stages may not recognize family members and often lose many of their core human traits and abilities. Many patients face institutionalization because of the common, yet extremely challenging, behavioral and psychiatric expressions of the disease. The financial costs are also significant. Current annual costs, both direct and indirect, approach $100 billion in the United States alone. It is urgent that research on this disease be strongly encouraged and facilitated.
    • Toward Solving the Health Care Crisis: The Paradoxical Case for Universal Access to High Technology

      Satz, Ani (2013-03-03)
      Nobody questions that the United States is in a health care crisis. Annual health care spending is over $1.9 trillion, 16% of the nation's GDP. Public spending is about 60% of that total, only 10% below that of public funding in countries with universal health care, yet there is no basic universal health care coverage and over 46 million people are uninsured. The daily news and print media are rife with distressing stories of underinsured individuals who are forced to declare personal bankruptcy, as insurers reimburse for fewer services and elevate co-insurance. In fact, 76% of individuals filing for personal bankruptcy due to medical expenses have insurance but are underinsured. Not surprisingly, proposed health care reforms focus on the supply of health care goods to patients. The problem, as reformers see it, is a simple and obvious one: More people need access to basic health care services. As straightforward as this reasoning may seem, it is based on a misperception of critical points within the problem.
    • The Medical Resident Working Hours Debate: A Proposal for Private Decentralized Regulation of Graduate Medical Education

      Ciolli, Anthony (2013-03-03)
      The debate over the regulation of resident working hours has been one of the most significant recent controversies in graduate medical education. A diverse array of organizations, including Congress, state governments, administrative agencies, and the Accreditation Council for Graduate Medical Education (ACGME), have had to confront this issue at some point over the past two decades. While a consensus has developed that at least some aspects of resident working conditions should be regulated in order to enhance patient safety, there remains an ongoing controversy over which organizations should implement and oversee these regulations. This Note examines and evaluates the costs and benefits of allowing certain bodies to regulate physician residency programs. Although most scholarship has promoted regulation either by governmental entities, the ACGME, or residents themselves, none of these groups is suited to this task. This Note argues that the ideal regulatory system should involve a decentralized private sector approach, achieved by ending the ACGME monopoly over graduate medical education accreditation and allowing for multiple accrediting agencies. Switching to a private decentralized system would allow for greater experimentation, which would increase the likelihood of discovering the best way to regulate resident working conditions to enhance patient safety.
    • Medicare's Coverage with Study Participation Policy: Clinical Trials or Tribulations?

      Carnahan, Sandra (2013-03-03)
      The Medicare program has, from its inception, sought to balance its duty to safeguard the Medicare trust, with its statutory obligation to pay only for "reasonable and necessary" health care for Medicare beneficiaries, and to honor the government's promise that its elderly and disabled citizens will receive the best that modern medicine has to offer. Modern medicine is expensive, and costs continue to rise, fueled by an influx of new medical technology and the fast approach toward Medicare eligibility for millions of baby-boomers. The Centers for Medicare and Medicaid Services (CMS) face legal and political restraints with respect to its ability to control costs. Although CMS has discretion in determining how much it will pay for new items and services, it does not have explicit statutory authority to consider cost when deciding whether to cover the intervention in the first instance. Faced with conflicting obligations and statutory restraints, CMS has endeavored to reduce costs, particularly with regard to expensive new technology, through an initiative known as Coverage with Evidence Development (CED). This new coverage policy, published by CMS on July 12, 2006, consists of two arms. The second, more controversial arm of CED is called Coverage with Study Participation (CSP). Under this program, CMS will pay for certain new medical tests, treatments, and biotechnology products, even though it deems the medical evidence insufficient to merit broad national coverage, provided that the services are received in the context of a prospective clinical trial aimed at generating additional evidence. Thus, CSP would restrict payment for certain services to a limited group of Medicare beneficiaries who "agree" to participate in a clinical trial. The idea of linking coverage to clinical research is not entirely new. In 1995, CMS conditioned payment for an innovative surgical procedure upon patient participation in a clinical trial. In that instance, CMS commenced a seven year clinical trial to compare the outcomes of emphysema patients who underwent lung volume reduction surgery with those patients who were given comprehensive pulmonary rehabilitation. In the face of vigorous opposition from provider representatives and some members of Congress, CMS restricted payment for lung volume reduction surgery to beneficiaries treated according to a clinical trial protocol. In a 2005 trial involving the use of FDG-PET scans to diagnose certain cancers, CMS conditioned coverage of the scans on participation in a prospective clinical trial or registry." Also in 2005, CMS conditioned coverage of implantable cardioverter defibrillators (ICDs) used for certain indications on participation in a clinical trial or registry. Prior to the publication of its July 2006 "Coverage with Evidence Development" guidelines, however, CMS had not explained its authority for linking coverage with participation in research.
    • Bioethics, Philosophy, and Global Health

      Merritt, Maria (2013-03-03)
      This Article addresses the present state and future prospects of the field of bioethics. The subject is open to more than one attitude of address. Possibilities include preoccupation with the professional status of bioethics, critical scrutiny of its research programs and methodologies, and anxiety about whether some areas of bioethics have become intertwined with-and perhaps co-opted byextra- professional, extra-academic agendas, such as those that drive profitmaking enterprises (pharmaceuticals, biotechnology, HMOs) or partisan politics (debates over abortion, stem cell research, withdrawing artificial nutrition and hydration from patients like Terri Schiavo). These attitudes, whatever their merits, are all somewhat self-focused. Without denying the importance of the problems they target or the necessity of continual self-critical reflection among the practitioners and friends of bioethics, this Article assumes a more straightforward, outward-looking stance. This stance is meant to complement the inward-looking attitudes and to affirm the values that motivate them. Those of us who work in bioethics can demonstrate the professional and academic value of our field only through the substance of the contributions we make in its name. With respect to worries about inappropriate involvement with corporate or partisan agendas, the issue is protecting the intellectual integrity we need in order to make headway on problems whose solutions cannot be left to the rough-and-tumble of the market and the political arena. We ought to set our own research agenda, rather than acquiesce in its distortion by external interests, political pressures, and popular sensations du jour.
    • Fluconomics: Preserving Our Hospital Infrastructure During and After a Pandemic

      Williams, Vickie (2013-03-03)
      Would an infectious disease pandemic overtax our hospitals to the extent that conditions for treating infectious disease would revert back to those prevalent in the nineteenth century? The United States is not immune to naturally occurring outbreaks of deadly diseases. The United States Centers for Disease Control (CDC) and the World Health Organization (WHO) are currently monitoring a strain of avian influenza, or "bird flu," that has infected 236 people in Asia, Turkey, and Iraq, and has a mortality rate of fifty-eight percent. If this virus mutates to become easily transmissible from person to person, it could become a pandemic even more deadly than the legendary Spanish flu that swept through the United States and the world in 1918. The Spanish flu infected more than twenty-five percent of the United States population, and killed 500,000 in the United States alone. It lowered the average life span of an adult in the United States by twelve years. Estimates of the total number of deaths from the Spanish flu worldwide range from 20 million to more than 100 million, with most occurring within the span of twenty-four weeks. If a similar pandemic occurred today, with a similar mortality rate, 1.5 million Americans would die. Virtually all experts agree that it is not a question of if but when another influenza pandemic as deadly as the Spanish flu will occur. The United States and the world are engaging in new pandemic preparedness efforts because of the recent emergence of the H5N1 avian flu as a human infection.
    • Pay-for-Performance: Is Medicare a Good Candidate?

      Cannon, Michael (2013-03-03)
      According to one prominent study, adults in the United States receive the generally accepted standard of preventive, acute, and chronic care only about 55% of the time. The likelihood that patients will receive recommended care "varie[s] substantially according to the particular medical condition, ranging from 78.7 percent of recommended care . . . for senile cataract to 10.5 percent of recommended care ... for alcohol dependence." Evidence of low-quality care appears in Medicare, the federal health program for the elderly and disabled. Quality of care does not appear to be higher in areas where Medicare spending is higher. In fact, some studies point to the somewhat paradoxical conclusion that Medicare patients are often less likely to receive recommended care in regions where Medicare expenditures are highest. Third-party payment is a potential contributor to the under-provision of quality health care. Most health care payments in the United States are made by third parties, usually employers, insurers, or government. Those purchasers typically reimburse health care providers on the basis of the volume and intensity of the services provided, rather than the quality or cost-effectiveness of those services. The result is a financing system akin to paying academics on the basis of the volume and intensity of footnotes.
    • The Three Faces of Retainer Care: Crafting a Tailored Regulatory Response

      Pasquale, Frank (2013-03-03)
      Retainer care arrangements allow patients to pay a retainer directly to a physician's office in order to obtain special access to care. Practices usually convert to retainer status by focusing their attention on those willing to pay a retainer fee, and dropping the majority of their patients, who are left to be absorbed by other practices. Also known as "boutique medicine," "concierge care," or "innovative practice design," retainer practices have drawn thousands of enthusiastic patients. They have also provoked scrutiny from politicians and consumer groups. Few recent developments in the business of medicine provoke emotional conflicts like retainer care does. Retainer care physicians are thrilled to break out of the vise of managed care, lavishing medical attention where they used to face the stark choice of rationing or involuntarily donating their services. Critics decry an ever-widening gap between haves and have-nots, and view retainer care as one more excess for the wealthy in an age of increasing medical scarcity.
    • Mortality, Equality, and Bioethics

      Cohen, Eric (2013-03-03)
      Given the close connection between bioethics and biomedical technology, it is hardly surprising that bioethicists often think about the future. There is a certain prophetic pleasure that comes with predicting the problems ahead, and a strong inclination to believe that our ethical thinking needs to "keep pace" with our technology, constantly updating its moral vision of man in light of the material possibilities of the age. In some sense, of course, this is true: Our ethics does need to keep pace with our changing technological condition. New problems arise for which old thinking is inadequate. Yet, to see the future clearly, it might also help to recover what is first in bioethics - first in the sense of the discipline's origins and first in the sense of man's perennial problems and possibilities. To invite such a recovery is the aim of this Commentary. In one sense, bioethics - at least American bioethics - began in the 1960s and 1970s, with a group of philosophers, theologians, and physicians interested in the future of human life in the budding age of biotechnology and advanced medicine. They held meetings. They wrote articles. They advised government bodies and influenced judicial decisions. They debated issues ranging from endof- life care to organ transplantation to research with human subjects to the initiation of human life in the laboratory. Through their labors, a new discipline and myriad new institutions were born: think-tanks, journals, degrees, commissions, committees, consultants, and media stars. Yet many of the questions these first bioethicists were asking were in fact very old, and so were many of the conflicting answers. New technological possibilities - such as in vitro fertilization, genetic testing of the unborn, the biochemical manipulation of psychic experience, the extended preservation of bodies between life and death, the transfer of body parts from the newly dead to the still living - were altering some of the fundamental experiences of being human. But these technical possibilities made us anxious because the image of man himself seemed to be at stake, with all the old conflicts and perennial problems about the good life and good death taking on a new, dramatic shape. Recovering this clash of images is the first step toward understanding the origins and thus the future of bioethics. In a very modest way, I'd like to attempt such a philosophical recovery in two parts: first, by exploring certain permanent alternatives in man's quest to live well with death, which is the problem that stands at the heart of many modern bioethical quandaries; and second, by looking at the founding framework for addressing such moral questions in America, namely the Declaration of Independence, with its mysterious teaching about human equality and human happiness. That mortality and equality should be considered together seems only fitting: In death, our ultimate equality is restored; in the circumstances of death, the inequities of nature and chance are sharply revealed; in seeking to conquer or ameliorate the sting of death, we are tempted to set the democratic ideal of equality aside. Only by recovering a deeper wisdom about mortality and equality can we consider wisely the future of bioethics - and, in particular, how new technologies and new social conditions will re-open, yet again, in ever novel ways, those inescapable problems that are inherent to being human.
    • The Uses of Psychoanalysis in Law: The Force of Jay Katz's Example

      Burt, Robert (2013-03-02)
      Jay Katz has been one of the most profound and enduring influences on my life as a legal scholar. His influence began at the very moment I entered the Yale Law School as a student in 1962. My understanding of the uses of psychoanalysis in legal analysis begins with the memory of my first encounter with him. I believe that my personal experience mirrors more generally how Jay came to influence all of his students-those lucky enough to sit in his classes as well as those who have only encountered him through his writings. Here then is my memory of my first classroom session with Jay Katz. I had just arrived at Yale Law School in 1962 after two years at Oxford studying law. Yale treated my Oxford degree as the equivalent of the first year course of study; so I began in effect as a transfer student with second-year status. (If you'll excuse the pun, it was transference all the way down from that moment onward.) This transfer status meant that I was immediately eligible for taking some upper-class courses and I enrolled in Family Law - taught by Professors Joe Goldstein and Jay Katz - and this was the first class I attended on my first day at Yale.
    • Experimentation with Human Beings: Light or Only Shadows?

      Capron, Alexander (2013-03-02)
      We have failed Jay Katz. Like the man looking under the lamp-post for his keys-not because that was where he was standing when he dropped them but because the light is better there-we have labored too long in the light and poked too infrequently into the shadows where the often painful truth is to be found. We have treated as exact the imprecise process of balancing research risks and benefits. We have exalted autonomy and made a sacrament of consent forms, even those that run to hellish lengths, littered with jargon - and forgotten the myriad constraints on subjects' choices. We have realized that, however well-intentioned researchers may be, their individual judgment of when and how to conduct research is usually very partial, in both senses of that word. Yet, from that realization we have moved to the contradictory conclusion that by instituting prior review by Institutional Review Boards (IRBs), we have solved the ethical problems involved in deciding when and how to conduct research. Above all, we have developed elaborate rules and processes to normalize human experimentation, to treat it as an ordinary activity. We have thus avoided looking clearly at the moral dilemma that lies at the heart of every research encounter: "We are asking you to do this not for yourself but for others, even though we know that the role of human subject entails real and sometimes unforeseen risks including death." Such a statement is significant not becauseor not solely because-it clearly describes the potential harm. I agree with Jay that this is not the critical issue, though it is hardly one that we can ignore, in light both of the historical abuses of research subjects and also of what has occurred much more recently at such renowned medical institutions as the University of Pennsylvania and Johns Hopkins. Rather, its central significance lies in its frank description of the aims of research and, hence, of the potential divergence of interest between the prospective subject and the person offering to enroll him or her in the research project.
    • The Web of Relations: Thinking About Physicians and Patients

      Clayton, Ellen (2013-03-02)
      Like the other contributors to this symposium, I owe a profound debt to Jay Katz for his intellectual rigor, his gentle but firm Socratic pedagogy, and his unparalleled generosity of time and friendship. I first met Jay during my last year of law school when, at the urging of friends, I enrolled in his seminar on informed consent. By that time, he had collected most of the materials on which he based his important book. Not surprisingly, a single semester could not contain all of that material, so many of us continued on into the second semester. During that time I learned a number of things, but largely in the abstract mode that often characterizes the law school classroom. Fortunately, I had the opportunity after my first year in medical school to work on Jay's book, The Silent World of Doctor and Patient. I am not sure that I contributed much. I have always viewed that summer as Jay's effort to create a tutorial designed to make sure I "got it." Even so, it required actually taking care of patients for the last twenty years to bring some of his lessons home. Over the years, I have come to see the physician-patient relationship not simply as a dyad of autonomous individuals, but as one part, albeit an important and complex part, of a web of dynamic interactions that influence both parties. This perspective has important implications. The work of Barabási and others has shown that networks are fluid, self-creating, and always changing. At the same time, networks tend to respond poorly or unexpectedly to deliberate attempts to induce change. Pressure at one point can lead to a countervailing response at another. This understanding provides additional insights into people's actions and suggests both reasons for resistance as well as the possibility of support from unanticipated sources.
    • Foreword: A World Less Silent: Celebrating Jay Katz's Contributions to Law, Medicine, and Ethics

      Tolley, David (2013-03-02)
      On October 15, 2004, more than one hundred and twenty people convened at the Yale Law School for what has come to be known as "Jay Katz Day." Many of them former students of Dr. Katz's, they came from as far as Geneva and California, and from as near as their offices down the halls of the law school. It was a day of celebration and reflection on what Harold Koh, Dean of the Yale Law School, called "the healing wisdom of Jay Katz." It was also a day of great anticipation. I had the privilege of serving as the primary coordinator for this conference, and I was in dialogue with Dr. Katz from the beginning-"What are you planning?" he often wanted to know. "Who will be there? What are the topics?" For many weeks through the spring and summer of 2004, Dr. Katz and I spoke often about how much he was looking forward to this great event. Besides the many scholars we invited, I sent more than one hundred invitations to friends and family of the Katz's. However, two weeks prior to the symposium, Dr. Katz fell ill with a serious respiratory infection. He spent the better part of those two weeks in a Boston hospital. Knowing that he had been discharged from the hospital on the afternoon of the October 14th - the day before the conference was to begin - we all hoped that he would be able to attend, but we were unsure. I met a friend of the Katz's, a gentleman who had been taking care of their New Haven home while Dr. Katz and his wife were in Boston, at 7:30 a.m. on Wall Street behind the law school. He and I carried Dr. Katz's recliner into the conference hall in hopes that he would be able to be with us.
    • Introductory Remarks: The Healing Wisdom of Jay Katz

      Koh, Harold (2013-03-02)
      I have known Jay Katz for over forty years, and I have been his colleague for nearly twenty. It is my great joy to welcome you all here and especially to thank Bob Levine and Alex Capron, Bo Burt, David Tolley, and Carol Pollard for putting this program together. You all know Jay Katz's story. He was born in Germany and emigrated to the United States at the age of eighteen. He earned his doctorate at Harvard Medical School, which he followed with a medical internship at Mount Sinai. Next is the part of his resume that has always been the most exciting and mysterious to me: his service as Captain Katz of the United States Air Force. (Imagine what that must have been like!) He first came to Yale as an assistant medical resident more than fifty years ago, and then to the Yale Law School as Assistant Professor of Psychology of Law in 1958. In time, Jay became Professor of Law, Science, and Medicine; the John Garver Professor of Law and Psychoanalysis; and the inaugural Elizabeth K. Dollard Professor of Law, Medicine, and Psychiatry. He has received numerous honorary degrees and delivered many named lectures. His greatest works, of course, are his books: The Family and the Law, with our beloved colleague, Joe Goldstein; Psychoanalysis, Psychiatry, and Law, with Joe Goldstein and Alan Dershowitz; Experimentation with Human Beings, with Alex Capron and Eleanor Swift Glass; and his landmark work, The Silent World of Doctor and Patient. Reading the introduction to that book, one can see that Jay's special skill lies in his ability to be both an outsider and an insider in the worlds of law and medicine. Upon reflection, the concept of "outsider-insider" is a description not just of Jay as a person, but also of the role that he defined for a doctor vis-à-vis his patient. On the one hand, Jay said, the doctor must be united with his patient in the act of healing and analysis; on the other, he must be sufficiently removed from his patient to retain his own objectivity.