Court rulings that changed medicine

What happens when technology firms, insurance companies, healthcare systems, and even the US government encroach on medical practice? In short, the courts get involved.

Landmark Supreme Court cases and lower court rulings have set the tone on medical ethics and shaped healthcare policy. Here are five such cases that made their mark on medicine.

Vizzoni v. Mulford-Dera, 2019

In this case, the Superior Court of New Jersey Appellate Division upheld a trial court decision to dismiss a malpractice lawsuit after the family of a New Jersey woman who was killed during a car-bicycle accident sued the driver’s psychiatrist for medical negligence. The psychiatrist had been treating the driver, Barbara Mulford-Dera, for psychological conditions, and when Mulford-Dera struck and killed the cyclist, she had been taking a prescription medication that she allegedly did not know made it dangerous to drive. The bicyclist’s family maintained that the psychiatrist should have disclosed the potentially harmful effects of driving while under the influence of the prescribed psychotropic medication. But the trial court dismissed the case, ruling that it was not medical negligence. In an amicus brief, the American Medical Association warned that expanding physician legal obligations to the general public would have profound negative implications for medical professionals.

State of Washington v. US Department of Health and Human Services, 2019

In this case, a federal judge in Washington issued a nationwide injunction blocking a series of proposed abortion restrictions. The restrictions, issued by the Trump administration, would have barred federally funded family planning facilities from advising or assisting patients seeking an abortion. Facilities backed by federal funding under the Title X program, including Planned Parenthood, were already prohibited from using those funds to perform abortions, but under this so-called “gag rule,” they would no longer be able to say or do anything to assist patients who were seeking an abortion, including referring them for abortion procedures. The rule was promulgated in March 2019 by the Department of Health and Human Services, and blocked by a federal judge the following month. In support of the injunction against the proposed plan, Washington state Attorney General Bob Ferguson said that it “ensures that clinics across the nation can remain open and continue to provide quality, unbiased healthcare to women.”

National Federation of Independent Business v. Sebelius, 2012

In a Supreme Court ruling, a key provision in the Affordable Care Act (ACA), passed by Congress in 2010, was upheld. The ACA, created during the Obama administration, contained an individual mandate that required all Americans to buy health insurance or pay a tax penalty. It also required states to expand their Medicaid programs or risk losing federal funding. The court upheld the individual mandate on American citizens but rejected the provision to withhold federal funding from states that didn’t expand Medicaid, ruling that state participation in the program would be voluntary. “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice John Roberts wrote in the ruling. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”

Sherley v. Sebelius, 2010

In this case, a scientist from the Boston Biomedical Research Institute sued to block a 2009 executive order by the Obama administration that expanded embryonic stem cell research. Obama’s order limited federal funding to research on embryonic stem cells that would otherwise be disposed by fertility clinics. The scientist, James Sherley, argued that the order would exclude his team from federal funding with work on adult stem cells. A federal judge ruled in favor of Sherley, stating that the executive order violated a law that prohibits federal financing of any research in which embryos are destroyed. Medical experts have long regarded embryonic stem cell research as a beneficial methodology to better understand how diseases appear and progress. However, this research has been at the center of heated political and ethical debate because it involves the destruction of human embryos. Ultimately, the US Court of Appeals for the District of Columbia Circuit voted to overturn the judge’s ruling, and the Supreme Court declined to hear the case. Stem cell research continues to be fraught with debate and controversy.

Gonzales v. Oregon, 1994

Oregon became the first state to legalize assisted suicide after enacting the Death with Dignity act. The law permitted physicians to dispense and prescribe a lethal dose of drugs to terminally ill patients who were within half a year of death. In 2001, the US Attorney General John Ashcroft challenged the law, stating that it violated the Controlled Substances Act of 1970. Ashcroft threatened to revoke the medical licenses of physicians who took part in assisted-suicide procedures. The case was brought to the District Court and Ninth Circuit Court of Appeals, which sided with the state of Oregon. Then, the Supreme Court affirmed the Ninth Circuit’s judgment. Writing for the majority, Justice Anthony Kennedy concluded that the federal government could not delegitimize a medical standard authorized under state law.

These cases not only shed light on how Congressional power is exercised over medical practice and public health, they are also representative of how the fields of healthcare and government work together. Each case is a unique effort geared at finding the balance between constitutional rights and public benefit, while considering scientific and ethical progress.