Posted: January 17th, 2023

Public health issues

Public health issues

Question 1
Your state has seen falling vaccination rates and public health officials are very concerned   about the risks
out outbreaks of diseases   like pertussis   and measles. Currently your state law provides philosophical and
religious exemption to vaccination. The  exemptions  are easy to obtain. With  the support of the  state
Bureau of Health, several legislators are interested in introducing a bill this   session t hat would eliminate
all  non- medical exemptions to vaccination    as a means to protect the public’s health. They have asked
you, as Assistant Attorney General , to provide a memo  outlining    any    constitutional problems that might
arise in changing the law in this way.  Please answer the following questions as part of your memo:
1.What are the First Amendment implications in both retaining or eliminating the exemptions
2. Are there any states that  allow only    medical exemptions     What have the courts said about these
laws
3. Consider how Jacobson v Massachusetts  or other  caselaw apply to this situation
Question 2
Y ou    have    been      appointed    by    the    Governor    to    a    Blue    Ribbon    Commission    on    Ethics    and
Human    Genetic    Technologies    to    study    and    report    on    genetics    issues    in    state    health    policy,
as    well    as    related    issues    in    genetic    reproductive    technologies.    The    Governor    has    asked    the
commission    to    explore    the    ethical    issues    and    make    recommendations    on    the    major    issue
currently    pending    in    the    state    legislature:     Should    parental    informed    consent    be
required    for    the    state    newborn    screening    program     Given    that    the    legislature    is
expected    to    hold     hearings    within    the    month,    each    member    of    the    Commission    is
asked    to    bring    a    statement    of    ethical    concerns    and    a    short    position    statement    to    the
first    commission    meeting.

You    have    consulted    the    director    of    the    city’s    department    of    maternal    and    child    healt h    and
learned    the    following:

The    current    state    law    authorizes    the    state    department    of    health    to    establish,    maintain    and
carry    out    a    newborn    screening    program    to    detect    hypothyroidism,    PKU,
hemoglobinopathy,    congenital    adrenal    hyperplasia    (CAH),    and    maple     syrup    urine    disease;
and    additionally    to    provide    each    infant    determined    to    be    at    risk    with    a    screening    test    for
sickle    cell    diseases.    The    state    legislature    currently    determines    which    tests    will    be
administered    under    the    newborn    screening    program,    with    consultation    from    an    advisory
board    of    the    state    health    department.    The    newborn    screening    requirements    do    not    apply    to
infants    whose    parents    object    for    religious    or    personal    reasons.    However,    parental    consent
for    newborn    screening    currently    is    not    required,    an d    even    though    newborn    testing    may    not
be    conducted    over    parental    objection,    virtually    no    parents    raise    the    issue    or    object    to
testing.    Currently    only    a    few    states    require    informed    consent    (that    is,    parental    permission)
for    newborn    screening,    while    about    a    dozen    other    states    require    that    before    testing    is    done,
parents    must    be    explicitly    informed    about    newborn    screening.

Your    health    policy    analyst    provided    the    following    background    information    about    informed
consent.

Analysis    of    informed    consent    generally    focuses    on    five    elements:    competence,    disclosure,
understanding,    voluntariness,    and    consent.    Ethicists    have    acknowledged    that    in    some
circumstances    obtaining    consent    that    satisfies    these    rigorous    standards    may    be
excessive    or    impossible    to    implement    and    that    an    alternate    framework    based    on    social    or
institutional    rules    of    consent    may    be    appropriate.    We    can    evaluate    institutional    rules    not
only    in    terms    of    respect    for    autonomy    but    also    in    terms    of    the    probable    consequences    of
imposing    burdensome    requirements     on    institutions    and    on    professionals,    the    effect    of
alternative    consent    requirements    on    efficiency    and    effectiveness    in    delivering    health    care
and    advancing    science,    and    the    effect    of    consent    requirements    on    the    welfare    of    patients.    In
some    circumstances,    patients    do    not    expect    to    be    asked    for    or    to    give    full    and    rigorous
informed    consent,    for    example,    as
with    a    routine    battery    of    blood    tests;    consent    in    these    circumstances    is    presumed    or
implied
because    testing    is    routine.

Further    background:    “Warrants    fo r    Screening    Programs:    Public    Heath,    Legal    and    Ethical
Frameworks”    Faden,    Kass    and    Powers.     Public    Health    Law    and    Ethics,    pp    390 -393.

Question    3

Gun    violence    is    a    major    public    health    problem    in    your    community.    A    recent    Supreme    Court
case,     District    of    Columbia    v.    Heller    (2008),    summarized    below,    is    one    of    few    Supreme    Court
Second    Amendment    cases    in    recent    years.    Your    city          health    department    has    asked    you    to
review    the    Heller    case    and    offer    your    opinion    about    the    implications    of    this    case    for
potential    gun    control    efforts.    Please    answer    the    following    questions:

1.   Why    was    the    D.C.    handgun    ban    found    unconstitutional    in    this    case
2.   Do    you    agree    with    the    majority    or    dissent (s)     in    this    case        Please    base    your
position    on    the    court’s    interpretation    of    the    law    and    constitution.         This    is    not     a
political    position    paper.
3.   Based    on    the    decision    in    Heller,      what    kinds    of    gun    control    laws    would    be
constitutional    in      your    community.

Summary of District of Columbia v. Heller , 554 U.S.  570, 128 S. Ct. 2783, 171 L. Ed. 2d 637
(2008)
Handgun possession is banned under District of Columbia (D)  law. The law prohibits the
registration of handguns and makes it a crime to carry an unregistered firearm. Furthermore all
lawfully owned firearms must be kept unloaded and dissembled or bound by a trigger lock unless
they are being used for lawful recrea tional activities or located in a place of business.
Dick Heller (P) is a special police officer in the District of Columbia. The District refused
Heller’s application to register a handgun he wished to keep in his home. Heller filed this lawsuit
in the Fe deral District Court for the District of Columbia on Second Amendment grounds. Heller
sought an injunction against enforcement of the bar on handgun registration, the licensing
requirement prohibiting the carrying of a firearm in the home without a license , and the trigger -lock requirement insofar as it prohibits the use of functional firearms within the home.
The District Court dismissed Heller’s complaint. The Court of Appeals for the District of
Columbia Circuit reversed and held that the total ban on handguns violated the individual right to
possess firearms under the Second Amendment. The Supreme Court granted certiorari.
Issue:What rights are protected by the Second Amendment
Holding and Rule (Scalia):  The Second Amendment protects an individual right  to possess a
firearm unconnected with service in a militia, and to use that arm for traditionally lawful
purposes, such as self -defense within the home.
Text of the Second Amendment:A well regulated Militia, being necessary to the security of a
free State , the right of the people to keep and bear Arms, shall not be infringed.
Constitutional Construction  (Scalia for the majority): The prefatory clause “A well regulated
Militia, being necessary to the security of a free State” merely announces a purpose. It does not
limit or expand the scope of the operative clause “the right of the people to keep and bear Arms,
shall not be infringed.” The operative clause’s text and history demonstrate that it connotes an
individual right to keep and bear arms.
The militia  consisted of all males capable of acting together for the common defense. The
Antifederalists feared that the Federal Government would disarm the people in order to disable
citizen militias, thereby enabling a politicized standing army or a select militia  to rule. The
Antifederalists therefore sought to preserve the citizens’ militia by denying Congress the power
to abridge the right of individuals to keep and bear arms.
This interpretation is confirmed by analogous arms-bearing rights adopted in state constitutions
immediately preceding and following the Second Amendment. Furthermore, the drafting history
reveals three proposals that unequivocally referred to an individual right to bear arms.
Interpretation of the Second Amendment by scholars, courts, and l egislators from ratification
through the late 19th century also supports the Court’s interpretation.
No precedent forecloses this interpretation. United States v. Miller limits the type of weapons to
which the right applies to those in common use for lawful purposes, but does not limit the right
to keep and bear arms to militia purposes.
The Second Amendment right is not a right to keep and carry any weapon in any manner  and for
any purpose. The Court has upheld gun control legislation including prohibitions on concealed
weapons and possession of firearms by felons and the mentally ill, laws forbidding the carrying
of firearms in sensitive places such as schools and government buildings, and laws imposing
conditions and qualifications on the commercial sale of arms. The historical tradition of
prohibiting the carrying of dangerous and unusual weapons supports the holding in United States
v. Miller that the sorts of weapons  protected are those in common use at the time.
The handgun ban and the trigger-lock requirement (as applied to self-defense) violate the Second
Amendment. The total ban on handgun possession in the home amounts to a prohibition on an
entire class of arms that Americans overwhelmingly choose for the lawful purpose of self -defense. This prohibition would fail constitutional muster under any standard of scrutiny.
Similarly, the requirement that any lawful firearm in the home be disassembled or bound by a
trigg er lock makes it impossible for citizens to use arms for the core lawful purpose of self-defense and is therefore unconstitutional.
The Court assumes that a license will satisfy Heller’s prayer for relief and therefore does not
address the  constitutionality of the licensing requirement. Assuming Heller is not otherwise
disqualified from exercising Second Amendment rights, the District of Columbia must permit
him to register his handgun and must issue him a license to carry it in the home.
Disposition :Affirmed.
Dissent (Stevens):  The Second Amendment was adopted to protect the right of the people to
maintain a well regulated militia. It was a response to the concern that the power of Congress to
disarm the state militias and create a national standing army posed an intolerable threat to state
sovereignty. Neither the text of the Second Amendment nor the arguments advanced by its
proponents evidence the slightest interest by the Framers in limiting any legislature’s authority to
regulate private civilian uses of firearms.
There is no indication that the Framers intended to enshrine the common law right of self -defense in the Constitution. The view in Miller that the Second Amendment protects the right to
keep and bear arms for certain military pu rposes, but does not curtail the Legislature’s power to
regulate the nonmilitary use and ownership of weapons, is both the most natural reading of the
Amendment’s text and the interpretation most faithful to the history of its adoption. The majority
fails  to identify any new evidence supporting the view that the Amendment was intended to limit
the power of Congress to regulate civilian uses of weapons.
Dissent (Breyer) :  The Second Amendment protects militia-related interests, not self -defense-related interests. Furthermore, the Amendment permits government to regulate the interests that
it serves. Colonial history itself offers important examples of the kinds of gun regulation that
citizens would then have thought compatible with the right to keep and bear arms, including
substantial regulation of firearms in urban areas, and regulations that imposed limitations on the
use of firearms for the protection of the home.
Adoption of a true strict scrutiny standard for evaluating gun control regulations would be
impossible and I would adopt an interest-balancing inquiry. In applying this kind of standard the
Court normally defers to a legislature’s empirical judgment in matters where a legislature is
likely to have greater expertise and greater institutional fact fi nding capacity.

Question    4

Please    read    “Who    Should    Get    Influenza    Vaccine    When    Not    All    Can”    by    Ezekiel    Emanuel    and
Alan    Wertheimer,     Public    Health    Law    and    Ethics,    pp.    433 -435.    This    article    presents    3    ethical
approaches    for    distributing    scarce    vaccines.

Choose         one    of    the    approaches    for    vaccine    allocation    and    support    your     choice      using
one    of    the    ethical    frameworks    from    Chap.    1,     Case    Studies    in    Public    Health    Ethics
(Coughli n).

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