Situations involving physical health and well-being, especially the availability and quality of life-saving treatments, are compelling subjects for judges and juries.  Health care represents nearly $2 trillion annually of American economic activity, much of that expense associated with innovations in diagnostic imaging, surgery, pharmaceuticals, and biotechnology.  Health care is also a paradigmatic regulated industry in which even the most committed "free-market" advocates acknowledge the inevitability of significant government involvement.  Moreover, because health care constitutes such a large and rapidly growing portion of the American economy, difficult issues of expense, equity, and individual rights frequently attract public attention and debate. 

Columbia students are introduced to issues involving health care and the law in their first year, examining individual disputes over medical care (in Torts and Contracts) as well as debates over social policy (in Foundations of the Regulatory State).  In their second and third years, students may pursue a more comprehensive understanding of the legal relationships among patients, health care providers and government.  Columbia offers courses and seminars dealing with the structure and regulation of health care (such as health law, food and drug law and biotechnology) and with social and ethical challengs to the health care system (such as bioethics, reproductive health, organ transplantation and maged care).  Columbia's health care curriculum also provides a looking glass through which law students can better appreciate their own roles and responsibilities by examining those of another profession.

L6355 HEALTH LAW (3 pts)
D. Trueman
This is a survey course covering legal issues in health care delivery, financing, and the responsibilities of health care professionals to patients. In addition to presenting essential material for those intending to represent health care organizations, the course offers students of all backgrounds an introduction to a subject that constitutes one-seventh of the U.S. economy. Although the course will include traditional areas of interest such as medical malpractice, it will emphasize the recent, rapid expansion of managed care and the ongoing transformation of health care from a regulated profession to a regulated industry.

L6356 MENTAL HEALTH LAW (3 pts)
S. Colb
This course considers the unique way in which the law has dealt with individuals suffering from mental disorders. Students first examine background assumptions that drive legal decisions about the mentally ill. The course then turns to the role of mental illness in determining people's legal rights and responsibilities in a variety of contexts. Consideration of civil lawsuits regarding the mentally ill will include a review of tort law doctrines that apply to the actions of mentally ill people and the professionals who diagnose and treat such illness. The course next considers civil commitment of the mentally ill and dangerous, a form of confinement that resembles but does not entirely mirror other categories of confinement in the law. The course explores distinctions in how the law treats different populations of mentally ill individuals (such as insanity acquittees and convicted sex offenders) when the government seeks to subject them to civil confinement. The third area of study and the bulk of the course focuses on the criminal justice system (including the trial process and the application of the death penalty to those suffering from mental disorders). It is here that students will examine doctrine in such areas as the insanity defense and competency to be executed.

L9169 SEMINAR: ABORTION: LAW IN CONTEXT (3 pts)
(see Family Law)

L8271 SEMINAR: ACCESS TO HEALTH CARE (2 pts)
D. Trueman
The purpose of the course is to provide students with an understanding of issues regarding access to the health care system. The course will consider the American health care system, its structure, financing and delivery aspects, and significant questions related to access to health care within the system. There will be an examination of all aspects of access to health care, including private and governmental provision of care, health care insurance, the inception and impact of managed care, and the extant procedures available to resolve health care grievances. Access to health care will be considered in the context of conflicting forces impacting on the system, including economic and market forces, issues of entitlement, rights and privileges, social and distributive justice, and public policy issues related to rationing of care and the utilization of increasingly expensive technological advances in medicine. The course will compare the structure of the health care systems of other countries, particularly those with universal health care, with the health care system of the United States and consider how the American system can be improved.

L8241 SEMINAR: BUSINESS AND LAW OF HEALTH CARE (2 pts)
S. Epstein, W. Kopit
This seminar focuses on the business aspects of the major components of the health care industry, and the implications and effects of the law on the industry. The goal of the seminar is to present students with knowledge of the key legal challenges and issues facing clients in the health care industry and the related challenge of advising clients on those issues.

The health care industry in the United States is huge and growing rapidly. In 2002, it accounted for approximately 14% of gross domestic product (GDP), or $1.6 trillion. Estimates are that within the next 10 years, health care spending will approach 20% of GDP. More importantly, the industry is unique in the diversity of its participants and the nature of its financing, with participants ranging in size from multi-billion dollar international drug and insurance companies to individual physicians and nurse practitioners. Federal, state, and local governments pay for approximately 45% of total U.S. expenditures on health care. Private insurance and other private spending account for 40%, and direct consumer out-of-pocket spending accounts for only 15%. Although approximately 40 million Americans have no health insurance, most Americans under 65 obtain private health insurance through their employer, or the employer of a family member, while virtually all Americans over 65 obtain health care coverage through the federal Medicare program. An additional 50 million people are eligible for coverage under the Medicaid program, an uneasy series of partnerships between the federal government and each of the states.

In addition to the instructors, the seminar will involve individuals with experience in particular industry sectors to assist in the discussion of the business and legal issues relevant to the various industry sectors. Students will be expected to participate in class discussions. Topics covered will include the business and legal aspects of: Commercial Payment Systems; Federal Payment Programs; Food and Drug Administration Regulation; Antitrust in the Health Industry; Corporate Compliance and Investigations; Pharmaceutical Manufacturers, Pharmacy Benefit Managers, and Retail and Specialty Pharmacies; and Health Care Transactions (Raising Capital, Funding, Investing and Diligence).

L8274 SEMINAR: HEALTH POLICY (2 pts)
J. Klick
This seminar will proceed in two parts. In the first half of the semester we will discuss the tools of microeconomics and statistical analysis as they apply to questions of health law and policy, including the general topics of insurance markets (both private and public), healthcare financing, medical malpractice and medical errors, and the labor market for healthcare professionals. During the second half of the semester, we will examine the recent empirical literature on a host of topics within health law and policy, including obesity, addiction, and defensive medicine.

L8273 SEMINAR: INFORMED CONSENT (2 pts)
P. Appelbaum
Informed consent to treatment and research occupies a dominant position in the legal regulation of physician-patient relationships. Built on the premise that patients can best protect their interests if afforded sufficient information to make informed choices about their care, informed consent in practice has often been criticized as favoring form over substance. Yet, the doctrine has been remarkably stable since its formulation, despite extensive critiques and suggestions for restructuring informed consent, suggesting that real needs of both patients and physicians are being met.

This seminar will consider informed consent's ethical underpinnings, evolution as a legal doctrine, and application in practice in both treatment and research contexts. Major critiques of informed consent will be considered from both autonomy-based and beneficence-based perspectives. An emphasis will be placed on the substantial empirical literature on consent to highlight the distinctions between the doctrine on paper and its application in real-life settings. Pressure to expand the scope of informed consent to accomplish additional goals (e.g., "economic informed consent" aimed at modulating increases in health care costs) will also be considered.

Participants in the seminar will be encouraged to think about the legitimate goals of regulation of the provision of health care, unanticipated consequences of regulatory interventions, and ways in which the goals of informed consent might better be accomplished.

L9563 SEMINAR: MENTAL HEALTH LAW (2 pts)
P. Appelbaum, R. Levy
This seminar will focus on some of the major issues in mental health law, both civil and criminal. Particular emphasis will be placed on understanding the historical development of mental health law, given the impact of temporally contingent factors on the current shape of the law. Empirical studies of the law in action will be used to illustrate the consequences of various approaches to the problems that mental health law is meant to address. Attention will be paid to the ever-present tension between impulses to act beneficently toward persons with mental disorders on one hand, and to respect their autonomy on the other. Students will be offered an opportunity to interact with persons with mental disorders who have been subject to some of the aspects of mental health law (e.g., civil commitment, outpatient commitment) that will be discussed in the seminar.

L8152 SEMINAR: REPRODUCTIVE HEALTH AND HUMAN RIGHTS (2 pts)
(see Human Rights)

L9390 SEMINAR: TOPICS IN JEWISH LAW: BIOMEDICAL ETHICS (2 pts)
(see History and Philosophy of Law)