Public Health Law: Power, Duty, Restraint

This is a revised and expanded second edition of the original text that was published in 2000. It is one of a series of books regarding health and the public sponsored by the Milbank Memorial Fund to help decision-makers use the best available evidence to inform health care policy change.

The author of this scholarly text, Lawrence Gostin, is Associate Dean and Professor of Global Health Law at the Georgetown University Law Center, as well as Professor of Public Health at Johns Hopkins University and Visiting Professor at Oxford University. He indicates that this volume is primarily designed for scholars and practitioners in public health, legislators, and public health law teachers. He distinguishes this treatise from the narrower literature on law and medicine through discussion of the government's responsibility to advance the public's health, the conflict between government coercion and setting limits on state power, and by partnering with other stakeholders in the public health system.

In this book, Gostin examines complications that occur when government strives to prevent injury and disease or to enhance the public's health. He notes that the government may opt to persuade, use incentives, or sometimes compel individuals and businesses to promote health and safety standards in the interest of public safety. He contends that this power and obligation form the basis of public health law.

The book is organized into four major parts: Conceptual Foundations of Public Health Law, Law and the Public's Health, Public Health and Civil Liberties in Conflict, and The Future of the Public's Health. In Part 1, Gostin explains his theory and definition of the field of public health and offers a systematic evaluation of public health regulation. In Part 2, he describes and discusses legal concepts of constitutional, administrative, tort, and global health law. In Part 3, he provides a representative sample of public health practices, as well as the conflicts with individual rights and interests, and in Part 4, he gives his vision of the future of public health law.

The author covers a host of public health topics, including infectious disease (HIV, pandemic influenza, severe acute respiratory syndrome (SARS), and anthrax), vaccination, and quarantines. Bioterrorism is reviewed as a matter of public health and national security. The roles of international treaties and multiple international health organizations, such as the World Health Organization, World Trade Organization, and United Nations, are described. Several public health topics may be of interest to health care professionals, including litigations related to tobacco, obesity, firearm prevention, and product liability. The duty to warn people who unknowingly have been exposed to HIV is of particular interest to forensic psychiatrists, as are confidentiality, privilege, and the Health Information Protection and Portability Act (HIPAA). Concise commentaries are provided about civil commitment, the right to refuse treatment, and Daubert¹ requirements for expert witness testimony. In these discussions, the author examines each problem, summarizes the current legislative and regulatory guidelines regarding each one, and often outlines relevant conflicts between governmental intervention and individual liberties. Each discussion concludes with recommendations for future public health measures.

In his discussion of the right to refuse treatment, Gostin describes the elements of informed consent that are necessary to initiate treatment. Embedded in this concept is the patient's right to refuse treatment, but the right is not absolute. A summary of case law contains exceptions to the right to refuse treatment in special circumstances, such as inmates in corrections systems and mentally ill defendants who are adjudicated incompetent to proceed with trial. Public health justifications for mandatory treatment are set forth, including preservation of health and life and prevention of harm to others.

The text is dense with case studies, tables, diagrams, photographs, and summaries that will assist the reader who seeks to research specific topics in greater detail. There are over 200 pages of notes connected with the chapters, as well as an extensive bibliography and list of the court cases referred to in the text. This book is timely, given the current debate regarding national health care and the conflict between mandatory participation and individual choices. Public Health Law is a comprehensive work that represents a major contribution to the public health policy literature.

• © 2012 American Academy of Psychiatry and the Law