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Step therapy, also termed fail-first policy, describes a practice of insurance and pharmacy benefit management companies denying reimbursement for a specific treatment until after other treatments have first been found ineffective (i.e. failed). Laws to limit step therapy have been passed in 29 states of the United States. Using extrapolated data on fully insured employees, we find that except for New York and New Mexico, enacted State laws don't apply to even one-third of a state's population. Using the more robust Kaiser Family Foundation (KFF) data, which do not include fully insured employees, we find that only 2–10% of a state's population is covered. Advocating for these laws has been an expensive and time-consuming process, likely to become more so for the 21 states without such laws. The laws that have been enacted can be near impossible, to enforce, and loopholes exist. As a result, using KFF data, more than 90% of people in the United States with health insurance may still be unable to access the treatment chosen as most appropriate for them with their physician. Based on these data, we conclude federal step-therapy legislation is needed.
Although significant progress has been made in Irish mental health law in recent decades, the Mental Health Act, 2001 still falls short of properly protecting human rights. A consideration of human rights developments, both domestically and internationally, highlights the urgent need for reform. In this paper we consider Sections 4 (‘Best interests’), 3 (‘Mental disorder’) and 57 (‘Treatment not requiring consent’) of the 2001 Act and related recommendations in the 2015 Report of the Expert Group on the Review of the Mental Health Act, 2001, and suggest specific areas for reform. Just as medicine evolves over time, so too does our understanding of human rights and law. While embracing a human rights-based approach to the extent suggested here might be seen as aspirational, it is important to balance achievable goals with higher ideals if progress is to be made and rights are to be respected.
I draw attention to a 12-page Vorarbeit to Kant’s Prolegomena from the so-called Scheffner-Nachlaß and argue that the parallel Kant draws there between the possibility of theoretical and practical synthetic a priori propositions provides important insight into the development of his account of practical autonomy in the Groundwork. Based on a brief sketch of the role synthetic a priori propositions play in the development of Kant’s critical philosophy, I conclude that for Kant the objective validity of any science depends on the objective validity of a number of synthetic a priori propositions.
Regulatory and legal processes relevant to avoidable adverse medication events have the potential to advance the cause of patient safety but it is expecting too much to believe that these processes alone will achieve the changes that need to be made, urgently and affordably, to reduce the persistently high rate of avoidable adverse medication events. Achieving the required change will require engagement by all concerned, from politicians, through directors of hospital boards and managers and clinical leaders of hospital services to front line clinicians – and also, of necessity, regulators and the legal profession. It has been argued elsewhere that there is an ethical imperative for greater engagement in patient safety,9 and we agree.
Patient safety is a complex systems issue. In this study, we used a scoping review of peer-reviewed literature and a case study of provincial and territorial legislation in Canada to explore the influence of mandatory reporting legislation on patient safety outcomes in hospital settings. We drew from a conceptual model that examines the components of mandatory reporting legislation that must be in place as a part of a systems governance approach to patient safety and used this model to frame our results. Our results suggest that mandatory reporting legislation across Canada is generally designed to gather information about – rather than respond to and prevent – patient safety incidents. Overall, we found limited evidence of impact of mandatory reporting legislation on patient safety outcomes. Although legislation is one lever among many to improve patient safety outcomes, there are nonetheless several considerations for patient safety legislation to assist in broader system improvement efforts in Canada and elsewhere. Legislative frameworks may be enhanced by strengthening learning systems, accountability mechanisms and patient safety culture.
In 2010, Ireland found itself at the eye of an international storm as a network of head shops emerged selling new psychoactive substances (NPS) and Irish youth rapidly became the heaviest users of NPS in Europe. Within months, the Irish government enacted novel legislation, which has since been copied by other countries, which effectively stopped the head shops selling NPS. Critics of this policy argued that it could cause harms to escalate. A number of separate studies indicate that a range of drug-related harms increased amongst Irish youth during the period of head shop expansion. Within months of their closure, health harms began to decline. NPS-related addiction treatment episodes reduced and admissions to both psychiatric and general hospitals related to any drug problem began to fall. Population use underwent sustained decline. Consequently, the closure of head shops can be viewed as a success in terms of public health.
This chapter introduces the mechanisms of deliberate or coincidental 'othering' of immigrants through law and the application of law. It starts by introducing what 'othering' means and then transplants the findings into the context of legislation and law. The chapter emphasizes the systemic 'otherness' of immigrants in a legal system defined by the nation state. Citizens are per definition in the in-group, whereas foreigners are per definition in the out-group. The chapter also addresses how the differentiation between foreigner and citizen is more complicated in the EU with its EU citizenship and free-movement rights. The chapter addresses the role of law as an amplifier of 'otherness' or as a tool for the inclusion of immigrants.
Not a day passes without political discussion of immigration. Reception of immigrants, their treatment, strategies seeing to their inclusion, management of migration flows, limitation of their numbers, the selection of immigrants; all are ongoing dialogues. European Societies, Migration, and the Law shows that immigrants, regardless of their individual status, their different backgrounds, or their different histories and motivations to move across borders, are often seen as 'the other' to the imaginary society of nationals making up the receiving (nation-)states. This book provides insights into this issue of 'othering' in the field of immigration and asylum law and policy in Europe. It provides an introduction to the mechanisms of 'othering' and reveals strategies and philosophies which lead to the 'othering' of immigrants. It exposes the tools applied in the implementation and application of legislation that separate, deliberately or not, immigrants from the receiving society.
In Brazil, the buffalo milk market has been growing. However, identity and quality standards have not been established for this raw material, nor have proper distinctions between buffalo milk and bovine milk been defined. Currently, the State of Rio Grande do Sul (RS) has only three producers that supply raw material for officially marketed derivatives. The aim of this study was to determine the identity and quality standards of raw buffalo milk in this region. Samples were obtained biweekly from three farm cooling tanks between June 2017 and August 2018, to reach a total of 69 samples. The averages for the results of the physicochemical parameters fat, protein, lactose, total solids, SNF (solids-not-fat), calcium, density, FP, acidity and SCC were 5.5 g/100 g, 4.06 g/100 g, 5.07 g/100 g, 15.5 g/100 g, 9.96 g/100 g, 0.161 g/100 g, 1.034 g/ml, −0.527°C, 16°D and 95 × 103 cells/ml, respectively. With reference to the microbiological parameters, the mean of the Standard Plate Count (SPC) and thermotolerant coliforms were 9,0 × 104 CFU/ml and 1.6 × 102 MPN/ml, respectively. Regarding coagulase-positive staphylococci, 36 samples tested positive (52% of total). Neither Salmonella spp. nor Listeria monocytogenes, nor antibiotic or antiparasitic residues were detected in any sample. In conclusion, the buffalo milk used as raw material for dairy products in southern Brazil demonstrated satisfactory physicochemical and microbiological characteristics, in accordance with recent scientific literature.
Care-leavers – those transitioning from alternative care towards young adulthood – are widely recognized as a vulnerable population, yet child protection legislation seldom applies to them because they have reached adulthood. Despite this, little internationally comparative research on care-leaving policy and legislation has been conducted. This paper maps multinational policy and legislation and its impact on the services to care-leavers and the challenges they experience. An online survey was conducted with key informants in 36 countries and analysed by a multinational team of care-leaving scholars. Findings reveal that few countries have well-developed care-leaving legislation. Most countries provide little aftercare beyond the age of 18, even when legislation provides for it. Within the context of suboptimal social policy and limited aftercare services, findings also reveal high vulnerability among care-leavers. Recommendations for policy development, global dialogue, further research and advocacy are proposed.
Although some studies have revealed practitioner disempowerment in cases of older adult mistreatment, this experience is poorly understood. In addition, dementia and contextual influences further complicate cases; yet, little is known about the experience of practitioners with this complexity. This critical inquiry, based on Critical social theory, critical consciousness, and professional agency, aimed to address these gaps. Fifty-one practitioners from diverse health care and social service disciplines from rural and urban communities in Northeastern Ontario participated in interviews, journals, and focus groups. Analysis of data revealed the need for empowerment within a perpetual cycle of non-resolution, to refocus on legal clarity and intervention versus the current legal complexity and education focus, and to develop adequate infrastructure to support interprofessional efforts. The infusion of this knowledge into policy, practice, and research has great potential to improve outcomes for older adults with dementia who are mistreated in their homes.
In general, when people in society refer to ‘the law’ they mean the rules made by parliaments. They have learned that ‘the parliament makes the law and the judges decide disputes.’ As a student you now know that the process of judicial interpretation inevitably strays into lawmaking, but in fact the popular understanding of law is just about right. In the modern era, the overwhelming majority of laws are made either by, or with the permission of, elected members in our Parliament.
Statutory interpretation is a core skill in the legal profession. At a basic level, it seems quite simple: statutory interpretation represents the art (or perhaps science) of reading legislation correctly. Unfortunately, beneath this simple description lies a much more complicated process. You see, words are almost always ambiguous. Words combined into sentences become more ambiguous. How many times in your daily life have you said something that you considered to be perfectly plain and simple, only to have others in the conversation completely misinterpret your meaning?
This chapter commences a case study analysis into the influence of economic and financial conditions on the operation of public finance law and the constitutional distribution of authority between parliaments and executive governments. The fiscal activities (taxing and spending) of the central governments of the UK and the Commonwealth of Australian between 2005 and 2016 are selected for analysis. The chapter begins with a detailed examination of appropriation and taxation legislation in the two jurisdictions, including the respective financing contribution of annual and standing statutes and their role in delegating authority to treasury departments. The chapter then examines the influence of expansions and contractions in economic output on the balance of constitutional authority possessed by parliaments, with a special focus on the impact of the financial crisis. Thereafter, the often-hidden reality of public spending in breach of appropriation legislation is studied, along with the legal frameworks governing public accounts and audit. The chapter concludes by observing the vast amount of fiscal authority delegated to treasury departments by public finance law.
This chapter provides a case study analysis of the operation of public finance law concerning sovereign debt and monetary finance in the UK and Australia between 2005 and 2016. The legal and financial mechanics of sovereign borrowing and monetary finance are closely examined by reference to the authority of central banks and treasuries to finance the state beyond the point of fiscal deficit. The very broad powers delegated to treasuries over sovereign debt are scrutinised in the context of vastly different economic conditions, and their capacity to shrink the financial authority held by parliaments is observed. Special attention is then given to the monetary financing powers of central banks, particularly the Bank of England. The emergency monetary finance provided by the Bank of England during the financial crisis is surveyed, and the public financing aspect of 'unconventional' monetary policy, particularly quantitative easing, is examined. The chapter closes by observing the absence of meaningful legislative governance of debt and monetary finance in the context of financial or economic emergencies.
The chapter examines political corruption, i.e. embezzlement and extortion, and explores material aspects of forgery with regard to the close connection of the scribae with public documentation. It discusses accountability and the oath of due diligence and, as a result, public perception of the scribae in light of accusations of corruption and abuse. It highlights the profiteering character of the post and discusses examples of scribal enrichment and its consequences for the individuals' social mobility.
To assess efforts of the Brazilian legislature to regulate ultra-processed food industry practices related to obesity and diet-related non-communicable diseases during the first 4 years of the United Nations’ Decade of Action on Nutrition.
We searched the Chamber of Deputies and Federal Senate internal databases to identify bills under consideration between 2016 and December 2019. Keywords related to the main recommendations of international organisations regarding the regulation of food industry practices were used. Descriptive and content analysis of the bills were carried out.
Brazilian legislature (Chamber of Deputies and Federal Senate).
Eighty-four bills were identified. The most frequently addressed topics were: nutrition labelling (38·1 %), marketing of unhealthy products (30·9 %), availability of unhealthy products (26·2 %) and critical nutrients content (14·3 %). Only 9·5 % of bills have proposed taxation on unhealthy products. No bill was passed during that period; 2·4 % were rejected and 10·7 % archived. Among the bills still under consideration, 52·4 % have not been passed in any Committee.
Although many bills have been introduced, no regulation of ultra-processed food industry practices has been enacted by the Brazilian legislature by 2020. It is likely that no positive impact on population nutrition in Brazil will be achieved by the end of the United Nation’s Decade of Action on Nutrition, in 2025 – especially regarding those goals set by the Brazilian government which were supposed to have been achieved by 2019.
This article considers the interpretive significance of legislative inaction. Section I considers the nature of arguments based on legislative inaction. Section II explores the practical, conceptual and constitutional problems with trying to rely on legislative inaction as an interpretive aid. Section III concludes that attempts to draw inferences from legislative inaction alone are deeply flawed, but that inferences might legitimately be drawn from inaction if it forms part of the context against which the legislation is enacted. Even then, however, there are practical difficulties in determining what inferences to draw.
This chapter explores how colonial authorities and settlers, in first Carolina and later Georgia, made substantial efforts to introduce silkworms to the southern boundaries of British America across the late seventeenth and eighteenth centuries. These attempts at sericulture played a significant part in influencing schemes for and arguments about economic development in the Lower South. They generated innovation in the justification and practice of state investment; taxes paid for public enslaved labourers and their training, bounties, filatures; and the global sourcing of technical knowledge, experts, and technology. As with the French and Armenian immigrants to Virginia, stretching towards silk helped to bring Huguenots, Swiss, and Italians to the Lower South, to shape schemes for westward expansion, and to broaden the employment of enslaved people. The investment left cultural, material, and environmental legacies within many households, markets, and estates in the region, as mulberries proliferated. The depth of interest ensured that these well-supported initiatives generated noteworthy output, centralised in dedicated buildings (filatures), through which agents sought to control quality and improve proficiency. The conquest of silkworms appealed to many planters in search of metropolitan recognition, who in spite of later racialised claims, deployed their bondspeople widely in the pursuit.