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Teaching Health Law: Teaching Social Justice and Health: Professionalism, Ethics, and Problem-Solving in the Medical-Legal Classroom

Published online by Cambridge University Press:  01 January 2021

Extract

Our course on social justice and health began as an experiment between Roger Williams University School of Law and the Warren Alpert Medical School of Brown University. As a course for both law and medical students, it broke relatively new ground by focusing on the intersection between law and the social determinants of health and the ways in which lawyers and doctors might partner to address social and health disparities. The course blends professionalism, ethics, and problem-solving by using case studies that raise practical challenges at the intersection of poverty, law, and health. This kind of collaborative, interdisciplinary teaching presents many challenges and rewards, which I discuss in this essay.

Type
JLME Column
Copyright
Copyright © American Society of Law, Medicine and Ethics 2010

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References

National Center for Medical-Legal Partnership, Medical-Legal Partnership Network Site Survey (March 2009), available at <http://www.medical-legalpartnership.org/sites/default/files/page/2009%20MLP%20Site%20Survey%20Report.pdf>(last visited August 4, 2010).(last+visited+August+4,+2010).>Google Scholar
For a description of the model, see Zuckerman, B., Sandel, M., Lawton, E., and Morton, S., “Medical-Legal Partnerships: Transforming Healthcare,” The Lancet 372, no. 9650 (2008): 16151617.CrossRefGoogle Scholar
Zuckerman, B. et al., “Why Pediatricians Need Lawyers to Keep Children Healthy,” Pediatrics 114, no. 1 (2004): 224228, at 224–225.CrossRefGoogle Scholar
There has also been a change in faculty since we began the joint course. Brown medical school faculty Dr. Alicia Monroe and Dr. Jay Baruch helped me to develop the course in 2003. After Dr. Monroe left Brown Medical School in 2008, Dr. Patricia Flanagan joined us as a teaching partner for the course.Google Scholar
For a more extensive discussion of our course, see Tobin Tyler, E., “Allies Not Adversaries: Teaching Collaboration to the Next Generation of Doctors and Lawyers to Address Social Inequality,” Journal of Health Care Law & Policy 11, no. 2 (2009): 249294.Google Scholar
This is not to suggest that there were no models for joint medical-legal courses. There is a long history of bringing medical and law students together in the classroom. See, for example, Naitove, B. J., Comment, “Medicolegal Education and the Crisis in Interprofessional Relations,” American Journal of Law & Medicine 8, no. 3 (1982): 293320, at 304; Wilkins, D. B., “Redefining the “Professional” in Professional Ethics: An Interdisciplinary Approach to Teaching Professionalism,” Law Contemporary Problems 58 (1995): 241258. Nonetheless, the focus of our course on the role of law in the social determinants of health and medical-legal partnership was new. Thus, we found no ready syllabi to help guide us.CrossRefGoogle Scholar
For discussion of the frustrations doctors face in trying to treat patients with complex medical and social problems, see Piscella, K. and Epstein, R. M., “So Much To Do, So Little Time: Care for the Socially Disadvantaged and the 15-minute Visit,” Archives of Internal Medicine 168, no. 17 (2008): 18431852.CrossRefGoogle Scholar
See Tyler, , supra note 5, Part II. For more recent discussion of how medical education should address these issues more directly, see Walker, B. and Moulton, C., “Medical Education in the 21st Century,” Journal of Health Care for the Poor and Underserved 20, no. 3 (August 2009): 617624 (commenting on a report by the Josiah Macy Foundation, Revisiting Medical School Mission at a Time of Expansion, 2009, available at <http://www.josiahmacyfoundation.org> [last visited August 11, 2010]).Google Scholar
For a discussion of the relationship between preventive medicine and preventive law, see Morton, S. et al., “Advancing the Integrated Practice of Preventive Law and Preventive Medicine,” in Barton, T., ed., Preventive Law and Problem Solving: Lawyering for the Future, (Lake Mary, FL: Vandeplas Publishing, 2009).Google Scholar
See Charon, R., “Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust,” JAMA 286, no. 15 (2001): 18971902; Gilkerson, C. P., “Poverty Law Narratives: The Critical Practice and Theory of Receiving and Translating Client Stories,” Hastings Law Journal 43 (1992): 861945.CrossRefGoogle Scholar
By “ethics” I mean both how legal and medical practice are shaped and governed by professional ethical rules, and also the moral ethical issues that arise for lawyers and doctors in practice. The ideas and expertise of one of my co-teachers, Dr. Jay Baruch, an emergency room physician and director of the ethics curriculum at Brown medical school, has been critical to our integration of these types of ethical issues into the course.Google Scholar
For a helpful discussion of the need to teach interdisciplinary collaboration in legal education, see Connelly, K. D., “Elucidating the Elephant: Interdisciplinary Law School Classes,” Washington University Journal of Law and Policy 11 (2003): 1161; Weinstein, J., “Coming of Age: Recognizing the Importance of Interdisciplinary Education in Law Practice,” Washington Law Review 74 (1999): 319366.Google Scholar
In developing my understanding of teaching problem-solving, I found Linda Morton's articles very instructive. See Morton, L., “Teaching Creative Problem Solving: A Paradigmatic Approach,” California Western Law Review 34 (1998): 375388; Morton, L., “A New Approach to Health Care ADR: Training Law Students to be Problem Solvers in the Health Care Context,” Georgia State University Law Review 21 (2005): 965992.Google Scholar
We focus our course and case simulations on issues of child health. Medical-legal teaching can just as easily be geared toward health law issues affecting adult populations, such as those with HIV/AIDS or cancer, or the elderly.Google Scholar
One class involves using the Community Action Poverty Simulation created by the Missouri Association for Community Action in which students must spend a “month” role playing a poor family's attempt to make ends meet on a limited budget. Information about the simulation is available at <http://www.communityaction.org/Poverty%20Simulation.aspx> (last visited August 5, 2010). (last visited August 5, 2010).' href=https://scholar.google.com/scholar?q=One+class+involves+using+the+Community+Action+Poverty+Simulation+created+by+the+Missouri+Association+for+Community+Action+in+which+students+must+spend+a+“month”+role+playing+a+poor+family's+attempt+to+make+ends+meet+on+a+limited+budget.+Information+about+the+simulation+is+available+at++(last+visited+August+5,+2010).>Google Scholar
All of the classes raise issues of the differences in professional ethical obligations of doctors and lawyers. The most overt discussion of these differences arises in the context of mandatory reporting of child abuse and exploring different professional obligations regarding confidentiality. For a discussion of the kinds of professional ethical issues that arise in medical-legal partnership, see Tames, P. et al., Commentary, “The Lawyer Is In: Why Some Doctors Are Prescribing Legal Remedies for Their Patients, and How the Legal Profession Can Support this Effort,” Boston University Public International Law Journal 12 (2003): 505527.Google Scholar
For example, a survivor of domestic violence has shared her very personal story of the difficulties she found in both the health care and legal systems as she was deciding to leave her abuser and seeking custody of her children who were also abused.Google Scholar
For an example of how we teach the class on substandard housing and lead poisoning, see Tyler, , supra note 5, Part V.Google Scholar
The students do not give legal advice. They help families and individuals with budget planning to see if they may be eligible for a budget plan through the utility company and/or inform them of the classifications under the regulations for protected status. Utility company representatives are on-site and the students help advocate for their “clients” with the company representative.Google Scholar
See Frank, et al., “Heat or Eat: The Low Income Home Energy Assistance Program and Nutritional and Health Risks Among Children Less than 3 Years of Age,” Pediatrics 118, no. 5 (November 2006): 12931302.CrossRefGoogle Scholar
As part of the training, we also discuss and practice client counseling. I am grateful to Bonnie Roswig, Senior Staff Attorney at the Medical-Legal Partnership Project at the Center for Children's Advocacy in Connecticut, for introducing me to the utility clinic as an effective experiential learning experience for law and medical students in advocating for low-income individuals and families.Google Scholar
Under Rhode Island regulations, a family with a child under 24 months of age that can show a financial hardship may qualify for protected status and may not have their utilities shut-off during the moratorium period of November 1st through April 15th. Rhode Island Public Utilities Commission, Rules and Regulations Governing the Termination of Residential Electric, Gas and Water Utility Service (February 1, 2007), available at <http://www.ripuc.org/rulesregs/commrules/termination.pdf> (last visited August 11, 2010).+(last+visited+August+11,+2010).>Google Scholar
Unnatural Causes: Is Inequality Making Us Sick? (California Newsreel and Vital Pictures, Inc. 2008). We show the first hour episode of the seven part series as part of our introduction to the social determinants of health.Google Scholar
The role of the law in public health can be understood both for the importance of legal rules in shaping population health as a whole and for understanding “that a particular legal rule or policy that may appear to have a positive impact on one population may have a very different impact on another.” Parmet, W., Populations, Public Health and the Law (Washington, D.C.: Georgetown University Press, 2009): At 54. We explore how particular legal rules (or the failure to enforce certain legal rules) on behalf of particular populations may lead to health disparities.Google Scholar
Carnegie Foundation for the Advancement of Teaching, Summary, Educating Lawyers: Preparation for the Legal Profession 3 (2007), available at <http://www.carnegiefoundation.org/dynamic/publications/elibrary_pdf_632.pdf> (last visited August 5, 2010).+(last+visited+August+5,+2010).>Google Scholar
Cooke, M. et al., “American Medical Education 100 Years After the Flexner Report,” New England Journal of Medicine 355, no. 13 (2007): 13391344, at 1341–1342.CrossRefGoogle Scholar
For a discussion of the difference in the ways that we teach doctors and lawyers to think and explore “truth,” see Gibson, J. M. and Schwartz, R. L., “Physicians and Lawyers: Science, Art, and Conflict,” American Journal of Law Medicine 6, no. 2 (Summer 1980): 173182. Jennifer Bard's column for this journal, “What We in Law Can Learn from Our Colleagues in Medicine about Teaching Students How to Practice Their Chosen Profession,” Journal of Law, Medicine & Ethics 36, no. 4 (2008): 841848, also provides an excellent comparison/contrast of how we educate lawyers and doctors.Google Scholar
See Association of American Medical Colleges Curriculum Directory, available at <http://services.aamc.org/currdir/> (last visited August 5, 2010).+(last+visited+August+5,+2010).>Google Scholar