42 Unit 1 Foundations of Medical Law and Ethics Copyright Goodheart-Willcox Co., Inc. As part of the Affordable Care Act’s reform to the American healthcare system, the Democratic Obama Administration included a provision that required all health insurance plans to provide many preventive healthcare services for no additional cost beyond the monthly insurance premium. One of these services was birth control. In January 2012, the US Department of Health and Human Services, following the general model of more than 10 states, issued regulations requiring that preventive services be covered by all insurance plans except those provided directly to religion- based organizations. Almost immediately, there was an outcry by the Catholic Church and Republican Party. Rather than indignation based on morals or ethics, opposition was raised on the constitutional grounds of the importance of separation of church and state and freedom of religion. Birth control is not against medical ethics, but it is morally objectionable to some. This issue was resolved by changing rules for organizations raising religion-based objections. However, if you, as a healthcare provider, were asked to vote on the issue in Congress, what would you do? How would you vote and why? To understand the relationship between the healthcare system and the legal system in the United States, you must understand that laws and ethical rules have been established to encourage and protect delivery of the best healthcare possible. This may not always work out in prac- tice. However, the fundamental principle is to assure maximum compe- tence and professional independence for practitioners to whom citizens, including the policymakers themselves, entrust their health and lives. In the United States, society’s rules and regulations are derived from a complex variety of sources. The United States Constitution is “the supreme law of the land,” which defines and limits the powers of the federal government (Figure 3.1). While the federal government has a per- vasive influence on healthcare, it plays a relatively minimal role in actu- ally providing care to patients. The authority and power to train, license, and set standards for actual medical care is retained by the states. Local governments, through their city planning, business licens- ing, and other practices, also affect the healthcare provider. In addition, professional associations establish their own independent rules and sanctions, which have a significant impact on members’ daily practical decisions. Finally, common law, derived from individual case law from England and predating US laws, serves as the basis for bringing chal- lenges to healthcare providers, such as medical malpractice suits that are often based on common law principles. What is the source of all this governmental authority? Such power derives from a democratic concept that individuals have voluntarily empowered the governing entities to act on behalf of the individual. United States Constitution the formal charter of the United States, which defines the powers and limitations of the national government and the rights of the people common law term that describes rules derived from English law (French law in Louisiana) and tradition that have often been formally adopted into state laws or used to determine decisions in American courts What Would You Do?