Legal Issues in Using the Police Powers Powers to Protect the
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Transcript Legal Issues in Using the Police Powers Powers to Protect the
The Police Power And HIV/STDs
In The Elderly
Edward P. Richards, III
Professor
University of Missouri – Kansas City
School of Law
5100 Rockhill Road
Kansas City, MO 64110
(816)235-2370/[email protected]
Overview
HIV/STDs As A Special Case
• HIV - Especially Dangerous To The Elderly
• General Problem of Communicable Diseases
Driven By Changing Demographics
Demands A Public Health Approach
• Police Powers To Protect the Community
• Personal Health Services for Individuals
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Risk Factors For HIV/STDs
Drug Use
• Sharing Needles
• Trading Sex For Drugs
Sexual Activity
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Frequency
Number Of Partners
Practices
Core Group Dynamics
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Why Are The Elderly At Risk?
Elderly Have Always Been At Risk
• Small Numbers
• Social Stigma Hides Cases
Changes in Community Demographics
• Increasing The Risks
• Increasing The Numbers
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Traditional Health Status
Death Came Earlier
• Less Time Retired
• Less Time Widowed
• Smaller Population Of Elderly
Not As Healthy
• Underestimated By Life Expectancy
• General Health
• Sexual Dysfunction
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Current Health Trends
Longer Life Span
• Longer Retirement
• Longer Widowed
• Larger Elderly Population
Better Health
• Masked By Static Life Expectancy
• Improvements In General Health
• Improvements In Sexual Function
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Traditional Demographics
No Distinct Elderly Community
• Poor
• Smaller Numbers
• Unorganized
Dispersed Through The Community
• Integrated With Extended Family
• Better Social Support Networks
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Contemporary Demographics
Elderly Only Communities
• Sun City - the Affluent
• Supervised Living
• Elderly Ghettos
Benefits of Homogenous Communities
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Critical Mass for Special Services
Crime and Violence are for the Young
No Stigmatization
Self-Quarantine
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Risks of Elderly Communities
Better Niche for Communicable Diseases
• Concentration of Hosts
• More Susceptible Population
• Increases Social Interaction Spreads Disease
Ignorance of Larger World Problems
• The Elderly Do Not See STDs As Their Problem
• Physicians Do Not Look for STDs in the Elderly
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Why Do Doctors Miss HIV/STDs In
The Elderly?
Mistaken Social Perceptions
• Elderly Do Not Have Sex
• Elderly Do Not Have STDs Even If They Have Sex
• Elderly Are Not Drug Abusers
Misleading Medical Cues
• Elderly Already Have Weak Immune Systems
• HIV Dementia Looks Like Other Dementias
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Implications of Missing HIV
Elderly Die, On Average, 30 Days From
Diagnosis
• Increased Susceptibility
• Evidence Of Very Delayed Diagnosis
Risks To Others
• Sharing Needles (Not Just Illegal Drugs]
• Sexual Activity
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Strategies To Prevent HIV/STDs
Personal Health Services Approach
Public Health Police Power
Personal Health Services
Approach
Education
• Safe Sex
• Avoid Sharing Needles
• Importance Of Getting Tested
Role Of Health Care Providers
• Must Recognize Disease
• Must Counsel All Patients
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Public Health Approach
Same Personal Health Education
Recognizes That Education Often Fails
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Does Not Reach Everyone
Some Do Not Understand It
Some Do Not Think It Applies To Them
Some Do Not Care About Risks To Others
Public Health Adds Active Case Finding And
Intervention
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The Public Health Police Power
"[T]he liberty secured by the Constitution of the
United States to every person within its
jurisdiction does not import an absolute right in
each person to be, at all times and in all
circumstances, wholly free from restraint. There
are manifold restraints to which every person is
necessarily subject for the common good. On any
other basis organized society could not exist with
safety to its members.”
Jacobson v. Massachusetts, 197 U.S. 11 (1905),
quoted in Hendricks at 356-367.
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Disease Reporting
"Unquestionably, some individuals' concern for their own
privacy may lead them to avoid or to postpone needed
medical attention. Nevertheless, disclosures of private
medical information to doctors, to hospital personnel, to
insurance companies, and to public health agencies are
often an essential part of modern medical practice even
when the disclosure may reflect unfavorably on the
character of the patient. Requiring such disclosures to
representatives of the State having responsibility for the
health of the community, does not automatically amount to
an impermissible invasion of privacy.”
Whalen V. Roe, 429 U.S. 589, 602 (1977)
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Case Finding
Contact Tracing/Partner Notification
• Voluntary
• Most People Want To Help
Works Because Of Core Group Dynamics
• Small Subset Accounts For Most Transmission
• Contact Networks Are Redundant
• Interview Enough People And You Get All The
Nodes
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Interventions
Newly Identified Contacts
Important Because HIV Is Hard To Catch
Warn That They Have Been Exposed
Counsel About The Disease And
Precautions
Help Them Get Tested And Medical Care
Interview Them About Their Contacts
Add To Surveillance Database
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Infected Contacts Who Continue
Unsafe Activities
Tuberculosis Is The Best Model
• Warn And Counsel
• Increasing Restrictions
• No Myth Of Self-Protection
What About HIV?
• Mental Health Confinement If Demented?
• Megan’s Law Approach?
• Prosecution For Reckless Endangerment?
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Community Ethics
The Constitution And The United States
Supreme Court Support Broad Public
Health Powers
How Do We Decide When We Should Use
These Powers To Protect The Vulnerable?
Have Individual Rights Undermined Public
Health?
20
Population Ethics
The Constitution And The United States
Supreme Court Support Broad Public
Health Powers
How Do We Decide When We Should Use
These Powers To Protect The Vulnerable?
Have Individual Rights Undermined Public
Health?
21