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1-1-2009 Teaching Sicko Elizabeth Weeks Associate Dean for Faculty Development & J. Alton Hosch Professor of Law University of Georgia Main Campus, [email protected]
Repository Citation Elizabeth Weeks, Teaching Sicko , 37 J.L. Med. & Ethics 139 (2009), Available at: https://digitalcommons.law.uga.edu/fac_artchop/1257
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Teaching Sicko Necessity Is the Mother of my upper-level courses. I do not use Invention Power Point in class. I am not entirely In long Midwestern winters, two sure how to turn on the "smart class- Elizabeth Weeks Leonard things are certain: snow and basket- room" "sympodia" that clutter the ball. But two things that you cannot fronts of our classrooms and require count on are snow day school closures me to stash several remote control and a home-team collegiate basket- devices before placing my casebook ball championship. In Kansas last and printed out, manila-filed notes winter, we had both. Winter pre- on the dais. For better or worse, I cipitation was much above average, understand my mission primarily to resulting in a rare invocation of the teach students to "think like lawyers,"' University's inclement weather policy not to entertain them. to cancel classes in early February. Accordingly, the idea of using a And the Kansas Jayhawks basketball feature-length, major Hollywood team brought home the National Col- studio release in class seemed scan- legiate Athletic Association champi- dalous. I recognize that our students onship trophy for the first time in two are products of the media generation, decades. The Chancellor commemo- suffer from hyper-stimulated, short rated the achievement with a campus- attention spans, and are immersed in wide celebration, including all-day visual and electronic stimuli. But I class cancellation. This is all well and resist playing into their "weaknesses.' good. I am all for respecting Mother Rather, I believe in teaching them Nature's forces and celebrating re- patience and the slow, deliberate, markable athletic accomplishments. and sometimes dry process of legal But the combination of events does reasoning.2 Accordingly, I felt guilty, leave law professors nearing the end like a busy parent buying the kids of the semester in a bit of a quandary. McDonald's for dinner and sticking How to make up the cancelled classes them in front of the television when to ensure compliance with Ameri- what they really need and deserve is a can Bar Association accreditation good helping of vegetables and some instructional hours requirements? fresh outdoor air. But I rationalized How to cover the missed course con- that if I added a sufficiently meaty tent? How to find mutually agreeable assignment along with the movie- make-up class times and locations viewing, maybe they would get some with a group of busy, upper-level law sustenance out of it. And after all, my students? Faced with the prospect of students had worked hard all semes- having to make up two hours each of ter; maybe they deserved a break that my Health Care Financing and Regu- day.3 lation course and my Public Health I required students in both classes, Law seminar, I turned to the teacher's either during an in-class make-up little helper: the DVD player. session on a Friday afternoon or on By way of full disclosure, I must their own, to watch and comment on admit that I am doggedly old-school Michael Moore's 2007 documentary AboutThis Column in many of my teaching philoso- expos6 of the U.S. health care sys- phies and methods. I mostly stick tem, Sicko.4 I required the seminar Charity Scott, J.D., is a Professor of to some "soft" version of the tradi- students to write short, two-to-three- Law and Director of the Center for tional Socratic, case-method even in page "reaction papers" to satisfy Law, Health & Society at the Georgia State University College of Law. Elizabeth Weeks Leonard, J.D., is an Associate Professor at the University of ([email protected]) Kansas School of Law.
VULNERABILITY IN BIOMEDICAL RESEARCH * SPRING 2009 JLME COLUMN their attendance and class partici- blockbuster or a bust. I wondered if instead to view the film with critical pation requirements for the missed a film could provide a fair and fertile and analytical eyes, applying their class. With the survey course, I took analytical subject from which I could legal knowledge. They rose to the the exercise even further: I used derive one-third of the survey course occasion. Moreover, they taught me the film as ready-made fact-pattern students' final grades. to question my own preconceptions for students to issue-spot and ana- The specific assignment for the about nontraditional approaches to lyze as a one-hour, eight-page-limit, take-home exam 7 was as follows: teaching and the power of the mov- take-home exam question. The idea ing image. of watching a Hollywood movie in Write a critical response and school alone would make me wince, analysis of the issues raised, What They Learned but now I, who almost without excep- problems presented, and argu- The students' essays gravitated to- tion give in-class, closed-book exams, ments made by the film, draw- ward many of the same, highly salient had allowed an open-book, take-home ing on your understanding of examples in the film. Their reactions, exam, based on a "question" that I did the U.S. health care system, insights, and abilities to identify the not write. Professor Kingsfield would based on regulations, financ- relevant laws and policies, while cit- be rolling over in his grave.5 ing, laws, and policies that we ing specific cases and readings in the covered in class. course materials8 and classroom dis- Warning: Don't Try This at Home cussions, were surprisingly good. A Contrary to good judgment and By"critical" I do not mean that few examples follow. teaching wisdom, I had not actually you have to disagree with the watched Sicko when I assigned it to film's premise or conclusions. Duty to Treat and EMTALA my students. For over a year since Rather, I want you to be in- Students were particularly drawn to the film was released, I had been un- sightful - more insightful, I two stories in the film involving pa- able to bring myself to watch Moore's hope, than someone who has tients who were denied emergency latest diatribe, addressing a topic a not taken the class would be care because they lacked health in- surance or their health insurer re- fused to cover the cost of care at a particular hospital. The first story in- I required students in both classes, either during volved a mother who took her infant, an in-class make-up session on a Friday afternoon Mychelle, to the emergency room with a high fever. The mom's health or on their own, to watch and comment on Michael insurer, Kaiser Permanente, we are Moore's 2007 documentary expose of the U.S. told, refused to cover the ER visit at a health care system, Sicko. non-Kaiser hospital. By the time that the mom managed to transport My- chelle to a Kaiser hospital, the baby had died from a high fever and sei- zure. little too near and dear to my heart. in reacting to the film. Your The second scenario involved indigent, uninsured patients being Moore, of course, has famously taken opinions, as informed by the on other industries and scandals, in- class, are welcome. The closer dropped off by ambulances at home- less shelters or community health cluding U.S. auto makers, the gun you can tie your analysis to the lobby, the Bush administration, and assigned readings and class clinics on Los Angeles's skid row. One patient seemed disoriented. Another the 9/11 terrorist attacks. Assuming discussion, the better. I will was still wearing a hospital gown and that Moore followed the same hack- be grading based on what we appeared to be suffering acute, un- neyed "docu-tainment" formula to the studied and learned, not sim- health care industry, I expected Sicko ply your personal opinions treated injuries. Moore offers these examples to be a frustratingly over-simplified, about health care system, of or "patient-dumping" to highlight the tug-at-the-heartstrings portrayal of your arm-chair critic's view of single-minded, money-grubbing all that is wrong with the U.S. health the film or the filmmaker. care system, urging the no-brainer motives of U.S. health care providers. The solution of single-payor, universal The seminar assignment was less health care industry is so cold 6 and calculating that even patients health care. Watching the film for specific and invited general reactions - even the first time during the in-class view- based on our much briefer discussion babies - with emergency and life-threatening conditions are ing session, I realized that my assess- of the U.S. health care system and denied care if they cannot pay. ment was not too far off of the mark. broader discussion of public health While recognizing the tragedy of the sto- But more to the point, I watched and population-based perspectives. ries, the students quickly pointed anxiously to see whether my ad hoc, I challenged students to avoid being out that there is a federal experimental assignment would be a sucked in by Moore's rhetoric and statute,
JOURNAL OF LAW, MEDICINE & ETHICS Elizabeth Weeks Leonard the Emergency Medical Treatment patients who had already been preexisting conditions, scrolled omi- and Labor Act (EMTALA), 9 that screened and stabilized in the emer- nously across an endless black screen expressly prohibits such conduct. gency room but who could not pay of outer space, reminiscent of the They criticized Moore for failing to for further treatment. EMTALA does "Star Wars" movie prologues. Patients mention EMTALA and then ana- not impose an ongoing duty to treat told tragic stories of being denied lyzed the examples under the statu- without compensation on hospitals. care based on a history of one yeast tory structure. Case law is divided on whether the infection, a child receiving cochlear As students correctly described, EMTALA duty to stabilize extends ear implant for one ear but being EMTALA requires all Medicare-par- beyond the hospital emergency room denied the same treatment for the ticipating hospitals with emergency to inpatient services. On the other other ear on the grounds that it was departments to screen, stabilize, and, hand, if the patients were presented "experimental," a hospital employee's if appropriate, transfer any patient in the emergency room and were "dis- spouse dying after his insurer refused who comes to the emergency room charged" to skid row without being to cover a bone marrow transplant, with an apparent emergency medical medically stable, then there could be a woman with breast cancer who condition.10 The law allows a private an EMTALA violation. was kicked off her insurance plan, a cause of action by the patient and patient with "non-life-threatening" the "dumpee" hospital against the brain tumor who obtained an MRI
Ilexpected Sicko to be a frustratingly over-simplified, tug-at-the-heartstrings portrayal of all that is wrong with the U.S. health care system, urging the no-brainer solution of single-payor, universal health care. Watching the film for the first time during the in-class viewing session, I realized that my assessment was not too far off of the mark.
"dumping" hospital. 1 Government Health InsuranceMarkets and in Japan after her U.S. insurance prosecutors can also bring charges Incentives company denied coverage, and other under EMTALA. 2 Students noted Another narrative thread in the film heartbreaking accounts. that EMTALA operates as an express involved former insurance industry Students in my survey course learn statutory exception to the common employees and patients affected by the basics of health insurance financ- law torts doctrine that individuals, insurance companies' refusal to cover ing, history of managed care, and even doctors, have no affirmative duty them or their treatment. Two com- financial incentives to limit high-cost to aid, assist, warn, or help, absent a mon practices of private health in- care and exclude high-risk patients. contractual or other special relation- surance involve policy exclusions for They noted that Moore failed to dis- 3 ship, or other exception.' preexisting conditions and for "exper- cuss the rational economic reasons Like any good exam question, imental" or "not medically necessary" and market incentives underlying students could argue both ways on treatment. some seemingly insidious insurance whether the EMTALA duty was vio- Moore interviewed insurance and health care industry practices. lated in the cinematic examples. Per- industry representative who spoke, They noted that pre-existing condi- haps the non-Kaiser hospital had tearfully in one case and boastfully in tion exclusions guard against "moral provided the requisite screening to another, about various industry prac- hazard" the tendency of people wait- Mychelle and determined that she did tices, including bonuses based on the ing to obtain health insurance until not require immediate medical atten- number of claims denied and taking they have gotten sick. Experimental tion. EMTALA expressly does not applications from patients whom treatment and not medically neces- provide a federal medical malprac- the insurer would never approve for sary exclusions help insurers ration tice standard of care for the screening coverage. One physician and former care across the entire insured popula- claim, so the fact that the child had a claims reviewer is shown testifying tion by avoiding spending too much bad medical outcome does not in and grimly before Congress. Another on very expensive, questionably effica- of itself establish a violation. On the insurance bureaucrat proudly admit- cious treatments. The Public Health other hand, if the non-Kaiser hospi- ted that he was known as the "Hit- Law seminar students raised concep- tal had refused to examine Mychelle man" for his success in ferreting out tual and ethical issues with rationing at all, then there would have been a pre-existing conditions for coverage scarce societal resources, notions of clear EMTALA screening violation. denials. Moore's voiceover rattles off health care and human rights, effects The skid row examples might involve a seemingly endless list of possible of socioecomomic disparities on
VULNERABILITY IN BIOMEDICAL RESEARCH * SPRING 2009 JLME COLUMN health, and controversy over wealth aimed at employer health plans but Government Health Care Programs redistribution and subsidization. provides limited remedies for plan Moore's film is almost entirely focused In addition, the survey course stu- participants against plan admin- on problems with private health in- dents identified specific, existing legal istrators. The statute provides an surance in the United States. As stu- mechanisms that already address exclusive federal cause of action for dents pointed out, that narrow focus some of the apparent abuses. First, employees to challenge plan admin- fails to capture the complete picture. the "portability" provisions of the fed- istrators' actions.19 But remedies are In particular, the film omits the ex- eral Health Improvement Portabil- equitable in nature, limited to the tensive federal and state health care ity and Accountability Act (HIPAA) benefits otherwise due, injunctive or system in the United States, which significantly restrict insurers' dis- declaratory relief.20 Despite ERISAs covers over one-quarter of the popu- cretion to exclude patients based on sweeping preemption effect and pal- lation,2' including a substantial num- pre-existing conditions. 14 Also, pro- try remedies, students urged that ber of elderly, disabled, and finan- visions of the Consolidated Omnibus Moore should have mentioned the cially needy individuals and families. Budget Reconciliation Act of 1985 statute and noted that it sometimes The film criticizes Medicare but never (COBRA coverage) protect employ- allows patients to sue health insurers mentions Medicaid, State Children's ees' right to maintain employer group for treatment denials or other seem- Health Insurance Program (SCHIP), health insurance for a limited period ingly arbitrary decisions. the Federal Employee Health Benefits of time after terminating employ- Students offered mixed views on Program, Veterans Affairs military ment to give them a chance to find the broader question of private mar- health program (TRICARE), and re- 5 new coverage.' ket incentives driving health insurers. lated public benefits that seek to im- Students also noted state laws that Some recognized the insurers' cost- prove health and welfare, such as food further limit pre-existing condition containment strategies as economi- stamps, subsidized housing, Head exclusions and waiting periods, guar- cally rational and necessary to sustain Start, and school lunch programs. anteed issue laws that require insur- the system. One student noted that Several students recounted the ers to sell a policy to anyone request- "what seems tragic on an individual story of Frank, a 79-year-old man, ing coverage, and community rating level may be a necessity on a larger whose prescription drug costs were so laws that require insurers to charge scale in terms of treating people with high that he had to continue working the same premiums to all subscrib- extremely advanced conditions.... as a janitor, and he and his wife had ers, regardless of individual risk fac- Sadly, even if every terminally ill to move into his daughter's storage tors.16 Moreover, state consumer patient got every experimental treat- room. Students used this example to protection, insurance and common ment available that 'might' have even discuss the recently added Medicare 22 law doctrines protect vulnerable the smallest effect, the cost of insur- Prescription drug benefit, Part D. patients in contract negotiations and ance would be unattainable for most They noted that because Frank is litigation with powerful insurance U.S. citizens." Others acknowledged over 65-years-old, he should qualify companies. For example, courts typi- the necessity of reducing health care for Medicare and could opt-in to the cally construe any ambiguities in the expenditures by placing limits on care new Part D to obtain some coverage contract against the drafter, refuse but urged stronger regulation and for his drug costs. Students discussed to enforce "surprise" terms, require oversight. Managed care, including Part D's limited, cumbersome drug conspicuousness, and construe exclu- health maintenance organizations coverage, characterized by a gaping sions narrowly and coverage language (HMOs), one student noted, "are in "doughnut hole.' Relatively low, rou- broadly7 place to help control utilization of tine drug costs are government subsi- Students also pointed out the health care services. They control dized up to a point, and catastrophi- impact of the Employee Retire- costs through the focus on primary cally high drug costs are covered by ment Income Security Act of 1974 care and preventative services and generous government subsidies. But (ERISA). 8 ERISA is a federal statute the limiting of costly services through in between those points - in the addressing employer benefit plans, prior approval and medical necessity." "doughnut hole" - Medicare pro- enacted after notorious bankruptcies Moore highlighted the conflicts of vides no coverage. That means that of large companies that defaulted on interests that HMOs can create, but Frank might be entitled to govern- employees' pension plans. Although according to another student, he took ment assistance for his drug costs, ERISA was not aimed at employer "an extremist position" and showed but the assistance would be limited health plans, they are included by only "one side of the HMO set up." and still could leave him financially definition and impacted most sig- Other students' sympathies remained distressed. nificantly not by detailed substantive aligned squarely with the patients, Students listened carefully to the federal regulations but by sweeping against insurance companies, consis- facts presented in the film, including preemption of state laws purport- tent with Moore's message. Frank's reported monthly drug costs. ing to regulate employee benefits. They then did the math, extrapolat- ERISA renders inoperable a host ing annual drug costs to determine of state statutory and common laws whether Frank, if he had Medicare
JOURNAL OF LAW, MEDICINE & ETHICS Elizabeth Weeks Leonard
Part D, nevertheless would fall in the a fiction of the director's own bud- ing than Moore's film led viewers to doughnut hole. They accurately and get and creation, showed 9/11 res- believe. critically noted the complexity and cue workers and other chronically ill inadequacy of the government pro- and ignored Americans being boated What I Learned gram but still thought that Moore down to Cuba, where they received a Although an admitted luddite when should have mentioned the fact that warm welcome and dramatic medical it comes to classroom technology, I some government assistance might improvement in a communist Cuban recognize that others, including my be available. They pointed out that hospital. health law colleagues, enthusiasti- Moore does mention Part D but in an One student noted that Moore cally and successfully incorporate entirely different segment of the film. "glamorizes the English, French, and film into the classroom for a variety of Moore shows President Bush signing Cuban systems of socialized medicine objectives: to contextualize abstract the landmark legislation, flanked by but spends only a couple of minutes principles of law,23 "humanize" the 2 pharmaceutical industry big-wigs, as discussing how these systems are material, 4 provide more readily ac- an example of industry "capture" of funded," Other students expressed cessible "texts" to media-generation the federal government at the expense skepticism that health care in rural students,25 and push students to iden- of needy citizens. areas of those countries would be as tify their own strengths and weak- Sicko's main point about govern- readily available or high quality as the nesses as future lawyers.26 But I am ment health care programs is to urban examples shown in the film. not aware of anyone "adventurous" contrast the United States' woefully Still others noted the challenges of enough to use an entire film as a final
Another benefit of the exercise was providing context for the course content. Youthful, healthy law students typically have very limited experience navigating the complex U.S. health care system and government health care programs, like Medicare and Medicaid. They may have never seen or read a health insurance contract or faced a denial of coverage. They may have friends or family members who are health care providers but know little about the practice of medicine and medical education system. Most have been fortunate enough not to have personal experience with serious injury, illness, or financial destitution. Therefore, health law instructors are challenged to place highly technical, abstract topics in context and make them relevant to students. Sicko achieved that objective far better than Ehave been able in previous years of teaching the course. Students saw a highly salient set of narratives to attract their sympathies and apply their legal knowledge.
inadequate competitive, private- overcoming traditional U.S. laissez- exam fact pattern. 27 Aside from the market system with idealized single- fare, free-market, small government pragmatic need to make up cancelled payor, universal health care systems values. Some urged that that com- classes and secondary advantage of in other countries, namely Canada, petition and litigation can improve saving myself the trouble of writing England, France - and, surprisingly, quality of care and promote research one exam question, my hope was that Cuba. Students identified the many and development, especially of pre- Sicko would serve as a "capstone" for ways that Moore oversimplified his scription drugs. Other students were the Health Care Financing and Regu- "easy" solution. The director por- persuaded by Moore's observation lation class and a valuable end-of-se- trayed seemingly utopian programs that the United States has "social- mester reflection opportunity for the in Canada, Great Britain, and France ized" firefighting, policing, public Public Health Law seminar students. to suggest how smoothly, success- schools, and libraries without appar- I learned a great deal from both sets fully, and lavishly single-payor health ently compromising the quality of of papers. But the exam assignment care can be achieved. And how stub- those services. The students' bottom- in particular taught me not to fear born and ill-motivated the United line, however, was that the problem innovation and value a bit of risk- States is to have not implemented the is much more complex and challeng- taking in my teaching. Although I do same. The Cuba boondoggle, entirely not boast a "teaching moment" in the
VULNERABILITY IN BIOMEDICAL RESEARCH * SPRING 2009 JLME COLUMN decision to rely so heavily on a sight- The seminar students embraced technical, abstract topics in context unseen Hollywood production, I was their reaction papers with unex- and make them relevant to students. proud of my students and the results pected enthusiasm. I anticipated Sicko achieved that objective far bet- of my experiment. groans and half-hearted effort on an ter than I have been able in previous Like an exam question that I would assignment that amounted to little years of teaching the course. Students write myself, I hoped that Sicko more than a "check" for attendance saw a highly salient set of narratives would require students to spot issues, and class participation for the missed to attract their sympathies and apply analyze the facts using the law that class. But they seemed hungry for their legal knowledge. they learned, and ferret out relevant the opportunity to express their views Students who tended to be reserved from irrelevant information. With and process themes and topics that in class discussions more freely volun- any luck, it would provide a real- we had been discussing all semester. teered relevant personal experiences world, detailed example upon which Their brief essays were polished and of family members' health care chal- students could synthesize a range of thoughtful. lenges, personal reluctance to seek out doctrinal topics covered in the sur- The survey course students' take- health care or purchase health insur- vey course. My concern, however, home exams, for the most part, pro- ance, and a range of emotional reac- was that the film might contain too vided comprehensive discussions of tions in their written responses. Stu- much extraneous commentary or course topics, accurate summaries dents struggled to both identify with would bear minimally on the course of the law, and appropriate cita- and distance themselves from the content. But I figured, as I do with tions to the text. More than tradi- people and problems presented in the 3 3 even my own less-than-well-crafted tional in-class exam responses, their film. Expecting the film to be about exams, that at least it provided an papers revealed a desire for catharsis, the unfortunate, uninsured Ameri- even playing field on which everyone a chance to expound on many of the cans, they quickly realized that the was evaluated. frustrations and ironies of the U.S. film was about everyone else - peo- Other than convenience, was any- health care delivery system about ple with insurance who nevertheless thing gained by my experiment? which they had learned.3 0 But they are victimized by the system. As one Were there any advantages to teach- stuck to the page limit and assigned student noted with surprise, "Sicko ing Sicko as opposed to a traditional task, closely tying their discussions was my story:' The film humanized in-class discussion of assigned read- to the legal rules and principles that the sometimes cold laws and topics ing or a hypothetical issue-spotting, we had studied.31 As rigid as I can be about access to care, financial incen- in-class exam? Would I do it again? about using the traditional Socratic tives, health insurance, government What would I do differently? Stu- method, punctuated with an occa- regulation, provider reimbursement, dents clearly appreciated the flexibil- sional explanatory lecture, I recog- fraud and abuse, and health reform. ity to watch the film on their own or nize that not all students are auditory Several students reported anger, 28 during the scheduled make-up class. learners or spontaneous, on-their- frustration, sadness, and disgust on I might not have elected to devote feet thinkers. The written exercise watching the film. Some identified two precious hours of in-class teach- allowed students in both classes with the inherent discomfort in health law ing time to watching a movie, absent different learning styles and methods of studying complex subject matter the exigency of the missed classes of expression to make their points at an emotional arms-length against and quickly approaching end of the clearly and deliberately.32 the terribly compelling humanitarian semester. Especially in an introduc- Another benefit of the exercise was and moral implications of the choices tory health law course - the only one providing context for the course con- we make to fund, regulate, and pro- offered at my school - instructors tent. Youthful, healthy law students vide health care in certain ways, to struggle to decide what we must cover typically have very limited experience certain people, to the exclusion of and what we can possibly cut to pres- navigating the complex U.S. health others. Other students noted that ent a useful, but manageable, semes- care system and government health they viewed the film more critically ter's worth of material for aspiring care programs, like Medicare and and less emotionally in light of taking health lawyers. Therefore, I would Medicaid. They may have never seen the health law course than they had be reluctant to take two hours, plus or read a health insurance contract or when watching it "uneducated:' in-class discussion time, for the exer- faced a denial of coverage. They may After the semester was over, two cise. In the future, I would probably have friends or family members who Health Care Financing and Regula- require students to watch the film on are health care providers but know tion students made a point of com- their own and place a copy of the DVD little about the practice of medicine ing by my office to tell me how useful on reserve for them to borrow.2 9 The and medical education system. Most Sicko was in helping them pull the written, as opposed to oral, reactions, have been fortunate enough not to course together and strongly encour- whether as exam format or informal have personal experience with seri- aged me to repeat the exercise every reaction papers, were also extremely ous injury, illness, or financial desti- year. Grateful for their unsolicited valuable. tution. Therefore, health law instruc- feedback, I tried to contain my sigh tors are challenged to place highly of relief that my little experiment had
JOURNAL OF LAW, MEDICINE & ETHICS Elizabeth Weeks Leonard
Moore film, Sicko (2007). Then, 16. See Furrow, supra note 8, at 654-660 worked. Teacher's little helper, the write a critical response and analysis (discussing various state regulatory "boob tube," to which I had turned of the issues raised, problems pre- responses). simply out of pragmatic desperation, sented, and arguments made by the 17. Lubeznik v. HealthChicago, Inc., 644 had artfully provided a valuable les- film, drawing on your understand- N.E.2d 777 (Ill. Ct. App. 1994); Sar- son for both the students and their ing of the U.S. health care system, chett v. Blue Shield of California, 729 based on regulations, financing, laws, P.2d 267 (Cal. 1987). teacher. On the way home from school and policies that we covered in class. 18. Public Law No. 93-406, 88 Stat. 829 that afternoon, I treated myself to my (1974) (codified at 29 U.S.C. §§ 1001 first Big Mac in years. By "critical;' I do not mean that - 1461). you have to disagree with the film's 19. 29 U.S.C. § 1132(1)(B). premise or conclusions. Rather, I want 20. 29 U.S.C. § 1132(1)(B)(2) - (3). References you to be insightful - more insightful, 21. Henry J. Kaiser Family Foundation, 1. N. Meyer, "Law Students R Go to the I hope, than someone who has not Fast Facts, Uninsured/Coverage, Slide Movies," Connecticut Law Review 24, taken the class would be in reacting to Show, Health Insurance Coverage in no. 3 (1992): 893-913, at 895 (not- the film. Your opinions, as informed by the U.S. in 2007, available at
VULNERABILITY IN BIOMEDICAL RESEARCH * SPRING 2009 JLME COLUMN
than simply enjoying [or being out- 33. See Elkins, supra note 1, at 776 and (noting that films allowed students raged by] them"). 777 (citing Meyer and noting that "this to "overcome fears about being seem 32. See Bergman, supra note 23, at 975 unsettling of students [through the use as insensitive or biased" and "lead to (suggesting that "[d]ivesity of class- of film] is done with a purpose ... to insight into their p~efoTmed impres- room activities is itself of value for shatter the formalistic shells in which sions of mental illness"). motivating students"). law school tend to encase students"); see also Hall, supra note 24, at 298
JOURNAL OF LAW, MEDICINE & ETHICS