Dissertation Title:  "The Regulation of Individual Autonomy in Medical Decision-Making"

In the United States, federal and state governments affect medical decision-making through numerous direct and indirect channels. For instance, government intervention can enhance individual decision-making by ensuring a range of treatment options, protect individuals and society from harm by limiting treatment options, and encourage compliance with a preferred treatment plan. This dissertation examines government intervention in individual medical decision-making in three distinct areas of medical care.

Health services research raises significant questions about the fundamental assumptions of our informed consent laws. After finding that current informed consent laws fail to protect patients’ ability to make informed medical decisions, the first article analyzes the advantages and disadvantages of adopting shared medical decision-making as an alternative to current informed consent requirements. The article concludes that the long-term benefits of shared decision-making and the use of evidence based decision aids to promote patient understanding and inform medical decision making outweigh the costs for both patients and physicians.

Tension surrounding government intervention into the reproductive decisions of individuals has caused lawmakers in the United States to eschew attempts to regulate assisted reproductive technology, including reproductive genetic testing. Advances in genetic technology will soon enable parents to screen their embryos for hundreds of genetic and chromosomal characteristics through preimplantation genetic screening. While these advances promise significant benefits, they also present risks to both individuals and society. The second article proposes the creation of a federal regulatory body to license and monitor assisted reproduction and suggests a balancing framework for addressing conflicting stakeholder interests in reproductive genetic testing.

Mental health courts divert mentally ill offenders from the criminal justice system into court-ordered treatment. Since their creation a decade ago, mental health courts have continued to change court policies, practices and services to improve participant success. The third article first argues that the structure and characteristics of mental health courts facilitated this innovation. Next, it analyzes qualitative interview data on how seven mental health courts have changed since 2003 and the potential impact of those changes on client success and the courts’ capacity for future change. The article concludes that innovation remains key to mental health court success.