This essay celebrates the BU Health Law Program upon its 70th anniversary, offering reflections on the founders of the program, Fran Miller, George Annas, and Wendy Mariner (“FGW,” endearingly), and their contributions to the field.

Current faculty offer reflections, including: Several speak to scholarly research, including Elizabeth McCuskey on health care finance, Aziza Ahmed on human rights, Dionne Lomax on antitrust, Christopher Robertson on trust, and Kathy Zeiler on the marketplace. Other contributors speak to the student experience, with Dianne McCarthy on mentorship, Laura Stephens on demanding excellence, Michael Ulrich on teaching, and Larry Vernaglia on merging law and public health. On FGW’s broader impacts, Nicole Huberfeld speaks to the translation of research to reach new audiences, and Kevin Outterson writes about FGW’s pivotal roles in establishing the health law field and the institutions that now define it.

Together these pieces testify to the astounding contributions of these scholar-teacher-leaders across many domains and dimensions of health law. While their contributions are countless and immeasurable, these reflections offer a start.

This piece takes as a given that we are stuck with our fragmented, inefficient, multi-payor health care system for at least the short run. It then analyzes the deficiencies of three payment mechanisms whereby regulators (including Congress) have invited private sector providers to help ameliorate perceived problems. The first concerns an inadequate supply of nursing home beds in the early ‘70s, the next focuses on Medicare Advantage as a supposedly superior cost containment alternative to traditional Medicare, and the final one involves the ‘devil’s bargain’ struck with the pharmaceutical industry to get prescription drug coverage added to Medicare. All three teach the same lesson: the government needs to be more vigilant not to give away the store when it invites the private sector in.

The celebration of the anniversary of the Center for Health Law, Ethics & Human Rights (the “Center”) provides an opportunity to reflect on what defines the field of health law, as well as its conjoined twins of bioethics and human rights. The related fields are vast, and the subjects they encompass are ever-expanding. It is probably impossible to lay out a summary that does justice to their expansive, interdisciplinary scope. Instead, my discussion of the Center examines a subject that barely existed when the Center was formed in 19581 and that continues to make headlines more than sixty–six years later — organ transplantation. Transplantation is useful as an illustration of the joint fields of health law, bioethics, and human rights. It is a field that grew with us from infancy to maturity during the time of the Center’s growth and that illustrates how several related disciplines — most notably law and medical sciences — are essential to the development of organ transplantation. Additionally, organ transplantation and experiments involving organ transplantation have produced some of the most spectacular cases of human experimentation. Because of both the novelty and human drama these experiments involve, I will use some of them as examples of the pivotal health law and bioethics work the Center engages in. These examples, and others that will be touched on, lead me to conclude that there is no field that matches the life and death drama of health law, especially in the human organ transplantation field. This selective history of health law at the Center, including the definition of death and the limits of surrogate consent, suggest that the legal and bioethical issues brought to us by innovative organ transplantation surgery are unlikely to be exhausted any time soon.

Current political divisions are destabilizing existing laws affecting the health field. Major changes in the field of health law have one thing in common: changes in who holds political power ‒ Congress and state legislatures, governors, presidents, judges, and agency officials. The laws that structure financial, economic, educational, and health care systems, environmental conditions, and civil society are primarily the product of elections that populate our political institutions. These structural determinants of health in turn create laws that influence how ‒ and how well ‒ we live and whether our society functions fairly under the rule of law. Thus, who gets elected matters a great deal to the health and safety of Americans. At the same time, changes in health laws resulting from elections may reveal shifts in the structures underlying our legal and economic systems and whether those shifts support or weaken principles of justice and the rule of law.

In 2023, Henrietta Lacks’ family won a settlement from Thermo Fisher Scientific on the grounds that the company had been “unjustly enriched” by the sale of products developed with Henrietta’s cells. Given that hundreds of thousands of people have tissue stored in the United States, this article explores how today’s patients might fare if they similarly sued professionals and companies that undertake unauthorized research on or commercialization of their tissue on the grounds of conversion, unjust enrichment, lack of informed consent, breach of fiduciary duty and, where government entities are involved, Fourteenth Amendment claims. The article notes that the practices that were subsequently seen as unethical in Henrietta Lacks’ care continue in some health care institutions today. It also analyzes how research and commercialization without consent can lead to a lack of trust in the research enterprise and the unwillingness of people to participate in research.

In 1974, the Center for Law and Health Sciences at the Boston University School of Law provided legal background papers on informed consent to research to the newly created National Commission for the Protection of Human Subjects of Biomedical and Behavioral Sciences. These papers were written by George J. Annas, the Center’s Director, as well as Barbara F. Katz and I, who were staff attorneys at the time. These papers can be found in the appendices to the Commission reports1 and in our book Informed Consent to Human Experimentation: The Subject’s Dilemma,2 in which we present a refined version of those papers. This project introduced me to the world of human research ethics and the complexities of protecting the rights and welfare of research subjects.3 Over the past fifty years, I have sat on Institutional Review Boards (IRBs), been a member of the FDA’s Pediatric Research Advisory Board, and engaged in varying activities related to human subject protection. During this time, I took for granted that consent forms were the best method for ensuring that subjects were thoroughly informed about all aspects of the proposed research. Like many IRB members, I spent considerable time reviewing, editing, and debating with other IRB members about the precise wording of these forms.

Fifty years ago, George J. Annas and Joseph Healey introduced the concept of a “patient rights advocate” in their seminal 1974 article published in the Vanderbilt Law Review. Annas expanded this vision in the ACLU Handbook, The Rights of Hospitalized Patients, later broadening its scope to all medical settings. This essay traces the evolution of patient advocacy, highlighting pivotal milestones: the advent of cancer navigators, the rise of the patient safety movement, the establishment of patient advocacy organizations, the development of Patient Advocate Offices in hospitals, and the emergence of independent advocates with board certification. It also examines the impact of advocacy on healthcare outcomes, costs, and patient-provider satisfaction, and explores future directions for this vital and growing profession.

The Supreme Court’s decision 2024 in Loper Bright Enterprises v. Raimondo to overturn the Chevron doctrine, which required Federal Courts to defer to agency interpretations of ambiguous laws, along with other decisions challenging the decisions of regulatory agencies, marks a significant shift in healthcare regulatory oversight and compliance. This article takes this shift as an opportunity to examine the evolution of healthcare compliance education in U.S. law schools and consider how it should evolve to meet new demands. Through analysis of existing J.D. programs, master’s degrees, and certificate programs in healthcare compliance, the article explores how law schools are already adapting to meet industry demands while distinguishing between programs designed for licensed attorneys and those for non-lawyer compliance professionals. The article highlights the role of external accreditation by the Compliance Certification Board (CCB) and clarifies the distinction between “certification” awarded through examination and “educational certificates” awarded by institutions. In light of the ironically almost total lack of regulatory attention to these programs from the Council on Legal Education that sets standards for law school J.D. programs, the article advocates for greater transparency in program outcomes and improved data collection regarding graduate career trajectories. It also addresses an often forgotten population, lawyers interested in changing practice areas at different stages of their careers. It concludes with recommendations for law schools to enhance their role in preparing both lawyers and compliance professionals for a post-Chevron regulatory environment, emphasizing the need for better tracking of program effectiveness and graduate outcomes to inform curriculum development and career pathways in healthcare compliance.

Experiential learning opportunities are recognized to help students put classroom discussions into practice, build new peer networks, and challenge their own preconceptions about the roles of global structures and systems to advance health and wellbeing. After a pandemic-related hiatus, the University of Southern California Institute on Inequalities in Global Health returned to Geneva, Switzerland with students for two weeks at the time of the 2024 World Health Assembly to learn and engage with how global health governance plays out on an international stage. We brought eleven passionate and engaged USC Master’s in Public Health (MPH) students whose interests covered a range of issues, including child and maternal nutrition, sexual and reproductive health and rights in conflict settings, mental health, and noncommunicable diseases, among many other topics. We spent two weeks meeting with inter-governmental organizations, international advocacy organizations, United Nations agencies, and joint funded programs, and our students built their own event schedule during the World Health Assembly to cover the health topics they were most interested in pursuing. Our aim was to have students engage with the complex interplay of health, law, and rights, and to see in real time how research and education inform policy, on local, national and global levels. As instructors and coordinators, we are convinced that the role of experiential learning has never been more important or influential. Multilateralism is under attack, and rights regressions are rampant. We found that fostering honest, content driven conversations with our organizational partners, and then having intense follow-up with our students, resulted in new perspectives– personally and professionally – which is likely to serve the work of the students in global health for the years to come. When the distance between classroom readings and the actual people steering global health can be bridged, university courses that center experiential learning offer the opportunity for emerging health leaders to truly understand the structures and systems in place, and better imagine their own roles in the fight for the right to health.

Over the past twenty-five years, the Center for Health Law, Ethics, and Human Rights (CLER) has been a leader in torture treatment, advocacy, and education. In 1998, the Boston Center for Refugee Health and Human Rights (BCRHHR) was founded to provide holistic treatment to asylum seekers who have been tortured by their governments and justifiably feared further persecution if they returned to their countries. Seeking justice is an important part of healing for survivors, and BCRHHR clinicians work closely with immigration attorneys to document clinical evidence of torture to support asylum applications. Following the September 11 attacks in 2001, it was revealed that the U.S. government tortured captives and committed other war crimes. CLER scholars examined how doctors and lawyers worked with the Central Intelligence Agency (CIA) to rationalize and sanitize torture, providing legal immunity for perpetrators. My colleagues and I at CLER assumed a national leadership role in opposing practices that constitute torture, as well as cruel, inhumane, and degrading treatment. These practices included the force-feeding of hunger strikers, the Rendition, Detention, and Interrogation (RDI) program (a covert operation involving disappearances, extrajudicial detentions, and torture of suspects in the so-called “War on Terror”), the use of lawyers and physicians to justify these actions, and U.S. policies that authorized torture. We met with military officials of the Department of Defense (DOD) and hosted a meeting with international experts to brainstorm solutions. We evaluated the devastating effects of the U.S. torture program on detainees and testified in the military commission’s pretrial hearings for a detainee accused of terrorism.

Doctors and lawyers at the CLER have focused on understanding contemporary torture and the relevance of the Nuremberg Doctors’ Trial which condemned Nazi doctors for torturing prisoners. The CLER continues to promote the importance of International Human Rights Law.

This essay reflects upon the last thirty-five years of public health law. Part One begins by discussing the growth and maturation of the field of public health law since the 1980s. Part Two examines current challenges facing public health law, focusing on those posed by the conservative legal movement and a judiciary that is increasingly skeptical of efforts to use law to improve health and mitigate health inequities. Part Three discusses potential responses to the increasingly perilous judicial climate, including thoughts that emerged from a convening held on the subject by the Act for Public Health Partnership in May 2024.

Firstly, I would like to thank George Annas, Wendy Mariner, and Fran Miller for nurturing the field of health law, and keeping the collaboration vibrant for more than half a century.

Today, considerations of disability are a vital part of health law scholarship and teaching, but that was not always the case. This Essay traces how disability’s role in health law has grown over the past three decades, alongside the author’s own evolution as a health and disability law scholar. The recent official designation of disabled people as a health disparities population is encouraging, but much work remains to achieve health equity for disabled persons.