* Solicitations Editor, Boston College Third World Law Journal (2000–2001).
1 See discussion infra Part I.C and notes 58–127.
2 See discussion infra Part I and notes 16–127.
3 See discussion infra Parts I.A–B and notes 16–57.
4 See discussion infra Part I.C and notes 58–127.
5 See discussion infra Part I.C and notes 58–127.
6 See discussion infra Part III.A and notes 180–194.
7 See discussion infra Part III.A and notes 180–194.
8 See discussion infra Part I and notes 16–127.
9 See discussion infra Parts I.A–B and notes 16–57.
10 See discussion infra Part I.C and notes 58–127.
11 See discussion infra Part II.A and notes 128–165.
12 See discussion infra Part II.B and notes 166–179.
13 See discussion infra Part III and notes 180–213.
14 See discussion infra Part IV and notes 214–297.
15 See discussion infra Part I.C and notes 58–127.
16 See David Barton Smith, Health Care Divided: Race and Healing a Nation 3–31 (1999); Barbara L. Bernier, Class, Race, and Poverty: Medical Technologies and Socio-Political Choices, 11 Harv. Blackletter L.J. 115, 116–25 (1994); Vernellia R. Randall, Slavery, Segregation and Racism: Trusting the Health Care System Ain’t Always Easy! An African-American Perspective on Bioethics, 15 St. Louis U. Pub. L. Rev. 191, 195–204 (1996) [hereinafter Randall, Trusting the Health Care System].
17 See Smith, supra note 16, at 11–12.
18 Id.
19 Id.
20 Id.
21 Larry J. Pittman, Physician-Assisted Suicide in the Dark Ward: The Intersection of the Thirteenth Amendment and Health Care Treatments Having Disproportionate Impacts on Disfavored Groups, 28 Seton Hall L. Rev. 774, 808–11 (1998) (citing commentators on both sides of this issue).
22 Id. at 811–12.
23 Bernier, supra note 16, at 118–20; Pittman, supra note 21, at 812–13.
24 Bernier, supra note 16, at 118--20; Pittman, supra note 21, at 812--13.
25 See Bernier, supra note 16, at 118–19; Pittman, supra note 21, at 813. For example, Dr. J. Marion Sims, hailed as the founder of modern gynecology, repeatedly performed operations on a group of female slaves in order to develop a surgical procedure to cure vesico-vaginal fistula. See id. Some historical accounts indicate that Dr. Sims failed to provide the African-American women he experimented on with anesthesia, despite its availability. See id. Other accounts explain that Dr. Sims administered opium post-operatively to sedate and pacify the victims of his experiments. See Randall, Trusting the Health Care System, supra note 16, at 197. As a consequence, the women used in these experiments became addicted to narcotics. See id.
26 Randall, Trusting the Health Care System, supra note 16, at 196.
27 Id.
28 Id. at 196–97.
29 Pittman, supra note 21, at 812.
30 Id.
31 Randall, Trusting the Health Care System, supra note 16, at 196.
32 Pittman, supra note 21, at 814–15.
33 Id.
34 Smith, supra note 16, at 12.
35 Id.
36 Id.
37 See id. at 12–24; Bernier, supra note 16, at 121–22; Pittman, supra note 21, at 815.
38 Smith, supra note 16, at 14; see, e.g., Plessy v. Ferguson, 163 U.S. 537, 550–51 (1896).
39 Smith, supra note 16, at 14.
40 See id.
41 See id.
42 Id.
43 Id. at 14–21.
44 Smith, supra note 16, at 16–17.
45 Id. at 24–27; Bernier, supra note 16, at 122–25.
46 Bernier, supra note 16, at 122–23; Pittman, supra note 21, at 816.
47 Bernier, supra note 16, at 122–23.
48 Id. at 123.
49 Pittman, supra note 21, at 816.
50 Bernier, supra note 16, at 123.
51 Id.
52 Smith, supra note 16, at 25.
53 Patricia A. King & Leslie E. Wolf, Empowering and Protecting Patients: Lessons for Physician-Assisted Suicide from the African-American Experience, 82 Minn. L. Rev. 1015, 1031 (1998).
54 Id.
55 Id.
56 Id.
57 See id.
58 See generally Council on Ethical and Judicial Affairs, Black-White Disparities in Health Care, 263 JAMA 2344 (1990); Barbara A. Noah, Racist Health Care?, 48 Fla. L. Rev. 357 (1996) [hereinafter Noah, Racist Health Care?]; Jane Perkins, Race Discrimination in America’s Health Care System, 27 Clearinghouse Rev. 371 (1993). The form of racism that currently exists in the health care sector of American society is sometimes described as institutionalized racism. Vernellia R. Randall, Racist Health Care: Reforming an Unjust Health Care System to Meet the Needs of African Americans, 3 Health Matrix 127, 144 (1993) [hereinafter Randall, Reforming an Unjust Heath Care System]. Racism comes in different forms. Id. Within the context of this Note it is important to draw a distinction between individual racism and institutionalized racism. See id. Individual racism is overt and typically occurs when individuals of one race act against individuals of another race. Id. In contrast, institutionalized racism is covert and typically occurs when an entire racial community acts against another racial community. Id. Institutional racism is
more subtle, less identifiable in terms of specific individuals committing the acts. But it is no less destructive of human life. . . . When black babies die each year because of lack of proper food, shelter and medical facilities, and thousands more are destroyed and maimed physically, emotionally, and intellectually because of the conditions of poverty and discrimination in the black community, that is a function of institutional racism.
Stokely Carmichael & Charles E. Hamilton, Black Power: The Politics of Liberation in America 4 (1967).
59 See Perkins, supra note 58, at 377.
60 Id. at 377–79.
61 Id. at 372. Low birth weight babies, any infant weighing less than 2500 grams, are more likely to have moderate and severe forms of mental retardation, cerebral palsy, seizure disorders, blindness, hearing loss and behavioral, learning and language disorders. Id. Thus, babies with low birth weights are more likely to be sickly throughout life than babies born with normal birth weights. Id. Studies indicate that African-American babies are 222.81% more likely to suffer from low birth weight than European-American babies. Randall, Reforming an Unjust Health Care System, supra note 58, at 140.
62 Perkins, supra note 58, at 372.
63 Id.
64 Id.
65 Id.
66 See id. at 372; Randall, Reforming an Unjust Health Care System, supra note 58, at 142.
67 See Randall, Reforming an Unjust Health Care System, supra note 58, at 142.
68 Id.
69 Perkins, supra note 58, at 372.
70 See Council on Ethical and Judicial Affairs, supra note 58, at 2344–46; Perkins, supra note 58, at 372–77.
71 Perkins, supra note 58, at 373–77.
72 See Clovis E. Semmes, Racism, Health and Post Industrialism: A Theory of African-American Health 112 (1996); Perkins, supra note 58, at 373–77.
73 See Perkins, supra note 58, at 373–74.
74 Id. at 373.
75 Id.
76 See id.
77 Id. at 374. One third of African Americans are below the poverty line. Id. In contrast, 10% of European Americans are below the poverty line. Id. Additionally, 30% of African-American households report no assets and 50% of African-American families report assets less than $5,000. Id.
78 Perkins, supra note 58, at 374. Twenty-four percent of African Americans are without medical insurance. Id. Only 38.1% of African-American children are covered by employment provided medical insurance. Id. Close to 14% of European Americans are without medical insurance. Id.
79 See id.
80 See id. at 373–75.
81 Id. at 374.
82 Id.
83 Perkins, supra note 58, at 374.
84 Randall, Trusting the Health Care System, supra note 16, at 210–11.
85 Marianne L. Engelman Lado, Breaking the Barriers of Access to Health Care: A Discussion of the Role of Civil Rights Litigation and the Relationship Between Burdens of Proof and the Experience of Denial, 60 Brook. L. Rev. 239, 245–46 (1994).
86 Id.
87 Id. at 248–49; Randall, Trusting the Health Care System, supra note 16, at 210–11.
88 See Lado, supra note 85, at 243–52; Randall, Trusting the Health Care System, supra note 16, at 210–12.
89 Randall, Trusting the Health Care System, supra note 16, at 211.
90 Id.
91 See id.
92 William J. Curran et al., Health Care Law and Ethics 142 (1998).
93 See id.
94 Randall, Trusting the Health Care System, supra note 16, at 211–12.
95 Id.
96 Barbara A. Noah, Racial Disparities in the Delivery of Health Care, 35 San Diego L. Rev. 135, 147–50 (1998) [hereinafter Noah, Racial Disparities].
97 Id. at 148.
98 Id. at 148–49. After controlling for variables such as the age of the child, the education level of the child’s mother, health insurance coverage and poverty status, this study revealed that of all children that made at least one visit to the doctor, African-American children were one half as likely as European-American children to be prescribed a prescription medication. Id.
99 Semmes, supra note 72, at 112.
100 Id.
101 See id.
102 Id.
103 See Council on Ethical and Judicial Affairs, supra note 58, at 2344–46.
104 Id. at 2344.
105 See id.
106 See Perkins, supra note 58, at 376.
107 Id. African-American individuals suffering from glaucoma are less likely to undergo corrective surgery than European Americans. Id. The magnitude of the disparity differs with geographic location. Id. In the mid-Atlantic region, African Americans are 29% less likely to undergo surgery for glaucoma than European Americans. Id. In the South, African Americans are 50% less likely than European Americans to have an operation to treat their glaucoma. Id.
108 Council on Ethical and Judicial Affairs, supra note 58, at 2345.
109 See Perkins, supra note 58, at 376.
110 Id.
111 Noah, Racist Health Care?, supra note 58, at 359.
112 See id.
113 Id.
114 Id.
115 See id.
116 See Noah, Racist Health Care?, supra note 58, at 359.
117 See Bernier, supra note 16, at 122.
118 Id.
119 Id.
120 Id.
121 Id.
122 Bernier, supra note 16, at 122.
123 Id.
124 Noah, Racist Health Care?, supra note 58, at 365–66. The exclusion of certain populations from drug trials has not been limited to racial/ethnic minorities. Id. Historically, females have also not been used as subjects in various pharmaceutical research projects. Id.
125 Id.
126 See id.
127 Id. at 366.
128 Mark A. Mintz, M.D. & John E. Eichenlaub, M.D., Urology, in Lawyers’ Medical Cyclopedia 1, 7 (Richard M. Patterson ed., 2000).
129 The World Book Medical Encyclopedia 511 (Robert O. Zeleny ed., 1988).
130 Id.
131 Mintz & Eichenlaub, supra note 128, at 10.
132 Id.
133 The World Book Medical Encyclopedia, supra note 129, at 511.
134 R.H. Flocks, M.D., Kidneys and Genito-Urinary Tract, in Family Medical Guide 281, 281 (Donald G. Cooley ed., 1980).
135 The World Book Medical Encyclopedia, supra note 129, at 512–13.
136 Id. at 512.
137 Id.
138 Mintz & Eichenlaub, supra note 128, at 94–102.
139 The World Book Medical Encyclopedia, supra note 129, at 512.
140 Id.
141 Id.
142 See Kevin McCoy, Wait for Organs is Long and Painful: Black New Yorkers in Need of Kidneys Suffer Longest, N.Y. Daily News, Aug. 9, 1999, at 6.
143 See id.
144 See id.
Life on dialysis is, to put it mildly, onerous. To exist is possible, to thrive unusual, and to prosper almost unheard of. The dialysis patient must keep on a strict diet. . . . The dialysis patient is subjected to a daily, never-ending procession of needles, tubes, blood work, and injections. . . . Marcia Campbell Marden has described life on dialysis: “A year ago I would not let you see me without mascara. Today you can view me three times a week without my pride. . . . I am dry, and always, always thirsty. . . . I smell old and sick. And even Shalimar cannot cover the odor of dialysate. . . . I am afraid. . . . I am determined to escape this.”
Laura G. Dooley & Robert S. Gaston, Stumbling Toward Equity: The Role of Government in Kidney Transplantation, 1998 U. ILL. L. REV. 703, 718 (1998).
145 See The World Book Medical Encyclopedia, supra note 129, at 512.
146 Id.
147 Mintz & Eichenlaub, supra note 128, at 98–102.
148 Id. at 98.
149 Id.
150 Id.
151 Id.
152 Mintz & Eichenlaub, supra note 128, 98–99.
153 Id. at 99.
154 Id. at 100.
155 Id.
156 Id.
157 See Mintz & Eichenlaub, supra note 128, at 100–01.
158 See Curran et al., supra note 92, at 720–21.
159 Id. at 721.
160 See id.
161 Id.
162 Id. The Uniform Anatomical Gift Act, a form of which is operative in almost all states, does not require the consent of anyone other than the individual who will make the donation upon their death. Unif. Anatomical Gift Act � 2(e) (1987). Despite this, almost all doctors are unwilling to remove organs from a deceased individual unless consent is obtained first from surviving family members. Curran et al., supra note 92, at 721.
163 Curran et al., supra note 92, at 720–21.
164 Dooley & Gaston, supra note 144, at 718.
165 See id.
166 42 U.S.C. � 274 (1994).
167 Id. � 274(b); Curran et al., supra note 92, at 721–22.
168 Curran et al., supra note 92, at 767.
169 Id.
170 Id.
171 Id.
172 See id.
173 Curran et al., supra note 92, at 767, 774–75. Waiting list times vary considerably with geographic location. Id.
174 Id. at 767.
175 Id.
176 Id. at 773.
177 Id.
178 Curran et al., supra note 92, at 767.
179 See id.
180 Id. at 782.
181 Noah, Racial Disparities, supra note 96, at 143.
182 Dooley & Gaston, supra note 144, at 714.
183 Id. “Some have suggested that passage to America in slave ships, with limited supplies of salt and water, might have exerted even more genetic pressure by favoring survival of those Africans best able to retain salt.” Id.
184 Id.
185 Id.
186 See id.
187 See discussion supra Part I.
188 Dooley & Gaston, supra note 144, at 714.
189 Id. at 715.
190 Council on Ethical and Judicial Affairs, supra note 58, at 2345.
191 Curran et al., supra note 92, at 782.
192 Randall, Trusting the Health Care System, supra note 16, at 219–20.
193 Id. at 220.
194 Dooley & Gaston, supra note 144, at 715; Randall, Trusting the Health Care System, supra note 16, at 220.
195 King & Wolf, supra note 53, at 1029.
196 Randall, Trusting the Health Care System, supra note 16, at 220; see Susan Okie, Racial Disparity Seen in Kidney Transplants, Blacks Less Likely to Be Recipients, Donors, Wash. Post, Jan. 31, 1991. “Blacks are only half as likely as whites to receive a kidney from a relative. Twenty-five percent of kidneys received by white patients come from a living relative, compared with about 12% of kidneys received by black patients.” Id.
197 King & Wolf, supra note 53, at 1029.
198 Id.; see also Randall, Trusting the Health Care System, supra note 16, at 220–21. Community rumors contribute to the fear of African Americans regarding organ donation King & Wolf, supra note 53, at 1029; see also Randall, Trusting the Health Care System, supra note 16, at 220–21. Rumors circulate in African-American communities about African Americans being prematurely declared brain dead so that their organs may be harvested for the benefit of European Americans in need of transplantation. King & Wolf, supra note 53, at 1029; see also Randall, Trusting the Health Care System, supra note 16, at 220–21.
199 See Noah, Racial Disparities, supra note 96, at 143–44.
200 Dooley & Gaston, supra note 144, at 715.
201 See Curran et al., supra note 92, at 767.
202 Noah, Racial Disparities, supra note 96, at 143–44; see Kevin McCoy, Deadly Disparity in Transplants: Blacks and Hispanics Deprived, N.Y. Daily News, Aug. 8, 1999, at 6. “The main factor blocking blacks and Hispanics from transplants was that they weren’t placed on organ waiting lists. This happened largely because their doctors did not refer them to transplant centers. . . . They don’t make it nearly as often as whites.” Id.
203 Noah, Racial Disparities, supra note 96, at 143–44.
204 Id. at 145.
205 Curran et al., supra note 92, at 773.
206 Noah, Racial Disparities, supra note 96, at 145.
207 See id.
208 Id.
209 42 U.S.C. � 274(b)(2)(A), (D) (1994).
210 See id.
211 See id.; Noah, Racist Health Care?, supra note 58, at 364.
212 Noah, Racist Health Care?, supra note 58, at 364.
213 Noah, Racial Disparities, supra note 96, at 145.
214 A problem as large and complex as the one presented should be attacked from various angles. Lado, supra note 85, at 256. Legal responses are one avenue that can and should be pursued in order to bring about racial parity in the allocation of kidneys. See id. However, the law, working in isolation, will not be able to effectively ameliorate this situation. See id. Other means of attacking racial inequity in the area of kidney allocation must be pursued. See id. Within the scientific realm researchers must continue to explore and develop alternative organ procurement options, such as xenotransplantation (animal to human transplantation), cloning (inducing animals to grow organs that have antigens that are compatible with humans) and new immune suppressing drugs. See Dooley & Gaston, supra note 144, at 723–24.
215 See Lado, supra note 85, at 256.
216 See id.
217 See Smith, supra note 16, at 26; Lado, supra note 85, at 256.
218 See Randall, Trusting the Health Care System, supra note 16, at 233–34.
219 See Perkins, supra note 58, at 379.
220 See Semmes, supra note 72, at 112–13.
221 See Mark F. Anderson, The Future of Organ Transplantation: From Where Will New Donors Come, to Whom Will Their Organs Go?, 5 Health Matrix 249, 258–70 (1995); Linda C. Fentiman, Organ Donation as National Service: A Proposed Federal Organ Donation Law, 27 Suffolk U. L. Rev. 1593, 1598–1600 (1993).
222 Fentiman, supra note 221, at 1598.
223 Id.
224 Id. at 1599.
225 Id.
226 See Dooley & Gaston, supra note 144, at 715–16.
227 See id.
228 Curran et al., supra note 92, at 772.
229 See id. at 772–73; Dooley & Gaston, supra note 144, at 715–16; Noah, Racial Disparities, supra note 96, at 145–46.
230 See Curran et al., supra note 92, at 772–73; Dooley & Gaston, supra note 144, at 715–16; Noah, Racial Disparities, supra note 96, at 145–46.
231 Curran et al., supra note 92, at 783.
232 Dooley & Gaston, supra note 144, at 720.
233 Id.
234 See Curran et al., supra note 92, at 783; Dooley & Gaston, supra note 144, at 720.
235 Dooley & Gaston, supra note 144, at 720.
236 See id.
237 See id.; Noah, Racial Disparities, supra note 96, at 145–46.
238 See Benjamin Mintz, Analyzing the OPTN Under the State Action Doctrine—Can UNOS’s Allocation Criteria Survive Strict Scrutiny?, 28 Colum. J.L. & Soc. Probs. 339, 384–96 (1995).
239 See id. at 367–76 (discussing whether UNOS is a state actor).
240 Id. at 367–76, 384.
241 Id. at 358–59.
242 Id. at 374–76.
243 See Mintz, supra note 238, at 384.
244 Washington v. Davis, 426 U.S. 229, 239 (1976).
245 See Mintz, supra note 238, at 384.
246 See id. at 386–89.
247 See id. at 367–76, 384.
248 See Amy Jurevic, Disparate Impact Under Title VI: Discrimination, By Any Other Name, Will Still Have the Same Impact, 15 St. Louis U. Pub. L. Rev. 237, 242–49 (1996).
249 See 42 U.S.C. � 2000d (1994).
250 Id.
251 Id.; Jurevic, supra note 248, at 240.
252 See Perkins, supra note 58, at 379.
253 Daniel K. Hampton, Title VI Challenges by Private Parties to the Location of Health Care Facilities: Toward a Just and Effective Action, 37 B.C. L. Rev. 517, 520–21 (1996).
254 Jurevic, supra note 248, at 241.
255 Sidney D. Watson, Health Care in the Inner City: Asking the Right Question, 71 N.C. L. Rev. 1647, 1669–70 (1993).
256 Id.
257 See id.
258 Ian Ayres et al., Unequal Racial Access to Kidney Transplantation, 46 Vand. L. Rev. 805, 859 (1993).
259 Id. at 859 n.248.
260 Jurevic, supra note 248, at 241.
261 See Hampton, supra note 253, at 536–49; Sidney D. Watson, Reinvigorating Title VI: Defending Health Care Discrimination—It Shouldn’t Be So Easy, 58 Fordham L. Rev. 939, 966–71 (1990) [hereinafter Watson, Title VI].
262 Alexander v. Choate, 469 U.S. 287, 293 (1985); Watson, Title VI, supra note 261, at 952–53.
263 Choate, 469 U.S. at 293; see Guardians Ass’n v. Civil Serv. Comm’n, 463 U.S. 582, 584 (1983).
264 Choate, 469 U.S. at 293.
265 Id. at 293–94.
266 Jurevic, supra note 248, at 241.
267 Id.
268 Id.
269 Id.
270 Id.
271 Jurevic, supra note 248, at 241.
272 See Watson, Title VI, supra note 261, at 954.
273 Id. at 955.
274 See id. at 958.
275 See id.
276 See Ayres et al., supra note 258, at 853–60.
277 Id. at 859; see Hampton, supra note 253, at 542–49.
278 See Ayres et al., supra note 258, at 855–59.
279 See id. at 859.
280 Curran et al., supra note 92, at 767.
281 Ayres et al., supra note 258, at 859.
282 See Curran et al., supra note 92, at 767; Ayres et al., supra note 258, at 859.
283 45 C.F.R. � 80.3(b)(2) (1973).
284 See Jurevic, supra note 248, at 241.
285 Ayers et al., supra note 258, at 855–56.
286 Id.
287 Jurevic, supra note 248, at 241.
288 Ayers et al., supra note 258, at 856–57.
289 See Watson, Title VI, supra note 261, at 955, 958.
290 See Ayers et al., supra note 258, at 855–57.
291 Id. at 856–57.
292 See 42 U.S.C. � 274(b)(2)(A), (D) (1994).
293 See Ayres et al., supra note 258, at 858.
294 See Hampton, supra note 253, at 543–49 (explaining recent cases brought against hospitals under Title VI); Jurevic, supra note 248, at 241.
295 See Perkins, supra note 58, at 379.
296 45 C.F.R. � 80.3(b)(2) (1973); Jurevic, supra note 248, at 241.
297 See Jurevic, supra note 248, at 241.
298 See discussion supra Part I.C and notes 50–119.
299 See discussion supra Parts I.B–C and notes 29–119.
300 See discussion supra Part III.A and notes 172–186.
301 See discussion supra Part III.A and notes 172–186.
302 See Lado, supra note 85, at 256.
303 See discussion supra Part IV.A and notes 207–217.
304 See discussion supra Parts IV.B–C and notes 218–29.
305 See discussion supra Parts IV.B–C and notes 218–229.
306 See discussion supra Part IV.D and notes 230–240.
307 See discussion supra Part IV.D and notes 241–289.
308 See discussion supra Part IV and notes 207–289.