Therapeutic jurisprudence's future in health law: Bringing the patient back into the picture.

More than 25 years ago, Professors David Wexler and Bruce Winick envisioned broad application of therapeutic jurisprudence (TJ), an interdisciplinary theory of law suggesting that legislatures, regulators, and judges consider the extent to which their decisions impact the psychological well-being of those upon whom the law acts. TJ most obviously plays a significant role in mental health and criminal law, where it originated, but Wexler and Winick long ago opined that TJ could be useful in a wide variety of other disciplines as well. Indeed, TJ has expanded exponentially in application over the years.

Theresa Marie Schiavo's long road to peace.

The death of Theresa Marie Schiavo came about only after almost 7 years of argument among her family members. Her husband, Michael Schiavo, was convinced that she would have refused the medically supplied nutrition and hydration maintaining her life. Her parents, Robert and Mary Schindler, and her siblings were equally convinced that her condition was not so hopeless that she would have chosen to refuse treatment.

Eliciting patient preferences in today's health care system.

The American Medical Association Council on Ethical and Judicial Affairs recommends that physicians discuss advance directives with their patients and the patients' proxies. The council could have gone further by recognizing the difficulties physicians will encounter in trying to implement its proposal in a managed health care system. There is an undeniable need for caregiver participation in end-of-life planning, but the health care system must recognize and support implementation of the council's recommendations to make that possible.