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• 26 Mar 2024
• Cold Call Podcast

How Do Great Leaders Overcome Adversity?

In the spring of 2021, Raymond Jefferson (MBA 2000) applied for a job in President Joseph Biden’s administration. Ten years earlier, false allegations were used to force him to resign from his prior US government position as assistant secretary of labor for veterans’ employment and training in the Department of Labor. Two employees had accused him of ethical violations in hiring and procurement decisions, including pressuring subordinates into extending contracts to his alleged personal associates. The Deputy Secretary of Labor gave Jefferson four hours to resign or be terminated. Jefferson filed a federal lawsuit against the US government to clear his name, which he pursued for eight years at the expense of his entire life savings. Why, after such a traumatic and debilitating experience, would Jefferson want to pursue a career in government again? Harvard Business School Senior Lecturer Anthony Mayo explores Jefferson’s personal and professional journey from upstate New York to West Point to the Obama administration, how he faced adversity at several junctures in his life, and how resilience and vulnerability shaped his leadership style in the case, "Raymond Jefferson: Trial by Fire."

• 02 Jan 2024

Should Businesses Take a Stand on Societal Issues?

Should businesses take a stand for or against particular societal issues? And how should leaders determine when and how to engage on these sensitive matters? Harvard Business School Senior Lecturer Hubert Joly, who led the electronics retailer Best Buy for almost a decade, discusses examples of corporate leaders who had to determine whether and how to engage with humanitarian crises, geopolitical conflict, racial justice, climate change, and more in the case, “Deciding When to Engage on Societal Issues.”

• 12 Dec 2023

Can Sustainability Drive Innovation at Ferrari?

When Ferrari, the Italian luxury sports car manufacturer, committed to achieving carbon neutrality and to electrifying a large part of its car fleet, investors and employees applauded the new strategy. But among the company’s suppliers, the reaction was mixed. Many were nervous about how this shift would affect their bottom lines. Professor Raffaella Sadun and Ferrari CEO Benedetto Vigna discuss how Ferrari collaborated with suppliers to work toward achieving the company’s goal. They also explore how sustainability can be a catalyst for innovation in the case, “Ferrari: Shifting to Carbon Neutrality.” This episode was recorded live December 4, 2023 in front of a remote studio audience in the Live Online Classroom at Harvard Business School.

• 11 Dec 2023
• Research & Ideas

Doing Well by Doing Good? One Industry’s Struggle to Balance Values and Profits

Few companies wrestle with their moral mission and financial goals like those in journalism. Research by Lakshmi Ramarajan explores how a disrupted industry upholds its values even as the bottom line is at stake.

• 27 Nov 2023

Voting Democrat or Republican? The Critical Childhood Influence That's Tough to Shake

Candidates might fixate on red, blue, or swing states, but the neighborhoods where voters spend their teen years play a key role in shaping their political outlook, says research by Vincent Pons. What do the findings mean for the upcoming US elections?

• 21 Nov 2023

The Beauty Industry: Products for a Healthy Glow or a Compact for Harm?

Many cosmetics and skincare companies present an image of social consciousness and transformative potential, while profiting from insecurity and excluding broad swaths of people. Geoffrey Jones examines the unsightly reality of the beauty industry.

• 09 Nov 2023

What Will It Take to Confront the Invisible Mental Health Crisis in Business?

The pressure to do more, to be more, is fueling its own silent epidemic. Lauren Cohen discusses the common misperceptions that get in the way of supporting employees' well-being, drawing on case studies about people who have been deeply affected by mental illness.

• 07 Nov 2023

How Should Meta Be Governed for the Good of Society?

Julie Owono is executive director of Internet Sans Frontières and a member of the Oversight Board, an outside entity with the authority to make binding decisions on tricky moderation questions for Meta’s companies, including Facebook and Instagram. Harvard Business School visiting professor Jesse Shapiro and Owono break down how the Board governs Meta’s social and political power to ensure that it’s used responsibly, and discuss the Board’s impact, as an alternative to government regulation, in the case, “Independent Governance of Meta’s Social Spaces: The Oversight Board.”

• 24 Oct 2023

From P.T. Barnum to Mary Kay: Lessons From 5 Leaders Who Changed the World

What do Steve Jobs and Sarah Breedlove have in common? Through a series of case studies, Robert Simons explores the unique qualities of visionary leaders and what today's managers can learn from their journeys.

• 03 Oct 2023
• Research Event

Build the Life You Want: Arthur Brooks and Oprah Winfrey Share Happiness Tips

"Happiness is not a destination. It's a direction." In this video, Arthur C. Brooks and Oprah Winfrey reflect on mistakes, emotions, and contentment, sharing lessons from their new book.

• 12 Sep 2023

Successful, But Still Feel Empty? A Happiness Scholar and Oprah Have Advice for You

So many executives spend decades reaching the pinnacles of their careers only to find themselves unfulfilled at the top. In the book Build the Life You Want, Arthur Brooks and Oprah Winfrey offer high achievers a guide to becoming better leaders—of their lives.

• 10 Jul 2023
• In Practice

The Harvard Business School Faculty Summer Reader 2023

Need a book recommendation for your summer vacation? HBS faculty members share their reading lists, which include titles that explore spirituality, design, suspense, and more.

• 01 Jun 2023

A Nike Executive Hid His Criminal Past to Turn His Life Around. What If He Didn't Have To?

Larry Miller committed murder as a teenager, but earned a college degree while serving time and set out to start a new life. Still, he had to conceal his record to get a job that would ultimately take him to the heights of sports marketing. A case study by Francesca Gino, Hise Gibson, and Frances Frei shows the barriers that formerly incarcerated Black men are up against and the potential talent they could bring to business.

• 04 Apr 2023

Two Centuries of Business Leaders Who Took a Stand on Social Issues

Executives going back to George Cadbury and J. N. Tata have been trying to improve life for their workers and communities, according to the book Deeply Responsible Business: A Global History of Values-Driven Leadership by Geoffrey Jones. He highlights three practices that deeply responsible companies share.

• 14 Mar 2023

Can AI and Machine Learning Help Park Rangers Prevent Poaching?

Globally there are too few park rangers to prevent the illegal trade of wildlife across borders, or poaching. In response, Spatial Monitoring and Reporting Tool (SMART) was created by a coalition of conservation organizations to take historical data and create geospatial mapping tools that enable more efficient deployment of rangers. SMART had demonstrated significant improvements in patrol coverage, with some observed reductions in poaching. Then a new predictive analytic tool, the Protection Assistant for Wildlife Security (PAWS), was created to use artificial intelligence (AI) and machine learning (ML) to try to predict where poachers would be likely to strike. Jonathan Palmer, Executive Director of Conservation Technology for the Wildlife Conservation Society, already had a good data analytics tool to help park rangers manage their patrols. Would adding an AI- and ML-based tool improve outcomes or introduce new problems? Harvard Business School senior lecturer Brian Trelstad discusses the importance of focusing on the use case when determining the value of adding a complex technology solution in his case, “SMART: AI and Machine Learning for Wildlife Conservation.”

• 14 Feb 2023

Does It Pay to Be a Whistleblower?

In 2013, soon after the US Securities and Exchange Commission (SEC) had started a massive whistleblowing program with the potential for large monetary rewards, two employees of a US bank’s asset management business debated whether to blow the whistle on their employer after completing an internal review that revealed undisclosed conflicts of interest. The bank’s asset management business disproportionately invested clients’ money in its own mutual funds over funds managed by other banks, letting it collect additional fees—and the bank had not disclosed this conflict of interest to clients. Both employees agreed that failing to disclose the conflict was a problem, but beyond that, they saw the situation very differently. One employee, Neel, perceived the internal review as a good-faith effort by senior management to identify and address the problem. The other, Akash, thought that the entire business model was problematic, even with a disclosure, and believed that the bank may have even broken the law. Should they escalate the issue internally or report their findings to the US Securities and Exchange Commission? Harvard Business School associate professor Jonas Heese discusses the potential risks and rewards of whistleblowing in his case, “Conflicts of Interest at Uptown Bank.”

• 17 Jan 2023

Good Companies Commit Crimes, But Great Leaders Can Prevent Them

It's time for leaders to go beyond "check the box" compliance programs. Through corporate cases involving Walmart, Wells Fargo, and others, Eugene Soltes explores the thorny legal issues executives today must navigate in his book Corporate Criminal Investigations and Prosecutions.

• 29 Nov 2022

How Will Gamers and Investors Respond to Microsoft’s Acquisition of Activision Blizzard?

In January 2022, Microsoft announced its acquisition of the video game company Activision Blizzard for $68.7 billion. The deal would make Microsoft the world’s third largest video game company, but it also exposes the company to several risks. First, the all-cash deal would require Microsoft to use a large portion of its cash reserves. Second, the acquisition was announced as Activision Blizzard faced gender pay disparity and sexual harassment allegations. That opened Microsoft up to potential reputational damage, employee turnover, and lost sales. Do the potential benefits of the acquisition outweigh the risks for Microsoft and its shareholders? Harvard Business School associate professor Joseph Pacelli discusses the ongoing controversies around the merger and how gamers and investors have responded in the case, “Call of Fiduciary Duty: Microsoft Acquires Activision Blizzard.”

• 15 Nov 2022

Stop Ignoring Bad Behavior: 6 Tips for Better Ethics at Work

People routinely overlook wrongdoing, even in situations that cause significant harm. In his book Complicit: How We Enable the Unethical and How to Stop, Max Bazerman shares strategies that help people do the right thing even when those around them aren't.

• 08 Nov 2022

How Centuries of Restrictions on Women Shed Light on Today's Abortion Debate

Going back to pre-industrial times, efforts to limit women's sexuality have had a simple motive: to keep them faithful to their spouses. Research by Anke Becker looks at the deep roots of these restrictions and their economic implications.

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• UNODC-UNESCO Guide for Policymakers
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• Justice Accelerators
• Introduction
• Organized Crime
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• Crime Prevention & Criminal Justice Reform
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• UN Congress on Crime Prevention & Criminal Justice
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• Criminal Justice & Crime Prevention
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• Introduction & Learning Outcomes
• Corruption - Baseline Definition
• Effects of Corruption
• Deeper Meanings of Corruption
• Measuring Corruption
• Possible Class Structure
• Core Reading
• Advanced Reading
• Student Assessment
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• Appendix: How Corruption Affects the SDGs
• What is Governance?
• What is Good Governance?
• Corruption and Bad Governance
• Governance Reforms and Anti-Corruption
• Guidelines for Stand-alone Course
• Corruption and Democracy
• Corruption and Authoritarian Systems
• Hybrid Systems and Syndromes of Corruption
• The Deep Democratization Approach
• Political Parties and Political Finance
• Political Institution-building as a Means to Counter Corruption
• Manifestations and Consequences of Public Sector Corruption
• Causes of Public Sector Corruption
• Theories that Explain Corruption
• Corruption in Public Procurement
• Corruption in State-Owned Enterprises
• Responses to Public Sector Corruption
• Preventing Public Sector Corruption
• Forms & Manifestations of Private Sector Corruption
• Consequences of Private Sector Corruption
• Causes of Private Sector Corruption
• Responses to Private Sector Corruption
• Preventing Private Sector Corruption
• Collective Action & Public-Private Partnerships against Corruption
• Transparency as a Precondition
• Detection Mechanisms - Auditing and Reporting
• Whistle-blowing Systems and Protections
• Investigation of Corruption
• Introduction and Learning Outcomes
• Brief background on the human rights system
• Overview of the corruption-human rights nexus
• Impact of corruption on specific human rights
• Approaches to assessing the corruption-human rights nexus
• Human-rights based approach
• Defining sex, gender and gender mainstreaming
• Gender differences in corruption
• Theories explaining the gender–corruption nexus
• Gendered impacts of corruption
• Anti-corruption and gender mainstreaming
• Manifestations of corruption in education
• Costs of corruption in education
• Causes of corruption in education
• Fighting corruption in education
• Core terms and concepts
• The role of citizens in fighting corruption
• The role, risks and challenges of CSOs fighting corruption
• The role of the media in fighting corruption
• Access to information: a condition for citizen participation
• ICT as a tool for citizen participation in anti-corruption efforts
• Government obligations to ensure citizen participation in anti-corruption efforts
• Teaching Guide
• Brief History of Terrorism
• 19th Century Terrorism
• League of Nations & Terrorism
• United Nations & Terrorism
• Terrorist Victimization
• Exercises & Case Studies
• Radicalization & Violent Extremism
• Preventing & Countering Violent Extremism
• Drivers of Violent Extremism
• International Approaches to PVE &CVE
• Regional & Multilateral Approaches
• Defining Rule of Law
• UN Global Counter-Terrorism Strategy
• International Cooperation & UN CT Strategy
• Legal Sources & UN CT Strategy
• Regional & National Approaches
• International Legal Frameworks
• International Human Rights Law
• International Humanitarian Law
• International Refugee Law
• Current Challenges to International Legal Framework
• Defining Terrorism
• Criminal Justice Responses
• Treaty-based Crimes of Terrorism
• Core International Crimes
• International Courts and Tribunals
• African Region
• Inter-American Region
• Asian Region
• European Region
• Middle East & Gulf Regions
• Core Principles of IHL
• Categorization of Armed Conflict
• Classification of Persons
• IHL, Terrorism & Counter-Terrorism
• Relationship between IHL & intern. human rights law
• Limitations Permitted by Human Rights Law
• Derogation during Public Emergency
• Examples of States of Emergency & Derogations
• International Human Rights Instruments
• Regional Human Rights Instruments
• Extra-territorial Application of Right to Life
• Arbitrary Deprivation of Life
• Death Penalty
• Enforced Disappearances
• Armed Conflict Context
• International Covenant on Civil and Political Rights
• Convention against Torture et al.
• International Legal Framework
• Key Contemporary Issues
• Investigative Phase
• Trial & Sentencing Phase
• Armed Conflict
• Case Studies
• Special Investigative Techniques
• Surveillance & Interception of Communications
• Privacy & Intelligence Gathering in Armed Conflict
• Accountability & Oversight of Intelligence Gathering
• Principle of Non-Discrimination
• Freedom of Religion
• Freedom of Expression
• Freedom of Assembly
• Freedom of Association
• Fundamental Freedoms
• Definition of 'Victim'
• Effects of Terrorism
• Access to Justice
• Recognition of the Victim
• Human Rights Instruments
• Criminal Justice Mechanisms
• Instruments for Victims of Terrorism
• National Approaches
• Key Challenges in Securing Reparation
• Topic 1. Contemporary issues relating to conditions conducive both to the spread of terrorism and the rule of law
• Topic 2. Contemporary issues relating to the right to life
• Topic 3. Contemporary issues relating to foreign terrorist fighters
• Topic 4. Contemporary issues relating to non-discrimination and fundamental freedoms
• Module 16: Linkages between Organized Crime and Terrorism
• Thematic Areas
• Content Breakdown
• Module Adaptation & Design Guidelines
• Teaching Methods
• Acknowledgements
• 1. Introducing United Nations Standards & Norms on CPCJ vis-à-vis International Law
• 2. Scope of United Nations Standards & Norms on CPCJ
• 3. United Nations Standards & Norms on CPCJ in Operation
• 1. Definition of Crime Prevention
• 2. Key Crime Prevention Typologies
• 2. (cont.) Tonry & Farrington’s Typology
• 3. Crime Problem-Solving Approaches
• 4. What Works
• United Nations Entities
• Regional Crime Prevention Councils/Institutions
• Key Clearinghouses
• Systematic Reviews
• 1. Introduction to International Standards & Norms
• 2. Identifying the Need for Legal Aid
• 3. Key Components of the Right of Access to Legal Aid
• 4. Access to Legal Aid for Those with Specific Needs
• 5. Models for Governing, Administering and Funding Legal Aid
• 6. Models for Delivering Legal Aid Services
• 7. Roles and Responsibilities of Legal Aid Providers
• 8. Quality Assurance and Legal Aid Services
• 1. Context for Use of Force by Law Enforcement Officials
• 2. Legal Framework
• 3. General Principles of Use of Force in Law Enforcement
• 4. Use of Firearms
• 5. Use of “Less-Lethal” Weapons
• 6. Protection of Especially Vulnerable Groups
• 7. Use of Force during Assemblies
• 1. Policing in democracies & need for accountability, integrity, oversight
• 2. Key mechanisms & actors in police accountability, oversight
• 3. Crosscutting & contemporary issues in police accountability
• 1. Introducing Aims of Punishment, Imprisonment & Prison Reform
• 2. Current Trends, Challenges & Human Rights
• 3. Towards Humane Prisons & Alternative Sanctions
• 1. Aims and Significance of Alternatives to Imprisonment
• 2. Justifying Punishment in the Community
• 3. Pretrial Alternatives
• 4. Post Trial Alternatives
• 5. Evaluating Alternatives
• 1. Concept, Values and Origin of Restorative Justice
• 2. Overview of Restorative Justice Processes
• 3. How Cost Effective is Restorative Justice?
• 4. Issues in Implementing Restorative Justice
• 1. Gender-Based Discrimination & Women in Conflict with the Law
• 2. Vulnerabilities of Girls in Conflict with the Law
• 3. Discrimination and Violence against LGBTI Individuals
• 4. Gender Diversity in Criminal Justice Workforce
• 1. Ending Violence against Women
• 2. Human Rights Approaches to Violence against Women
• 3. Who Has Rights in this Situation?
• 4. What about the Men?
• 5. Local, Regional & Global Solutions to Violence against Women & Girls
• 1. Understanding the Concept of Victims of Crime
• 2. Impact of Crime, including Trauma
• 3. Right of Victims to Adequate Response to their Needs
• 4. Collecting Victim Data
• 5. Victims and their Participation in Criminal Justice Process
• 6. Victim Services: Institutional and Non-Governmental Organizations
• 7. Outlook on Current Developments Regarding Victims
• 8. Victims of Crime and International Law
• 1. The Many Forms of Violence against Children
• 2. The Impact of Violence on Children
• 3. States' Obligations to Prevent VAC and Protect Child Victims
• 4. Improving the Prevention of Violence against Children
• 5. Improving the Criminal Justice Response to VAC
• 6. Addressing Violence against Children within the Justice System
• 1. The Role of the Justice System
• 2. Convention on the Rights of the Child & International Legal Framework on Children's Rights
• 3. Justice for Children
• 4. Justice for Children in Conflict with the Law
• 5. Realizing Justice for Children
• 1a. Judicial Independence as Fundamental Value of Rule of Law & of Constitutionalism
• 1b. Main Factors Aimed at Securing Judicial Independence
• 2a. Public Prosecutors as ‘Gate Keepers’ of Criminal Justice
• 2b. Institutional and Functional Role of Prosecutors
• 2c. Other Factors Affecting the Role of Prosecutors
• Basics of Computing
• Global Connectivity and Technology Usage Trends
• Cybercrime in Brief
• Cybercrime Trends
• Cybercrime Prevention
• Offences against computer data and systems
• Computer-related offences
• Content-related offences
• The Role of Cybercrime Law
• Harmonization of Laws
• International and Regional Instruments
• International Human Rights and Cybercrime Law
• Digital Evidence
• Digital Forensics
• Standards and Best Practices for Digital Forensics
• Reporting Cybercrime
• Who Conducts Cybercrime Investigations?
• Obstacles to Cybercrime Investigations
• Knowledge Management
• Legal and Ethical Obligations
• Handling of Digital Evidence
• Digital Evidence Admissibility
• Sovereignty and Jurisdiction
• Formal International Cooperation Mechanisms
• Informal International Cooperation Mechanisms
• Data Retention, Preservation and Access
• Challenges Relating to Extraterritorial Evidence
• National Capacity and International Cooperation
• Internet Governance
• Cybersecurity Strategies: Basic Features
• National Cybersecurity Strategies
• International Cooperation on Cybersecurity Matters
• Cybersecurity Posture
• Assets, Vulnerabilities and Threats
• Vulnerability Disclosure
• Cybersecurity Measures and Usability
• Situational Crime Prevention
• Incident Detection, Response, Recovery & Preparedness
• Privacy: What it is and Why it is Important
• Privacy and Security
• Cybercrime that Compromises Privacy
• Data Protection Legislation
• Data Breach Notification Laws
• Enforcement of Privacy and Data Protection Laws
• Intellectual Property: What it is
• Types of Intellectual Property
• Causes for Cyber-Enabled Copyright & Trademark Offences
• Protection & Prevention Efforts
• Online Child Sexual Exploitation and Abuse
• Cyberstalking and Cyberharassment
• Cyberbullying
• Gender-Based Interpersonal Cybercrime
• Interpersonal Cybercrime Prevention
• Cyber Organized Crime: What is it?
• Conceptualizing Organized Crime & Defining Actors Involved
• Criminal Groups Engaging in Cyber Organized Crime
• Cyber Organized Crime Activities
• Preventing & Countering Cyber Organized Crime
• Cyberespionage
• Cyberterrorism
• Cyberwarfare
• Information Warfare, Disinformation & Electoral Fraud
• Responses to Cyberinterventions
• Framing the Issue of Firearms
• Direct Impact of Firearms
• Indirect Impacts of Firearms on States or Communities
• International and National Responses
• Typology and Classification of Firearms
• Common Firearms Types
• 'Other' Types of Firearms
• Parts and Components
• History of the Legitimate Arms Market
• Need for a Legitimate Market
• Key Actors in the Legitimate Market
• Authorized & Unauthorized Arms Transfers
• Illegal Firearms in Social, Cultural & Political Context
• Supply, Demand & Criminal Motivations
• Larger Scale Firearms Trafficking Activities
• Smaller Scale Trafficking Activities
• Sources of Illicit Firearms
• Consequences of Illicit Markets
• International Public Law & Transnational Law
• International Instruments with Global Outreach
• Commonalities, Differences & Complementarity between Global Instruments
• Tools to Support Implementation of Global Instruments
• Other United Nations Processes
• The Sustainable Development Goals
• Multilateral & Regional Instruments
• Scope of National Firearms Regulations
• National Firearms Strategies & Action Plans
• Harmonization of National Legislation with International Firearms Instruments
• Assistance for Development of National Firearms Legislation
• Firearms Trafficking as a Cross-Cutting Element
• Organized Crime and Organized Criminal Groups
• Criminal Gangs
• Terrorist Groups
• Interconnections between Organized Criminal Groups & Terrorist Groups
• Gangs - Organized Crime & Terrorism: An Evolving Continuum
• International Response
• International and National Legal Framework
• Firearms Related Offences
• Role of Law Enforcement
• Firearms as Evidence
• Use of Special Investigative Techniques
• International Cooperation and Information Exchange
• Prosecution and Adjudication of Firearms Trafficking
• Teaching Methods & Principles
• Ethical Learning Environments
• Overview of Modules
• Module Adaption & Design Guidelines
• Table of Exercises
• Basic Terms
• Forms of Gender Discrimination
• Ethics of Care
• Case Studies for Professional Ethics
• Case Studies for Role Morality
• Additional Exercises
• Defining Organized Crime
• Definition in Convention
• Similarities & Differences
• Activities, Organization, Composition
• Thinking Critically Through Fiction
• Excerpts of Legislation
• Research & Independent Study Questions
• Legal Definitions of Organized Crimes
• Criminal Association
• Definitions in the Organized Crime Convention
• Criminal Organizations and Enterprise Laws
• Enabling Offence: Obstruction of Justice
• Drug Trafficking
• Wildlife & Forest Crime
• Counterfeit Products Trafficking
• Falsified Medical Products
• Trafficking in Cultural Property
• Trafficking in Persons
• Case Studies & Exercises
• Extortion Racketeering
• Loansharking
• Links to Corruption
• Bribery versus Extortion
• Money-Laundering
• Liability of Legal Persons
• How much Organized Crime is there?
• Alternative Ways for Measuring
• Measuring Product Markets
• Risk Assessment
• Key Concepts of Risk Assessment
• Risk Assessment of Organized Crime Groups
• Risk Assessment of Product Markets
• Risk Assessment in Practice
• Positivism: Environmental Influences
• Classical: Pain-Pleasure Decisions
• Structural Factors
• Ethical Perspective
• Crime Causes & Facilitating Factors
• Models and Structure
• Hierarchical Model
• Local, Cultural Model
• Enterprise or Business Model
• Groups vs Activities
• Networked Structure
• Jurisdiction
• Investigators of Organized Crime
• Controlled Deliveries
• Physical & Electronic Surveillance
• Undercover Operations
• Financial Analysis
• Use of Informants
• Rights of Victims & Witnesses
• Role of Prosecutors
• Adversarial vs Inquisitorial Legal Systems
• Mitigating Punishment
• Granting Immunity from Prosecution
• Witness Protection
• Aggravating & Mitigating Factors
• Sentencing Options
• Alternatives to Imprisonment
• Death Penalty & Organized Crime
• Backgrounds of Convicted Offenders
• Confiscation
• Confiscation in Practice
• Mutual Legal Assistance (MLA)
• Extradition
• Transfer of Criminal Proceedings
• Transfer of Sentenced Persons
• Module 12: Prevention of Organized Crime
• Adoption of Organized Crime Convention
• Historical Context
• Features of the Convention
• Related international instruments
• Conference of the Parties
• Roles of Participants
• Structure and Flow
• Recommended Topics
• Background Materials
• What is Sex / Gender / Intersectionality?
• Knowledge about Gender in Organized Crime
• Gender and Organized Crime
• Gender and Different Types of Organized Crime
• Definitions and Terminology
• Organized crime and Terrorism - International Legal Framework
• International Terrorism-related Conventions
• UNSC Resolutions on Terrorism
• Organized Crime Convention and its Protocols
• Theoretical Frameworks on Linkages between Organized Crime and Terrorism
• Typologies of Criminal Behaviour Associated with Terrorism
• Terrorism and Drug Trafficking
• Terrorism and Trafficking in Weapons
• Terrorism, Crime and Trafficking in Cultural Property
• Trafficking in Persons and Terrorism
• Intellectual Property Crime and Terrorism
• Kidnapping for Ransom and Terrorism
• Exploitation of Natural Resources and Terrorism
• Review and Assessment Questions
• Research and Independent Study Questions
• Criminalization of Smuggling of Migrants
• UNTOC & the Protocol against Smuggling of Migrants
• Offences under the Protocol
• Financial & Other Material Benefits
• Aggravating Circumstances
• Criminal Liability
• Non-Criminalization of Smuggled Migrants
• Scope of the Protocol
• Humanitarian Exemption
• Migrant Smuggling v. Irregular Migration
• Migrant Smuggling vis-a-vis Other Crime Types
• Other Resources
• Assistance and Protection in the Protocol
• International Human Rights and Refugee Law
• Vulnerable groups
• Positive and Negative Obligations of the State
• Identification of Smuggled Migrants
• Participation in Legal Proceedings
• Role of Non-Governmental Organizations
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University Module Series: Integrity & Ethics

Module 12: integrity, ethics and law.

  This module is a resource for lecturers  

Case studies.

Choose one or more of the following case studies and lead a discussion which allows students to address and debate issues of integrity, ethics and law. If time allows, let the students vote on which case studies they want to discuss.

For lecturers teaching large classes, case studies with multiple parts and different methods of solution lend themselves well to the group size and energy in such an environment. Lecturers can begin by having students vote on which case study they prefer. Lecturers could break down analysis of the chosen case study into steps which appear to students in sequential order, thereby ensuring that larger groups stay on track. Lecturers may instruct students to discuss questions in a small group without moving from their seat, and nominate one person to speak for the group if called upon. There is no need to provide excessive amounts of time for group discussion, as ideas can be developed further with the class as a whole. Lecturers can vary the group they call upon to encourage responsive participation.

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Top Ten Cases Involving Ethical Issues for In-House Counsel (United States)

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Speakers on ethical issues for in-house counsel often get challenged by the audience as to the reality of the problems posed. Many in-house counsel apparently believe that the ethical rules do not apply to them, or apply with less force.

In fact, reported cases involving ethical issues in-house counsel have risen dramatically in recent years. What follows is a list of ten of the most significant cases involving in-house counsel and ethical issues.

1. Kaye v. Rosefielde , 75 A.3d 1168, 1204 (New Jersey Super. Ct. App. Div. 2013).

This is a dream case for commentators on in-house ethics because it raises two of the most common "defenses" asserted by in-house lawyers when pushing back against ethical concerns.

Mr. Rosefielde was in-house for several small companies owned by Mr. Kaye. He also represented Mr. Kaye himself and a trust for his children. As he had done many times before, Mr. Rosefielde created a small company at Mr. Kaye's direction and gave himself a small equity share. He did not hide this from Mr. Kaye, but he also did not comply with Rule of Professional Conduct 1.8 regarding business transactions with a client.

Mr. Kaye later sued Mr. Rosefielde for malpractice, and alleged among other things that Mr. Rosefielde had violated Rule 1.8 by not advising Mr. Kaye in writing to have another lawyer review the transaction, and giving him (Mr. Kaye) time to do so.

Mr. Rosefielde's first defense was that the requirements of Rule 1.8 regarding a business transaction with a client did not apply to him because he was in-house. This was rejected so soundly as to be described as being irrational:

"Independent of the particular facts of this case, we also discern no rational basis to exempt attorneys who have been hired by corporate clients to serve as in-house counsel from the ethical requirements of RPC 1.8" (Emphasis added.)

Another argument of Mr. Rosefielde was that for some conduct he was acting as officer of the company, not as its in-house lawyer, and therefore the ethical rules did not apply to his conduct. This was also squarely rejected as "fallacious."

Practice Tips: The ethical rules, including Rule 1.8 restrictions on getting an equity interest in your client, apply to you. Further, the ethical rules probably apply even when you are acting not as counsel, but as an officer of the company.

2. Yanez v. Plummer , 164 Cal. Rptr. 3d 309 (California Ct. App. 2013)

This case involved an incident at a factory. The company conducted an investigation, and Mr. Yanez, a company employee and bystander witness, told the investigator the company was not at fault. In later litigation, Mr. Yanez was identified as a witness and his deposition was to be taken.

The company agreed to provide him with counsel to defend the deposition, and it provided its in-house counsel Mr. Plummer. Literally on the way to the deposition, Mr. Yanez told Mr. Plummer that: (a) he had lied to the company investigator; and (b) that the truth was worse for the company than he had said previously. Mr. Plummer essentially said: "Just tell the truth; you'll be fine."

Mr. Yanez indeed testified differently than he had told the company investigator. The company opened a new investigation, and subsequently fired Mr. Yanez for lying during the first investigation. He sued the company for wrongful discharge and Mr. Plummer for malpractice. While the trial court granted summary judgment for Mr. Plummer, the court of appeals reversed.

Mr. Plummer's error was in not recognizing that, once Mr. Yanez told him that his testimony at deposition would be different than he had given previously and not as favorable to the company, Mr. Plummer had an irreconcilable conflict of interest between his two clients (the company and Mr. Yanez).

Practice tip: In-house counsel have to be vigilant regarding possible conflicts when representing anyone other than the company.

3. Pang v. International Document Services, 2015 WL 4724812 (Utah).

The in-house attorney reported improper business practices "up the ladder" as required by Rule 1.13. At some point, the attorney was fired and brought suit for retaliatory discharge. The attorney's claim was dismissed and the dismissal was affirmed on appeal. The Utah Supreme Court held that the attorney was an employee at will, was entitled to be fired for any reason not illegal, and the ethical requirements that he report "up the ladder" were insufficient to overcome the general public policy in favor of employees being at will.

This is contrary to other cases that have allowed lawyers to bring suit for whistle-blower terminations, seeking monetary relief but not reinstatement. In Van Asdale v. International Game Technology , 587 F.3d 989 (9th Cir. 2009), the Ninth Circuit reinstated a claim for wrongful discharge under Sarbanes Oxley brought by two terminated in-house counsel. The in-house counsel had brought suit claiming they were discharged for reporting possible stock fraud to higher-ups within the company. The District Court had granted summary judgment on the grounds that the claims were not "protected activity." The Ninth Circuit, however, reversed, holding that reporting stock fraud was a protected activity.

Practice tip: complying with your ethical obligations may not be painless. This is the life we have chosen, and it comes with some costs.

4. Anwar v. Fairfield Greenwich Ltd., 982 F. Supp. 2d 260 (Southern District of New York 2013)

This is yet another in the long line of cases out of the Southern District of New York (SDNY) involving issues of in-house counsel not being licensed in the jurisdiction where they regularly office. The court held that there was no attorney-client privilege for communications between the in-house counsel and the client because the in-house counsel was not licensed and, therefore, not an "attorney."

There is some split of authority on this issue. Some courts have held that if the attorney is licensed somewhere then the fact that the attorney is practicing law without a license in the particular state does not implicate the attorney-client privilege. Other courts have held this rule only applies where the company reasonably relies on the attorney having a license.

Crews v. Buckman Labs. Int'l , 78 S.W.3d 852 (Tenn. 2002) demonstrated the burden on counsel, co-workers, and the client that can arise from the unlicensed practice of law in-house. An associate in-house counsel discovered that the general counsel was not licensed to practice law in Tennessee where the general counsel officed. She reported this first to the general counsel and later to the company's board of directors. After considerable time, the general counsel was still not admitted, so the in-house obtained her own legal advice concerning her ethical obligations and felt compelled to report the unlicensed practice of law to appropriate State agency. The reporting counsel was later fired and brought suit for common-law retaliatory discharge. No lawyer should want to subject their client to this kind of embarrassment, and this was all driven by the general counsel's refusal to become licensed in the state where she practiced.

Practice Tip: Not being licensed in the jurisdiction where you regularly office can be a crime, an ethical violation in the state where you are licensed, can get your colleagues in trouble, and can wreck your client's claim to the attorney-client privileged. Please consider getting licensed where you regularly office.

5. Haeger v. Goodyear Tire and Rubber Co, 793 F. 1122 (9th Cir. 2015).

In this case, Goodyear withheld documents and otherwise gave false responses during discovery. The court entered drastic sanctions against Goodyear, and the "nail in the coffin" was the fact that Goodyear's in-house counsel had participated in reviewing the false discovery responses before they were filed.

Practice Tip: If you are practicing law, take it seriously.

6. People v. Miller, 354 P.3d 1136 (Colorado O.P.D.J. 2015).

A lawyer was helping run the family business, which was controlled by his mother and shared with his siblings. There was no engagement letter. As the mother started aging and fading, there were disputes among the children (the lawyer and his siblings) how things should be handled.

The lawyer had the mother sign documents giving lots of power and authority to the lawyer and putting him on a salary, and he hid these documents from his siblings. The lawyer was disciplined for violations of Rule 1.7 (conflicts of interest); Rule 1.8 (business transaction with a client); and Rule 8.4(c) (dishonesty, fraud, and deceit). Interestingly, disciplinary prosecutor asked for a 90-day suspension as a penalty, but the court sua sponte imposed twice that.

Practice Tip: All the ethical rules apply to in-house counsel, including prohibition on deceitful conduct.

7. Douglas v. DynMcDermott Petroleum Operations Co., 144 F.3d 364 (5th Cir. 1994)

This case involved an in-house attorney who complained to the US Department of Energy (DOE) about discrimination at her client. To further her case, she gave information to the DOE about other complaints of discrimination at the company. Even though she prevailed in her jury trial, the ruling was reversed. The Fifth Circuit held that there was no exception to the ethical rules that allowed her to disclose information regarding other wrongs without client consent, which she did not have. The verdict was reversed and the case dismissed based on the lawyer's misconduct.

Practice Tip: You cannot talk about client information with any third parties absent with some narrow exceptions. Even when an exception applies, it is no broader than is absolutely necessary to fulfill the purpose of the exception.

8. Dinger v. Allfirst Fin., Inc., 82 Fed. Appx. 261, 265 (3rd Cir. 2003)

In this case, former officers of a bank brought a claim against the bank, alleging that its in-house counsel had given them bad legal advice regarding the exercise of stock options. The company won on summary judgment on the merits of the case, with the District Court determining that the lawyer's advice had been reasonable. The issue of the lawyer giving advice to someone other than his client was not discussed. In affirming, the Third Circuit noted that "The District Court recognized that defendants owed plaintiffs a fiduciary duty based on the confidential relationship that existed between [the lawyer] and plaintiffs, but found no breach of that duty."

Practice Tip: Be careful in giving advice to anyone other than your client. You may inadvertently create an attorney-client relationship.

9. In re Teleglobe Commc'ns. Corp., 493 F.3d 345 (3rd Cir. 2007)

This case involved a dispute among related companies. The in-house counsel for one company had often performed legal work for the related companies. In the dispute, it was determined that the lawyer's notes were not privileged as to any of the companies in the dispute, as he was each company's lawyer. It was also held that the common-interest doctrine did not apply to protect the notes, because that doctrine requires the involvement of multiple lawyers.

An even more striking case arose in GSI Commerce Solutions, Inc. v. BabyCenter, L.L.C. , 618 F.3d 204 (2nd Cir. 2010). Again, this case involved the question of attorney-client relationship where a lawyer did legal work for multiple closely-related companies. When a dispute arose between a subsidiary and a third party, the subsidiary was able to disqualify the third-party's lawyer who had previously done work for the parent company. The court held that the connection between the wholly owned subsidiary and its parent corporation was sufficiently close that the two were a single client for attorney-disqualification purposes. The court noted, among other things, that the subsidiary and the parent relied on the same in-house legal department, and that the parent's legal department had been involved in the dispute between the plaintiff and subsidiary since it first arose.

Practice Tip: When you do work for related companies, you are the lawyer for all of them, owe fiduciary duties to all of them, and cannot prefer one over the other.

10. Harkabi v. SanDisk Corp., 275 F.R.D. 414 (S.D.N.Y. 2010)

In this case, the defendant was sanctioned because its in-house counsel failed to preserve evidence while litigation was pending. Although in-house counsel was involved in several steps to protect information, he did not supervise or even approve the copying and wiping of laptop hard-drives and was not involved in the transfer of email archives from servers. Thus, when that information was no longer available, the defendant was determined to have a culpable state of mind regarding the failure to preserve.

Practice Tip: If you are going to bring litigation in house, be aware of the risks. Your in-house litigators will essentially have the duties of both lawyer and client.

The ethical rules still apply to in-house counsel. Not only that, the stakes are higher because it is much more difficult for your to disengage from your client when you are in-house. If you have any questions about your ethical duties at all, contact the author.

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H. Barrett D, W. Ortmann L, Dawson A, et al., editors. Public Health Ethics: Cases Spanning the Globe [Internet]. Cham (CH): Springer; 2016. doi: 10.1007/978-3-319-23847-0_2

Public Health Ethics: Cases Spanning the Globe [Internet].

Chapter 2 essential cases in the development of public health ethics.

Lisa M. Lee , PhD, MA, MS, Kayte Spector-Bagdady , JD, M Bioethics, and Maneesha Sakhuja , MHS.

Affiliations

Published online: April 13, 2016.

While “public health” has been defined as what society does to “assure the conditions for people to be healthy” (Institute of Medicine 2003, xi), public health ethics is a “systematic process to clarify, prioritize, and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information” (Schools of Public Health Application Service 2013). Despite several important characteristics that distinguish public health from clinical medicine, from the beginning, public health ethics borrowed heavily from clinical ethics and research ethics (see Chap. 1 ). In the 1980s, with the onset of the AIDS epidemic and unprecedented advances in biomedicine, the inability of clinical ethics to accommodate the ethical challenges in public health from existing frameworks led pioneering ethicists to reframe and adapt clinical ethics from an individual and autonomy focused approach to one that better reflected the tension between individual rights and the health of a group or population (Bayer et al. 1986; Beauchamp 1988; Kass 2001; Childress et al. 2002; Upshur 2002). Others called for public health ethics to emphasize relational ethics and political philosophy (Jennings 2007). More recently, some authors have suggested outlining foundational values from which operating principles for public health ethics can be articulated only after careful consideration of the goals and purpose of public health. This approach would require us to establish a clear definition of the moral endeavor of public health as a field (Lee 2012) and construct an ethical framework stemming from the nature of it (Dawson 2011).

2.1. Introduction

While “public health” has been defined as what society does to “assure the conditions for people to be healthy” (Institute of Medicine 2003 , xi), public health ethics is a “systematic process to clarify, prioritize, and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information” (Schools of Public Health Application Service 2013 ). Despite several important characteristics that distinguish public health from clinical medicine, at its start public health ethics borrowed heavily from clinical ethics and research ethics (see Chap. 1 ). In the 1980s, with the onset of the AIDS epidemic and unprecedented advances in biomedicine, the inability of clinical ethics to accommodate the ethical challenges in public health from existing frameworks led pioneering ethicists to reframe and adapt clinical ethics from an individual and autonomy focused approach to one that better reflected the tension between individual rights and the health of a group or population (Bayer et al. 1986 ; Beauchamp 1988 ; Kass 2001 ; Childress et al. 2002 ; Upshur 2002 ). Others called for public health ethics to emphasize relational ethics and political philosophy (Jennings 2007 ). More recently, some authors have suggested outlining foundational values from which operating principles for public health ethics can be articulated only after careful consideration of the goals and purpose of public health. This approach would require us to establish a clear definition of the moral endeavor of public health as a field (Lee 2012 ) and construct an ethical framework stemming from the nature of it (Dawson 2011 ).

A versatile framework for public health ethics must accommodate public health in practice and research. In public health practice, an ethics framework must guide decisions about activities like infectious disease control, primary prevention, and environmental health, as well as newer expectations of public health such as chronic disease control and preparedness. In public health research, biomedical and behavioral research ethics provide a great deal of guidance—but research that focuses on population-based outcomes and community concerns reveals additional ethical considerations.

A fundamental tension in public health is one between individual- and population-based interests. Various political traditions place different value on each, and these values can fluctuate within the same political structure over time. When authorities intervene to affect population health, they must find an equilibrium between individual and population interests in all political contexts, whether authoritarian, socialist, or liberal individualist. To consider individual interests as well as population interests, regardless of the philosophical tradition within which these interests are valued, is a challenge for a public health ethics framework. The cases we present in this chapter illustrate how this equilibrium between individual and population interests has been established in the context of dynamic political and historical influences.

One way of approaching public health ethics deliberation is through the method of casuistry, defined as “the interpretation of moral issues, using procedures of reasoning based on paradigms and analogies, leading to the formulation of expert opinion about the existence and stringency of particular moral obligations, framed in terms of rules or maxims that are general but not universal or invariable, since they hold good with certainty only in the typical conditions of the agent and the circumstances of action” (Jonsen and Toulmin 1988 , 297). Consideration of case studies and the use of casuistic methods of resolution of morally similar cases through interpretation of ethical principles have played important roles in the development of public health ethics—particularly before public health ethics was viewed as distinct from clinical ethics. Individual case studies enable discussions about which ethical norms we should adopt for the practice of public health and how public health professionals should deliberate to resolve ethical problems in practice (Centers for Disease Control and Prevention [CDC] 2012 ). In this chapter, we review several seminal cases that shaped the ethics of public health research and practice over the past century to provide the foundation of current public health ethics and lay the groundwork for a casebook to enable casuist analysis.

Our first case example is Jacobson v Massachusetts , set in the beginning of the twentieth century. Jacobson is a foundational U.S. public health legal case that supports states’ rights to create and enforce laws and regulations that limit individual autonomy to protect the public’s health and stop the spread of communicable disease. Our second case study, from the mid-1900s, looks at two ethically troubling U.S. Public Health Service (PHS) protocols for studying sexually transmitted diseases (STDs) in the U.S. state of Alabama and Guatemala. These experiments, like most research protocols, were not intended to benefit the subjects; rather their intent was the broader benefit of the public’s health. They show however, that researchers, despite the apparent motivation to advance public health, can breach public health research ethics and harm research subjects. The final case, a contemporary example of the New York City A1C Registry to monitor and address the diabetes epidemic in the city, demonstrates how addressing the ethical dimensions of public health interventions can facilitate their implementation. This case moves our focus from public health interventions targeting communicable diseases to those supporting secondary prevention of noncommunicable diseases. It focuses on the ethical dimensions that can arise when technological advances in communication might affect individual privacy. Unlike the consistent movement forward with which casuistry has moved clinical ethics, (Jonsen 1991 ), the outcomes in the cases we describe here shaped, and sometimes jolted, the nascent field of public health ethics.

These three case studies, occurring within the same political structure over the span of a century, illustrate the tension between individual autonomy and protection of public health in very different ways. The first case depicts a situation where the balance tipped in favor of protection of the public’s health in the context of infectious diseases. The second case demonstrates unconscionable exploitation of vulnerable research subjects for the benefit of other communities. Finally, the third case presents a situation in which solutions to public health problems based on technological advances and access to data can strike a balance with individual health privacy concerns. Each case illustrates the quest for equilibrium between individual and population interests.

2.2. Case Study: Jacobson v. Massachusetts

The earliest activities associated with modern public health are sanitation and infectious disease control. From the first public health surveillance system in colonial America that required tavern keepers in Rhode Island to report contagious disease, to John Snow removing the Broad Street pump handle in London to end the 1854 cholera epidemic, control of communicable diseases has been firmly in the jurisdiction of public health (Thacker 2010 ). Discovery of the physiological mechanisms of vaccines in the eighteenth century gave us new tools to control infectious diseases but also raised critical questions about how to carry out—effectively and ethically—policies and plans that support individual and community health.

2.2.1. Background

By the turn of the twentieth century, public health campaigns—including improved hygiene, sanitation, and access to safer food and water—had already extended the average life expectancy in the United States (CDC 1999 ). But infectious diseases were still the leading cause of mortality, with tuberculosis, pneumonia, and diarrheal disease accounting for 30 % of U.S. citizen deaths (Cohen 2000 ). Evolving support for the government’s involvement in protecting public health led to the establishment of hygienic laboratories in 1887 (Kass 1986 ). These laboratories continue today to provide essential services such as diagnostics, public health surveillance, research, and vaccine development.

Edward Jenner, who discovered that a vaccine for smallpox could be created using cowpox lesions, sent his vaccine from England to Benjamin Waterhouse at Harvard University in 1800 (Riedel 2005 ). After successfully vaccinating the members of his household, Waterhouse began selling the vaccine in Boston, Massachusetts (Kass 1986 ). Not all physicians vaccinated as meticulously as Waterhouse however, and in one unfortunate incident, adulterated smallpox vaccine caused an epidemic in the Boston area (Kass 1986 ).

As interest in and concern about the vaccine grew, the Board of Health of Boston decided to perform one of the first controlled clinical trials in U.S. history, which eventually demonstrated effectiveness of the vaccine (Kass 1986 ). A century later, Massachusetts had established vaccination campaigns, but smallpox persisted: One hundred cases were reported in Massachusetts in 1900 with 2314 cases by 1902 (Parmet et al. 2005 ). The Board of Health had originally promoted a voluntary vaccination scheme until January 1902 when two children, one in Boston, died of post-vaccination complications within a month of each other (Willrich 2011 ). After voluntary efforts stalled, the Board ordered mandatory vaccination in February, but did not enforce the order. After an outbreak sent another 50 adults and children to the hospital and caused seven deaths, the Board voted that the regulations needed to be enforced (Willrich 2011 ).

Local public health officials employed creative ways to follow enforcement orders, “many of which were scientifically sound but not all of which were apt to inspire public trust” (Parmet et al. 2005 , 653). The Boston Herald, for example, reported in March 1902 that public health doctors and guards forcibly vaccinated “Italians, negroes and other employees” (Parmet et al. 2005 , 653). Despite the success of the smallpox vaccine in curtailing disease, anti-vaccinationists described compulsory vaccination as “the greatest crime of the age” and as “more important than the slavery question, because it is debilitating the whole human race” (Washington Post 1905 ; Gostin 2008 , 122). Pro-vaccinationists were as polarizing, describing the debate as “a conflict between intelligence and ignorance, civilization and barbarism” (New York Times 1885 ; Gostin 2008 , 122).

2.2.2. Case Description

It was in this context that the U.S. Supreme Court heard Jacobson v. Massachusetts , which despite, and perhaps because of, the vastly different ways it has been interpreted and applied since then, is arguably the most important legal public health case ever decided in the United States (Gostin 2005 ). Under the doctrine of “police power,” it had already been established in the late 1800s that states had the authority to enforce “sanitary laws, laws for the protection of life, liberty, health or property within its limits [and] laws to prevent persons and animals suffering under contagious or infectious diseases …” within their own boundaries (R. R. Co. v. Husen 1877 , 465, 472). In 1885, the Supreme Court confirmed that this included ensuring conditions essential to the “safety, health, peace, good order and morals of the community” as “even liberty itself… is only freedom from restraint under conditions essential to the equal enjoyment of the same right by others” (Crowley v. Christensen 1890 , 86, 89).

In 1902, in response to the increase in smallpox cases discussed above, the Cambridge, Massachusetts Board of Health issued an order, which became law, requiring citizens be vaccinated against smallpox or pay a $5 fine (the equivalent of about $135 in 2015) (Massachusetts Revised Laws 1902 ; Commonwealth v. Henning Jacobson 1903 ; Mariner et al. 2005 ). Henning Jacobson, a Cambridge minister, refused both the vaccination and to pay the fine. He argued he had previously received the smallpox vaccination in Sweden as a child and had experienced “great and extreme suffering, for a long period” as a result and that one of his sons had experienced adverse events from vaccination as well (Commonwealth v. Henning Jacobson 1903 , 246). Jacobson argued that the law was thus “hostile to the inherent right of every freeman to care for his own body and health in such way as to him seems best ....” (Jacobson v. Massachusetts 1905 , 26). The case went to trial.

At trial, Jacobson argued that his history of adverse reaction to the smallpox vaccine should grant him an exception from the law. However, the law did not actually provide for such exceptions for adults (as it did for children). Jacobson was found guilty of “the crime of refusing vaccination” (Willrich 2011 , 285). He appealed to the superior court, where the judge again ruled that Jacobson’s medical history was “immaterial” to his legal violation. The judge also refused Jacobson’s plea to tell the jury that the law was a violation of the constitutions of Massachusetts and the United States because it offered no such exception. The court again found Jacobson guilty (Willrich 2011 ).

Jacobson fared no better in the Massachusetts Supreme Court. It too rejected Jacobson’s evidence of his prior adverse experience with the vaccination as well as his son’s as “matters depending upon his personal opinion, which could not be taken as correct, or given effect, merely because he made it a ground of refusal to comply with the requirement” (Commonwealth v. Henning Jacobson 1903 , 246). Moreover, it pointed out that even if Jacobson could prove that he would suffer adverse effects from the vaccine, the statute did not offer an exception for such a case. In response to Jacobson’s argument that this deficiency rendered the statute unconstitutional, the court responded that the “theoretical possibility of an injury in an individual case as a result of its enforcement does not show that as a whole it is unreasonable. The application of a good law to an exceptional case may work hardship” (Commonwealth v. Henning Jacobson 1903 , 247). However, the Massachusetts court held that if citizens refused to be vaccinated it was not within the power of public health authorities to vaccinate them by force (as the Boston Herald had reported occurring) (Commonwealth v. Henning Jacobson 1903 ; Parmet et al. 2005 ).

When the Jacobson case finally made its way to the U.S. Supreme Court, the Court found that the vaccination statute was generally a reasonable protection of the public health while maintaining individual liberty. The Supreme Court did conclude that to subject someone to vaccination who was unfit because of a health condition “would be cruel and inhuman in the last degree;” it stipulated that “we are not inclined to hold that the statute establishes the absolute rule that an adult must be vaccinated if it be apparent or can be shown with reasonable certainty that he is not at the time a fit subject of vaccination or that vaccination, by reason of his then condition, would seriously impair his health or probably cause his death” (Jacobson v. Massachusetts 1905 , 38–39). However, the Court found that Jacobson was “in perfect health and a fit subject of vaccination” and that he simply “refused to obey the statute and the regulation adopted in execution of its provisions for the protection of the public health and the public safety, confessedly endangered by the presence of a dangerous disease” (Jacobson v. Massachusetts 1905 , 39). The Court ordered Jacobson to submit to vaccination or pay the fine (Jacobson v. Massachusetts 1905 ). Three years after his legal fight began, Jacobson paid the $5 penalty (Willrich 2011 ).

2.2.3. Discussion

Legal cases since 1890 had allowed states to require citizens be vaccinated, but around the turn of the century, limits to that right began appearing that included a “present danger” standard requiring a real and immediate threat and adherence to the harm avoidance principle protecting citizens from undue burden as much as possible (Willrich 2011 ). Jacobson has endured as a fundamental philosophical foundation of the reconciliation of individual interests with those of the public’s health in a political system emphasizing liberal individualism.

Despite the limitations of the facts in Jacobson , it has been interpreted in many ways to support numerous public health activities over the past century. Notably, the Supreme Court did not require that otherwise healthy citizens submit to vaccination, only that it was constitutional to require citizens to be vaccinated or pay a fine. Also, while the Court found that a lack of a health exception to the vaccination mandate would be unconstitutional, it did not grant Jacobson this exception for himself.

However, as with so many examples in the lexicon of medical ethics, one of the most important practical effects of historical cases is how they have been interpreted and applied to future circumstances. Part of Jacobson ’ s legacy has been the Court’s “community oriented philosophy” based in social-contract (or compact) theory (Gostin 2005 , 578): “a fundamental principle of the social compact [is] that the whole people covenants with each citizen, and each citizen with the whole people, that all shall be governed by certain laws for ‘the common good ….’” (Jacobson v. Massachusetts 1905 , 26). While the Court recognized individual liberty interests protected by the Constitution, it found that these interests did not impart an absolute right of freedom from restraint because “on any other basis organized society could not exist with safety to its members” (Jacobson v. Massachusetts 1905 , 26). It noted that no citizen could enjoy full liberty in a society that recognized “the right of each individual person to use his own [liberty] … regardless of the injury that may be done to others” (Jacobson v. Massachusetts 1905 , 26).

The Court also found that reasonable regulations to protect the public health and safety were among these constitutional limits on liberty (Jacobson v. Massachusetts 1905 ). Despite the fact that Jacobson found mandatory vaccination distressing and objectionable, it was the responsibility of the city board of health to “not permit the interests of the many to be subordinated to the wishes or convenience of the few” (Jacobson v. Massachusetts 1905 , 29). As discussed above, the Court found that exceptions were needed for citizens with established concerns for their health—but did not apply this exception in Jacobson’s case.

The social contract implied in this case also needed to be reconciled with limits on government and constitutional protections of individual liberty. While the Court had already established a standard of fair application of public health interventions (e.g., not targeting a specific race-based group) (Jew Ho v. Williamson 1900 ; Gostin 2008 ), Jacobson built on several cases to further explain standards of constitutional protections (i.e., there must be a public health threat to the community, and the state or board of health must design the public health intervention to combat that threat). The Court found that the intervention must be proportionately tailored to that threat creating a “reasonable balance … between the public good and the degree of personal invasion ” and should not harm citizens in and of itself (Gostin 2008 , 126–127).

While it is hard to reconcile some of the facts of Jacobson with its lofty constitutional deliberation, it is the Court’s desire to reconcile individual interests with those of the public health in a society that values liberal individualism that has become its enduring legacy. Many court decisions following Jacobson reaffirmed states’ use of police power for the public health (Gostin 2005 ), and in 1922 the Supreme Court agreed that states could require vaccinations for children who attend school (Zucht v. King 1922 ). Jacobson was an important step in the lengthy public health battle against smallpox, culminating in its eradication in 1977 (Cohen 2000 ).

The legal and ethical boundaries between the individual and public health remain mobile in public health law and policy despite the Jacobson decision. Notwithstanding its rejection of forced vaccination, coercion—as opposed to the modern emphasis on education—continued as a public health tactic, employed frequently and often directed toward vulnerable citizens (e.g., quarantined sex workers during World War I) (Colgrove and Bayer 2005 ). And despite the liberty protections it carved out, the Court itself struggled with upholding both individual rights and constitutional liberties. In 1927, citing Jacobson , the Court upheld a forced-sterilization law in Virginia of “mental defectives.” The Buck v. Bell decision reasoned that “[i]t is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the fallopian tubes” (Buck v. Bell 1927 , 207).

In more communitarian-leaning societies, Jacobson ’ s value serves less as a map for navigating public good in an individualist context, and more as an illustration of how individual and community interests can be balanced within the political and social structure. Even within the United States, however, Jacobson has been interpreted over the decades to be a foundation for diverse legal opinions supporting remarkable expansions of federal power—including warrantless entry into homes in time-sensitive circumstances of compelling need and a defense of the federal government’s right to detain U.S. citizens without due process as “enemy combatants” (in a dissenting opinion) (Willrich 2011 ). Many of these cases, and certainly Buck v. Bell serve as a stark reminder that federal powers ostensibly in the public interest cannot be used solely to maximize perceived public benefit—they must be tempered by justice and fairness to both communities and individuals (Lombardo 2008 ). But as the legal community continued to struggle with what the implications and contours of what Jacobson should be in the United States, officials continued to press on in what was then an unregulated field—that of public health research.

2.3. Case Study: U.S. Public Health Service Research on Sexually Transmitted Disease: Alabama and Guatemala

Since the 1940s, contemporary research ethics has developed rapidly through a desire to protect human participants in research. Internationally, the Nuremberg Trials for Nazi war criminals, including the trial of Nazi physicians who conducted torturous medical experiments on subjects, resulted in the Nuremberg Code ( 1947 ), a compilation of guidelines for conducting research with human participants. In 1964, the World Medical Association’s (WMA) Declaration of Helsinki further refined ethical guidance for research with humans, and in particular the participation of vulnerable populations (WMA 1964 ).

The next case study focuses on two separate mid-century U.S. PHS experiments on sexually transmitted diseases in the U.S. state of Alabama and Guatemala. While one of the ten essential public health services is to “conduct research to attain new insights and innovative solutions to health problems” (CDC 2013b ; Harrell et al. 1994 , 29), these experiments demonstrate how an imbalance of population and individual interests—coupled with disregard for respect for persons—can lead to tragic results.

2.3.1. Background

In the early 1900s, STDs—and syphilis in particular—were major concerns for public health. Conservative estimates suggested that syphilis affected 10–15 % of the U.S. population (Jabbour 2000 ) with symptoms ranging from sores to paralysis, blindness, and death (CDC 2013a ). One leading expert at the time described syphilis as a plague “which, in these times of public enlightenment, is still shrouded in obscurity, entrenched behind a barrier of silence, and armed, by our own ignorance and false shame, with a thousand times its actual power to destroy…” (Stokes 1920 , 7). In 1905, German scientists isolated the microbe that caused syphilis, and in 1910 other scientists proposed salvarsan (a preparation of arsenic) as the cure (Jones 1993 ). Salvarsan treatment involved a painful set of injections over a long period and ultimately turned out to be highly toxic (Jones 1993 ).

In 1912, the U.S. government established PHS to join other federal public health efforts to improve administration and distribution of public health aid to the states, to oversee interstate infectious diseases and sanitation, and to conduct public health research (Jones 1993 ). In 1918, PHS established a Division of Venereal Disease to organize and support state prophylactic and treatment work (Jones 1993 ). World War I had highlighted the harmful effect of STDs on the U.S. armed forces, but after interest in the disease from a wartime perspective abated, public health workers focused on syphilis as a poverty-linked disease—and a disease that reportedly affected African Americans in particular. Some physicians even argued that syphilis was a “quintessential black disease” and African Americans a “notoriously syphilis-soaked race” (Jones 1993 , 24, 27).

Funding for and interest in preventing and treating STDs waned during peacetime, though they remained a public health problem. With World War II on the horizon, the director of the PHS Venereal Disease Research Laboratory argued that “[t]he prevention of the primary invasion of the male by the syphilis spirochete, as a means of minimizing the loss of effectiveness which is incident to established disease, still constitutes one of the most pressing problems of military medicine” (Mahoney 1936 , 78–79). When the United States became involved in World War II, public health officials once again became concerned about STD rates in American troops and predicted “approximately 350,000 fresh infections with gonorrhea [in the armed forces], [which] will account for 7,000,000 lost man days per year, the equivalent of putting out of action for a full year the entire strength of two full armored divisions or of ten aircraft carriers” (Presidential Commission for the Study of Bioethical Issues [PCSBI] 2011 , 12). The cost of treating the anticipated infections was $34 million (about $465 million in 2015, adjusted for inflation) (PCSBI 2011 , 12).

2.3.2. Case Description

In search of a more effective treatment for syphilis, U.S. PHS researchers in the 1930s had turned to African-American communities for public health research in part because of the perception of high rates of infection, as discussed above. PHS surveyed six southern counties and found the highest syphilis rates among black men in Macon County, Alabama, where the city of Tuskegee serves as the county seat. Created in part by a confluence of economic, social, and clinical factors—including the Great Depression, lack of public and private funds for continuation of development projects, pervasive racism in American medicine, and failed attempts in the pre-penicillin era to treat syphilis with heavy metals—public health researchers decided to conduct a study to observe the “natural progression” of untreated syphilis (Brandt 1978 ; U.S. Department of Health, Education, and Welfare [HEW] 1973 ).

The Tuskegee syphilis study or, more accurately, the U.S. Public Health Service Study of Untreated Syphilis in the Male Negro , Macon County , Alabama , was an observational study of 399 men with syphilis, and 201 men without, conducted from 1932 through 1972. After 40 years, it finally ended when a PHS STD investigator, Peter Buxton, went to the press with allegations of gross ethical violations, including a lack of informed consent for participation, deception, withholding treatment, as well as racism and lack of scientific soundness (Jones 1993 ; Brandt 1978 ).

During this study, public health researchers posed as physicians and told the men, who were already infected with syphilis, that they were going to treat them for “bad blood” (which, in common vernacular referred to a range of chronic conditions of unknown origin that could have included anything from syphilis to anemia). In reality, the researchers were not treating the subjects for any of these diseases. While during the salvarsan-era, nontreatment would not necessarily have made a large difference clinically , once the Venereal Disease Research Laboratory established that penicillin was a safe, effective, and inexpensive cure for syphilis in 1943, the profound clinical detriment of being a study participant became clear. After 1943, the researchers actively kept subjects from receiving penicillin for other ailments so as not to interfere with their ability to analyze the primary outcome of interest, which was the natural progression of untreated syphilis (CDC 2013c ).

Throughout the study, the public health researchers practiced active deceit resulting in 399 infected men being kept from penicillin treatment until their death or 1972 when the study was stopped. The Assistant Secretary for Health and Scientific Affairs, under the then U.S. Department of Health, Education, and Welfare, chartered an advisory panel to investigate the circumstances surrounding the study. The panel later issued the Final Report of the Tuskegee Study Ad Hoc Advisory Panel in April 1973 (HEW 1973 ).

Meanwhile, the experience of soldiers during World War II had confirmed the need for improved diagnosis and treatment of STDs. After the war, these efforts were revitalized by animal studies that demonstrated the effectiveness of a new post-exposure prophylaxis called “orvus-mapharsen.” PHS was interested in whether this solution would be effective in humans, and it was believed that establishing efficacy in humans required controlled intentional exposure in humans—preferably via the “natural method” of sexual intercourse. Because, in part, commercial sex work was legal in the prison in Guatemala City, Guatemala, the researchers planned to conduct prophylaxis experiments there. The plan was to intentionally expose prisoners to STDs through sexual intercourse with commercial sex workers carrying infection (PCSBI 2011 ).

As a result, from 1946 through 1948, the U.S. government funded, via a federal grant from the National Institutes of Health and approved by the highest echelons of PHS (including Surgeon General Thomas Parran), STD, serological, and inoculation experiments in Guatemala (Spector-Bagdady and Lombardo 2013 ). The researchers, led on the ground by a senior surgeon in the PHS, John C. Cutler, soon discovered that they could not reliably infect prison subjects with STDs through sexual intercourse with commercial sex workers; the researchers were thus unable to compare the effectiveness of the prophylaxis regimen they were testing. In an effort to increase infection rates, researchers expanded to other vulnerable populations, such as soldiers and psychiatric patients, and engaged in more invasive methods of intentional exposure, such as abrasion of genitals and manually applying syphilitic emulsion—despite objections of their PHS supervisors that the latter methods of inoculation were scientifically unsound (PCSBI 2011 ).

By the end of these experiments, considered by some at the time to be “ethically impossible” in design (Kaempffert 1947 ), public health researchers intentionally exposed approximately 1300 Guatemalan prisoners, soldiers, commercial sex workers, and psychiatric patients to syphilis, gonorrhea, and/or chancroid without informed consent. The researchers documented some form of treatment for only half of the subjects they exposed to infection (PCSBI 2011 ).

The Guatemala STD experiments ended in 1948 when the researchers decided not to apply for a continuation of funding due to concerns about reporting project activities to the approving study section and the new surgeon general in the United States (PCSBI 2011 ). The Guatemala STD experiments remained undiscovered for nearly 65 years until Cutler’s papers, uncovered in 2003, were brought to the attention of the U.S. government and presented at a professional meeting in 2010 (PCSBI 2011 ; Reverby 2011 ). Upon learning of the experiments, President Barack Obama requested that his Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) conduct a historical review and ethical analysis of the studies in Guatemala. The Bioethics Commission concluded its analyses and reported its results to President Obama in September 2011 (PCSBI 2011 ).

2.3.3. Discussion

The U.S. PHS Study of Untreated Syphilis in the Negro Male unmasked a range of important ethical issues that fit into three fields of bioethics we now call professional ethics, public health ethics, and research ethics. Through the lens of professional ethics, the untreated syphilis study calls into question what it means to be an ethical scientist, an ethical physician, and an ethical government steward of public trust. Through the public health ethics lens, it raises issues of imposing the risk of harm to individuals to benefit the community, appropriate engagement with the affected community, and justice and fairness.

Far and away, however, the untreated syphilis study in Tuskegee had the most substantial impact on research ethics. It was not the first study to egregiously disrespect personal autonomy and grossly exploit vulnerable populations. Indeed, by 1966, Henry Beecher had outlined 22 such studies in clinical research, some involving children, mentally and physically compromised patients, and incarcerated individuals (Beecher 1966 ). Nor was it the first instance of African Americans being mistreated by the medical establishment (Gamble 1997 ), but it was the first unethical study of this magnitude scandalously exposed by the mainstream media involving and funded by the U.S. federal government. While the original intent of the untreated syphilis study in Tuskegee was to contribute to the greater and seemingly more urgent social good, it has been remembered for withholding treatment from a socially and politically vulnerable group by actively deceiving them.

Comprehensive scholarship has examined the legacy of the untreated syphilis study. Its impact is as deep as it is broad in the bioethics community and the social culture of the United States. This case study examines only the policy outcomes that resulted from the ethical review and analysis of the untreated syphilis study, which is but a small slice of its legacy, yet one that has profoundly shaped the way clinical and public health research is conducted in the United States.

The Tuskegee Study Ad Hoc Advisory Panel (Advisory Panel) submitted its final report to then Assistant Secretary for Health, Charles C. Edwards, in April 1973 (HEW 1973 ). The Advisory Panel found that the study was ethically unjustified in 1932 due to the lack of evidence that any consent was obtained from participants, breaking “… one fundamental ethical rule…that a person should not be subjected to avoidable risk of death or physical harm unless he freely and intelligently consents” (HEW 1973 , 7). Also, the lack of a study protocol or plan left the study’s scientific soundness highly suspect, especially in light of the “disproportionately meager” scientific data it produced (HEW 1973 , 8).

Besides the lack of informed consent, other important ethical violations noted by the Advisory Panel included researchers lying and withholding penicillin even after it was established to be effective as a treatment for syphilis. The insults to basic dignity and respect for persons forced on the men in the study convinced the Advisory Panel to recommend a permanent body to regulate all federally supported research involving human participants. This permanent body was to formulate policies for establishing institutional review boards (IRBs), compensating research participants who suffer research-related injury, and reviewing protocols at local institutions before beginning research studies. It also called for creating local subject advisory groups to monitor consent procedures (HEW 1973 ). While the U.S. Department of Health, Education, and Welfare (now the U.S. Department of Health and Human Services) had guidelines for research grants and contracts, the Advisory Panel recommended “… that serious consideration should be given to developing, through Congressional action, rules and procedures which apply to the entire human research enterprise without reference to the source of funding” (HEW 1973 , 37).

The Advisory Panel report paved the way for creation of the first congressionally formed national bioethics committee: the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission). As a direct consequence of the ethical investigation into the untreated syphilis study, and acknowledgment that this was not an isolated incident, the National Commission began work in 1974 developing national guidelines for research involving human participants.

The National Commission’s most cited work, the Belmont Report , outlined three ethical principles for research still in use today: respect for persons, beneficence, and justice (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1979 ). It also provided guidance on informed consent, special rules for vulnerable populations, and requirements for review of protocols by IRBs. These recommendations, later codified into federal regulations that govern federally funded research with human participants, continue to influence human research today—helping ensure the respectful and ethical treatment of participants in biomedical and public health research (U.S. Department of Health and Human Services 2009 ).

A more subtle, but enduring impact of the National Commission’s efforts specific to public health research was its focus on engaging the community in which research is to be conducted. Although only anecdotally reported, a lack of trust in government, health care, and research is widely believed to be a lasting consequence of the untreated syphilis study (Gamble 1993 ; Swanson and Ward 1995 ). Empirical data suggest, however, that the untreated syphilis study itself did not deter participation (Katz et al. 2008 ), but rather a lack of trust stemming from a larger social legacy of racism and fears of exploitation originating in the era of slavery in the United States (Gamble 1993 ). In recent times, these fears resurfaced at the onset of the AIDS epidemic in the 1980s in the form of suspicion of intentional infection and genocide (Jones 1993 ). This mistrust resulted in the distribution of misinformation and difficulties in delivering education and care for those at high risk for HIV (Thomas and Quinn 1991 ). Since then, methods and best practices for community engagement have been developed and published both in the United States (Barnett 2012 ; U.S. Department of Health and Human Services 2011 ) and internationally (World Health Organization [WHO] 2012 ; UNAIDS 2011 ).

When analyzing the effect of the Guatemala STD experiments on public health ethics, it is important to note that while the experiments took place in the 1940s, they were critically investigated only recently—65 years after their occurrence. Despite the stark contrast of today’s regulated research context with research conducted in the 1940s, scholars continue to examine the original research documents, and our ability to learn from past errors continues. That the U.S. government, at least, had learned lessons from the Tuskegee study is evident by the swiftness of its response to the discovery of the Guatemala STD experiments. While it took 25 years for a U.S. president to apologize to the Tuskegee syphilis study participants, families, and community (The White House 1997 ), President Barack Obama called President Alvaro Colom of Guatemala to apologize for the STD research immediately following the announcement of its discovery to the public in 2010.

The PHS research studies in Tuskegee and Guatemala demonstrate the serious consequences that can result when the relative interests of the individual and the population are inappropriately reconciled. Indeed, these abuses of individual research subjects have created an enduring legacy of cautionary tales that, together with an orientation toward liberal individualism, have provided a lasting and powerful check on public health authority in the United States. Major policy changes were put into practice after the discovery of the syphilis studies in Alabama. These policies were intended to protect research participants from being treated as mere means to an end, to bring back into equilibrium the individual and population interests that public health must reconcile. Still, public health interventions continue to face resistance to actions perceived to limit individual choice—making substantive engagement of the relevant community even more critical for turn-of-the-century public health campaigns. The case that follows describing the New York City A1C Registry highlights how, even after all of the regulatory and ethical work accomplished over the past four decades, innovative approaches to public health advances interpreted to curtail some individual liberty can still inspire debate about the optimal role of government in promoting public health.

2.4. Case Study: The New York City A1C Registry

Public health increasingly has focused on secondary prevention, or the prevention of disability from disease. As the burden of disease in the United States has shifted from communicable diseases like smallpox and STDs to noncommunicable diseases, public health professionals face new ethical challenges related to monitoring chronic conditions and inspiring individuals to improve their health. The following case illustrates how new technologies affect public health interventions and can limit the precedent set by Jacobson when health risks are neither communicable nor imminent. Such cases call for a recalibration of population and individual interests when considering dramatically different health and social settings.

2.4.1. Background

Although infectious diseases accounted for more than 80 % of deaths in the United States in the 1900s (Steinbrook 2006 ), in 2011, WHO estimated that noncommunicable diseases were responsible for 66 % of deaths worldwide (WHO 2013 ). These changes in the causes of morbidity and mortality are typical of an “epidemiologic transition,” a population health phenomenon that occurs when populations carry out public health measures such as sanitation and immunization, which decrease death rates from infectious diseases, increase life expectancy, and simultaneously begin to increase risk for noncommunicable conditions (McKeown 2009 ).

Of noncommunicable disease deaths worldwide in 2008, deaths from diabetes alone accounted for 1.3 million (WHO 2011 ). In the United States, 8.3 % of the population (about 25.8 million people) had diabetes in 2011 (CDC 2011 ). Because of the significant impact that noncommunicable diseases, such as diabetes, have on health systems, WHO has promoted lifestyle modifications and other public health interventions (WHO 2011 ).

Several interventions, such as providing advice about physical activity and a healthy diet to people with impaired glucose tolerance, have lowered rates of diabetes (Dornhorst and Merrin 1994 ; Ramachandran et al. 2006 ). Research also has shown that controlling blood sugar levels (measured by A1C levels), blood pressure, and LDL cholesterol can reduce the risk of long-term complications and death among people with diabetes (Chamany et al. 2009 ). Some evidence suggests improvements from educating patients in diabetes management, but more evidence is needed (Chamany et al. 2009 ).

Although there are effective ways of controlling risk factors for complications once diabetes is diagnosed, management of these risk factors across the United States has been deemed inadequate (Chamany et al. 2009 ). In New York City the percentage of adults who reported having diabetes more than doubled from 3.7 % in 1994 to 9.2 % in 2004 (Chamany et al. 2009 ). A 2005 report of the New York City Department of Health and Mental Hygiene (NCY DOHMH) showed that diabetes prevalence was higher among non-white residents (NCY DOHMH 2007 ; NCY DOHMH 2006a ). In 2004, NCY DOHMH found that diabetes was the fourth leading cause of death in the city’s population (NCY DOHMH 2004 ), and a survey of New York City adults in 2004 showed that fewer than 10 % of those with diabetes were able to manage blood sugar, blood pressure, and cholesterol satisfactorily according to city public health standards (Chamany et al. 2009 ). In New York City, 37 % of diabetes patients on state and federally funded Medicaid had an A1C level (reflecting average blood sugar) greater than 9 %—which suggests poor glycemic control (Barnes et al. 2007 ). WHO has found that policies that promote management of these risk factors have potential to reduce spending for individuals and the public (WHO 2011 ).

2.4.2. Case Description

In December 2005, the NCY DOHMH submitted a proposal to the New York City Board of Health that would require laboratories with electronic reporting capabilities to submit A1C test results for New York City residents to the NCY DOHMH (NCY DOHMH 2005a ). After a period for public comment, the New York City Board of Health approved this proposal, creating the first U.S. program requiring public health reporting of A1C results. Supported by evidence from the success of other disease control programs (such as programs targeting lead poisoning and tuberculosis), this program established a public health surveillance system to track diabetes in the population and to support those who could benefit from diabetes control (Chamany et al. 2009 ).

The mandate required applicable laboratories to submit A1C test results to the NCY DOHMH within 24 h of completion. Data to be reported included date of the test; name of the testing facility; name and address of the ordering facility or provider; and name, address, and date of birth of the individual tested (Chamany et al. 2009 ). The NCY DOHMH proposed to use the reported A1C results to generate a registry to monitor glycemic control in the New York City population and to provide mechanisms to support patients and physicians in controlling diabetes (NCY DOHMH 2005a ). The data in the registry were analyzed by various factors including age, location, and type of health care facility to determine distinctions in testing patterns, health care usage, and glycemic control. However, race and ethnicity data were not reported and therefore not included in the longitudinal analysis (Chamany et al. 2009 ).

After the A1C test results reached the NCY DOHMH, if the average blood sugar level exceeded a predetermined threshold, the patient and provider were notified. Providers were mailed a roster of their patients ordered from highest to lowest A1C level, listing the patients’ two most recent test results calling special attention to A1C levels greater than 9 % (NCY DOHMH 2006b ). Patients at least 18 years of age with an A1C level greater than 9 % or who were overdue for testing also received a letter informing them of their test results, advising them on how to control their A1C level, and specifically recommending a follow-up appointment with their provider. The letter was printed in English and Spanish (NCY DOHMH 2005a ).

The goals of the provider and patient notification program were to increase providers’ knowledge about glycemic control in their patient population, facilitate providers in assisting and guiding patients at high risk for complications, and inform and aid patients at high risk for devastating sequelae (NCY DOHMH 2012 ). While patients had the option to opt-out of the provider and patient notification program, laboratories were still required to report their data to the registry (NCY DOHMH 2005b ). Reported data were held confidentially and were unavailable to insurers, licensure organization, or employers (NCY DOHMH 2005c ). In 2009, 3 years after initiation of the program, 4.2 million A1C test results for almost 1.8 million individuals were registered with the NCY DOHMH (Chamany et al. 2009 ).

2.4.3. Discussion

The mandated reporting of A1C results in New York City and the interventions that followed stimulated discussion about the role of government in preventing noncommunicable diseases. Mandated communicable disease reporting is a longstanding and widely accepted essential public health practice, but the modern technology available to collect, analyze, and respond to health data today is unprecedented. While there are clear population interests in controlling the sequelae of diabetes—preventing limb amputations and reducing care disparities, for example—there are also individual interests such as privacy and self-determination at stake. Current public health ethics frameworks must consider the tension between individual and population interests in conjunction with the social, epidemiologic, technologic, and economic context of the case.

Proponents of the A1C Registry argued that outreach for noncommunicable disease is an integral part of public health practice and indeed is an obligation of public health agencies, especially for a disease deemed epidemic (WHO 2011 ). They argued that the A1C Registry allowed practitioners to identify patients in greatest need of follow-up or referral—often patients with fewest resources—and develop disease management strategies (Chamany et al. 2009 ). One of the program’s goals in mailing test results to patients was to enable them to better manage their own diabetes (e.g., only 10 % of people with diabetes know their own A1C level) (Berger and Silver 2008 ).

Others criticized some of New York City Mayor Michael Bloomberg’s public health policies and interventions as creating a “nanny state” (characterized by being overly controlling of the lives of its citizens) (Magnusson 2014 ). Some patients believed that the A1C Registry represented an unwarranted invasion of privacy (Barnes et al. 2007 ), and some providers considered it an intrusion in the provider–patient relationship (Goldman et al. 2008 ). Many who argued against public health interventions such as the A1C Registry view choices about food and health—even when damaging—as choices that should enjoy a high degree of autonomy uninfluenced by government (although they generally are silent about the influence of food and beverage industry advertising). A public health entity with fiscal and moral interests in the well-being of its citizenry should also work to ensure that individuals have accurate and actionable information with which to make their health decisions (Thaler and Sunstein 2008 ).

Unlike the early 1900s when Jacobson was decided, or the 1940s when the U.S. PHS STD research was conducted in Alabama and Guatemala, we now have several public health ethics frameworks that help us approach ethical issues more systematically (Kass 2001 ; Childress et al. 2002 ; Baum et al. 2007 ; Bernheim et al. 2007 ). These frameworks reflect attempts to reconcile individual and population interests outlined by the Jacobson Court. For example, the A1C Registry case raised issues relating to principles of least infringement, social justice, health equity, and evidence of benefit.

When applying these ethical precepts to the A1C Registry case, the principle of least infringement requires that public health pursue the least intrusive course of action that still achieves the public health goals. The A1C Registry attempted to accommodate this principle by allowing people to opt out, which prevented NCY DOHMH from contacting patients and their clinicians, but did not relieve the laboratory from submitting reports to the registry. While the opt-out mechanism gives individuals some control over how their data are used, it can still allow a public health entity to seek to improve constituents’ well-being with minimal infringement.

Policy makers must also explain the aims of the program and whether benefits and burdens are expected to be distributed equitably throughout the population. In the A1C Registry case, these foundational values of social justice and health equity in large part motivated the reporting system. In New York City, substantial differences in morbidity and mortality by race/ethnicity and neighborhood income level were evident. NCY DOHMH use of the data to identify and then reduce these differences promoted public health goals. One challenge in addressing such disparities is to ensure efforts do not inadvertently increase disparities or cause other social harms, including stigma or loss of social capital.

Finally, policy makers have a duty to ensure public health programs are effective, including empirically evaluating programs to provide evidence of this effectiveness. In developing the A1C Registry, policy makers compiled evidence from effective public health programs to help explain the need and potential effectiveness of this program. As the NCY DOHMH evaluates the program and collects evidence of the A1C Registry’s effect on diabetes in the city, it might alter policies and procedures. Empirical data on the effectiveness of the registry are pending, and those results will certainly play an important role in assessing the program’s scientific and ethical rationale. As this brief analysis demonstrates, contemporary frameworks to guide ethical public health decision making offer additional nuance to the foundational tension between individual and population interests.

The case of the A1C Registry draws attention to important implications of the Jacobson precedent and the continued influence of major historic breaches of public health ethics. The current agreed-upon equilibrium in the United States emphasizes individualism, even as similar noncommunicable disease public health campaigns continue to be established (e.g., attempting to control the addition of trans fats to foods and the size of sugar-sweetened beverages) (Gostin 2013 ). These contemporary cases in the United States are being established and deliberated in a climate of changing health care policy and in the absence of an agreed-upon framework for public health ethics. The challenges they elucidate, however, are likely to have an important impact on the future role of public health in health care.

2.5. Conclusions and Implications

The cases discussed here demonstrate how providing essential public health services requires ethical principles and analysis as varied as the goals they hope to achieve. Clinical and research ethics play a role, but are not sufficient for the consideration of competing public health values. More substantial limits on liberty and privacy can be justified as public health ethics aims to alleviate the “collective hazard,” as opposed to individual risk, for both motivation and validation of interventions (Bayer and Fairchild 2004 ). However, as the cases in Alabama and Guatemala underscore, limitations on power are as important as justifications.

In different ways, the cases outlined here shaped public health practices and ethical expectations in the United States. However, as our world grows more connected and our work increasingly crosses jurisdictional boundaries, it is clear that there are common values that motivate public health ethics even in vastly different political, social, and economic contexts. The global setting in which many public health professionals work requires attention to such contextual factors.

Many of the cases outlined in the chapters that follow uncover additional ethical considerations affecting daily public health practice wherever that practice occurs. Whether it is social duty or political feasibility of the negative right to noninterference, case studies can clarify ethical dimensions, help us examine alternatives for approaching decisions, and remind us that ethical decision making in public health is not an optional endeavor in any case. These case studies underscore the need to identify decision-making frameworks that lead to careful consideration of individual and public interests, as a disregard for one or the other is perilous to both.

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• Cite this Page Lee LM, Spector-Bagdady K, Sakhuja M. Essential Cases in the Development of Public Health Ethics. 2016 Apr 13. In: H. Barrett D, W. Ortmann L, Dawson A, et al., editors. Public Health Ethics: Cases Spanning the Globe [Internet]. Cham (CH): Springer; 2016. Chapter 2. doi: 10.1007/978-3-319-23847-0_2
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• Introduction
• Case Study: Jacobson v. Massachusetts
• Case Study: U.S. Public Health Service Research on Sexually Transmitted Disease: Alabama and Guatemala
• Case Study: The New York City A1C Registry
• Conclusions and Implications

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Edward Snowden: Whistleblower http://www.nytimes.com/2014/01/02/opinion/edward-snowden-whistle-blower.html?_r=0

Edward Snowden Broke the Law and should be Prosecuted http://www.nytimes.com/roomfordebate/2013/06/11/in-nsa-leak-case-a-whistle-blower-or-a-criminal/edward-snowden-broke-the-law-and-should-be-prosecuted

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Urban Greening as a Response to Societal Challenges. Toward Biophilic Megacities (Case Studies of Saint Petersburg and Moscow, Russia)

• First Online: 17 March 2023

Cite this chapter

• Diana Dushkova 8 ,
• Maria Ignatieva 9 &
• Irina Melnichuk 10  

Part of the book series: Cities and Nature ((CITIES))

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The population density in megacities is continuously increasing, resulting in a reduction of green spaces and a deterioration in the urban environment quality. Urban green is often being replaced by parking places, shopping centers, and service enterprises. This chapter examines the efforts of two megacities in Russia—Moscow and Saint Petersburg—to organize sustainable greening solutions for their residential areas using new achievements in landscape design theory and practice, such as the concept of the biophilic city. The chapter analyzes the history of greening strategies and discusses the concept of urban green infrastructure and its implementation in both Russian megacities. The chapter presents an assessment of the current state of urban green spaces and the most recent master plans and how these cities are facing and responding to modern societal challenges. The results of an analytical review of the most successful urban greening projects in Moscow and Saint Petersburg are presented as well. The economic and climatic features of the urban green areas and their architectural and planning features are considered, along with strategies for further development of the urban green spaces in both cities, aiming to address the new principles of biophilic cities.

• Urban green spaces
• Greening strategies
• Biophilic cities
• Societal challenges
• Saint Petersburg

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Acknowledgements

This work was supported by the Russian Foundation for Basic Research (RFBR) project “Mathematical-cartographic assessment of medico-ecological situation in cities of European Russia for their integrated ecological characteristics” (2018–2020) under Grant number No 18-05-406 00236/18 and by the Horizon 2020 Framework Program of the European Union project “Connecting Nature” under Grant Agreement No 730222.

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Diana Dushkova

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Faculty of Landscape Architecture, Saint Petersburg State Forest Technical University, Institutskij pereulok 5, St.-Petersburg, 194021, Russia

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Dushkova, D., Ignatieva, M., Melnichuk, I. (2023). Urban Greening as a Response to Societal Challenges. Toward Biophilic Megacities (Case Studies of Saint Petersburg and Moscow, Russia). In: Breuste, J., Artmann, M., Ioja, C., Qureshi, S. (eds) Making Green Cities. Cities and Nature. Springer, Cham. https://doi.org/10.1007/978-3-030-73089-5_25

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Alabama lawmakers to consider bill to repeal and replace state ethics law

A labama lawmakers will consider a bill that would repeal and replace the Alabama ethics act, the first major revisions in more than a decade to the law intended to prevent elected officials and public employees from using their offices for personal gain.

Rep. Matt Simpson, a Republican from Baldwin County who is sponsoring the bill, drafted and revised it after months of study and public meetings. Simpson said it will clarify the law for the hundreds of thousands of public officials, public employees, teachers, and their family members who fall under it.

“We just want people to know, here’s the line, if you cross it, this is what you’re facing,” Simpson said. “We want people to know, this is what you can do, this is what you can’t do.”

Alabama Ethics Commission Executive Director Tom Albritton said Simpson’s bill, HB227, will open loopholes and weaken the law. Albritton distributed a one-page summary of the Ethics Commission’s objections to the bill.

“HB227 is a blatant attempt to water down the Ethics Act, and it will enable corruption in the state of Alabama,” the summary says. “HB227 hides under the guise of seeking ‘clarity.’ However, it provides no such thing. (Simpson) says that he wants people to know ‘where the lines are’ but he effectively removed the lines altogether.”

The House of Representatives is scheduled to debate Simpson’s bill when lawmakers return from spring break Tuesday.

The Ethics Commission works somewhat like a grand jury. The agency’s staff investigates complaints alleging violations of the ethics law and campaign finance law and presents cases to the appointed, five-member commission, which decides whether there is probable cause that the law was broken. The commission does not determine guilt but forwards cases to the attorney general or a district attorney.

HB227 would reduce the scope of the Ethics Commission’s authority. It would remove from the ethics law the crime of using office for personal gain. Instead, those cases would be handled by district attorneys or the attorney general under a bribery law or a new law creating the crime of using public office for pecuniary benefit.

Under HB227, the Ethics Commission would have jurisdiction on cases involving conflicts of interest, improperly steering government contracts and benefits, and restrictions on gifts to public officials. Violations would result in civil penalties, although the commission could still notify the attorney general or district attorney of possible criminal violations.

Albritton said the bill would expand exceptions to the ban on gifts to public officials that would make the ban meaningless.

For example, it would narrow the definition of a public official’s family members to spouses and dependents. The definition in the current ethics law includes spouses, dependents, adult children and their spouses, parents, spouse’s parents, and siblings and their spouses.

Simpson said that change is an example of making the law simpler and more fair. Simpson said, for example, he should not be subject to prosecution because somebody buys a meal for his father-in-law. He said it is more reasonable to hold a public official accountable for gifts and things of value given to their spouse or dependent children.

Albritton said the bill would loosen a friendship exception to the restriction on gifts. The current ethics law says the friendship exception applies “under circumstances which make it clear that it is motivated by a friendship and not given because of the recipient’s official position.” Relevant factors include whether the friendship started and gifts were exchanged before the recipient became a public official.

Simpson said his bill only changes the burden of proof, requiring the prosecution to show that a gift was not the result of friendship. Albritton said that’s an important distinction.

“That changed standard of proof really matters here,” Albritton said. “It creates a loophole that pretty much anybody can walk through.”

Simpson pointed to sections of the bill that he said show it would provide thorough safeguards against corruption. For example, it prohibits a public servant from steering contracts, grants, or financial business from the public servant’s government body to a business the public servant is associated with or any family member, including a child, parent, sibling, grandchild, grandparent, aunt, uncle, niece, nephew, cousin, or spouse, or the child, parent, or sibling of the spouse.

The new section on using a public office for pecuniary benefit applies the law to a benefit that goes to anyone, not just the public official, Simpson noted.

“This is not a weakening the ethics laws bill,” Simpson said. “This is a strengthening the ethics laws bill. This is not something where we’re trying to make it where everybody can go and get what they want.”

There are numerous exceptions to the restrictions on gifts and favors offered to public officials both in the current law and in Simpson’s bill.

The current law allows gifts of up to $32 per occasion, an amount that is periodically adjusted by inflation. Simpson’s bill would raise that to $100 for a single occasion, or $500 total during a 12-month period.

The current law allows legislators and other public officials to have their expenses paid for transportation, lodging, food, and beverages at events defined as economic development or education functions. Simpson’s bill retains allowances for such events.

Alabama lawmakers have proposed and made changes to the ethics law in recent years, but the last major revisions came in 2010, when a newly elected Republican majority in the Legislature passed sweeping reforms, fulfilling a campaign promise they said would help stamp out corruption. The stricter laws were a factor in the conviction of former House Speaker Mike Hubbard on 12 ethics violations in 2016.

The Alabama Court of Criminal Appeals and the Alabama Supreme Court overturned a total of six of Hubbard’s convictions and urged the Legislature to clarify the law.

Supreme Court Justice Tommy Bryan wrote that parts of the ethics law are “inexplicably broad and somewhat confusing.”

“Thus, I encourage the legislature to take immediate action to once again revise and clarify the language of the Ethics Code,” Bryan wrote in the 2020 decision.

Simpson said the court’s opinions were among the factors considered in HB227. For example, his bill narrows the definition of principal, a person or company that hires a lobbyist. That definition is one of the sections in the current law the courts said was too broad.

Simpson is a lawyer and prosecutor who was elected to the House in 2018. Shortly after his election, Simpson said he learned about what he considers the confusing nature of the ethics act during a legislative orientation session. He said three lawyers conducting the session repeatedly gave different answers to the legislators’ questions about what the law prohibits.

“One person would say, ‘Yes, you could do it.’ One person would say, ‘No, you can’t do that,’ and another person would say, Well it depends, maybe,’” Simpson said.

“That just doesn’t make sense. Why is it so hard for people to understand what you can and can’t do?” Simpson said.

Simpson made the Ethics Act a priority when he became chairman of the House Ethics and Campaign Finance after the previous chairman, Rep. Mike Ball, retired when his term ended in 2022.

The committee held hearings and began work on the ethics bill after the 2023 regular session ended.

“I learned that 300,000 people directly fall under the ethics laws as they are now, meaning every county, state, city employee that falls under the ethics laws,” Simpson said. “By the time you include their extended family the numbers in that report indicated it is over a million people, which is roughly a quarter of the population.”

Simpson said he’s concerned that many of those people do not understand the law.

“I have been practicing law for almost 20 years, including prosecuting some of these cases,” Simpson said. “If I still can’t figure out what we’ve got to do, and what I can do and what I can’t do, and I still have to call the Ethics Commission and keep them on speed dial to get guidance and advice, what chance does the teacher have? What chance does the first responder have? What chance does your average city employee have of knowing what they can and can’t do?”

Albritton said the Ethics Commission is responsive to questions from those affected by the law and how it applies through hundreds of informal opinions it issues every year. Simpson’s bill would require the commission to publish a summary of those informal opinions on its website.

Albritton said a major concern about HB227 is that it would strip the Ethics Commission of its independence by empowering the Legislative Council, a committee of 20 state lawmakers, to impeach the Ethics Commission director after a recommendation by the attorney general.

“It would make me subject to impeachment by somebody we regulate under the Ethics Act,” Albritton said.

Albritton said that undermines a fundamental principle that’s been part of Alabama’s ethics law since it was first enacted in 1973, a principle he said is nationally recognized.

Simpson said he believes the additional check on the Ethics Commission is justified.

“There’s no government job, where you can just act as king without anybody having to answer to the people,” Simpson said. “The AG would have to answer to the people for the recommendation that he’s done. The Legislative Council would have to answer to the people when they’re up for a vote for something that they’ve done. You can’t have anyone in government with that type of power that doesn’t have to answer to the people.”

Albritton noted that he works for the commission, which hired him and can fire him. He said the current system of checks and balances in the ethics law works well, noting that district attorneys and the attorney general decide whether to prosecute cases and approve administrative penalties recommended by the commission.

“All that we do is make a recommendation,” Albritton said. “But if you’ve got one central body that is defining this area and says this conduct violates use of office for personal gain or it doesn’t, then it standardizes that approach with a group of people who are dedicated only to this.

“This is not just an area that everybody is fluent in. There’s an established approach to this that’s been going on for about 50 years since the commission was formed, a little over 50 years. And if this bill passes, you’re going to be losing all that.”

Simpson said Albritton is mischaracterizing his bill and what it would do.

“The argument that the Ethics Commission is trying to make that this is weakening the ethics laws is just not factually correct,” Simpson said. “It’s just different than what they’re used to. They’re concerned about their jobs and I understand that.

“My interest is not protecting someone’s job. My interest is making sure the people have someone that has to answer to the people in their role.”

©2024 Advance Local Media LLC. Visit al.com. Distributed by Tribune Content Agency, LLC.

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Erin Hawley: The Woman Arguing Against the Abortion Pill

Erin Hawley, a law professor and wife of Senator Josh Hawley, is arguing the Supreme Court case.

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By Elizabeth Dias and Abbie VanSickle

It was 2014, and Erin Morrow Hawley was fighting against the egg-laying hens of Missouri. Specifically, a new requirement that chicken cages have enough space for the hens to stand up, turn around and stretch out.

A law professor from five generations of ranchers and the wife of Senator Josh Hawley, Ms. Hawley joined a challenge to California, which required more spacious enclosures for hens laying eggs to be sold there. The state where she taught, Missouri, sold a third of its eggs to California, and Ms. Hawley believed that a blue state had no right to impose its values and rules on Missouri’s farmers.

She joined in a lawsuit against California’s attorney general at the time, Kamala Harris. A judge found that the challengers could show no direct injury and dismissed the case. Ms. Hawley continued teaching, and Ms. Harris became Joe Biden’s vice president.

Ten years later, Ms. Hawley, 44, is now at the center of one of the country’s most heated cultural battles about bodily autonomy, gender roles and abortion. On Tuesday, for the first time since the overturning of Roe v. Wade, the Supreme Court considered a case involving nationwide limits on abortion access. And Ms. Hawley was the woman standing before the justices, arguing to sharply curtail access to the abortion pill.

The case centers on the Food and Drug Administration’s approval of mifepristone, a commonly available drug used in the majority of abortions in the country. Limiting medication abortion is a next frontier for the anti-abortion movement in the post-Roe era.

Ms. Hawley represents a group of anti-abortion doctors and an umbrella group of conservative medical associations that claim that the abortion pill — approved more than two decades ago — is a danger to women. The F.D.A. has pointed to substantial scientific evidence that the medication abortion is safe .

Ms. Hawley views the cause as similar to her fights against government interference, rooted in her experience of ranch life.

“You see how those regulations impact people that are really living on the ground, and sometimes for good and sometimes maybe not for good,” she said in an interview with The Times earlier this month. “And so being pro-life, and believing that every child, no matter how small, no matter if they’re not yet born, is invested with inherent dignity and worth — government action can have a lot to say about that as well.”

She argues that federal approval of the abortion pill went forward without enough consideration of possible side effects and dangers, and that subsequent changes to enable greater access have ignored health risks to women.

The government lawyers in this case, led by Solicitor General Elizabeth B. Prelogar, have argued in court filings that Ms. Hawley and her legal team offered scant evidence of real injury, and that declarations from “seven identified doctors” were “often vague or conclusory.”

Ms. Hawley’s particular background makes her ideal for this moment. Her longtime interest in limiting the power of the administrative state is well suited to speak to the current court’s conservative supermajority, which has welcomed cases challenging regulations on everything from herring fish to machine guns and, now, abortion.

Ms. Hawley brings her credentials not only as a former clerk to Chief Justice John G. Roberts Jr. but as a millennial Christian mother. An evangelical believer who forefronts her identity as a wife and mother of three, Ms. Hawley works for the Alliance Defending Freedom, a powerful conservative Christian legal group. She represents the ideals of womanhood many in the anti-abortion and conservative Christian movement seek to elevate.

Until now, Ms. Hawley has been best known as the wife of Senator Hawley, Republican of Missouri, who actively sought the overturning of Roe and has supported anti-abortion legislation.

In a campaign ad for him, Ms. Hawley starred as an everyday mom, playing with their children in the kitchen, while he took the spotlight. But she will be one of a few women to argue a prominent abortion case at the Supreme Court for the anti-abortion side.

Even anti-abortion leaders often said “who?” or “Josh’s wife?” when asked about Ms. Hawley. Penny Nance, president of Concerned Women for America, has met her at events supporting Senator Hawley but did not realize that Ms. Hawley was arguing the mifepristone case.

“There are millions of conservative women all over our country who are educated and powerful and love their families, similar to Erin Hawley,” Ms. Nance said. “She is actually fairly typical of young millennial conservative Christian women coming up through the ranks.”

But it may be Ms. Hawley, not Sen. Hawley, whose work will most power the anti-abortion cause.

“I think it may be more accurate to say that he’s Erin Hawley’s husband,” Mary Ziegler, a law professor and historian at University of California, Davis, said of the senator. “I think people are just beginning to see how influential she is.”

Erin Morrow was born into a family of frontier women and grew up on a cattle ranch near Folsom, N.M., population roughly 50. The foundation of her great-great-great grandmother’s homestead is still visible on the land, where family lore says that as a young widow, she outwitted marauding bandits.

The oldest of three daughters, Ms. Hawley was raised mainly by her mother after her parents divorced. Her father, a former national rodeo champion who struggled with alcoholism and depression, died by suicide when she was in high school, a pivotal moment she has spoken about on her podcast . Her mother, Shari Morrow, ran the family’s ranch, WineCup, and started teaching Erin to ride horses before she could walk.

“She was there when the bus came home, and often she’d throw us on horseback, and we’d help her move cattle, and we were able to sort of participate in her job in a small way,” Ms. Hawley said in the interview with Times reporters. “She was just a wonderful example of putting her family first but also doing something she loved and cared about.”

Her mother, a registered Democrat in the 1990s, had wanted to be a veterinarian, and for a while her daughter did too. Ms. Hawley studied animal science at Texas A&M University and considered a doctorate in genetics. But an internship for the House Committee on Agriculture sparked her interest in regulatory law.

Ms. Hawley started law school at the University of Texas in Austin, then transferred to Yale Law School, where she was a senior editor on the law review.

She clerked for J. Harvie Wilkinson III, a Reagan appointee on the U.S. Court of Appeals for the Fourth Circuit, and for Chief Justice Roberts in 2007.

There, her desk faced that of another clerk from Yale, Josh Hawley, and they secretly dated. He persuaded her to get married, when she was skeptical after having grown up “in a home with a marriage that wasn’t ideal,” she said in a podcast, and they moved back to his home state of Missouri.

When they searched for jobs, she impressed the faculty at the University of Missouri’s School of Law and expressed interest in filling a need to teach tax law. The school offered jobs to both of them.

Together they started the Missouri Liberty Project, “dedicated to promoting constitutional liberty and limited government.” But her husband’s career soon took the lead in their lives. As he campaigned for the U.S. Senate, she wrote a devotional book for mothers, drawing spiritual lessons from the lives of her children while comfortably weaving in references to modern theologians like Stanley Hauerwas. Her light textual analysis of original Greek words in the Bible echoes her approach to interpreting the Constitution in her legal work.

“Why can’t a high-powered lawyer also share that side of her life? Why not? That is her foundation, that is who she is,” said Julie Holmquist, who edited the book.

Ms. Hawley had expected her husband to pursue a political career after their children were grown. When they felt God calling him to run for office, she packed the family onto the campaign bus. The couple voted at their home church, The Crossing Church, an evangelical Presbyterian congregation, and the Hawleys moved to Washington.

Only a few months into her role as a lawyer for the conservative Christian legal advocacy group A.D.F. in 2021, Ms. Hawley flew to Mississippi to strategize on the Dobbs case, which overturned Roe v. Wade.

Ms. Hawley and her infant daughter arrived on time, but her babysitter did not. In the middle of the meeting, the baby let out a wail.

As Ms. Hawley tells it, this moment encapsulated her purpose, both as a Christian mom and as a lawyer aimed at dismantling the right to abortion. On the couple’s podcast, she described her baby’s crying as “a tangible reminder of why the Dobbs case might matter so much.”

At a speech after the Dobbs oral argument, Ms. Hawley said she had “been blessed to have a front-row seat on this case.” She added, “As a conservative mother, I can tell you it has been the project of a lifetime.”

Ms. Hawley has notched other legal victories, becoming synonymous with conservative social-issue cases. She worked on 303 Creative, the case in which the Supreme Court justices ruled in favor of a Colorado web designer who cited the First Amendment in refusing to serve same-sex couples.

Ms. Hawley is currently helping the Idaho attorney general defend the state’s abortion ban from a challenge by the Biden administration.

At the Supreme Court on Tuesday, her unique background was on display, even as most justices seemed skeptical of her argument. She answered a question from Justice Samuel A. Alito Jr. about determining standing — whether the anti-abortion doctors could show direct harm — by referencing how the court considered the issue in a case about genetically engineered crops. In that case, Ms. Hawley said, the court looked at “the distance that bees might fly in order to pollinate seed farms,” she said. She had the support of her husband, who was present in the courtroom.

Even with the pressure of a first-time oral argument, she said in the interview that she remained calm because the decision was ultimately up to God.

“Christians are called to work with excellence but also to rest in the knowledge that God is sovereign, and that we can trust the results to Him,” she said. “To have the faith that all of it is in His hands, I think does help.”

The justices are expected to make a decision in June.

Julie Tate and Kitty Bennett contributed research.

Elizabeth Dias is The Times’s national religion correspondent, covering faith, politics and culture. More about Elizabeth Dias

Abbie VanSickle covers the United States Supreme Court for The Times. She is a lawyer and has an extensive background in investigative reporting. More about Abbie VanSickle

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Talking the Walk Case Study #31 – Leader Guide

Supreme Court Declines to Revive Map in ‘Upside Down’ Voter Case

By Kimberly Strawbridge Robinson

The US Supreme Court declined to put on hold use of a Washington state voting map that a lower court redrew over concerns an earlier one disadvantaged Hispanic voters.

The justices’ didn’t explain in their one-sentence order on Tuesday why they declined the request from three Hispanic voters. The were no noted dissents.

The high court often is reluctant to make changes to contested voter maps close to an election.

The request for the justices to stay use of the map ordered by US District Judge Robert S. Lasnik while the matter is appealed is the latest battle over how ...

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