HealthLawProf Blog

Editor: Katharine Van Tassel
Case Western Reserve University School of Law

Tuesday, August 16, 2022

Medical-Legal Partnerships Reinvigorate Systems Lawyering Using an Upstream Approach

Kate Mitchell (Loyola University Chicago), Debra Chopp (University of Michigan), Medical-Legal Partnerships Reinvigorate Systems Lawyering Using an Upstream Approach, SSRN (2022):

This article will explore the medical-legal partnership model and its role in bringing the public health concept of “upstreaming” to legal practice. The upstream model reframes systems advocacy to effectuate transformational change at the source. Medical-legal partnerships engage in upstream lawyering through alternative methods of identifying legal issues and creative interdisciplinary preventive problem solving. This article will explore how medical-legal partnerships have embraced upstream practices to create systems change and will utilize a case study to demonstrate the transformational power of upstream practice.

Prior to 2021, parents of medically fragile, terminally ill school aged children were required to get a court order before Michigan school districts would honor properly executed Do-Not-Resuscitate (DNR) orders. The palliative care team at the University of Michigan Children’s Hospital referred families seeking school enforcement of DNR orders to the University of Michigan Law School medical-legal partnership, the Pediatric Advocacy Clinic (PAC), for representation on this issue. While these children had valid DNR orders, signed by their parents and physicians because attempted resuscitation would cause pain in their child’s final moments of life rather than save them, school districts were requiring that the parents file affirmative litigation to seek a court order to enforce the DNR. Following successful advocacy obtaining court orders on behalf of individual parents, the PAC went upstream to address the source of the problem and prevent further burdens on already burdened families. The clinic teamed up with palliative care doctors and nurses, as well as school district administrators, to launch a statewide advocacy initiative seeking a new state law clarifying the obligation of school districts to comply with DNR orders for students. This successful advocacy effort, which united a broad coalition of professionals dedicated to improving health and well-being of critically ill students and their families, underscores the power of medical-legal partnerships engaged in upstream advocacy.

This case study, and other examples linked to medical-legal partnerships and their patients-to-policy model, provides a framework for reshaping lawyering upstream. This article will explore the upstream framework of public health and its adoption by medical-legal partnerships to engage in systems-based problem solving to address the root causes of health disparities, poverty, and oppression.

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