Academic journal article Issues in Law & Medicine

Medical Treatment for Older People and People with Disabilities: 1988 Developments

Academic journal article Issues in Law & Medicine

Medical Treatment for Older People and People with Disabilities: 1988 Developments

Article excerpt

Medical Treatment for Older People and People with Disabilities: 1988 Developments


In 1988, the United States Supreme Court determined that "primary alcoholism" is "willful misconduct" that disqualifies veterans for an extension of time for educational benefits eligibility based on disability. The Civil Rights Restoration Act, passed in 1988, broadened the scope of programs or activities which may be covered by federal civil rights statutes that prohibit discrimination by entities receiving federal financial assistance. Decisions by the highest courts in two states may signal a trend toward reestablishing protection for persons with disabilities who are incompetent and are being threatened with denial of life-sustaining food and fluids. Federal and state courts addressed the issue of withholding medical treatment from persons with disabilities. The rights of persons with AIDS to participate in programs receiving federal financial assistance continue to be litigated with increasing frequency. Lastly, thirty-eight states and the District of Columbia have "living will" legislation.


Access to adequate and appropriate health care continues to be a problem facing older persons and persons with disabilities. Recognizing this problem, two state supreme courts have issued decisions halting a trend of cases which authorized the denial of beneficial food and fluids to persons with disabilities who are incompetent. Both cases require a stricter evidentiary standard in that patients must give her informed refusal while competent before food and fluids may be withdrawn. It is expected that persons with AIDS will also be affected in today's climate of increasing pressure to curtail rising health care costs. Attempts to regulate the costs of health care coupled with discriminatory attitudes toward persons with disabilities and persons with AIDS will undoubtedly impact adversely on these populations who are often indigent or quickly impoverished by costs of needed medical care. Legal services attorneys should be aware of these trends to better identify and represent these client populations.

The United States Supreme Court

In Traynor v. Turnage,(1) the United States Supreme Court held in a 4-3 decision (Justices Scalia and Kennedy did not participate) that a Veterans Administration's regulation that irrebuttably presumes that primary alcoholism is the result of willful misconduct and, therefore, is not a protected disability for the purpose of extended education benefits, does not violate section 504 of the Rehabilitation Act of 1973.(2) Section 504 provides that no otherwise qualified individual with handicaps can be denied benefits or be discriminated against in any program or activity that receives federal financial assistance.(3)

Veterans who are honorably discharged from the United States Armed Forces are entitled to receive educational assistance benefits under the Government Issue Bill,(4) which must be used within ten years following discharge or release form active duty.(5) In 1977, Congress created a statutory exception to extend the ten-year period if a veteran was prevented from using his benefits earlier by "a physical or mental disability which was not the result of...[his or her] willful misconduct."(6) The Veterans Administration had characterized primary alcoholism, a dependency not the result of a psychiatric disorder, as "willful misconduct."(7)

The Supreme Court found that the text and legislative history of the 1977 statute,(8) confirmed that Congress clearly intended to use the term "willful misconduct," which had long been used in other veterans' benefits statutes(9) and which had long encompassed primary alcoholism.(10) Moreover, the Court found that Congress did not intend for the 1978 antidiscrimination amendments to the Rehabilitation Act of 1973 to expressly contradict, repeal, or amend the precise "willful misconduct" statute of 1977 to extend educational benefits under the Government Issue Bill. …

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