https://jamanetwork.com/journals/jama/fullarticle/2803498
The Supreme Court Is Harming Public Health and the Environment
Lawrence O. Gostin, JD1; Sarah Wetter, JD, MPH1
Author Affiliations Article Information
JAMA. Published online March 31, 2023. doi:10.1001/jama.2023.3564
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Afundamental shift in the Supreme Court was set in motion in 2020 with
the death of Ruth Bader Ginsburg. President Trump appointed Amy Coney
Barrett as his third appointee, forming a conservative 6-3
supermajority. The Supreme Courts jurisprudence is having a profound
effect on public health, safety, and environmental policy. This
Viewpoint looks back at the Supreme Courts 2021 and 2022 terms and
forward to the 2023 term and beyond.
Public Health Powers During the COVID-19 Pandemic
Rather than deferring to scientific decisions during the COVID-19
pandemic, the Supreme Court often struck them down. The justices
invalidated New York and Californias restrictions on religious
gatherings (eTable in the Supplement) despite considerable evidence that >congregate settings pose a high transmission risk. The Supreme Court >similarly overturned the Centers for Disease Control and Prevention
eviction moratorium despite findings that evictions contribute to the
spread of SARS-CoV-2.
The justices similarly blocked an Occupational Safety and Health >Administration emergency temporary standard ordering large businesses to >either require COVID-19 vaccination or regularly test employees.
Scientists from the Occupational Safety and Health Administration
estimated it would prevent 6500 deaths and 250?000 hospitalizations over
6 months. The Supreme Court narrowly upheld a mandate from the Centers
for Medicare & Medicaid Services for health care workers to be
vaccinated or undergo testing.
False and Misleading Scientific Information
Public trust in science is vital not only for an informed populous but
also to enhance compliance with public health guidance. Yet, 230 of the >Communications Decency Act protects social media companies against
lawsuits regarding users posts even if they are false, misleading, or >extremist.
The Supreme Court will decide whether 230 should shield giant
technology companies from accountability. The Supreme Court is also >considering whether to hear challenges to laws in Texas and Florida
barring online platforms from removing certain political content. The
outcome of these cases could upend the internet with vast significance
for regulation of online media content.1
Environmental Health
The air we breathe and the water we drink have profound effects on
health. Last term, the Supreme Court invalidated the Clean Power Plan,
which would have required power plants to install energy-efficient
devices and demonstrate progress toward sustainable energy. The justices >relied on the major questions doctrine, which holds that Congress must >explicitly authorize agency actions with major social or economic effects.
Because most federal regulations have wide social and economic effects,
the Supreme Courts reasoning could prove fatal to many health, safety,
and environmental regulations. Laws grant agencies broad discretion
because Congress cannot anticipate every health threat, thus relying on >agencies to confront new challenges. Federal agencies like the
Environmental Protection Agency have far more subject matter expertise
than Congress or the courts.
This term, the Supreme Court could further weaken the Environmental >Protection Agency by narrowing the definition of waters of the United >States under the Clean Water Act.2 The Supreme Court is widely expected
to supplant the agencys expertise with the courts own judgement. The >narrowed definition would exclude wetlands and the oil, gas, mining, and >agricultural industries would be able to discharge pollutants into
wetlands without even needing a permit. This would threaten natural
habitats as well as waters for recreation, fishing, and drinking. Just
as climate change has become a defining issue, the Supreme Court is >curtailing regulatory action to ensure a cleaner environment.
Firearm Safety
A conservative majority has drastically expanded the reach of the Second >Amendment, limiting government action to prevent gun violence. Last
term, the Supreme Court invalidated a New York law that, since 1911, has >required a person to show proper cause for a license to carry a handgun >outside the home. Lower courts have used this precedent to invalidate
other long-standing, common sense gun laws.
On February 2, 2023, the Fifth Circuit Court of Appeals ruled >unconstitutional a federal law banning gun possession by people subject
to domestic violence restraining orders.3 Guns, now the leading cause of >death in children and adolescents aged 1 to 19 years, have already taken
more than 4000 lives in the US in 2023, with mass shootings occurring
every day.4
Abortion Rights
Last term marked the first time in history the Supreme Court withdrew a >constitutional right, finding that a right to abortion was not deeply
rooted in our Nations history. At least 13 states have fully banned >abortion and 5 states have partial bans on abortion while proposed
abortion bans remain blocked in 8 states. These restrictions have caused
a patients average travel time to an abortion facility to more than
triple.5
Abortion bans have the most significant effect on individuals who lack
the resources and support to travel longer distances as well as minors, >racial and ethnic minority individuals, non-English speakers, and
migrants. The ruling spurred crucial legal questions, including whether >emergency medical care must include abortion services.6 Litigation is
also ongoing over approval of abortion medications by the Food and Drug >Administration.
LGBTQ+ Rights
Last term, the Supreme Court ruled that a city-funded Catholic social >services agency could deny same-sex couples the opportunity to foster >children in defiance of Philadelphias antidiscrimination law. The
unanimous decision centered on a technicality in the law. More alarming
was a concurring opinion by Justices Alito, Gorsuch, and Thomas that
argued for overturning the 1990 ruling in Employment Division v Smith,7
which established that generally applicable laws do not require
religious exemptions. The justices advocacy for religious rights could >undermine vaccination mandates, while also legitimizing discrimination >against the LGBTQ+ community.
This term, the Supreme Court will decide whether businesses open to the >public can refuse to serve LGBTQ+ individuals. If the Supreme Court
places commercial expression above LGBTQ+ rights, it could relegate
LGBTQ+ individuals to a disfavored class, further narrowing access to
goods and services. LGBTQ+ people already face higher rates of violence
and discrimination, putting them at risk for physical and mental harms.
Medicaid
This term, the Supreme Court will decide whether Medicaid recipients can >challenge state denials of federally guaranteed benefits. A federal law
known as 1983 has long granted individuals denied benefits access to
the courts.8 Decades of precedent support a judicial pathway to enforce >rights under federally funded programs (eg, Medicaid, the Supplemental >Nutrition Assistance Program, and Temporary Assistance for Needy
Families). Yet the Supreme Court may find these programs are simply
contracts between states and the federal government, with no enforceable >rights. Low-income individuals would have federally protected rights,
but no remedy when states deny benefits for which they are eligible.
Medicaid and the Childrens Health Insurance Program are among the few
safety nets for low-income individuals, and are used by 90 million >individuals in the US. Especially as states wind down COVID-19
protections, Medicaid enrollees need an outlet to safeguard benefits >wrongfully denied.
Health Equity
This year, the Supreme Court is poised to rule on cases that go to the
heart of equity in US society. In 2 consolidated cases, the Supreme
Court is expected to invalidate affirmative action designed to increase >diversity and opportunity in higher education.9 Yet as Justice Ketanji
Brown Jackson stated, education is a major social determinant of health. >American Indian, Black, Hispanic, and Pacific Islander populations
remain vastly underrepresented in higher education. These groups
experience less economic opportunity, less representation in the health
care workforce, and fill fewer leadership positions.
Forbidding racial- and ethnic-based decisions could also derail public
health programs designed to reduce health inequities by prioritizing >underserved populations. The Supreme Court could also overturn the
Indian Child Welfare Act (ICWA) that prioritizes placement with tribal >families when American Indian children are removed from their homes. The
ICWA was enacted in 1978 in response to a history of forcibly removing >American Indian children from their families to send them to boarding
schools as a form of cultural genocide.10 Medical organizations argue
that the ICWA promotes stability, helping children overcome trauma.
Conclusions
The Supreme Courts 6 conservative justices are bringing vast changes to
the public health legal landscape. The Supreme Court is impairing the >governments ability to act in the public interest and undermining
safeguards for groups that have been historically marginalized. Yet far
from affecting only a subset of US individuals, the justices are
weakening public health, with health and equity on the line.
Back to topArticle Information
Corresponding Author: Lawrence O. Gostin, JD, ONeill Institute for
National and Global Health Law, Georgetown University, 600 New Jersey
Ave NW, Washington, DC 20001 (gostin@georgetown.edu).
Published Online: March 31, 2023. doi:10.1001/jama.2023.3564
Conflict of Interest Disclosures: None reported.
References
1.
McCabe D?. Supreme Court poised to reconsider key tenets of online
speech. Published January 19, 2023. Accessed March 23, 2023. >https://www.nytimes.com/2023/01/19/technology/supreme-court-online-free-speech-social-media.html
2.
US Environmental Protection Agency. Waters of the United States.
Accessed March 23, 2023. https://www.epa.gov/wotus
3.
US v Rahimi, case No. 21-11001 (5th Cir) (2022).
4.
Webster DW?, Gostin LO?. The Supreme Court expands Second Amendment
rights as the nation experiences historic levels of firearms violence. ?
JAMA. 2022;328(12):1187-1188.
ArticlePubMedGoogle ScholarCrossref
5.
Rader B?, Upadhyay UD?, Sehgal NKR?, et al. Estimated travel time
and spatial access to abortion facilities in the US before and after the >Dobbs v Jackson Womens Health decision. ? JAMA. 2022;328(20):2041-2047. >ArticlePubMedGoogle ScholarCrossref
6.
Reingold RB?, Gostin LO?. Roe v Wades 50th anniversary. ? JAMA. >2023;329(11):877-878.
ArticlePubMedGoogle ScholarCrossref
7.
Employment Division v Smith, 494 US 872 (1990).
8.
Rosenbaum S?, Jost T?. Is the Supreme Court poised to wipe out legal
rights for Medicaid beneficiaries? May 20, 2022. Accessed March 23,
2023. https://www.healthaffairs.org/do/10.1377/forefront.20220518.925566/
9.
Hodge JG?. Affirmative action and public health repercussions.
Published December 15, 2022. Accessed March 23, 2023. >https://www.networkforphl.org/resources/affirmative-action-and-public-health-repercussions/
10.
Henry TA?. How tribal placements benefit Native foster childrens
health. Published September 21, 2022. Accessed March 23, 2023. >https://www.ama-assn.org/delivering-care/population-care/how-tribal-placements-benefit-native-foster-children-s-health
https://jamanetwork.com/journals/jama/fullarticle/2803498
The Supreme Court Is Harming Public Health and the Environment
Lawrence O. Gostin, JD1; Sarah Wetter, JD, MPH1
Author Affiliations Article Information
JAMA. Published online March 31, 2023. doi:10.1001/jama.2023.3564
related articles icon Related
Articles
Afundamental shift in the Supreme Court was set in motion in 2020 with the death
of Ruth Bader Ginsburg. President Trump appointed Amy Coney Barrett as his third
appointee, forming a conservative 6-3 supermajority. The Supreme Court’s jurisprudence is having a profound effect on public health, safety, and environmental policy. This Viewpoint looks back at the Supreme Court’s 2021 and
2022 terms and forward to the 2023 term and beyond.
Public Health Powers During the COVID-19 Pandemic
Rather than deferring to scientific decisions during the COVID-19 pandemic, the
Supreme Court often struck them down. The justices invalidated New York and California’s restrictions on religious gatherings (eTable in the Supplement)
despite considerable evidence that congregate settings pose a high transmission
risk. The Supreme Court similarly overturned the Centers for Disease Control and
Prevention eviction moratorium despite findings that evictions contribute to the
spread of SARS-CoV-2.
The justices similarly blocked an Occupational Safety and Health Administration
emergency temporary standard ordering large businesses to either require COVID-19 vaccination or regularly test employees.
HeartDoc Andrew, in the Holy Spirit, boldly wrote:
Subject: The LORD says "Blessed are you who hunger now ..."
Shame on andrew, look at his red face.
He is trying to pull a fast one. His scripture bit is found among these:
'14 Bible verses about Spiritual Hunger'
Psalms
81:10 I am the LORD thy God, which brought thee out of the land of Egypt: >open thy mouth wide, and I will fill it.
Proverbs
13:25 The righteous has enough to satisfy his appetite, But the stomach of >the wicked is in need.
Joel
2:26 And ye shall eat in plenty, and be satisfied, and praise the name of
the LORD your God, that hath dealt wondrously with you: and my
people shall never be ashamed.
Psalms
107 For he satisfies the thirsty and fills the hungry with good things.
Acts
14:17 "Yet he did not leave himself without witness, for he did good by >giving you rains from heaven and fruitful seasons, satisfying
your hearts with food and gladness."
someone eternally condemned & ever more cursed by GOD perseverated:
HeartDoc Andrew, in the Holy Spirit, boldly wrote:
Subject: a very very very simple definition of sin ...
Does andrew's "definition" agree with scripture? Let's see in 1 John:
John wrote this to christians. The greek grammer (sic) speaks of an ongoing >> status. He includes himself in that status.
1:8 If we say that we have no sin, we deceive ourselves, and the truth is
not in us.
1:9 If we confess our sins, he is faithful and just to forgive us our sins, >> and to cleanse us from all unrighteousness.
1:10 If we say that we have not sinned, we make him a liar, and his word is >> not in us.
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