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Medical School for Judges Focuses on Cancer

Hogan, Michelle

doi: 10.1097/01.COT.0000293397.10360.01
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For four days at the University of North Carolina School of Medicine, 70 judges traded their usual courtroom bench for the lab bench.

They're training to become better versed in science, technology, and medicine, both to enhance their ability to judge science in the courtroom and to serve as a resource on science matters for their colleagues. As part of their training, they attended the first National Judges' Medical School Program on Biogenetic & Environmental Triggers & Treatment of Cancer.

The Program was produced by the Advanced Legal Studies Institute for Bioscience, Biomedical, and Biotechnology Education for the Advanced Science and Technology Adjudication Resource Center (ASTAR), and it was hosted by the Supreme Court of North Carolina.

“Technology in general, genetics in particular, and medicine are all moving so quickly that they have tremendous implications for broader reaches of society,” James P. Evans, MD, PhD, Chief Science Advisor for the Judges' Medical School, said in an interview.

“Technology and medicine are no longer just questions for the doctor and the patient behind the closed door. They bring up huge societal issues, and this type of program can broaden the understanding among people who are going to be making important decisions about them.” Dr. Evans is also Director of Clinical Cancer Genetics and of the Bryson Program in Human Genetics at the University of North Carolina.

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Judging Science & Medicine

ASTAR is the successor of the Einstein Institute for Science, Health, and the Courts (EINSHAC), a congressionally mandated program designed to prepare the courts for the implications of the Human Genome Project through conferences on genetics, molecular biology, and biotechnology, said the organization's President, Franklin M. Zweig, PhD, JD.

It is a consortium of the Supreme Court of Ohio and the Court of Appeals of Maryland, and membership opened to other jurisdictions in January. North Carolina has begun training its judges in partnership with ASTAR, with Illinois and New York set to follow suit later this year. The judiciaries of Missouri, Washington, Florida, and Texas are slated to start their programs in 2007.

Judges must complete 120 hours of training in order to become a Resource Judge. These hours are usually split evenly between national programs—the annual medical school and annual science school run by ASTAR—and in-state courses organized by the individual member states. The Adjudication Resource Center aims to train 1,000 judges by 2010.

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Building a Background in Medicine

ASTAR chose cancer as the subject of the first Judges' Medical School for a couple of reasons, Dr. Zweig said.

“Cancer is an important modality for teaching judges about science because everyone has experienced it, either personally or through family members or friends' networks, and it permits the application of fundamental principles of molecular biology and genetics to human disease.

“Also, anecdotally, the lion's share of medical negligence cases appearing in our courts revolve around issues of cancer.”

The program included lectures and reading assignments as well as more hands-on presentations, which Dr. Evans highlighted. The judges isolated their DNA, keeping part of it for novelty purposes and having the other part sequenced so they could see the person-to-person variability in the human genome.

They also met two breast cancer survivors, listened as their surgeon interviewed them, and asked the women questions themselves. On the final day of the Program, the judges saw a moot court case of alleged medical malpractice involving cancer treatment and discussed aspects of medical care and uncertainties.

“I think the judges came out of the three days with a more nuanced view of medical care,” Dr. Evans said. “There's a tendency among people not practicing medicine to think that things are clear cut. But here the judges were able to see in graphic terms how complex and nuanced many decisions are.

“For example, we delved into the issue of cancer screening in the healthy population, and that was a real eye-opener to see that screening itself can cause problems and that you have to balance the benefits and the risks.”

Robert M. Bell, JD, Chief Judge of the Court of Appeals of Maryland and ASTAR Chairman, agreed, emphasizing the value of discussions with members of the cancer treatment team and patients:

“When you put all of that together you do seem to get a much better appreciation for what they do and for the kinds of decisions that are required to be made.

“The key is that we're exposing the judges to this information so when a case comes before them they're better able to determine whether the person who is presenting the information is in fact [presenting] serious science or junk science. It exposes us to the updated information on these diseases and allows us then to be in a position later on to bring that to bear when hearing evidence in a case in another context.”

© 2006 Lippincott Williams & Wilkins, Inc.
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