Ethical and legal issues confronting college health

More than 11 million students currently attend institutions of higher education in the United States. While this segment of the population traditionally constitutes a young, healthy cohort, experience demonstrates that college and university health services play a critical role in assuring student health maintenance, completion of school, consumer health education, and the development of sound health practices and behaviors. In examining institutional policies and protocols governing the support and the delivery of student health services, several critical ethical issues emerge from both a macro and micro orientation. As university and college resources become more scarce and budget decreases increase, institutions are reestablishing priorities. Oftentimes, the question of continued support of campus based health services is raised. Suggestions range from discontinuing their operation, to dramatic decreases in their services, to requiring them to become fully self-sufficient (i.e., through mandatory prepayments or fee-for-services mechanisms and elimination of general fund support). At a macro level, such discussions raise issues associated with social justice and whether the universities and colleges should serve in a loco parentis (paternalistic) role. This essay more specifically addresses several micro issues that directly impinge on the delivery of health services to millions of college and university students.