Factual causation in medical negligence

The conventional approach to causation in negligence is the "but for" test, decided on the balance of probabilities. Even when supplemented by the "material contribution" principle, satisfying the onus of proof of causation can be an insuperable obstacle for plaintiffs, particularly in medical cases. Yet, having found a breach of duty, a court's sympathies may gravitate toward the plaintiff at this point in the case. Accordingly, courts have sometimes accepted a relaxation of strict causation principles. The judicial devices are described: a special principle of causation in particular duties of care; a shifting burden of proof; "bridging the evidentiary gap" by drawing a robust inference of causation; treating a material increase in risk as sufficient proof of causation; and permitting causation to be established on the basis of the loss of a material chance of achieving a better outcome and discounting damages. In Accident Compensation Corp v Ambros [2007] NZCA 304 the New Zealand Court of Appeal recognised the need for a legal device to ameliorate the injustice sometimes caused by the strict rules of causation, and preferred the "inferential reasoning" approach favoured by the Canadian common law for use in the context of the accident compensation scheme. It is hoped that the New Zealand Supreme Court approves Ambros if the opportunity arises.     

论辩护性证明理论的建构

辩护性证明是指在刑事诉讼中被告人及其辩护人提供证据证实其辩护性主张成立的诉讼活动。学界对被告人证明责任问题已有论及,对辩护性证明对象及其证明标准却鲜有研究,对辩护证明理论的全面研究更是寥寥无几。辩护性证明责任、辩护性证明对象以及证明标准等是辩护性证明理论中重要的基础性问题,它们是建构我国辩护性证明理论的重要组成部分。     

Causation in negligence: from anti-jurisprudence to principle--individual responsibility as the cornerstone for the attribution of liability

Causation is one of the most esoteric and poorly defined legal principles. The common law standards of the "but for" test and common sense are, in reality, code for unconstrained judicial choice. This leads to a high degree of unpredictability in negligence cases. Changes to the causation standard following the torts reforms have done nothing to inject principle into this area of law: the concept of "appropriateness" is no more illuminating than common sense. Despite this, the trend of recent High Court decisions offers some prospect of clarifying the test for causation. Key themes to emerge are an increased emphasis on individual responsibility and the associated concept of coherency with other legal standards. This article examines the doctrinal reasons underpinning the increasingly important role of these ideals and suggests how they can be accommodated into the test for causation to inject greater coherence and predictability into this area of law.     

Proof of cancer causation and expert evidence: bringing science to the law and the law to science

This article discusses the medico-scientific and the legal views of cancer causation and how these two approaches impact on expert evidence. Cancer cause lends itself well to an exploration of the critical issues which surround its proof and the role of expert evidence in this proof. The article does not seek to identify or to resolve all the controversies or inconsistencies in the area. Rather, it sets up a basic framework for the general presentation and testing of expert medico-scientific evidence in litigation related to cancer causation. Specifically, it seeks to identify the technical questions of law and medical science regarding which medico-scientific disciplines can be relevant to proving cancer causation, and who the relevant expert witnesses to achieve this task would be. Emerging areas of cancer causation are then examined in light of this framework.     

Environmental liability under uncertain causation

Recently, the European Commission has issued the “Directive 2004/35/CE on environmental liability with regard to the prevention and remedying of environmental liability”. The Directive extends liability that usually refers to personal injuries and private property to harm where private property does not exist (e.g. biodiversity and endangered species). In these cases, problems with multiple causation and uncertain causation tend to be even more severe than for cases where solely private property is affected. Nevertheless, the otherwise very ambitious Directive remains silent about how to deal with these problems. We focus on uncertain causation and analyze second best optimal standards of proof in a model where benefits of risky activities are private information, and where the firm’s care level chosen to avoid the damage is only imperfectly observable. We derive three results: first, we characterize the factors determining the second best standards. Second, and conversely to the previous literature, high standards of proof such as proof beyond reasonable doubt can be second best optimal even though they lead to inefficiently low care levels. Third, legislators should leave discretionary power to courts which allows them to choose the standard of proof conditional on factors such as the degree of uncertainty over causation or the information quality about care levels as taken by injurers.     

英联邦国家医疗侵权诉讼中因果关系之证明及评价

在因果关系的证明上，英联邦国家司法总体上贯彻了法律与科学有别、司法者与医学专家有别的观念。传统的因果关系证明规则在医疗诉讼中面临挑战和困境。在寻找解决此类困境的方法中．“举证负担转移”方法因其操作生硬、对传统规则的过于颠覆以及可能对医学、医疗诉讼和医疗保险产生不良影响而未能在英联邦司法中获得普遍认可：“风险的实质性增加”方法和“机会丧失”视为损害的方法能否适用于医疗侵权案件尚未得到确定。与前些方法相比，“因果关系的推断”在英联邦司法中获得了较大程度的认可。该方法的优势在于弹性强、对传统规则的偏离较为缓和且充分利用了法庭的事实认定过程。它进一步增加了法院的自由裁量．减弱了对医疗专家意见的依赖。     

A comparison of insanity defense standards on juror decision making

Following the Hinckley acquittal, 17 states and the federal government made changes to the insanity defense, including revising the standard, reassigning the burden of proof, and altering the standard of proof. Two studies were conducted to determine whether the specific insanity standard (including the assignment of burden of proof and standard of proof) employed had a significant effect on mock jurors' verdicts. Participants' comprehension of insanity defense instructions was measured and the factors jurors used to decide whether to find the defendant not guilty by reason of insanity (NGRI) were also assessed. Participants' comprehension of insanity defense standards was very low. When asked to identify the factors they considered important in determining whether to find a defendant NGRI, only three elements of insanity defense standards were identified as significant. The results may have important implications for policy decisions regarding the insanity defense.     

环境侵权证明责任倒置合理性论证

为减轻环境侵权诉讼中原告证明损害和被告加害行为之间存在因果关系的困难,发达国家发展出了多种形态的因果关系推定学说、判例和立法。中国现行法确立的因果关系举证责任倒置规则,对环境侵权诉讼原告的举证困难减轻得更多。从促进信息供给、保护受害者、预防污染和惩戒污染、实质正义、利益平衡、立法难易度、司法可预测性、制度变迁成本等七个方面来看,在环境侵权诉讼中实行因果关系证明责任倒置较因果关系推定为优,因此我国环境侵权立法中应继续实行因果关系证明责任倒置原则,没有必要退回到适用因果关系推定。     

论我国民事诉讼证明责任分配的一般原则

最高人民法院《关于民事诉讼证据的若干规定》第二条第一款确立了我国民事证明责任的一般原则。该原则可以概括为两个命题:一是提出诉讼请求的当事人对权利根据事实承担证明责任,反对诉讼请求的当事人对抗辩事实承担证明责任;二是当事人各自负有证明责任的事实是实体法所规定的要件事实。我国证明责任分配一般原则需要借助于一定的理论方法才能适用于案件,法律要件分类说应当是主要和首选的理论方法,但是不能排除其他理论的运用。关于证明责任分配一般原则的例外亦即举证责任倒置,现行司法解释中关于特殊侵权案件证明责任分配的规定,多数属于证明责任分配一般原则的具体化,只有很少的内容属于一般原则的例外,构成举证责任倒置。     

试论我国死刑案件的证明标准

与国外刑事证明标准相比，我国死刑案件的证明标准“案件事实清楚、证据确实充分”存在过于理想化的“客观真实”，缺乏操作性等弊端。需要对我国死刑案件的证明标准进行重构：即区分定罪程序和量刑程序，对定罪程序适用“排除合理怀疑”的证明标准；在量刑程序中对于控方主张判处死刑的情形应适用“排除一切怀疑”的证明标准。     

准确分析伤病关系是人体损伤程度鉴定的关键

损伤与疾病的关系是法医临床鉴定实践中经常遇到的问题,在人体损伤程度的鉴定中往往直接关乎鉴定意见,值得高度重视。最新发布的《人体损伤程度鉴定标准》对伤病关系处理原则做出了规定,是法医学的一大进步。准确分析伤病关系,要掌握损伤、疾病、损伤性疾病及损伤后疾病、病理基础、潜在性疾病及既往伤病等概念,对损伤与疾病的因果关系进行恰当的分析,并将分析结果运用到损伤程度的鉴定中。在伤病关系分析时,应当遵循事实因果关系的认定原则,从时间上的先后关系、解剖部位上的吻合性以及逻辑上的关联等角度加以论证。损伤程度的鉴定须遵循刑事证据的证明原则．排除合理怀疑。故鉴定人应注意采用恰当的分析方法,尽可能从更高的标准证明伤病关系是否存在。病理学、病因学、临床学上的因果关系,其证明价值要显著高于流行病学、案例报道及实验医学上的因果关系,在实际应用中应高度关注．     

Trial and Error – Failing and Learning in Criminal Proceedings

This paper addresses the selective mechanisms by which criminal proceedings produce strong arguments. It does so by focusing on the failing of argument themes (topoi) in the course of criminal proceedings, rather than on their career. In a further step, the notion of failing is bound to learning: different forms of failing point at different ways and places of learning. The study is comparative, relating cases from four different legal regimes (England, USA, Italy and Germany) that are taken from four extensive ethnographic studies in defense lawyer’s firms. We will track down the failures of topoi at three different stages (pre-trial, trial, and deliberation) in our different legal regimes. Failing occurs in all proceedings in various modes and at different stages. We argue that those modes as well as the different stages at which they occur point at the spots in the respective procedures that allow for learning about the inherent conceptions of “good reasons.”     

A judge's three worlds: proof, philosophy, and the prison

Tensions between the world of science and the world of law may arise because of their differing viewpoints and philosophies. Disagreements may center around such questions as what constitutes proof, around human behavior, and around the use of the insanity defense in criminal cases. The just deserts model is examined and is criticized as being harsh and possibly unrealistic in today's society.     

《人体损伤程度鉴定标准》研制的基本思路

对《人体损伤程度鉴定标准》研究和制定过程中有关问题的思考进行了全面、系统的总结，包括标准制定的基本原则、基本结构、主要内容以及重点关注的几个问题。重点介绍了标准制定的基本原则，即充分体现标准的法律性和适用性、系统性和完整性、科学性和先进性、客观性和实用性以及符合性和关联性。简要介绍了标准的基本结构和主要内容，即损伤程度的分级以颅脑、脊髓、头面、颈、胸、腹、盆、脊柱、四肢、体表等解剖部位，并按重伤一级、重伤二级、轻伤一级、轻伤二级和轻微伤为序罗列出人体组织结构破坏和功能障碍损伤程度鉴定的具体条款，并以附录的形式规定组织器官功能障碍的评定技术和方法。并对标准关注的几个主要问题，如伤病关系、医疗干预、内源性疾病、多部位同性质损伤等处理原则进行了深入的讨论．对于法医临床鉴定人及有关法律工作者进一步学习和理解标准，具有重要的现实意义和指导意义。     

沉默权之赋予与证明标准之转型

口供之必取是支撑我国"符合说"之证明标准理论成立的关键。在赋予被追诉者沉默权之后,我国的证明标准必将面临转型。对于那些被追诉者不予供述的案件,应当实行内心确信的证明标准;对于那些被追诉者自愿供述的案件,可实行高度盖然性的证明标准。     

移送审查起诉的证明标准探析──以证伪思维为视角

证伪思维具有科学性和批判性。我国现行的移送审查起诉的证明标准,即"案件事实清楚,证据确实充分"是运用证实思维,忽视了排除案件疑点,应予以完善。移送审查起诉应确立"排除合理怀疑"的证明标准,该标准符合证伪思维的要求以及认识的模糊性原理和证明标准的层次性。为了保障"排除合理怀疑"证明标准的实施,在贯彻全面取证原则的前提下,应实行侦查部门与预审部门分立,在一定条件下,在侦查阶段扩大律师提前介入的范围。     

The Responsibility Gap in Corporate Crime

In many cases of criminality within large corporations, senior management does not commit the operative offense—or conspire or assist in it—but nonetheless bears serious responsibility for the crime. That responsibility can derive from, among other things, management’s role in cultivating corporate culture, in failing to police effectively within the firm, and in accepting lavish compensation for taking the firm’s reins. Criminal law does not include any doctrinal means for transposing that form of responsibility into punishment. Arguments for expanding doctrine—including broadening of the presently narrow “responsible corporate officer” doctrine—so as to authorize such punishment do not fare well under the justificatory demands of criminal law theory. The principal obstacle to such arguments is the large industrial corporation itself, which necessarily entails kinds and degrees of delegation and risk-taking that do not fit well with settled concepts about mens rea and omission liability. Even the most egregious and harmful management failures must be addressed through design and regulation of the corporation rather than imposition of individual criminal liability.     

我国刑事非法证据排除规则司法实践实证研究-以W市刑事审判实务为视角

在我国立法层面逐步建立非法证据排除制度的背景下,非法证据排除制度能否发挥预期的效果仍取决于在司法实务中的贯彻落实情况。通过分析W市法院近三年启动非法证据排除程序的实际情况,我们发现实务中仍存在对非法证据的范围认识不统一、刑讯逼供、疲劳审讯等非法方法的界定不明确、重复自白是否可采具有争议、程序性情况说明尚普遍存在等问题。在司法实务中正确贯彻落实非法证据排除规则,实现对非法取证行为的一般预防功能,首先需要转变重实体轻程序的传统观念,树立实体正义与程序正义并重的新观念,同时要着眼于我国刑事诉讼的现状,避免非法证据排除泛化。在具体操作上,要严格落实证明责任倒置原则,对控辩双方在非法证据排除程序中实行不同层次的证明标准,辩方提供的线索或材料只需达到“存在非法取证的可能性”这样较低程度的证明标准即可,控方的举证则需达到“排除合理怀疑”这样较高程度的证明标准。对于有辩护人的案件,尽量保证在庭前会议中最大可能地解决非法证据排除问题,避免不具备准入资格的非法证据进入庭审,在法官主持下,控辩双方在庭前会议中达成的协议应当具有约束力。     

Intentional torts claims in medical cases

Civil liability legislation enacted in each Australian jurisdiction following the Ipp Report recommendations created a clear divide between "negligence" and "intentional" torts. The common law action for trespass to the person is to varying extents maintained in the approaches taken by the State and Territory legislatures. This article explores the potential application of intentional torts claims in a medical context in light of recent case law. It identifies advantages for plaintiffs who plead intentional tort claims, including onus of proof, causation, remoteness, the quantum of compensatory damages and the availability of aggravated and exemplary damages.