Medical–Legal Partnerships: How Legal Services can Dramatically Improve Health Outcomes,and the Missed Opportunity to Help Women Seeking Abortions

There are significant health disparities in the United States, with low‐income and minority Americans experiencing higher rates of chronic disease and autoimmune disorders. Research has firmly established that social factors ‐ such as malnutrition, limited access to healthcare, and safe housing ‐ play a critical role in these health disparities. Medical‐Legal Partnerships are a relatively new approach to improving the health of people living in poverty by addressing the root causes of these health‐harming social factors. This article discusses the benefits of Medical‐Legal Partnerships and argues for continued expansion of the model, particularly in pediatricians’ offices, because parents are more likely to seek medical care for their children than themselves. This article further discusses how legal constraints prevent federal funding for Medical‐Legal Partnerships in abortion clinics; this creates a missed opportunity to work with women who are seeking abortions, many of whom face considerable social and economic challenges that could be addressed through legal assistance. This article digs into the legal restrictions that create this missed opportunity and proposes potential solutions to better serve the vulnerable population of abortion‐seeking women.     

关于我国医疗过失与因果关系之鉴定和认定的思考

我国法律在医疗过失和因果关系的认定问题上,应坚持医疗＂专家＂判断和＂同行＂鉴定,旨力于构建平衡患者利益和医方利益的规则,区分医疗专家意见和法官法律判断,区分违反通常诊疗义务的医疗侵权和违反告知义务的医疗侵权,区分＂合理医生＂标准、＂医疗水平＂标准和＂医疗常规＂标准。     

论医疗损害

医疗损害是因医疗行为对患方造成损害的一种法律事实。它不仅包括对患者生命健康权的侵害,而且还包括因医疗过失行为引起的一切不利的事实和后果。对医疗损害的内涵和外延应当依据侵权法上损害事实理论进行认定,但要注意识别医疗损害与医疗事故之间的联系与区别。只有在理论层面上全面了解医疗损害的适用范围,才能切实保障医患双方的合法权益,公正合理地裁决医疗纠纷,才能构建和谐的医患关系。     

论医学人体试验中的侵权责任——以比较法为视角

当前我国立法与司法未对医学人体试验侵权责任与医疗损害责任加以区分,对其归责原则和因果关系也有不同认识。在美国,法院渐趋认可人体试验侵权责任为独立诉因,在过错和因果关系的认定上,则分别有主观说和客观说等不同的观点。大陆法系国家中,法国将人体试验侵权责任作为一种特殊侵权,并区分治疗性试验和非治疗性试验分别适用过错责任原则和无过错责任原则。德国将人体试验作为一般过错侵权,并在涉及药品的案件中适用产品责任。荷兰将人体试验侵权责任作为一种独立的侵权责任,并适用过错责任原则。晚近的立陶宛《生物医学试验法》规定了人体试验侵权的无过错责任。我国应当构建独立于医疗侵权责任的人体试验侵权责任,其归责原则为过错责任原则。在因果关系问题上,应当采取相当因果关系、疫学原理因果关系以及因果关系推定理论来进行综合判断。     

重大医疗过失的判断标准——基于对中美医疗过失犯罪的比较考察

重大医疗过失意味着,诊疗行为表现出对患者安全的有意识漠视。重大医疗过失的典型行为类型是,明知从事医疗所需要的前提条件严重欠缺,却冒险开始或继续实施诊疗,以及在诊疗中轻率冒险或不注意而未认识到应该认识到的显著危险。最近,在医学判断错误成为问题的案件中,刑事司法的介入反映了医疗过失处罚范围的扩大化趋势。     

医疗差错认定与Res Ipsa Loquitur

ＲｅｓＩｐｓａＬｏｑｕｉｔｕｒ是拉丁文的法律专业术语 ,在英美法系多用于处理民事纠纷已经有一百多年历史 ,在医疗差错的认定上常被应用。我国司法与医疗卫生工作者对医疗差错的认定多有争议 ,分析了解英美法系对ＲｅｓＩｐｓａＬｏｑｕｉｔｕｒ应用的历史、案例和有关学说 ,与我国的现行法律制度进行比较 ,相信会有所帮助。一、医疗差错与中国的相关法律近年来因医疗纠纷到法院起诉的损害赔偿案件越来越多[1] ,因而法庭将面对如何质证被告是否侵害原告身体并造成伤害 ,已经确认被告的行为是否有过错 ,是否与损害后果之间具有因果关系 ,…     

Hospitals’ Liabilities in Times of Pandemic: Recalibrating the Legal Obligation to Provide Personal Protective Equipment to Healthcare Workers

The Covid-19 pandemic has precipitated the global race for essential personal protective equipment in delivering critical patient care. This has created a dearth of personal protective equipment availability in some countries, which posed particular harm to frontline healthcare workers’ health and safety, with undesirable consequences to public health. Substantial discussions have been devoted to the imperative of providing adequate personal protective equipment to frontline healthcare workers. The specific legal obligations of hospitals towards healthcare workers in the pandemic context have so far escaped important scrutiny. This paper endeavours to examine this overlooked aspect in the light of legal actions brought by frontline healthcare workers against their employers arising from a shortage of personal protective equipment. By analysing the potential legal liabilities of hospitals, the paper sheds light on the interlinked attributes and factors in understanding hospitals’ obligations towards healthcare workers and how such duty can be justifiably recalibrated in times of pandemic.

     

Reforming residency: modernizing resident education and training to promote quality and safety in healthcare

The goal of medical residency is to provide the best clinical education for future practice, while increasing quality and safety in current and future healthcare. This goal is not being met. Traditional residency programs often continue to utilize individually oriented, shame-and-blame approaches that do not recognize the systems nature of outcomes, care, and patient safety. Appropriate substantive methods, content, and training tools are also lacking, while residents continue to labor in a poor working environment. All these factors create a system that serves no one-not the resident, the patient, or the system in which both interact. Residency reforms are proposed to address these imperative concerns.     

英美法对医疗过失的判定原则及对我国的启示

过失是医疗损害责任认定中最为重要的条件,如何确定过失是医疗纠纷和诉讼中最为关键的问题。我国在该问题上的研究及实践均存有欠缺之处,而英美国家在过失判定原则中,其注意义务标准的设定和认定具有一定的合理之处,对我国医疗过失理论研究和司法实践均有借鉴作用。     

The Good,the Bad,and the Klutzy: Criminal Negligence and Moral Concern

One proposed way of preserving the link between criminal negligence and blameworthiness is to define criminal negligence in moral terms. On this view, a person can be held criminally responsible for a negligent act if her negligence reflects a deficit of moral concern. Some theorists are convinced that this definition restores the link between negligence and blameworthiness, while others insist that criminal negligence remains suspect. This article contributes to the discussion by applying the work of ethicist Nomy Arpaly to criminal negligence. Although not interested in legal issues herself, Arpaly has a well-developed theory of moral agency that explains moral concern in terms of responsiveness to moral reasons. Introducing her work to the ongoing scholarly debate will be helpful for two reasons. First, while a definition of negligence in terms of moral concern is recognized as one proposed solution to the negligence–blameworthiness problem, authors promoting it have yet to give a systematic account of moral concern and its relation to blame. Borrowing Arpaly's account will help clarify the idea of moral concern so that both proponents and critics of a concern approach to negligence can have a better-defined debate. Second, her theory of blameworthiness is especially suited to defending the blameworthiness of negligent actions, because it does not have recourse to a special quality of choice or self-control that must be active to render conduct blameworthy. To make this second advantage clear, the article argues that reliance on choice or self-control problematizes blameworthiness for negligence. Those who wish to defend blameworthiness for negligent acts should base their work on an account of moral agency that does not rely on either choice or self-control to explain when an action is blameworthy.     

医疗侵权损害赔偿的限制规则

因医疗侵权行为引起的损害赔偿问题,司法解释采取了以是否构成医疗事故为依据适用不同法律法规的制度,引起较大争议。作为一种侵权行为,医疗侵权造成患者损害的,应以全部赔偿为原则,辅之以过失相抵规则和衡平原则。对患者因医疗行为带来的损害,医疗机构原则上应全部予以赔偿;由于患者本身的原因与医疗过错共同作用造成损失的发生和扩大的,应适用过失相抵规则,适当减轻甚至免除医疗机构的赔偿责任;在精神损害赔偿方面,还应当考虑医疗机构的过错程度和偿付能力等因素,适用衡平原则。     

医疗立法探讨

医疗立法是保障公民健康权的重要途径，是我国卫生法制建设的重要内容，是保证新医改关于医疗服务体系健全和公立医院改革顺利进行的重要保障之一，是依法卫生行政的内在要求。在分析医疗法立法的依据和-原则后，借鉴Et本、德国、台湾医疗立法经验，建议以总则、医疗法人制度、医疗安全保障、病人权益保护、信息公开制度、监督管理体制、法律责任作为医疗法的基本框架，并就我国医疗立法的相关问题进行探讨。     

Distinguishing Race Effects on Pre-Trial Release and Sentencing Decisions

Racial disparities in court dispositions and sentences might reflect systemic biases toward minorities, but they might also stem from race group differences in legal or other extra-legal factors linked to a defendant’s risk for future criminality. Analyses of over 5,000 felony defendants from an urban Ohio jurisdiction revealed that significant main effects of a defendant’s race on release on one’s own recognizance (ROR), bond amounts, and prison sentences were rendered nonsignificant when controlling for legal factors, such as offense severity. Analyses of interaction effects, on the other hand, revealed that African American males age 18–29 experienced lower odds of ROR, higher bond amounts, and higher odds of incarceration in prison relative to other demographic subgroups, even with the inclusion of rigorous controls for legally relevant criteria. The relevance of these findings for understanding disparate treatment at different stages of case processing is discussed.     

试论医疗机构及其医务人员的伦理困境与法律对策——以法定医疗伦理损害责任为背景

在医疗伦理损害责任背景下,医疗机构及其医务人员在具体履行医疗告知义务时、患者(特定情况下其近亲属)知情不同意时、以及面临具体法之局限性时,常常陷于对患者的知情权、生命健康权、自主决定权、乃至自身的法律责任风险进行个人抉择的伦理困境。尽管导致伦理困境的原因是多方面的,但从法律视角来看,制定明确、规范的医疗伦理行为指引,建立解决医疗伦理困境的常设机构,健全医疗风险规避、医疗社会保障和医疗伦理督察制度,应是现实可行的应对之策。     

A normality bias in legal decision making

It is important to understand how legal fact finders determine causation and assign blame. However, this process is poorly understood. Among the psychological factors that affect decision makers are an omission bias (a tendency to blame actions more than inactions [omissions] for bad results), and a normality bias (a tendency to react more strongly to bad outcomes that spring from abnormal rather than normal circumstances). The omission and normality biases often reinforce one another when inaction preserves the normal state and when action creates an abnormal state. But what happens when these biases push in opposite directions as they would when inaction promotes an abnormal state or when action promotes a normal state? Which bias exerts the stronger influence on the judgments and behaviors of legal decision makers? The authors address this issue in two controlled experiments. One experiment involves medical malpractice and the other involves stockbroker negligence. They find that jurors pay much more attention to the normality of conditions than to whether those conditions arose through acts or omissions. Defendants who followed a nontraditional medical treatment regime or who chose a nontraditional stock portfolio received more blame and more punishment for bad outcomes than did defendants who obtained equally poor results after recommending a traditional medical regime or a traditional stock portfolio. Whether these recommendations entailed an action or an omission was essentially irrelevant. The Article concludes with a discussion of the implications of a robust normality bias for American jurisprudence.     

The new JCAHO patient safety standards and the disclosure of unanticipated outcomes. Joint Commission on Accreditation of Healthcare Organizations

This article looks at the newly-issued JCAHO standards and their increased focus on patient safety in performance standards for healthcare organizations. As part of these standards, hospitals are required to inform patients of outcomes of care, including unanticipated outcomes. This article examines this requirement and suggests varying interpretations of it. After looking at the current legal and ethical standards requiring disclosure of errors or negligent acts, the article suggests that hospitals are faced with many difficulties in implementing the standard. Specifically, the article argues that more details are necessary regarding what events must be reported and what hospitals are required to do when members of the medical staff refuse to inform patients of medical error.     

Cybersecurity,safety and robots: Strengthening the link between cybersecurity and safety in the context of care robots

This paper addresses the interplay between robots, cybersecurity, and safety from a European legal perspective, a topic under-explored by current technical and legal literature. The legal framework, together with technical standards, is a necessary parameter for the production and deployment of robots. However, European law does not regulate robots as such, and there exist multiple and overlapping legal requirements focusing on specific contexts, such as product safety and medical devices. Besides, the recently enacted European Cybersecurity Act establishes a cybersecurity certification framework, which could be used to define cybersecurity requirements for robots, although concrete cyber-physical implementation requirements are not yet prescribed. In this article, we illustrate cybersecurity challenges and their subsequent safety implications with the concrete example of care robots. These robots interact in close, direct contact with children, elderly, and persons with disabilities, and a malfunctioning or cybersecurity threat may affect the health and well-being of these people. Moreover, care robots may process vast amounts of data, including health and behavioral data, which are especially sensitive in the healthcare domain. Security vulnerabilities in robots thus raise significant concerns, not only for manufacturers and programmers, but also for those who interact with them, especially in sensitive applications such as healthcare. While the latest European policymaking efforts on robot regulation acknowledge the importance of cybersecurity, many details, and their impact on user safety have not yet been addressed in depth. Our contribution aims to answer the question whether the current European legal framework is prepared to address cyber and physical risks from care robots and ensure safe human–robot interactions in such a sensitive context. Cybersecurity and physical product safety legal requirements are governed separately in a dual regulatory framework, presenting a challenge in governing uniformly and adequately cyber-physical systems such as care robots. We conceptualize and discuss the challenges of regulating cyber-physical systems’ security with the current dual framework, particularly the lack of mandatory certifications. We conclude that policymakers need to consider cybersecurity as an indissociable aspect of safety to ensure robots are truly safe to use.     

Wrongful life actions: the legal and ethical hurdles

This article discusses the various legal and ethical issues arising out of the cause of action for wrongful life. This action involves a claim by a child that but for the negligence of the doctor, hospital or other medical institution, his or her mother would have terminated the pregnancy and he or she would not have been born. The courts have generally rejected this cause of action on the basis of legal, ethical and policy considerations. The author proposes that the legal hurdles can be overcome and that the ethical and policy considerations do not outweigh the desirability of upholding wrongful life claims.