The criminalisation of medical mistakes in Canada : a review

The issue of health professionals facing criminal charges of manslaughter or criminal negligence causing death or grievous bodily harm as a result of alleged negligence in their professional practice was thrown into stark relief by the recent acquittal of four physicians accused of mismanaging Canada’s blood system in the early 1980s. Stories like these, as well as international reports detailing an increase in the numbers of physicians being charged with (and in some cases convicted of) serious criminal offences as the result of alleged negligence in their professional practice, have resulted in some anxiety about the apparent increase in the incidence of such charges and their appropriateness in the healthcare context. Whilst research has focused on the incidence, nature and appropriateness of criminal charges against health professionals, particularly physicians, for alleged negligence in their professional practice in the United Kingdom, the United States, Japan, and New Zealand, the Canadian context has yet to be examined. This article examines the Canadian context and how the criminal law is used to regulate the negligent acts or omissions of a health care professional in the course of their professional practice. It also assesses the appropriateness of such use. It is important at this point to state that the analysis in this article does not focus on those, fortunately few, cases where a health professional has intentionally killed his or her patients but rather when patients’ deaths or grievous injuries were allegedly as a result of that health professional’s negligent acts or omissions when providing health services to that patient.

Zaburoni HIV case: The law can sometimes be an ass, but not in this case

Lana Nowakowski's opinion piece on the High Court decision in the Zaburoni HIV case attacks "Queensland's absurd necessity to prove intention on transmission" and argues that "changes to the law are long overdue". Both claims are wrong...

Consent as a Common Law Defence to Non-Sexual Assaults: The Effect of Neal v The Queen

The following discussion is an exposition of the recognised exceptions to the general rule that the law will not sanction the giving of a lawful consent to the application or threat of actual or grievous bodily harm. The discussion will also focus on a series of decisions in the UK and Australia, particularly Neal v The Queen, that have altered the law's approach to these exceptions and, more importantly, now permit a personto give an informed consent to the risk of contracting HIV or any other sexually transmitted diseases, provided there was no intention on the part of the accused to actually infect the other person. The underlying rationale for sanctioning an informed consent to such a risk is that consenting adults should be accorded the utmost autonomy in conductingtheir private affairs, and particularly so in the context of the choices they make regarding their private sexual activities. Whether one agrees or disagrees with the notion of allowing one to lawfully consent to such a risk, it raises an important question as to the current status of the general rule that one cannot generally give an informed consent to the applicationor threat of actual or grievous bodily harm. More succinctly stated, if the law is prepared to allow an informed consent to the risk of contracting a potentially fatal disease, then what remains of what had previously been a well-settled rule that, save for a few well-recognised exceptions, persons were generally prohibited from consenting to the application or threat of actual or grievous bodily harm?

Ograniczona względami ekonomicznymi dostępność świadczeń zdrowotnych a naruszenie przez lekarza reguł ostrożności

Odpowiedzialność karną lekarza łączy się powszechnie z problematyką błędu medycznego, choć właściwie odpowiada on nie za sam błąd medyczny, jako że prawo karne nie zna przestępstwa polegającego na popełnieniu błędu medycznego, ale za ewentualne jego skutki, które mogą być kwalifikowane jako nieumyślne spowodowanie śmierci, nieumyślne spowodowanie ciężkiego, średniego albo lekkiego uszczerbku na zdrowiu bądź nieumyślne narażenie na niebezpieczeństwo utraty życia albo ciężkiego uszczerbku na zdrowiu. Nie można oczywiście wykluczyć wystąpienia sytuacji, w której lekarz swoim zachowaniem zrealizowałby znamiona typu umyślnego, jednakże na potrzeby niniejszej publikacji przyjęto, że co do zasady lekarz działa w celu ratowania dóbr prawnych, jakimi są życie i zdrowie pacjenta, nie zaś z zamiarem narażenia ich na niebezpieczeństwo bądź naruszenia, a ewentualne negatywne skutki dla życia i pacjenta, powstałe w miejsce lub obok zamierzonego stanu rzeczy, nie są przez niego objęte umyślnością. Kluczowym warunkiem uznania, że czyn popełniony został nieumyślnie jest ustalenie, że sprawca naruszył reguły ostrożnego postępowania, wymagane w danych okolicznościach. W odniesieniu do zawodu lekarza na pierwszy plan wysuwa się wśród nich wymóg stosowania się do wskazań aktualnej wiedzy medycznej. Autorka przekłada ten obowiązek na grunt realiów systemu ochrony zdrowia i rozważa, jaki wpływ na jego niedopełnienie mają okoliczności ograniczonej względami ekonomicznymi dostępności świadczeń zdrowotnych oraz w jaki sposób niedostatek środków finansowych może rzutować na naruszenie przez lekarza reguł ostrożnego postępowania, o których mowa w art. 9 § 2 Kodeksu karnego.

The Right to a Fair Fight: Sporting Lessons on Consensual Harm

This article critically assesses the criminal law on consensual harm through an examination of the legality of fighting sports. The article begins by considering fighting sports such as bare-fisted prize fighting (dominant in the nineteenth century). It then, in historical chronology, examines the legality of professional boxing with gloves (dominant in the twentieth century). Doctrinally, the article reviews why and how, in a position adopted by the leading common law jurisdictions, fighting sports benefit from an application of the “well-established” category-based exceptions to the usual bodily harm threshold of consent in the criminal law. Centrally, fighting sports and doctrinal law on offenses against the person are juxtaposed against the theoretical boundaries of consent in the criminal law to examine whether and where the limit of the “right to be hurt” might lie. In sum, this article uses fighting sports as a case study to assess whether the criminal law generally can or should accommodate the notion of a fair fight, sporting or otherwise, predicated on the consent of the participants to the point that the individuals involved might be said, pithily, to have extended an open invite to harm.

Notas dispersas sobre algumas normas do C.P.

In this paper it is made a reflection on some rules of the Portuguese Criminal Code. First it is made an analysis of some aspects related to the crime of simple bodily harm, in particular on its public or semi public nature. Thereto, some aspects regarding articles 143, 145 and 146 of the portuguese Criminal Code have to be taken under consideration. Then, in the context of crimes against property, it is analised the legal institute referred to in paragraph 1. of article 206 (restitution or compensation), as well as it subjective scope.

Attacking human implants: a new generation of cybercrime

Human ICT implants, such as RFID implants, cochlear implants, cardiac pacemakers, Deep Brain Stimulation, bionic limbs connected to the nervous system, and networked cognitive prostheses, are becoming increasingly complex. With ever-growing data processing functionalities in these implants, privacy and security become vital concerns. Electronic attacks on human ICT implants can cause significant harm, both to implant subjects and to their environment. This paper explores the vulnerabilities which human implants pose to crime victimisation in light of recent technological developments, and analyses how the law can deal with emerging challenges of what may well become the next generation of cybercrime: attacks targeted at technology implanted in the human body. After a state-of-the-art description of relevant types of human implants and a discussion how these implants challenge existing perceptions of the human body, we describe how various modes of attacks, such as sniffing, hacking, data interference, and denial of service, can be committed against implants. Subsequently, we analyse how these attacks can be assessed under current substantive and procedural criminal law, drawing on examples from UK and Dutch law. The possibilities and limitations of cybercrime provisions (eg, unlawful access, system interference) and bodily integrity provisions (eg, battery, assault, causing bodily harm) to deal with human-implant attacks are analysed. Based on this assessment, the paper concludes that attacks on human implants are not only a new generation in the evolution of cybercrime, but also raise fundamental questions on how criminal law conceives of attacks. Traditional distinctions between physical and non-physical modes of attack, between human bodies and things, between exterior and interior of the body need to be re-interpreted in light of developments in human implants. As the human body and technology become increasingly intertwined, cybercrime legislation and body-integrity crime legislation will also become intertwined, posing a new puzzle that legislators and practitioners will sooner or later have to solve.

Violência doméstica: análise das lesões em mulheres

Este estudo tem como objetivo avaliar a prevalência de lesões de cabeça e pescoço em mulheres, frente aos inquéritos policiais registrados como lesão corporal e maus-tratos na Delegacia de Defesa da Mulher de Araçatuba, São Paulo, Brasil, no ano de 2002. Foram totalizados 204 inquéritos policiais no ano de 2002, e destes extraídos 33 laudos periciais referentes aos crimes de lesões corporais e maus-tratos em mulheres. Analisou-se nos laudos médicos da perícia, aspectos relativos à idade das vítimas e local das lesões por elas apresentadas na ocasião do exame. Os resultados encontrados revelam que as agressões ocorrem em faixas etárias diversas, com predominância na infância e adolescência. Além disso, ocorreu a maior prevalência de lesões na região da cabeça e pescoço, área de atuação do cirurgião-dentista que necessita estar preparado para atender, entre outros, o paciente vítima de violência.

Le mariage forcé de femmes immigrantes au Québec

Cette thèse a pour objet de comprendre la question du mariage forcé vécu par des femmes immigrantes vivant au Québec et, les réponses politiques, législatives et sociales qu’on y apporte. De façon plus spécifique, il s’agit de mettre à jour la diversité des situations et des significations que recouvre la notion de mariage forcé pour tenter d’en dégager des éléments de définition et de compréhension. La thèse vise également à identifier les conséquences spécifiques qui découlent d’un mariage forcé pour les femmes immigrantes vivant au Québec, et enfin, d’analyser les réponses politiques, législatives et sociales visant le mariage forcé au Canada et au Québec afin de prévenir, dépister et d’en protéger ses victimes en contexte interculturel. S’appuyant sur un corpus de dix entrevues avec des femmes immigrantes vivant, ayant vécu ou menacées d’un mariage forcé et de dix-huit informateurs clés intervenant auprès d’elles et provenant de différents milieux de pratique (police, justice, santé services sociaux et communautaires), une analyse intersectionnelle a permis de révéler toute la complexité des mariages forcés due notamment aux interrelations entre des systèmes d’oppression et des vulnérabilités multiples. La recension des écrits et nos résultats indiquent que certains éléments caractérisent les mariages forcés. Premièrement, la préservation de l’honneur patriarcal qui problématise et contrôle le comportement des femmes en ce qui à trait notamment à leur vie sexuelle, mais aussi sociale. Deuxièmement, le fait que le mariage forcé soit un moyen de poursuivre des intérêts plus souvent collectifs qu’individuels. Dimension collective qui devra nécessairement être prise en considération lors des solutions à apporter à cette problématique. Troisièmement, le rôle des femmes (mères, belles-mères et autres femmes de la communauté culturelle d’appartenance) dans l’arrangement des mariages, mais également dans la surveillance et le contrôle de tous les faits et gestes des autres femmes. i Quatrièmement, le potentiel d’agresseurs multiples, y compris la communauté elle-même, dans les actes de violence commis avant, pendant et, le cas échéant, après le mariage. Une autre dimension qui devra elle aussi être prise en compte lors de l’inter- vention. Cinquièmement, le potentiel d’exploitation sexuelle (viol conjugal, grossesses forcées), physique (mauvais traitements, blessures), psychologique (pressions, manipulations) ou encore économique (travail forcé, privation d’autonomie financière). L’ensemble de ces résultats a permis de cerner certains besoins liés à l’intervention, en terme de prévention, de dépistage et de protection des victimes de mariage forcé.

Le mariage forcé de femmes immigrantes au Québec

Cette thèse a pour objet de comprendre la question du mariage forcé vécu par des femmes immigrantes vivant au Québec et, les réponses politiques, législatives et sociales qu’on y apporte. De façon plus spécifique, il s’agit de mettre à jour la diversité des situations et des significations que recouvre la notion de mariage forcé pour tenter d’en dégager des éléments de définition et de compréhension. La thèse vise également à identifier les conséquences spécifiques qui découlent d’un mariage forcé pour les femmes immigrantes vivant au Québec, et enfin, d’analyser les réponses politiques, législatives et sociales visant le mariage forcé au Canada et au Québec afin de prévenir, dépister et d’en protéger ses victimes en contexte interculturel. S’appuyant sur un corpus de dix entrevues avec des femmes immigrantes vivant, ayant vécu ou menacées d’un mariage forcé et de dix-huit informateurs clés intervenant auprès d’elles et provenant de différents milieux de pratique (police, justice, santé services sociaux et communautaires), une analyse intersectionnelle a permis de révéler toute la complexité des mariages forcés due notamment aux interrelations entre des systèmes d’oppression et des vulnérabilités multiples. La recension des écrits et nos résultats indiquent que certains éléments caractérisent les mariages forcés. Premièrement, la préservation de l’honneur patriarcal qui problématise et contrôle le comportement des femmes en ce qui à trait notamment à leur vie sexuelle, mais aussi sociale. Deuxièmement, le fait que le mariage forcé soit un moyen de poursuivre des intérêts plus souvent collectifs qu’individuels. Dimension collective qui devra nécessairement être prise en considération lors des solutions à apporter à cette problématique. Troisièmement, le rôle des femmes (mères, belles-mères et autres femmes de la communauté culturelle d’appartenance) dans l’arrangement des mariages, mais également dans la surveillance et le contrôle de tous les faits et gestes des autres femmes. i Quatrièmement, le potentiel d’agresseurs multiples, y compris la communauté elle-même, dans les actes de violence commis avant, pendant et, le cas échéant, après le mariage. Une autre dimension qui devra elle aussi être prise en compte lors de l’inter- vention. Cinquièmement, le potentiel d’exploitation sexuelle (viol conjugal, grossesses forcées), physique (mauvais traitements, blessures), psychologique (pressions, manipulations) ou encore économique (travail forcé, privation d’autonomie financière). L’ensemble de ces résultats a permis de cerner certains besoins liés à l’intervention, en terme de prévention, de dépistage et de protection des victimes de mariage forcé.

Adolescent protective behaviour to reduce drug and alcohol use, alcohol-related harm and interpersonal violence

Typically adolescents' friends are considered a risk factor for adolescent engagement in risk-taking. This study took a more novel approach, by examining adolescent friendship as a protective factor. In particular it investigated friends' potential to intervene to reduce risk-taking. 540 adolescents (mean age 13.47 years) were asked about their intention to intervene to reduce friends' alcohol, drug and alcohol-related harms and about psychosocial factors potentially associated with intervening. More than half indicated that they would intervene in friends' alcohol, drug use, alcohol-related harms and interpersonal violence. Intervening was associated with being female, having friends engage in overall less risk-taking and having greater school connectedness. The findings provide an important understanding of increasing adolescent protective behavior as a potential strategy to reduce alcohol and drug related harms.

Data Report No. 1 : Self-harm Including Suicide

This report focuses on our examination of extant data which have been sourced with respect to self-harm and suicide in Australia. Moreover, specific areas of concern regarding elevated rates of suicide for rural males and data anomalies which emerged during our examination of these data are discussed. Additional commentary resulting from exploration, examination and analyses of secondary data is published online in complementary reports in this series.

Does research into sensitive areas do harm? Experiences of research participation after a child’s diagnosis with Ewing’s Sarcoma

Objective: To investigate family members’ experiences of involvement in a previous study (conducted August 1995 to June 1997) following their child’s diagnosis with Ewing’s sarcoma. Design: Retrospective survey, conducted between 1 November and 30 November 1997, using a postal questionnaire. Participants: Eighty-one of 97 families who had previously completed an in-depth interview as part of a national case–control study of Ewing’s sarcoma. Main outcome measures: Participants’ views on how participation in the previous study had affected them and what motivated them to participate. Results: Most study participants indicated that taking part in the previous study had been a positive experience. Most (n = 79 [97.5%]) believed their involvement would benefit others and were glad to have participated, despite expecting and finding some parts of the interview to be painful. Parents whose child was still alive at the time of the interview recalled participation as more painful than those whose child had died before the interview. Parents who had completed the interview less than a year before our study recalled it as being more painful than those who had completed it more than a year before. Conclusions: That people suffering bereavement are generally eager to participate in research and may indeed find it a positive experience is useful information for members of ethics review boards and other “gatekeepers”, who frequently need to determine whether studies into sensitive areas should be approved. Such information may also help members of the community to make an informed decision regarding participation in such research.