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.

Punitiveness and the criminalisation of the other : State wards, unlawful non-citizens and Indigenous youth

This paper explores the genealogies of bio-power that cut across punitive state interventions aimed at regulating or normalising several distinctive ‘problem’ or ‘suspect’ deviant populations, such as state wards, non-lawful citizens and Indigenous youth. It begins by making some general comments about the theoretical approach to bio-power taken in this paper. It then outlines the distinctive features of bio-power in Australia and how these intersected with the emergence of penal welfarism to govern the unruly, unchaste, unlawful, and the primitive. The paper draws on three examples to illustrate the argument – the gargantuan criminalisation rates of Aboriginal youth, the history of incarcerating state wards in state institutions, and the mandatory detention of unlawful non-citizens and their children. The construction of Indigenous people as a dangerous presence, alongside the construction of the unruly neglected children of the colony — the larrikin descendants of convicts as necessitating special regimes of internal controls and institutions, found a counterpart in the racial and other exclusionary criteria operating through immigration controls for much of the twentieth century. In each case the problem child or population was expelled from the social body through forms of bio-power, rationalised as strengthening, protecting or purifying the Australian population.

Criminalisation and normative theory

Criminal law scholarship is enjoying a renaissance in normative theory, evident in a growing list of publications from leading scholars that attempt to elucidate a set of principles on which criminalisation and criminal law might — indeed should — be based. This development has been less marked in Australia, where a stream of criminologically influenced criminal law scholarship, teaching and practice has emerged over nearly three decades. There are certain tensions between this predominantly contextual, process-oriented and criminological tradition that has emerged in Australia, characterised by a critical approach to the search for ‘general principles’ of the criminal law, and the more recent revival of interest in developing a set of principles on which a ‘normative theory of criminal law’ might be founded. Aspects of this tension will be detailed through examination of recent examples of criminalisation in New South Wales that are broadly representative of trends across all Australian urisdictions. The article will then reflect on the links between these particular features of criminalisation and attempts to develop a ‘normative theory’ of criminalisation.

A common ‘outlawness’ : criminalisation of Muslim minorities in the UK and Australia

Since mass immigration recruitments of the post-war period, ‘othered’ immigrants to both the UK and Australia have faced ‘mainstream’ cultural expectations to assimilate, and various forms of state management of their integration. Perceived failure or refusal to integrate has historically been constructed as deviant, though in certain policy phases this tendency has been mitigated by cultural pluralism and official multiculturalism. At critical times, hegemonic racialisation of immigrant minorities has entailed their criminalisation, especially that of their young men. In the UK following the ‘Rushdie Affair’ of 1989, and in both Britain and Australia following these states’ involvement in the 1990-91 Gulf War, the ‘Muslim Other’ was increasingly targeted in cycles of racialised moral panic. This has intensified dramatically since the 9/11 terrorist attacks and the ensuing ‘War on Terror’. The young men of Muslim immigrant communities in both these nations have, over the subsequent period, been the subject of heightened popular and state Islamophobia in relation to: perceived ‘ethnic gangs’; alleged deviant, predatory masculinity including so-called ‘ethnic gang rape’; and paranoia about Islamist ‘radicalisation’ and its supposed bolstering of terrorism. In this context, the earlier, more genuinely social-democratic and egalitarian, aspects of state approaches to ‘integration’ have been supplanted, briefly glossed by a rhetoric of ‘social inclusion’, by reversion to increasingly oppressive assimilationist and socially controlling forms of integrationism. This article presents some preliminary findings from fieldwork in Greater Manchester over 2012, showing how mainly British-born Muslims of immigrant background have experienced these processes.

A normative approach to the criminalisation of cartel activity

Although cartel behaviour is almost universally (and rightly) condemned, it is not clear why cartel participants deserve the full wrath of the criminal law and its associated punishment. To fill this void, I develop a normative (or principled) justification for the criminalisation of conduct characteristic of ‘hard core’ cartels. The paper opens with a brief consideration of the rhetoric commonly used to denounce cartel activity, eg that it ‘steals from’ or ‘robs’ consumers. To put the discussion in context, a brief definition of ‘hard core’ cartel behaviour is provided and the harms associated with this activity are identified. These are: welfare losses in the form of appropriation (from consumer to producer) of consumer surplus, the creation of deadweight loss to the economy, the creation of productive inefficiency (hindering innovation of both products and processes), and the creation of so-called X-inefficiency. As not all activities which cause harm ought to be criminalised, a theory as to why certain harms in a liberal society can be criminalised is developed. It is based on JS Mill's harm to others principle (as refined by Feinberg) and on a choice of social institutions using Rawls's ‘veil of ignorance.’ The theory is centred on the value of individual choice in securing one's own well-being, with the market as an indispensable instrument for this. But as applied to the harm associated with cartel conduct, this theory shows that none of the earlier mentioned problems associated with this activity provide sufficient justification for criminalisation. However, as the harm from hard core cartel activity strikes at an important institution which permits an individual's ability to secure their own well-being in a liberal society, criminalisation of hard core cartel behaviour can have its normative justification on this basis.

Étude des discours experts sur la régulation et la criminalisation du trafic d'organes

La présente recherche décrit et examine la problématique posée par le trafic d’organes, de tissus et de cellules d’origine humaine, ainsi que les modes de régulation envisagés au niveau mondial pour lutter contre ce trafic, appréhendés sous l’angle de l’analyse de plusieurs conventions et protocoles internationaux et de leurs recommandations. Nous avons sélectionné, analysé et comparé les discours les plus significatifs de quatre types d’organisations internationales, les associations médicales internationales, l’Organisation des Nations Unies, l’Organisation mondiale de la Santé et le Conseil de l’Europe. Nous avons cherché à connaître leur point de vue sur la commercialisation des organes humains et plus spécifiquement sur le trafic des organes humains, à travers 17 textes que ces acteurs ont produit de 1987 jusqu’en 2014. L’analyse de ces discours experts révèle que la perspective éthique domine l’ensemble des documents. Elle met en évidence les convergences des discours sur la nécessité d’adopter une double stratégie fondée à la fois sur la prévention et la criminalisation du trafic d’organes ainsi que sur l’analyse du lien existant entre la pénurie croissante d’organes et l’avènement du trafic d’organes. Les discours sur la régulation et la criminalisation ont évolué vers un degré de précision et de complexification de la notion du trafic d’organes, une notion qui reste encore peu consensuelle dans sa définition. Quant aux stratégies, il faut observer que l’évolution des discours est assez significative et inégale à ce chapitre. C’est surtout dans les discours experts produits à partir des années 2000 que nous retrouvons des propositions plus concrètes sur les stratégies. La régulation des transactions financières, notamment par les balises de pratiques médicales et celles des intermédiaires, ainsi que les prescriptions entourant le consentement forment les deux types de stratégies les plus souvent mises de l’avant par les experts, toutes organisations confondues. Au fil de l’analyse des textes sur la régulation il est possible d’entrevoir des nuances et des brèches dans le principe d’interdiction de la commercialisation des organes humains, plus précisément en ce qui concerne les types d’organes, de tissus ou de cellules.