Consider the following hypothetical scenario: A patient suffering constant abdominal pain is referred to State Hospital A from her local clinic after not responding to simple analgesics for chronic pelvic pain associated with irregular menstruation. The doctors at State Hospital A discover that she has a suspicion of adenomyosis. She gives written informed consent for a hysterectomy. During routine postoperative check-ups she reports no alleviation of the pelvic pain, urinary frequency along with burning on micturition and a persistent vaginal discharge. (...) Preoperatively, she was not told that the surgeons had inserted a surgical mesh to prevent vault prolapse. She is given antibiotics and further simple analgesia. As her symptoms do not improve she self-refers to State Hospital B. She is informed that she needs a CAT scan. However, the hospital’s scanner has been out of order for three years. She is advised to go to State Hospital C, where the scanner works, but is not given a referral note. She is told by Hospital C that the doctors are too busy to see her, and as she does not have an appointment, and is not an emergency case she should go back to Hospital A. She does not want to go back to Hospital A, as during her last visit there, nursing staff accused her of being a nuisance and escorted her off the premises. She approaches Private Hospital D, where her abdomen and pelvis are scanned. The scan shows the surgical mesh inside her pelvis which had disintegrated. She is told that it is too risky to remove all the fragments, but that some could be removed at a cost - which she could not afford. The surgeon refers her back to State Hospital A with a referral note and copy of the CAT scan report. (shrink)

Background: Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly understood. -/- (...) Methods: 12 facilitators were interviewed from 10 Canadian medical tourism companies. -/- Results: Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry. -/- Conclusion: Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles. (shrink)

Political contestability is an important issue in the ethical analysis of corporate political activity (hereafter CPA). Though previous studies have proposed analytical frameworks for creating contestable political systems, these studies conceive firm-level factors such as size and wealth as the main (and perhaps, only) determinants of contestability. This relegates the influences of informal managerial-level attributes such as tribalism, especially in ethnically diverse contexts where politics and tribe are inseparable. In this article, I explore the linkages between managers’ tribal identity and (...) political contestability among firms in Ghana. I found that contestability is affected by _tribal consonance_ (similarity) and _tribal dissonance_ (difference) between corporate executives and policymakers. I also found that dissonance creates _liability of tribe_, which causes contestability problems in all four stages of the CPA process—i.e., _political planning_, _political access, political voice_, and _political influence_. Overall, this article extends the micro–macro link of political connections from performance to the ethics of political competition and contestability. It offers important contributions to the literature, advances insightful implications for practice, and outlines useful future research directions. (shrink)

This paper offers an economic analysis of one aspect of the possible liability for incorrect information traded on information markets: expert liability for incorrect asset valuation. The article does not address the questions of whether and under what circumstances an expert should bear contractual liability for an incorrect valuation. Rather, it assumes such contractual liability towards the person who has solicited the opinion and focuses instead on analyzing the circumstances under which the expert’s liability should (...) be extended to third parties as well. (shrink)

Legal acts of the Republic of Lithuania establish several types of material liability of workers engaged in labour (professional) relations: material liability applied pursuant to the Labour Code of the Republic of Lithuania (hereinafter referred to as the LC) and material liability applied pursuant to the Law on Public Service of the Republic of Lithuania (hereinafter referred to as the LPC). In the present article, theoretical and practical aspects of material liability of Lithuanian public servants for (...) material damage caused are analysed. The authors of the article study the conditions for the application of the material liability and identify the main circumstances that must be determined in applying this type of legal compulsion. Furthermore, the authors investigate the relation between the material and disciplinary liabilities, study the limits of the application of labour law norms (that regulate material liability of employees) and civil law norms (regulating personal civil liability) in professional legal relations, identify the means and procedure for solving disputes arising in the application of the material liability. Practical mistakes in the application of the material liability of public servants and violations are analysed on the basis of a rather sparse case-law of the Supreme Administrative Court of Lithuania related to the material liability. (shrink)

Criminal liability of legal entities was legitimized in the Republic of Lithuania eight years ago, and in the ruling of the Constitutional Court of 8 June 2009, a conclusive confirmation on its accordance with the Constitution was made. It should be noted that the extension of the concept of criminal offense subject has received considerable attention of Lithuanian scientists. It was obvious that this penal law novel would cause many problems and, surely, it has become a reason of many (...) doubts in the judicial practice. However, despite the fact that a fairly broad scientific analysis of the topic under consideration has been made, none of the Lithuanian authors has ever addressed the issue regarding the sources of the criminal liability of legal entities. (shrink)

The practice of nonphysician ethicist-consultants giving ethics advice concerning the appropriate medical treatment of patients in hospitals is a relatively recent development. Although only a minority of hospitals make substantial use of any formal ethics consulting service, the number is growing and apparently will continue to do so. Indeed, at least among urban teaching hospitals, some sort of ethics consulting service is increasingly commonplace.

The United Nations’ Sustainable Development Goals (UN-SDGs) offer a comprehensive framework for global sustainable development, embraced by both UN member states and multinational enterprises (MNEs). The SDGs take a holistic approach and emphasize the need to align public- and private-sector actions. However, understanding the effectiveness of the SDG framework in coordinating stakeholder actions remains a challenge. This study explores how MNEs engage with the SDGs as a function of their home countries’ SDG profiles. Leveraging institutional theory, we test competing mechanisms (...) by analyzing sustainability reports from 150 MNEs across 23 countries. Our results suggest that MNEs’ engagement with the SDGs aligns most closely with a “liability of origin” explanation, with firms showing greater SDG engagement when their home countries have lower progress on the SDGs. However, at the individual SDG level, the engagement patterns are more nuanced. Our findings have important implications for both theory and practice, providing insights into the complex dynamics that shape MNEs’ engagement with the SDGs and offering guidance for policymakers and businesses seeking to enhance their contributions to sustainable development. (shrink)

One of the most striking features of Athenian laws regulating commercial activities is the absence of any concept akin to the modern legal notion of the partnership or corporation. Despite the presence in Athenian society of numerous koinoniai, groups of individuals cooperating for some purpose, be it commercial or otherwise, Athenian law concerned itself solely with individual persons and did not recognize the separate legal existence of collective entities. And just as Athenian law did not recognize the legal existence of (...) partnerships or corporations, it also did not possess the notion of corporate liability. This meant that if someone entered into an agreement with a group of individuals and one of those individuals violated the terms of the agreement, the plaintiff proceeded only against the individual who acted contrary to the agreement, not against the group as a whole. If the plaintiff won his suit, he only had a right to receive compensation from the defendant's private property; he did not have a claim on all the funds held in common by the group. (shrink)

McMahan argues that justification defeats liability to defensive attack (which would undermine the thesis of the "moral equality of combatants"). In response, I argue, first, that McMahan’s attempt to burden the contrary claim with counter-intuitive implications fails; second, that McMahan’s own position implies that the innocent civilians do not have a right of self-defense against justified attackers, which neither coheres with his description of the case (the justified bombers infringe the rights of the civilians) nor with his views about (...) rights forfeiture, is unsupported by independent argument, and, in any case, extremely implausible and counter-intuitive; and third, that his interpretation of the insulin case confuses the normative relations between an agent’s justification and non-liability on the one hand and permissible or impermissible interference with the agent’s act on the other. Similar confusions, fourth, affect his discussion of liability to compensation. (shrink)

The issue of the biological origin of consciousness is linked to that of its function. One source of evidence in this regard is the contrast between the types of information that are and are not included within its compass. Consciousness presents us with a stable arena for our actions—the world—but excludes awareness of the multiple sensory and sensorimotor transformations through which the image of that world is extracted from the confounding influence of self-produced motion of multiple receptor arrays mounted on (...) multijointed and swivelling body parts. Likewise excluded are the complex orchestrations of thousands of muscle movements routinely involved in the pursuit of our goals. This suggests that consciousness arose as a solution to problems in the logistics of decision making in mobile animals with centralized brains, and has correspondingly ancient roots. (shrink)

This article makes a comparative examination of the widening spectrum of cases in which both tort law and contract law are employed, jointly or separately, to impose non-consensual liability on a contracting party. The article focuses on liability imposed on a contracting party either toward another contracting party or toward a third party for failure to perform an obligation that, on the one hand, is predicated on and arises from the contract, but, on the other hand, does not (...) genuinely originate in the consent of the liable party because it is external to her genuine intention. The primary objective of this article is to propose general guidelines for either choosing between tort law and contract law when imposing non-consensual liability on a contracting party or else allowing liability under both headings. These guidelines for the classification of non-consensual liability also bear on the preliminary question of whether to impose non-consensual liability at all and on the delicate interplay between contract and tort in general and particularly when the two lead to conflicting legal outcomes. (shrink)

Alisdair MacIntyre argues that the virtues necessary for good work are everywhere and always embodied by particular communities of practice. As a general surgeon, MacIntyre’s work has deeply influenced my own understanding of the practice of good surgery. The task of this essay is to describe how the guild of surgeons functions as a more-or-less coherent tradition of moral enquiry, embodying and transmitting the virtues necessary for the practice of good surgery. Beginning with an example of surgeons engaged (...) in a process of moral discernment, I describe how the practice of surgery depends on the cultivation of a certain kind of practical wisdom (phronesis) that effectively orders the techniques of surgery toward particular notions of human flourishing within the limits of what is possible with the particular body on which the surgeon operates. I then argue that one reason why surgeons train in an apprenticeship model of "residency" is to cultivate not only the technical skill but also the practical wisdom to perform good surgery. I conclude by noting that the surgical profession is enduring necessary, but unprecedented, changes in the way it practices and transmits its art; and without deliberate and sustained attention to the character formation of surgeons, the profession runs the risk of creating excellent technicians who are nonetheless ill-equipped to practice wise and good surgery. (shrink)

In “Bioethics and the Moral Authority of Experience,” Ryan Nelson et al. (2022) argue that personal experience can simultaneously be an asset and a liability in the practice of bioethics and medici...

There is currently a stalemate over the correct approach to legal liability. To take a prominent example, it remains a point of contention whether land owners should be held liable for injuries to trespassers. Many of those who insist that land owners should be held liable for injuries to trespassers maintain this for purely economic or pragmatic reasons. In contrast, those on the other side frequently defend their view on the grounds that, in such trespass cases, owners are not (...) morally responsible for the injuries. We maintain that the best way forward for all parties in this debate is to recognize the existence of “morally responsible liability ”—of cases where owners qua owners are morally responsible for damages caused by their property. Once this is recognized, the debate can be framed in terms of whether there are economic or pragmatic reasons for legal liability to diverge from morally responsible liability. Unfortunately, there is no good account of morally responsible liability in the literature. Taking lessons from the failings of the few extant accounts, we draw on the work of A. M. Honoré and Jeremy Waldron to develop an account of our own. We argue that owners are morally responsible for damages caused by their property when and because their taking ownership of something leads to increased risk to others. We explain how and why such increases in risk come about, and how our account captures our intuitions concerning various cases, including those concerning injuries to trespassers. (shrink)

To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2–3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with relatively (...) minor afflictions, thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They now seem to treat more in accordance with patients’ preferences and less in accordance with medical need. Market reforms do affect medical professional principles, and it is doubtful whether these changes were intended when Dutch policy makers decided to introduce market elements in the health care system. Policy makers in other countries considering similar reforms should pay attention to these results. (shrink)

Hannah James makes a persuasive case for the use of donated bodies and body parts in surgical training, enabling high fidelity training, improved competency of surgeons and reduced risk of harm to patients from trainees ‘learning on the job’.1 She also identifies some pertinent ethical questions that arise from this practice that should be considered by training organisations, regulatory authorities and the trainees themselves. Many countries throughout the world have regulated programmes, governed by strict ethical principles, for donating bodies, (...) usually to academic institutions for the purposes of medical education.2 In the UK the Human Tissue Authority sets out guiding principles for institutions licensed to handle human tissue including donation of bodies for anatomical examination, education and research; consent, dignity, quality, and honesty and openness.3 The Nuffield Council on Bioethics, in its 2011 report, Human Bodies: donation for medicine and research, identified a number of relevant ethical values including autonomy, altruism, justice, dignity, reciprocity, maximising welfare, and honesty and respect.4 While this report did not focus specifically on donation of human tissue for education and training the principles identified are equally relevant in this context. In terms of maximising welfare whole body donation for education and training provides benefit to many patients over a relatively short time frame …. (shrink)

Video recording is widely available in modern operating rooms. Here, I argue that, if patient consent and suitable technology are in place, video recording of surgery is an ethical duty. I develop this as aduty to protect,arguing for professional and institutional duties, as distinguished forduties of rescue.A professional duty to protect is described in mental healthcare. Practitioners have to take reasonable steps to prevent serious, foreseeable harm to their clients and others, even if that entails a non-consensual breach of confidentiality. (...) I argue surgeons have a similar duty to patients which means that, provided the patient consents, surgery should be routinely videoed. This avoids non-consensual breaches of patient confidentiality and is aligned with stated professional obligations.An institutional duty to protect means institutions have to take reasonable steps to prevent serious, foreseeable harm at the hands of their surgeons. Rulli and Millum highlighted how institutions can meet their duty using a more consequentialist approach that balances wider interests.To test the force and scope of such duties, I examine potential impacts of routine videoing on aspects of autonomy, justice, beneficence and non-maleficence. I find routine videoing can benefit areas including safety, candour, consent and fairness in access (to surgical careers and expertise). Countervailing claims, for example, on liability, confidentiality and privacy can be resisted—such that where consent and the technology are in place, routine videoing meets aduty of easy protection. In other words, its use should be standard of care. (shrink)

Cigarette smoke is by far the leading preventable cause of death and disease in the United States. It has been estimated to kill between 419,000 and 589,000 smokers and up to 65,000 non-smokers each year. This premier status is hardly a new development, having been true for most of the last century, and known to be true at least since the first Surgeon General’s Report in 1964.Why then are tobacco products exempt from any significant federal oversight or control? Why do (...) cigarette advertisements, pitched to young smokers and non-smokers, continue to be plastered on every available surface inside and outside many convenience stores and to adorn the pages of popular magazines? Why, decades since the makers of far less dangerous products began to be held accountable in tort law, was the first payment by a cigarette company on a products liability judgment not made until 2001? (shrink)

This paper explores the role of ideology in attempts to influence public policy and in business representation in the EU–China solar panel anti-dumping dispute. It exposes the dynamics of international activity by emerging-economy multinationals, in this case from China, and their interactions in a developed-country context. Theoretically, the study also sheds light on the recent notion of ‘liability of origin’, in addition to the traditional concept of ‘liability of foreignness’ explored in international business research, in relation to firms’ (...) market and political strategies and their institutional embeddedness in home and host countries. Through a qualitative analysis of primary and secondary materials and interview data with key protagonists, we provide a detailed evolution of the case, the key actors involved and their positions, arguments and strategies. This illustrates the complexities involved in the interaction between markets and ideologies in the midst of debates regarding different forms of subsidy regimes for renewable energy, free trade versus protectionist tendencies by governments, and the economic and sustainability objectives of firms and societies. The case shows how relative newcomers to the EU market responded to overcome a direct threat to their business and became, with support from their home government, active participants in the public debate through interactions with local commercial partners and non-governmental organisations. Firms adopted relatively sophisticated strategies to reduce their liabilities vis-à-vis host-country institutions and local stakeholders, including collective action, to increase their legitimacy and reputation, and counter ideologically based attacks. We also discuss implications and limitations. (shrink)

The problem of history in Nietzsche’s second Unfashionable Observation is best approached through that which it is supposed to serve: life, more specifically human life. I argue that Nietzsche presents an oblique but nevertheless complete articulation of the nature of the human soul as consisting of two basic parts, of desiring (the unhistorical) and memory (the historical): of a multiplicity of desires that struggle for domination over the others, and which express themselves in more complex ways through memory-based structures such (...) as conscience. I then discuss some implications of this conception. First, I interpret the significance of the useful kinds of history: rather than being different modes of historical science, they are much more basic modes of practical relating to the matters of our world (especially to other humans and their ways of life) that are external to us both temporally and spatially. Second, I discuss the particular kinds of desires which underpin the three useful kinds of history. Third, I interpret the problem of scientific history as arising from a turning of the normal human structures of meaningfulness against themselves, and as resulting in two specific kinds of psychic damage: to our capacity for growth and self-cultivation, and to our will to do so at all. Finally, I show the importance of the erotic-historic soul for the questions of right and wrong methods of self-knowledge and for the meaning of the imperative “sei du selbst!” that we find in Schopenhauer as Educator. (shrink)

Who is responsible when an AI machine causes something to go wrong? Or is there a gap in the ascription of responsibility? Answers range from claiming there is a unique responsibility gap, several different responsibility gaps, or no gap at all. In a nutshell, the problem is as follows: on the one hand, it seems fitting to hold someone responsible for a wrong caused by an AI machine; on the other hand, there seems to be no fitting bearer of responsibility (...) for this wrong. In this article, we focus on a particular (aspect of the) AI responsibility gap: it seems fitting that someone should bear the legal consequences in scenarios involving AI machines with design defects; however, there seems to be no such fitting bearer. We approach this problem from the legal perspective, and suggest vicarious liability of AI manufacturers as a solution to this problem. Our proposal comes in two variants: the first one has a narrower range of application, but can be easily integrated in current legal frameworks; the second one requires a revision of current legal frameworks, but has a wider range of application. The latter variant employs a broadened account of vicarious liability. We emphasise strengths of the two variants and finally highlight how vicarious liability offers important insights for addressing a moral AI responsibility gap. (shrink)

The object of this study is the legal framework for the sale or purchase of company shares when the goal of the transaction is the sale of a business. The impact of such transactions on Lithuanian economic development underlines the importance of this study. The recent wave of mergers and acquisitions in Lithuania is likely to substantially increase the number of related legal disputes as well. Legislation on the purchase and sale of company shares and the resulting transfer of business (...) has been enacted in Lithuania only recently. The regulation of such cases remains rather unclear, few cases have been brought to court, and the topic has been barely addressed by legal scholarship in Lithuania to date. It is unclear whether the fact that the real purpose of the transaction is not a simple reassignment of company shares, but business transfer, results in any differences in the interpretation and application of the law. An especially delicate question, raised in Lithuania and other European countries, is whether the buyer may submit a warranty claim to the seller regarding the business acquired. (shrink)

In 2021, there was a significant amendment to the legislation on medical experimentation. In particular, Chapter 4 of the Law of December 5, 1996 on the Profession of Physician and Dentist (Journal of Laws 2023, item 1516) was amended, in which the prerequisites of legally relevant consent given by the participant in the experiment or by other entities that express a position on their behalf were specified. In addition, procedures related to the opinion of the research project by the so-called (...) bioethics committee were described. Its members were obliged to maintain confidentiality with regard to information obtained in connection with the fulfilled function. These norms became protected by criminal sanctions, set forth in the amended Article 58 of the law. New generic types of criminal acts were introduced, primarily aimed at protecting the participant's right to self-determination, the voluntariness of participation in the experiment, and the confidentiality of data submitted by the experimenters in their proposals to bioethics committees. These norms fill in the gaps that have existed so far in the criminal law protection of these values. The article systematically discusses the generic types of criminal acts that have been penalized in Article 58 (4) to (6) of the referenced law. Their object of protection, object side, subject, subject side, punishability and potential confluence with other regulations are presented. The historical-dogmatic justification for the introduction of these regulations is also shown. (shrink)

Questions regarding the moral responsibility of Internet accessand service providers relating to information on the Internetcall for a reassessment of the ways in which we think aboutattributing blame, guilt, and duties of reparation andcompensation. They invite us to borrow something similar to theidea of strict liability from the legal sphere and to introduceit in morality and ethical theory. Taking such a category in thedistribution of responsibilities outside the domain of law andintroducing it into ethics, however, is a difficult thing. (...) Doingso seems to conflict with some broadly shared and deeply feltintuitions regarding the individuality of responsibility and therelationship between responsibility and guilt. These convictionscoincide with some basic ideas in Kantian moral theory and theascriptive theory based on these ideas. Nevertheless, theproblems to which the proposed liabilities / responsibilitiesrelate are so serious that they do not seem to leave room foraloofness. At least, they encourage us to reconsider the idea ofstrict liability carefully and to assess its merits. (shrink)

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results (...) show that while nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way they function as clinical ethicists. (shrink)

The Moral Responsibility Account of Liability to Defensive Harm (MRA) states that an agent becomes liable to defensive harm if, and only if, she engages in a foreseeably risk-imposing activity that subsequently threatens objectively unjustified harm. Advocates of the account contend that liability to defensive harm is best understood as an aspect of distributive justice. Individuals who are liable to some harm are not wronged if the harm is imposed on them, and liability to defensive harm thus (...) helps ensure that harm is borne by whoever has least of an objection of justice against being burdened with it—or so advocates of the MRA insist. In this paper, I argue that liability to defensive harm is not grounded in considerations of distributive justice. While it depends on the wider societal context what allocation of a burden is distributively most just, liability to defensive harm is a distinctly localised affair. I propose that liability to defensive harm is best understood as part of the enforcement dimension of our rights to non-interference. Framing liability in this way does not invalidate the MRA. It does, however, render subjective impermissibility accounts of liability particularly promising. (shrink)

ObjectivesTo compare changes in the number and amount of payments received by orthopedic and non-orthopedic surgeons from industry between 2014 and 2017.MethodsUsing the Centers for Medicare and Medicaid Services (CMS) Open Payment database from 2014 to 2017, we conducted a retrospective cohort study of industry payments to surgeons, including general payments and research payments.ResultsAmong orthopedic surgeons, the total number of general payments decreased from 248,698 in 2014 to 241,966 in 2017, but their total value increased from $97.1 (...) million in 2014 to $110.2 million in 2017. Among non-orthopedic surgeons, the total number decreased from 604,884 in 2014 to 582,490 in 2017, while the total value remained stable at approximately $159 million. Between 2014 and 2017, there was a differential increase in the median number of general payments received by non-orthopedic when compared to orthopedic surgeons (incidence rate ratio, 1.09; 95% CI, 1.08–1.09; p < 0.001), but a differential decline in the median value of general payments (− 8.9%; 95% CI, − 9.5%, − 8.4%; p < 0.001). Findings were consistent when stratified by nature of payment. In contrast, between 2014 and 2017, there was neither a differential change in the median number nor median value of research payments received by non-orthopedics.ConclusionExamination of a natural experiment of prior public disclosure of payments to orthopedic surgeons suggests that the Physician Payment Sunshine Act was associated with an increase in the number, but a decline in the value, of general payments received by non-orthopedic surgeons, but not on research payments received. (shrink)

“Every surgeon carries within himself a small cemetery where from time to time he goes to pray—a place of bitterness and regret, where he must look for an explanation of his failures” René Leriche,...

Women are under-represented in surgery, especially in leadership and academic roles, and face a gender pay gap. There has been little work on the role of implicit biases in women’s under-representation in surgery. Nor has the impact of epistemic injustice, whereby stereotyping influences knowledge or credibility judgements, been explored. This article reports findings of a qualitative in-depth interview study with women surgeons that investigates gender biases in surgery, including subtle types of bias. The study was conducted with 46 women (...) surgeons and trainees of the Royal Australasian College of Surgeons. Maximum variance sampling strategies ensured a comprehensive set of perspectives. Data were analysed using iterative thematic analysis to document and classify forms of gender bias experienced by the participants, including implicit bias and epistemic injustice. It found four types of bias affecting women surgeons: (1) workplace factors such as access to parental leave and role models; (2) epistemic injustices—unfair assessments of women surgeons’ credibility by patients and colleagues; (3) stereotyped expectations that they will carry out more of surgery’s carework, such as meeting the emotional needs of patients and (4) objectification. Implicit biases arose in each category. Given that many of the biases identified in this study are small, are harmless on their own and are not necessarily under anyone’s conscious control, important questions arise regarding how they cause harm and how to address them. I draw on theoretical work on cumulative harm to answer these questions. (shrink)

Due to its specificity, the legal institute of preliminary agreement poses a number of questions. This pre-contractual agreement is not yet a contract. Therefore, the form and scope of legal protection will not be the same as that guaranteed to contracting parties. However, the European legal systems would claim that the relationships between the parties during pre-contractual negotiations have to be regulated and protected by the law. The first part of this article deals with the legal nature of pre-contractual (...) class='Hi'>liability: tort, contractual or sui generis. The question of determining the type of applicable civil liability for breach of a preliminary agreement still remains a matter under debate in the Lithuanian legal doctrine as well as in legal practice. Taking into account the specific interest that may be infringed and the fact that the aggrieved party cannot recover the expectations it had in profit of the sought contract, including the remedy of the right of performance, there is nosufficient reason to apply contractual legal regime for breach of the preliminary agreement either. Hence, the special nature of the pre-contractual phase merits special treatment. In the Lithuanian legal system, liability for breach of a preliminary agreement should therefore be qualified as a separate sui generis kind of liability. In fact, the biggest problem is the scope of damages recoverable under the preliminary agreement. As far as the tendencies of a legal doctrine and jurisprudence of Lithuania and other countries are concerned, the aggrieved party should be compensated not only the direct expenses incurred during the negotiations, but also the value of lost opportunity, which must be based on real, proven, unavoidable income or expenses. It is not possible to claim the profit which would have resulted had the main contract been concluded (the so-called expectation damages). Recent tendencies show that the Lithuanian courts are prone to make no distinction between the concept of the lost opportunity to conclude a transaction with a third party (as reliance damages) and lost profits as expectation damages. The reason for such an interpretation is the fact that the value of lost opportunity can be determined by applying the principle of price difference provided in Article 6.258(5) of the Lithuanian Civil Code, which is used for contractual liability. This principle should be applied in accordance with the Commentary on the UNIDROIT Principles of International Commercial Contracts and in the context of the nature of the preliminary agreement. Therefore, the aggrieved party may claim compensation for damages in the amount of difference between the price of the contract that has not been concluded with a third party and the price of the replacement contract. Such an interpretation reflects the compensatory function of the recovery of the value of the lost opportunity. (shrink)

Aim To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. Design A questionnaire about attitudes towards PAS, including prioritisation of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. Participants All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Main (...) outcome measures Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. Results The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Conclusions Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS. (shrink)

The article deals with the concept of the court’s fault in the action for damages against a state suffered due to infringement of European Union law. The author searches for the right position of the criterion in the system of the conditions of state liability and discusses whether European Union law establishes a uniform standard of fault, or at least the guidance on the application of the criterion that would enable uniform national judicial practices concerning state liability for (...) the infringements attributable to the courts of last instance. The article also analyses national legal regulation and jurisprudence of several Member States such as France, Belgium and Italy, providing the definitions of different forms of fault and (or) examples of their practical implementation. (shrink)

Surgeons are commonly evaluated with respect to outcomes and adherence to rules and regulations, rather than a true holistic examination of the character of the surgeon in question. We sought to examine the character failings of surgeons who faced fitness to practice enquiries under the Medical Practitioner Tribunal Service in the UK. In particular, we examined the absence of virtue as perceived through the lens of Aristotelian ethics using thematic analysis of tribunal hearing transcripts from 2016 to 2020. (...) We identified three overarching themes that are explored in depth: ‘the god complex’, ‘reputation over integrity’ and ‘wounded pride’. We hope to use this as the foundation for a re-examination of the place of phronesis in postgraduate surgical education, which we argue should be perceived as an exercise in character development and reformation rather than the simplistic teaching of skills to standardised outcomes. (shrink)

PurposeAdolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of Pediatrics (AAP). In this research, we aim to define the current knowledge of AAP recommendations and surgeon practices regarding assent for elective reconstructive procedures.MethodsAn anonymous electronic survey was distributed to North American paediatric surgeons and fellows through the American Pediatric Surgical Association (n=1353).ResultsIn total, 220 surgeons and trainees responded (...) (16.3%). Fifty per cent of the surgeons who are familiar with the concept of assent had received formal training; 12% of the respondents had not heard of assent before the survey. Forty-seven per cent were aware of the 2016 AAP policy statement regarding assent in paediatric patients. Eighty-nine per cent always include adolescents as part of the consent discussion. Seventy-seven per cent solicit an expression of willingness to accept the proposed care from the patient. The majority (74%) of the surgeons perceived patient cooperation/understanding as the biggest barrier to obtaining assent. Over half of the respondents would consider proceeding with elective surgery despite the adolescent patient’s refusal. Reasons cited for proceeding with elective surgery include surgeons’ perception of medical necessity, perceptions of disease urgency, and lack of patient maturity.ConclusionPaediatric surgeons largely acknowledge the importance of assent, but variably practice the principles of obtaining assent from adolescent patients undergoing elective reconstructive procedures. Fewer surgeons are explicitly aware of formal policy statements or received formal training. Additional surgeon education and institutional policies are warranted to maximise inclusion of adolescents in their medical care. (shrink)

Surgical training has traditionally involved a lengthy apprenticeship to a series of master surgeons, who teach medical students and residents the techniques of surgery while allowing them to work on patients in the operating room. This article examines surgical training as a structured environment that prepares students for the embodied lessons taught by a surgeon. It argues that even the most seemingly mechanical of surgical techniques contains social lessons when taught by a surgeon within the rich environment of the (...) operating room. (shrink)

There are two main sources of compensation liability in Islamic Law of Obligations. These; contract and tort. Harming someone else is prohibited by any means. However, in social life, we witness that people harm others. Here, too, the legal order tries to ensure that the said damage is remedied. However, it is not a legal way to harm the other party for this. Are there other obligations at the same time as the liability for compensation? In this regard, (...) Article 86 of Mecelle regulates that compensation liability and usage benefit cannot be combined in accordance with the Hanafi sect. There are some theoretical reasons for this within the sect. However, other sects have opposing views to the Hanafi sect on this issue. In particular, they approached positively to the compensation of the usage benefit of the usurped property separately. The basis of this difference is based on whether the benefit is legally accepted as property. However, in the later periods, some exceptions were made to the first view within the Hanafi sect. These; foundation, orphan and commercial property. In addition, it has been accepted that in the Majalla amendments, the benefit can be accepted as property and may be the subject of compensation. (shrink)

Certainly principles of criminal liability may be understood as rules or norms outlining orders or prohibitions and standing out among other norms with their weight, for legal culture, legal doctrine, etc. In such a classic approach they are norms defining basic rights and obligations in the applicable criminal law. However, is it the only possible and cognitively interesting meaning of the word “principle” in jurisprudence? From the semiotic point of view, they can occur in three forms: special-kind norms, teleological (...) directives, rules which constitute valid performance of conventional activities. In an extra-directival sense these principles may be understood as models-descriptions of shaping the system of criminal law. From a theoretical and practical point of view principles addressed to the legislator are extremely weighty—they can be called rules constructing the system of criminal liability. These all problems are discussed in the article. (shrink)

Background Defensive medicine is physicians’ deviation from standard medical care which is primarily intended either to reduce or avoid medico legal litigation. Although the Federal Ethics Committee review in Ethiopia has shown that applications for medical/surgical error investigation claims are increasing at an alarming rate, there is no study to date done to estimate the degree of defensive practice done by the physicians with an intention of avoiding this increasing legal claim. This study assessed the practice of defensive medicine among (...) highly litigious disciplines (surgery) and described factors associated with its practice. Methods Cross sectional quantitative study using online survey questionnaires was conducted to assess the degree of defensive practice and six factors (age, years of experience, specialty, monthly income, place of practice and previous medico legal history) associated with its practice were assessed among surgeons working in Ethiopia. Results A total of 430 surgeons directly received an online survey questionnaire and 236 of them successfully completed the questionnaire making the response rate 51.2%. Nearly half of the study participants (51.7%) were aware of the concept of defensive medicine and 174 (74%) reported performing one form of defensive practice. Twenty-nine (12.3%) of the participants have legal dispute history, though only 1.3% of them ended up in penalty. Avoiding high risk procedures was the commonest defensive act performed by 60% of the participants, followed by ordering tests unnecessarily (52.1%). Multinomial logistic regression model showed that there was no association between age of the participant, place of practice, year of experience and defensive practice. This model also showed that cardiothoracic and vascular surgeons perform less defensively than surgeons with other specialty with P value of 0.02. Conclusion The practice of defensive medicine is widespread among surveyed Ethiopian surgeons and further studies are required to objectively estimate the effect of defensive practice on the health care system of the country. Policy makers need to develop strategy towards decreasing this high rate of defensive practice. (shrink)