OBJECTIVE As a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the... Show moreOBJECTIVE As a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the practice of defensive medicine is linked to experience with malpractice lawsuits remains unclear. The aims of this study were to clarify this by surveying neurosurgeons about the frequency of experiencing medical lawsuits and to show how neurosurgeons reflect on facing such lawsuits.METHODS A survey consisting of 24 questions was distributed among members of the Congress of Neurological Surgeons. The survey consisted of four parts: 1) demographics of participants; 2) the way malpractice lawsuits affect the way respondents practice medicine; 3) experiences with medical malpractice lawsuits; and 4) the effect of the medical malpractice environment on one's own practice of medicine.RESULTS There were a total of 490 survey respondents, 83.5% of whom were employed in the US. Of the respondents, 39.5% stated they were frequently or always concerned about being sued, and 77.4% stated their fear had led to a change in how they practice medicine. For 58.4%, this change led to the practice of defensive medicine, while for others it led to more extensive documentation (14.3%) and/or to referring or dropping complex cases (12.4%).Among the respondents, 80.9% at some time were named in a medical malpractice lawsuit and 12.3% more than 10 times. The main concerns expressed about being sued included losing confidence and practicing defensive medicine (17.8%), personal assets being at risk (16.9%), and being named in the National Practitioner Data Bank (15.6%). Given the medical malpractice environment, 58.7% of respondents considered referring complex patient cases, whereas 36.5% considered leaving the practice of medicine. The fear of being sued (OR 4.06, 95% CI 2.53-6.51) and the consideration of limiting the scope of practice (OR 3.08, 1.80-5.20) were both independently associated with higher odds of considering leaving the practice of medicine.CONCLUSIONS The current medicolegal landscape has a profound impact on neurosurgical practice. The fear of being sued, the financial aspects of practicing defensive medicine, and the proportion of neurosurgeons who are considering leaving the practice of medicine emphasize the need for a shift in the medicolegal landscape to a system in which fear of being sued does not play a dominant role and the interests of patients are protected. Show less
This article argues that it is possible—given the right resources and expertise—to hold individual non-state actors responsible for violations of international humanitarian law (also known as ‘the... Show moreThis article argues that it is possible—given the right resources and expertise—to hold individual non-state actors responsible for violations of international humanitarian law (also known as ‘the laws and customs of war’) perpetrated with cyberweapons. It describes jurisdictional elements of violations of the laws and customs of war as well as points that prosecutors and investigators must consider when planning investigations of serious violations of international humanitarian law perpetrated in cyberspace. It addresses how certain theories of individual criminal responsibility for war crimes apply to offences committed by non-state actors during cyberwarfare and identifies particular evidentiary challenges arising from the particular qualities of cyberspace and cyberweapons. Individual accountability for war crimes perpetrated during cyber operations requires new thinking about the application of legal principles and theories during cyber conflict. Show less
Op 5 maart 2015 wees het Europese Hof van Justitie arrest in twee prejudiciële procedures over de uitleg van de Richtlijn Productaansprakelijkheid (Richtlijn 85/374). Het ging kort gezegd om de... Show moreOp 5 maart 2015 wees het Europese Hof van Justitie arrest in twee prejudiciële procedures over de uitleg van de Richtlijn Productaansprakelijkheid (Richtlijn 85/374). Het ging kort gezegd om de kosten van verwijdering van een aantal specifieke pacemakers en defibrillatoren, medische hulpmiddelen dus. Van die hulpmiddelen stond vast dat ze tot een groep producten behoorden die een verhoogd veiligheidsrisico met zich brachten, maar het was niet zeker dat die specifieke exemplaren ook dat risico in zich droegen. Het Hof oordeelt dat ook die exemplaren ‘gebrekkig’ kunnen zijn in de zin van de Richtlijn en dat de kosten van vervanging onder het begrip ‘schade’ gebracht kunnen worden. Het arrest is van grote betekenis vanwege de door het Hof gehanteerde oprekking van de begrippen ‘gebrek’ en ‘schade’. Het arrest lijkt daarnaast relevant voor de verhouding tussen het productaansprakelijkheidsrecht en de recallverplichtingen uit het productveiligheidsrecht. Alle reden dus voor een annotatie. Show less
