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In healthcare, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouse concerns about possible implications for patients’ health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In this chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research.

Public reports of provider-specific patient outcomes aim to help consumers select suppliers of medical services. Yet, in an environment of rapidly changing medical technology and increasingly heterogeneous patient populations, and because they necessarily reflect the experience of other patients who received care in the past, such reports may be of limited value in helping patients forecast the probability of an adverse outcome for each provider they are considering. I propose that providers underwrite insurance policies that promptly pay patients a predetermined sum after an adverse outcome. Patients can use such outcome warranties to infer quality differences among providers easily and reliably. In addition, outcome warranties efficiently reward both providers and patients for reducing the risk of adverse outcomes and thereby improve the safety and affordability of health care. As such, outcome warranties help advance four important goals of health care management: reduction of financial risk, recruitment and retention of physicians, remediation of adverse outcomes, and raising the provider's reputation.

This paper analyzes the perception by researchers, public policy makers, and physicians that the medical malpractice system is in disarray and in need of reform. The perception of a medical malpractice crisis arose because of what was viewed as sudden and dramatic increases in physician liability for malpractice. Contrary to the common perception, however, previous research has shown that historical growth rates in physician liability are similar in magnitude to current growth rates. This paper focuses on explaining the conditions under which increased physician liability would be optimal. According to the theoretical model, increased physician liability would be optimal when (1) physicians become more adept at curing patients, especially by increased technological ability, (2) the costs of physicians' time increases, or (3) the cost to physicians of defending against malpractice claims decreases. The paper carefully examines the available historical evidence that indicates that these three reasons account for much of the increased liability of physicians in the United States. The finding that much of the historical increases in physician liability are consistent with the model, further questions the existence of a medical malpractice crisis.

Who is ultimately responsible for the harms that befall us? Corporations who make dangerous products, or the consumers who use them? The answer to this question has a profound impact on how personal injury lawyers screen products liability cases. In this chapter, I analyze results from an experimental vignette study in which 83 lawyers were asked to evaluate a hypothetical products liability case. Half of the lawyers practice in states considered to be difficult jurisdictions for the practice of personal injury law due to tort reform and conservative political climates (Texas and Colorado), while the other half work in states that have been relatively unaffected by tort reform and are considered to be more “plaintiff friendly” (Pennsylvania and Massachusetts). While lawyers in reform states and non-reform states were equally likely to accept the hypothetical case with which they were presented, they approached the case in different ways, used different theories, and made different arguments in order to justify their acceptance of the case. Lawyers in states with tort reform were most likely to accept the case when they focused on the issue of corporate social responsibility – that is, what the defendant did wrong, how they violated the rules, and how they could have prevented the injury in question. Lawyers in non-reform states, however, were most likely to accept the case when they believed that jurors would feel sorry for the injured child and not find their client at fault for the injury.

There has been substantial interest in US cesarean rates, which increased from 5% of deliveries in the 1970s to nearly one-third of births by the mid-2000s. Explanations typically emphasize individual risk factors (e.g., advanced maternal age, increased BMI, and greater desire for control over delivery) of women giving birth, or address institutional factors, such as the medicalization of childbirth and the culture of liability leading physicians to practice defensive medicine. We focus here on another non-medical explanation – childbirth education (CBE). CBE is an important, underexplored mechanism that can shape women’s expectations about labor and birth and potentially lead them to expect, or desire, a cesarean delivery as a normalized outcome. We analyze data from three waves (2002, 2006, 2013) of the Listening to Mothers national survey on US women’s childbearing experiences (n = 3,985). Using logistic regression analysis, we examined both mode of delivery (vaginal versus cesarean), and attitudes about future request for elective cesarean among both primiparous and multiparous women. Despite previous research suggesting that CBE increased the likelihood of vaginal delivery, we find that CBE attendance was not associated with likelihood of vaginal delivery among either primiparous or multiparous women. However, both primiparous and multiparous women who attended CBE classes were significantly more likely to say they would request a future, elective cesarean. Furthermore, these effects were in the opposite direction of effects for natural birth attitudes. Our findings suggest that contemporary CBE classes may be a form of “anticipatory socialization”, potentially priming women’s acceptance of medicalized childbirth.

In Chapter 10 in this volume, Comandé (2009) has proposed that American courts adapt “scheduling” for use by juries in awarding nonpecuniary damages in personal injury and wrongful death cases. Comandé suggests that American courts can develop schedules for awarding damages for nonpecuniary losses on the basis of the severity of the injury and the age of the injured party, based on data on prior awards by particular courts in specific jurisdictions. Comandé's proposal is shaped by the experiences of European jurisdictions that have developed scheduling for awarding nonpecuniary damages.

A balance between environmental protection and sustainable development of the energy industry is fostered in the majority of nations. China’s economic growth has been rapid in the past few decades, with the unfortunate side effect of environmental pollution and ecological deterioration in the country. In this chapter, we provide a study of Chinese legal rules about civil liability for environmental damages in the light of objectives of sustainable development of the energy industry.

The research approach is based on the Regulatory Impact Assessment.

International funds and private investors, especially those working in FDI, have to cope with the legal framework more or less favorable to investment and innovation deriving from experimentation and development of new energy products and processes. In each jurisdiction, the mechanism of civil liability is crucial in determining such a legal framework.

The real functioning of civil liability as applied by the doctrinal and judicial interpretation has to be taken into account for minimizing the mass damages for the environment and individuals.

Different from other assumptions based on administrative rules or policy issues, the balance between environmental protection and sustainable development is considered in this chapter under a view that emphasizes the role of legal rules from a civil law perspective.

Our legal system has a well-established set of laws and procedures for injured people to seek redress for their injuries. Over the years universalised legal injury narratives have developed. In other words, repeated applications of the law have generated standard, abstract, generalised versions of individual injury narratives. Accordingly, from any particular injury narrative, there can be distilled an “essential or abstract” legal injury narrative which is the same universal narrative that can be distilled from other like cases (Klinck, 1992). It seems likely that there are different versions of the legal injury narrative that have developed due to an accumulation of a large number of similar cases. For example, there is likely to be a version of the legal injury narrative for injuries arising out of each of motor vehicle accidents, workplace incidents, occupier’s liability, medical malpractice or defective products. However, this paper will demonstrate that underlying all of these versions is the generic legal injury narrative with particular and common characteristics. This paper develops the idea of the universal “legal injury narrative” – that is, a legally idealised narrative about injury, based on a number of implicit rules about the way injuries occur and their consequences. The legal injury narrative is the framework by which other injury narratives are judged.

No topic in medical education has received more attention and generated more discussion in recent years than that of “professionalism”. In many ways, this should come as no surprise in light of the dramatic technical and scientific advances in medicine, the changing, and often confounding, roles of physicians in complex health care systems, and the growing expectation throughout society that physicians should provide more effective, patient-centered care. Any of these factors alone is sufficient to create anxiety and confusion about basic duties and responsibilities of physicians to patients, the medical profession and to society. In this complex, demanding, commercialized and yet, values-laden, world of health care it is an understatement to say that there are fundamental challenges to what it means to be a medical professional in today's society.