The Rise and Decline of the Reversal of the Burden of Proof in China's Medical Negligence Law: A Political Economy of Lawmaking Perspective
An issue of central importance to the medical negligence law reforms in China over the past decade is the allocation of the burden of proof between the plaintiff patient and the defendant medical care provider in medical negligence actions. From a political economy of lawmaking perspective, this article examines the evolution of the burden of proof rules, with a focus on the reversal rule developed by the judiciary. Drawing extensively on firsthand legislative materials, this article argues that the successful lobbying of the medical profession in the legislative process leading to the enactment of the 2010 Tort Liability Law explains the nonadoption of a full-blown reversal of the burden of proof rule for medical negligence actions in the law.
Defensive medicine or economically motivated corruption? A confucian reflection on physician care in China today.
In contemporary China, physicians tend to require more diagnostic work-ups and prescribe more expensive medications than are clearly medically indicated. These practices have been interpreted as defensive medicine in response to a rising threat of potential medical malpractice lawsuits. After outlining recent changes in Chinese malpractice law, this essay contends that the overuse of expensive diagnostic and therapeutic interventions cannot be attributed to malpractice concerns alone. These practice patterns are due as well, if not primarily, to the corruption of medical decision-making by physicians being motivated to earn supplementary income, given the constraints of an ill-structured governmental policy by the over-use of expensive diagnostic and therapeutic interventions. To respond to these difficulties of Chinese health care policy, China will need not only to reform the particular policies that encourage these behaviors, but also to nurture a moral understanding that can place the pursuit of profit within the pursuit of virtue. This can be done by drawing on Confucian moral resources that integrate the pursuit of profit within an appreciation of benevolence. It is this Confucian moral account that can formulate a medical care policy suitable to China's contemporary market economy.
Intelligibility of modified speech for young listeners with normal and impaired hearing.
Exposure to modified speech has been shown to benefit children with language-learning impairments with respect to their language skills (M. M. Merzenich et al., 1998; P. Tallal et al., 1996). In the study by Tallal and colleagues, the speech modification consisted of both slowing down and amplifying fast, transitional elements of speech. In this study, we examined whether the benefits of modified speech could be extended to provide intelligibility improvements for children with severe-to-profound hearing impairment who wear sensory aids. In addition, the separate effects on intelligibility of slowing down and amplifying speech were evaluated. Two groups of listeners were employed: 8 severe-to-profoundly hearing-impaired children and 5 children with normal hearing. Four speech-processing conditions were tested: (1) natural, unprocessed speech; (2) envelope-amplified speech; (3) slowed speech; and (4) both slowed and envelope-amplified speech. For each condition, three types of speech materials were used: words in sentences, isolated words, and syllable contrasts. To degrade the performance of the normal-hearing children, all testing was completed with a noise background. Results from the hearing-impaired children showed that all varieties of modified speech yielded either equivalent or poorer intelligibility than unprocessed speech. For words in sentences and isolated words, the slowing-down of speech had no effect on intelligibility scores whereas envelope amplification, both alone and combined with slowing-down, yielded significantly lower scores. Intelligibility results from normal-hearing children listening in noise were somewhat similar to those from hearing-impaired children. For isolated words, the slowing-down of speech had no effect on intelligibility whereas envelope amplification degraded intelligibility. For both subject groups, speech processing had no statistically significant effect on syllable discrimination. In summary, without extensive exposure to the speech processing conditions, children with impaired hearing and children with normal hearing listening in noise received no intelligibility advantage from either slowed speech or envelope-amplified speech.