The cost of health care, its growing share of the gross domestic product (GDP), and dire predictions about the future are a major political and economic issue in the U.S. The American legal system is commonly viewed as a significant part of the problem, particularly by those who believe that medical providers engage in defensive medicine in an effort to avoid malpractice litigation. Yet scholars and commentators in the U.S. have shown relatively little interest in how other nations manage legal conflict over health care and whether they might learn something from abroad about the relationship between malpractice litigation and the health care system more generally.

To that end, this article analyzes the Japanese health care experience, specifically the management of what are variously called adverse outcomes, medical accidents, and medical malpractice. How frequently do Japanese patients sue their doctors? Are medical malpractice litigation rates in Japan rising? If so, what is being done to control the increase and its impact on medical care? How well is Japan doing when it comes to balancing the needs of patients who believe they are victims of medical negligence with those of providers who think they are being unfairly accused? These are the questions, about Japan (and elsewhere), that need to be asked by those interested in the nexus of law and health care in the U.S.

My aim in this paper is simply to show that, in bioethics no less than in other areas of health care, policy in democracies is shaped not only by principles and values, but also — and to some extent independently — by the shape and history of particular political institutions and past policies. “Path dependency,” or what one scholar has called the “accidental logics” of already-existing institutions, condition and guide national policy choices. These institutional and historical pressures can even create substantial policy divergences between quite likeminded nations. I shall illustrate the point using some comparative data about national policies regarding research on human embryonic stem cells. The fact that gaps can develop between values and policies is readily visible to anyone who compares national stemcell research policies to the expressed attitudes of the citizens of various democratic countries regarding human embryonic stem-cell research. The role of path dependency and the accidental logics of institutional structure in creating those gaps can be illustrated by tracking down the details of the development of human embryonic stem cell policies in a few different countries.

During World War II, the Allies created the United Nations and its associated international institutions to stabilize the post-war world. The Allies envisioned a coordinated world in which human rights for all were respected, economic and social progress for all promoted, and global warfare prevented. This was a phenomenally fantastic vision that seemed unattainable in the wake of the most devastating global war in history.

Today, the world is witnessing some of the fruits of these mid-20th century events and aspirations, especially since the collapse of Communism in 1989. Economic integration and free trade has become much more prevalent as exemplified by astounding developments such as the European Union. And there is a greater appreciation of human rights, including the international human right to health. This article examines the evolution of trade policy and the impact of free trade policies on the health care sectors of the three countries of North America and the realization of the human right to health in North America.

Corporate social responsibility has become a potential path to legitimacy and improved public relations for both companies that produce mainstream products and those that sell vice, such as the tobacco industry. Since the early 1990s, the tobacco industry has sought to bridge the gap between the public perception it has earned as a merchant of death and its goal of gaining corporate legitimacy and normality by promoting programs, positions, and policies it hopes the general public will believe are aimed at preventing or mitigating some of the societal ills that smoking causes, such as youth smoking. There is, however, an intractable problem that corporate social responsibility efforts can mask but not resolve: the tobacco industry’s products are lethal when used as directed, and no amount of public relations or funding of ineffective youth smoking prevention programs can reconcile that fundamental contradiction with ethical corporate citizenship. The focus of this study is to better understand the tobacco industry’s corporate social responsibility efforts and to assess whether there has been any substantive change in the way it does business with regard to the issue of exposure to secondhand smoke.

It is axiomatic that tobacco smoking is hazardous to health. The statistics are well documented and often very grim. For example, the 2008 World Health Organization Report on the global tobacco epidemic presented the following statistics: a hundred million people died of tobacco-related diseases globally in the 20th century; there are approximately over five million tobacco-related deaths every year; and an estimated one billion could die of tobacco-related diseases in this 21st century.

Significantly, no other risky, self-indulgent addictive behaviors such as cocaine abuse directly endanger bystanders as much as cigarette smoking or tobacco use endangers nonsmokers through secondhand tobacco smoke or inhaled environmental tobacco smoke (ETS). Environmental tobacco smoke comprises sidestream smoke (smoke that emanates from the burning end of a tobacco product) and mainstream smoke (smoke exhaled by the smoker). About 85 percent of environmental tobacco smoke is sidestream smoke, while the remainder is mainstream smoke.

It is common for physicians who prescribe opioids for chronic pain to have their patients sign an opioid contract (OC) in order to receive opioid therapy. A vast majority of these contracts contain a stipulation requiring patients to submit to random drug testing (RDT) which screens for both licit and illicit drugs. Physicians who prescribe opioids may be concerned about prosecution and disciplinary actions; medication abuse and misuse; and addiction. Steven Passik et al. write, “…physicians still fear the risk of abuse or addiction as well as the potential legal consequences of their prescribing.”

Issues surrounding OC/RDT need a closer look with a focus on enforceability and efficacy of the opioid contract; accuracy and complications of drug screens and their interpretation; and the importance of trust between patient and physician. In addition, it is vital to dispel fears with facts regarding prosecutions, nonmedical use of prescription opioids, and addiction.