I suspect/hope that Switzerland doesn't charge Drs with a crime if they were merely negligent. People make mistakes, and unfortunately, due to the nature of the job when you're a surgeon or anesthesiologist, a possible outcome of those mistakes is that someone can die. Charging someone with a crime for making a mistake at their job seems harsh. Drs. already complain they are being driven out of the profession by insurance premiums and the risk of malpractice suits. I would expect that they would flee if, instead of the cost of an error being a higher premium, it was jail time.
There's obviously a threshold question here. If the death is due to a doctor coming to work intoxicated or intentionally cutting corners, I can see treating it as a crime (though I always thought you should charge the action, not the outcome), but if it's just missing a spot on an x-ray or accidentally reading a prescription as 100mg rather than 10mg, treating it as a crime.
I don’t know for sure (the investigation into Eugene’s doctors was very quick, and the police found that his doctors had acted appropriately), but I think the standard for negligence in Switzerland is much higher than the examples you cite, all of which really do sound like honest mistakes.
Here’s a personal example that illustrates the distinction: A few years ago, my dad had his gall bladder removed. During the surgery, the doctor nicked an artery, which caused my dad to bleed into his abdomen. The nick was an honest mistake. (My BIL, an ER doctor, said that this is quite common with gall bladder surgery.) Had she admitted her mistake and fixed it, none of us would have had any issue with her.
However, the doctor insisted on discharging my dad the day after the surgery, even though his infection markers were in the life-threatening range (my BIL confirmed this), and even though my dad’s abdomen was clearly distended and getting worse. My parents begged the doctor to let him stay in the hospital, at least until his white blood cell count dropped, and they kept raising the issue of the swollen abdomen. The doctor refused to listen to my parents’ concerns and dismissed all their questions. My dad almost died. That was negligence, or maybe even malice, in my opinion. Any system that disincentivizes doctors from behaving in this way and encourages them to listen to their patients and fix their mistakes is all to the good.
It may just be a definitional thing. In US law, "negligence" and "accident" are basically interchangeable.
That said, one of my bugaboos is that we do like to criminalize negligent homicide in the US, with which I very much disagree. I strongly believe that crimes should require some level of intent, and not just a combination of carelessness and bad luck. Even with something like deaths due to drunk driving accidents, I see the point of criminalizing the drunk driving, maybe even more harshly than we already do, but not to imposing harsher penalties if the drunk driving leads to a death. No one drives drunk with the expectation that they will kill someone, and drunk driving very rarely (in absolute terms) leads to someone dying. Moreover, to the extent they expect their drunk driving to lead to a death, they are already likely deterred from doing so, particularly if the dead person is a passenger who may very well be a friend or family member. As a result, punishing someone more harshly for having the bad luck of killing someone has essentially zero added deterrent effect - very few people are OK doing something they expect to kill someone, but not OK if they expect it to kill someone and send them to jail, they just underestimate the risk of their actions killing someone. Punishment for criminally negligent homicide is really just a desire for retribution, which I don't think belongs in the criminal justice system.
This all comes down to moral luck. The action—in this case driving drunk—is the same, but the outcome varies wildly depending on chance. Most drunk drivers get home without incident. But many cause crashes that cause injuries and fatalities. Is the drunk driver who got home safely morally superior to the drunk driver who killed someone? It’s a tough question!
I think the Swiss approach is "very low bar for investigation, very high bar for charges".
Sorry for the macabre part of this story, but a friend once told me whenever a train has a "person incident", the driver is always investigated, and always found guiltless as trains cannot stop on line of sight in most circumstances. The police "investigation" is a way to provide the driver with state-funded psychological care as much as anything else.
A lot of the money being made is by middlemen; not those who research new medicines, not the doctors, those businesses that just buy and sell pharmaceuticals that already have a buyer and a seller. There is also a lack of transparency in hospital care costs, no competition and no motive for efficiency, similar to the shots you cite as administered more efficiently with less waste- managing resources better helps all the way around.
Totally agree. This is one reason I really like the direct-service model, where patients pay the doctor directly, and the doctor provides healthcare to the patients directly. It is good to cut out the middleman when possible, and especially when they are just engaging in rent-seeking.
I think the "allow anyone to buy medicare, but not force anyone" runs into the problem that lots of people with existing conditions will sign up whereas lots of healthy people won't (after all, they can sign up later if they get a chronic condition). So the cost of providing insurance shoots through the roof. Put another way: if one in 100'000 people has a condition that costs $10'000 to treat, a single payer system can allocate $0.1 premium per person towards that to break even. If mostly the people with the condition sign up and you can't refuse them, your expenses for that condition tend towards $10k per person.
This is a good point. Any system where insurance is voluntary will lead to a race to the bottom, exactly as you describe. This is why insurance is mandatory in Switzerland. Everyone, including young healthy people, must purchase health insurance. It’s the only way the risk can be pooled sufficiently to make the system work.
Just a very tangential note: great on the malaria vaccine. However, millions of lives could already have previously been saved if DDT had not been hysterically and nearly-completely banned because Rachel Carson did not know (or care) how to do basic research in 1962.
Yeah, I agree. This is off-topic, but the DDT issue reminds me of the fears about nuclear power. We tend to fear rare but catastrophic events and forget about much more likely bad effects—like malaria and climate change.
I suspect/hope that Switzerland doesn't charge Drs with a crime if they were merely negligent. People make mistakes, and unfortunately, due to the nature of the job when you're a surgeon or anesthesiologist, a possible outcome of those mistakes is that someone can die. Charging someone with a crime for making a mistake at their job seems harsh. Drs. already complain they are being driven out of the profession by insurance premiums and the risk of malpractice suits. I would expect that they would flee if, instead of the cost of an error being a higher premium, it was jail time.
There's obviously a threshold question here. If the death is due to a doctor coming to work intoxicated or intentionally cutting corners, I can see treating it as a crime (though I always thought you should charge the action, not the outcome), but if it's just missing a spot on an x-ray or accidentally reading a prescription as 100mg rather than 10mg, treating it as a crime.
I don’t know for sure (the investigation into Eugene’s doctors was very quick, and the police found that his doctors had acted appropriately), but I think the standard for negligence in Switzerland is much higher than the examples you cite, all of which really do sound like honest mistakes.
Here’s a personal example that illustrates the distinction: A few years ago, my dad had his gall bladder removed. During the surgery, the doctor nicked an artery, which caused my dad to bleed into his abdomen. The nick was an honest mistake. (My BIL, an ER doctor, said that this is quite common with gall bladder surgery.) Had she admitted her mistake and fixed it, none of us would have had any issue with her.
However, the doctor insisted on discharging my dad the day after the surgery, even though his infection markers were in the life-threatening range (my BIL confirmed this), and even though my dad’s abdomen was clearly distended and getting worse. My parents begged the doctor to let him stay in the hospital, at least until his white blood cell count dropped, and they kept raising the issue of the swollen abdomen. The doctor refused to listen to my parents’ concerns and dismissed all their questions. My dad almost died. That was negligence, or maybe even malice, in my opinion. Any system that disincentivizes doctors from behaving in this way and encourages them to listen to their patients and fix their mistakes is all to the good.
It may just be a definitional thing. In US law, "negligence" and "accident" are basically interchangeable.
That said, one of my bugaboos is that we do like to criminalize negligent homicide in the US, with which I very much disagree. I strongly believe that crimes should require some level of intent, and not just a combination of carelessness and bad luck. Even with something like deaths due to drunk driving accidents, I see the point of criminalizing the drunk driving, maybe even more harshly than we already do, but not to imposing harsher penalties if the drunk driving leads to a death. No one drives drunk with the expectation that they will kill someone, and drunk driving very rarely (in absolute terms) leads to someone dying. Moreover, to the extent they expect their drunk driving to lead to a death, they are already likely deterred from doing so, particularly if the dead person is a passenger who may very well be a friend or family member. As a result, punishing someone more harshly for having the bad luck of killing someone has essentially zero added deterrent effect - very few people are OK doing something they expect to kill someone, but not OK if they expect it to kill someone and send them to jail, they just underestimate the risk of their actions killing someone. Punishment for criminally negligent homicide is really just a desire for retribution, which I don't think belongs in the criminal justice system.
This all comes down to moral luck. The action—in this case driving drunk—is the same, but the outcome varies wildly depending on chance. Most drunk drivers get home without incident. But many cause crashes that cause injuries and fatalities. Is the drunk driver who got home safely morally superior to the drunk driver who killed someone? It’s a tough question!
I think the Swiss approach is "very low bar for investigation, very high bar for charges".
Sorry for the macabre part of this story, but a friend once told me whenever a train has a "person incident", the driver is always investigated, and always found guiltless as trains cannot stop on line of sight in most circumstances. The police "investigation" is a way to provide the driver with state-funded psychological care as much as anything else.
Very interesting! I didn’t know this. I think that “very low bar for investigation, very high bar for charges” strikes the right balance.
A lot of the money being made is by middlemen; not those who research new medicines, not the doctors, those businesses that just buy and sell pharmaceuticals that already have a buyer and a seller. There is also a lack of transparency in hospital care costs, no competition and no motive for efficiency, similar to the shots you cite as administered more efficiently with less waste- managing resources better helps all the way around.
Totally agree. This is one reason I really like the direct-service model, where patients pay the doctor directly, and the doctor provides healthcare to the patients directly. It is good to cut out the middleman when possible, and especially when they are just engaging in rent-seeking.
US psychiatrist Scott Alexander has an opinion on employer-provided health insurance: https://slatestarcodex.com/2020/04/24/employer-provided-health-insurance-delenda-est/
I think the "allow anyone to buy medicare, but not force anyone" runs into the problem that lots of people with existing conditions will sign up whereas lots of healthy people won't (after all, they can sign up later if they get a chronic condition). So the cost of providing insurance shoots through the roof. Put another way: if one in 100'000 people has a condition that costs $10'000 to treat, a single payer system can allocate $0.1 premium per person towards that to break even. If mostly the people with the condition sign up and you can't refuse them, your expenses for that condition tend towards $10k per person.
This is a good point. Any system where insurance is voluntary will lead to a race to the bottom, exactly as you describe. This is why insurance is mandatory in Switzerland. Everyone, including young healthy people, must purchase health insurance. It’s the only way the risk can be pooled sufficiently to make the system work.
Just a very tangential note: great on the malaria vaccine. However, millions of lives could already have previously been saved if DDT had not been hysterically and nearly-completely banned because Rachel Carson did not know (or care) how to do basic research in 1962.
Yeah, I agree. This is off-topic, but the DDT issue reminds me of the fears about nuclear power. We tend to fear rare but catastrophic events and forget about much more likely bad effects—like malaria and climate change.