Lara Khoury | McGill University (original) (raw)

Papers by Lara Khoury

Canadian health policy, Apr 29, 2022

Social Science Research Network, 2014

English Abstract: In this paper the author discusses the treatment of uncertain causation in medi... more English Abstract: In this paper the author discusses the treatment of uncertain causation in medical liability cases decided by the highest courts in Canada, England, and Australia. The author specifically focuses on judicial reasoning with regard to three particular concepts: creation of or increased risk, knowledge of causal facts, and loss of chance. A review of this case law reveals that these courts generally decline to find causation or liability proven on the basis that the defendant increased the risk of injury. Also marginal are those instances in which causation has been inferred on the basis of the particular knowledge of the defendant. The Supreme Court of Canada has drawn such inferences only where the defendant has particular knowledge of the causal facts and, by his or her own negligence, has rendered the evaluation of the causal link impossible. Finally, this text addresses the recent treatment of loss of chance in medical liability cases, observing that all the courts studied have rejected this approach. This brief review sheds light on the observation that, despite being sensitive to difficulties plaintiffs face in proving uncertain causation in medical liability cases, the courts studied continue to take orthodox approaches to causation. This study also allows the reader to observe the important place that comparative law has played in the high court decisions rendered in this field. French Abstract: IL’auteure examine le traitement de l’incertitude causale dans les affaires de responsabilité médicale décidées par les tribunaux de dernière instance au Canada, en Angleterre et en Australie. Elle se penche notamment sur le raisonnement judiciaire à l’égard de trois concepts particuliers, soit la création ou l’augmentation du risque, la création fautive de l’incertitude causale et la perte de chance. Une analyse de cette jurisprudence permet de constater que la possibilité de trouver la causalité ou la responsabilité prouvée sur la base de l’augmentation du risque de préjudice par le défendeur est généralement rejetée en matière médicale. Quant au raisonnement permettant d’inférer la causalité lorsque le défendeur possède une connaissance particulière des faits et que, par sa faute, il a rendu impossible l’évaluation du lien causal, il fut marginalement appliqué par la Cour suprême du Canada. Enfin, le texte s’attarde au traitement récent de la perte de chance en matière médicale et constate son rejet par tous les tribunaux d’instance supérieure étudiés. Cette brève étude montre que, malgré l’expression d’une sensibilité à l’égard des difficultés rencontrées par les demandeurs dans la preuve de la causalité médicale en présence d’incertitude, les approches judiciaires dans les ressorts étudiés demeurent orthodoxes. L’étude permet également de réaliser la place importante que tient le droit comparé dans les décisions récentes des tribunaux supérieurs dans le domaine.

This paper explores Canadian liability concerns flowing from the integration of artificial intell... more This paper explores Canadian liability concerns flowing from the integration of artificial intelligence (AI) in health care (HC) delivery. It argues that the current Canadian legal framework is sufficient, in most cases, to allow developers and users of AI technology to assess each stakeholder’s responsibility should the technology cause harm. Further, it inquires as to whether an alternative approach to existing liability regimes should be adopted in order to promote AI innovation based on recognized best practices which, in turn, could lead to increased use of AI technology.

Journal of Public Health Policy

The COVID-19 pandemic-with its wide-reaching social, political, and economic implications-showcas... more The COVID-19 pandemic-with its wide-reaching social, political, and economic implications-showcases the importance of public health governance. Governmental accountability is at the forefront of societal preoccupations, as state actors attempt to manage the pandemic by using sweeping emergency powers which grant them significant discretion. Though emergency measures have tremendous impacts on citizens' lives, elected officials and civil society have little input in how governments wield these powers. We reviewed available mechanisms in Canadian private, constitutional, and criminal law and found them to be unlikely sources of muchneeded accountability. Therefore, we propose that provincial and territorial legislatures modify public health legislation to expand mechanisms to foster public confidence in decision-makers, and bolster accountability to parliaments and citizens.

To achieve and protect public health, collective action is essential, especially through governme... more To achieve and protect public health, collective action is essential, especially through government intervention. In combating the COVID-19 pandemic, societies across the globe have allowed governments to exercise extensive emergency powers, which has led to unprecedented measures and responses, including significant restrictions on citizens' rights. These measures have often been taken swiftly, with little (and sometimes no) input from the electorate or from civil society. This paper describes the breadth of Canadian public authorities’ emergency powers to manage a pandemic, and provides an overview of emergency powers included in public health legislation. It then assesses avenues for accountability through law – specifically through private, criminal and constitutional law. It argues that accountability through private law litigation is the wrong avenue to pursue in the context of the COVID-19 pandemic and that criminal law safeguards and constitutional rights litigation only...

International Journal of Health Policy and Management, 2016

Background: Healthcare stakeholders have a great interest in the adoption and use of electronic p... more Background: Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption. Methods: Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted. Results: We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security). Conclusion: ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem wellprepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders including clinicians, decision-makers, patients and the public. In turn, it may facilitate their adoption in the country.

This paper seeks to show the relationship between reasonable foreseeability and innovations in bi... more This paper seeks to show the relationship between reasonable foreseeability and innovations in biotechnology. It will examine how reasonable foreseeability can and has been applied to biotechnology. More specifically, it will comment on how uncertainties related to biotechnology developments affect – or may affect – reasonable foreseeability and, hence, liability resulting from the genetic modification of microbes, animals and plants. This examination will identify how social concern about liability from these innovative GM products has changed over time. It will also analyze how these social concerns may impact on the way reasonable foreseeability is – or should be- assessed in this area.

French Abstract: Les infections nosocomiales sont un des plus graves problemes auxquels fait face... more French Abstract: Les infections nosocomiales sont un des plus graves problemes auxquels fait face la medecine moderne et revetent une ampleur qui leur a valu de faire recemment l'objet d'une attention mediatique et sociale accrue au Quebec. Bien qu'il soit habituellement aise de relier l'apparition de l'infection a l'acte ou au milieu medical, il est souvent impossible de determiner la cause de cette infection. Cette incertitude empeche par la suite de determiner si une faute est a l'origine de la contraction de l'infection. La victime d'une infection nosocomiale fait donc face a la lourde tâche de prouver la cause probable de son prejudice et de demontrer si celle-ci peut etre reliee a une faute du medecin, du personnel hospitalier ou de l'hopital. L'augmentation du nombre de victimes d'une infection contractee en milieu hospitalier met donc au defi la stucture, les elements constitutifs, et meme le champ d'application des regles ...

Scientific uncertainty affecting the demonstration of the causal link in medical, environmental, ... more Scientific uncertainty affecting the demonstration of the causal link in medical, environmental, and product liability often proves fatal to plaintiffs’ claims for judicial compensation of their personal injuries. Responding to this challenge, the tribunals of several legal traditions have relaxed their application of the traditional rules of causation and evidence. Others refuse to do so, however, despite the resulting adverse impact on the victims’ chances of obtaining compensation for their injuries. This text examines the French and Quebec civil law courts’ willingness to adapt rules of evidence and causation to respond to causal uncertainty in cases involving injuries to human health allegedly caused by medical acts, environmental pollution or defective products. It studies how this desire has expressed itself across these disciplines, but also how it differs depending on the civil law jurisdiction concerned. Ultimately, this paper defends the idea that a more flexible approach...

Introduction – The Context Nosocomial infections have been a reality since the origin of medicine... more Introduction – The Context Nosocomial infections have been a reality since the origin of medicine and have been the object of judicial decisions for a long time. Canadian judges have dealt with potential liability arising from healthcare-related infections since at least the beginning of the twentieth century. However, the increased incidence rates of nosocomial infections in the last few years have put them at the forefront of social and media scrutiny. They now present particular challenges for the courts because of their proliferation and the evasive nature of their causes. This paper comments on the judicial treatment of the uncertainty that often surrounds the causes of infections contracted in the healthcare setting.

This paper reviews the book "Le droit francais de la responsabilite civile confronte aux pro... more This paper reviews the book "Le droit francais de la responsabilite civile confronte aux projets europeens d’harmonisation”, a collection of 54 texts based on seminars and a closing colloquium held between 2009 and 2011 under the umbrella of the GRERCA. This book examines the law of several European member states, while focusing primarily on the convergence and divergence of French law with European harmonisation projects in the field of civil liability.

The constant evolution of the importance of auditors’ functions during the twentieth century brou... more The constant evolution of the importance of auditors’ functions during the twentieth century brought with it considerable scholarship on their responsibility. Indeed, confronted with the insolvency of a company in which they have invested, shareholders, investors, and offerors increasingly seek to recover their economic loss from auditors who, solvent and insured, were negligent in auditing the financial statements of the company in question. Accordingly, the study of the liability of an auditor towards third parties has a growing importance. In this article the author analyzes comparatively auditors’ liability under the common law of England and Canada and under the civil law of France and Quebec. Specifically, she attempts to show how courts use the duty of care in the common law and causality in the civil law to limit this liability. Furthermore, she pays particular attention to the influence of Canadian, English, and French law on the law of Quebec. The author not only delineate...

Shortly after Fairchild v. Glenhaven Funeral Services Ltd., the House of Lords once again departe... more Shortly after Fairchild v. Glenhaven Funeral Services Ltd., the House of Lords once again departed from orthodox causation rules in order to assist what it thought was a deserving plaintiff. In Chester v. Afshar, the highest English court went further than it had previously dared to by accepting such a departure in a medical liability case.

French Abstract: Le 5 decembre 2014, la Cour d’appel du Quebec rendait une decision majeure, St-G... more French Abstract: Le 5 decembre 2014, la Cour d’appel du Quebec rendait une decision majeure, St-Germain c Benhaim, 2014 QCCA 2207, portant sur le lien de causalite entre l’omission d’effectuer des tests et prendre d’autres mesures qui auraient permis de diagnostiquer le cancer d’un patient en temps utile et son deces eventuel. Dans son jugement, la majorite de la Cour d’appel base une inference quant a la causalite medicale sur le seul fondement d’une donnee statistique, justifiant cet allegement de preuve par le fait que les defendeurs ont, par leur faute, empeche les demandeurs de prouver la causalite. Le commentaire cherche a montrer comment cette decision fait preuve d’audace en s’eloignant de l’orthodoxie ambiante et manipule les concepts pertinents de facon habile.English Abstract: On 5 December 2014, the Quebec Court of Appeal rendered a groundbreaking decision, St-Germain c Benhaim, 2014 QCCA 2207, regarding the causal link between, on the one hand, an omission to conduct te...

DALHOUSIE MEDICAL JOURNAL

This paper explores Canadian liability concerns flowing from the integration of artificial intell... more This paper explores Canadian liability concerns flowing from the integration of artificial intelligence (AI) as a tool assisting physicians in their medical decision-making. It argues that the current Canadian legal framework is sufficient, in most cases, to allow developers and users of AI technology to assess each stakeholder's responsibility should the technology cause harm.

Revue de droit de l'Université de Sherbrooke

Les Cahiers de droit

Le traitement judiciaire de la preuve scientifique en droit de la responsabilité civile en présen... more Le traitement judiciaire de la preuve scientifique en droit de la responsabilité civile en présence d’incertitude ou de débats est un sujet qui fait couler de plus en plus d’encre. Dans leur étude de droit comparé qui porte sur des jugements au fond de la France et du Québec, les auteurs évaluent la façon dont le juge accède à la conviction qu’un fait est prouvé lorsque cette représentation intellectuelle passe par la médiation de la connaissance scientifique, c’est-à-dire qu’elle nécessite d’avoir recours à une analyse scientifique de la situation de fait. L’étude s’interroge donc sur la manière dont les juges français et québécois appréhendent cette connaissance scientifique et se focalise ainsi sur le rapport des juges à la connaissance scientifique. En se penchant sur le raisonnement judiciaire français et québécois en matière de responsabilité civile, l’étude permet d’évaluer ce rapport au sein d’un champ de droit dont les racines sont similaires dans les deux ressorts, à la lu...