Defensive medicine (DM) refers to clinical practices motivated primarily by perceived medicolegal risk rather than patient benefit. In Jordan, evidence remains limited regarding physicians' defensive practices, awareness of defensive medicine as a formal concept, understanding of the 2018 Medical Liability Law, and attitudes toward malpractice litigation. A cross-sectional survey was conducted among a convenience sample of 211 physicians in Jordan between August 2023 and March 2024. A structured questionnaire assessed DM practices (10-item scale), attitudes toward malpractice litigation (5-item scale), familiarity with defensive medicine, self-rated understanding of the 2018 Medical Liability Law, litigation exposure, insurance status, and perceived patient pressure. Multivariable linear regression analyses were performed to examine factors associated with defensive medicine and attitude scores. Defensive medicine was reported by 84.4% of physicians, with a low-to-moderate overall intensity (mean item score across the 10 DM items : 2.1 ± 0.54 on the original 1-5 scale). Assurance behaviors predominated, particularly additional diagnostic testing perceived as precautionary or unnecessary (59.3%). Only 30.8% were familiar with the term "defensive medicine", and 60.7% rated their understanding of the 2018 Medical Liability Law as poor. In the multivariable analysis, younger age (B = -0.34, p = 0.024), prior malpractice litigation experience (B = 4.89, p < 0.001), and perceiving litigation as a personal attack (B = -1.18, p = 0.012) were independently associated with higher defensive medicine scores (R² = 0.178). Specialty risk category was not independently associated with defensive medicine after adjustment. In the attitude model, familiarity with defensive medicine (B = 0.82, p = 0.028) and lower defensive medicine scores (B = -0.06, p = 0.047) were associated with higher attitude scores toward malpractice litigation (R² = 0.132). Defensive medicine was common among physicians in this sample and was expressed mainly through assurance-type behaviors. The findings suggest that defensive practices may be more closely associated with perceived professional vulnerability, prior litigation experience, and threat-related perceptions than with specialty risk category or self-rated legal understanding alone. Given the cross-sectional design and convenience sampling, these findings should be interpreted as exploratory and require confirmation in larger, more representative studies.

Sexual violence affects 22% of Australian women, posing health and justice challenges. Systemic failures, fragmented data, and low conviction rates hinder effective responses. This study integrates Australian Capital Territory (ACT) medical and policing datasets to examine victim characteristics and case progression from clinical presentation to legal outcomes. This retrospective study analyzed 2179 deidentified cases of female sexual assault victims presenting to Forensic and Medical Sexual Assault Care (FAMSAC) between 2004 and 2022. De-identified patient variables and ACT Policing data were integrated and analyzed to examine victim characteristics and case progression from medical consultation to legal outcomes. Of 2179 females presenting for forensic and medical care, 41.8% reported to ACT Policing, 19.2% progressed to court and 10.4% of cases resulted in a conviction. Drug use (14.9%) was negatively associated with case progression, while alcohol use and pre-existing mental health conditions showed no significant effect. No victim, assailant, or medical factors were associated with conviction outcomes. Among cases withdrawn at the policing stage, anal penetration, forensic photography, and presentation outside business hours were associated with continuation to court. Overall, 54.3% of cases that proceeded to court resulted in conviction. Through collaborative practices, this study establishes a baseline for continuous system review from forensic medical presentation to court outcome. Legal outcomes were independent of victim characteristics, assault details, and medical findings, with attrition at every stage. Medical documentation alone could not predict conviction, though it may support the finders of fact. Further research is needed to assess whether medical evidence influences police action, court pleas, and convictions.

This study evaluated the impact of medical and recreational cannabis laws in the United States on health-related workplace absenteeism across different demographics, occupations, and industries. Using state-level variation in the timing of cannabis decriminalization and the onset of regulated sales, we applied a flexible difference-in-differences approach to monthly data from the Current Population Survey, covering the period from January 1990 to March 2025. The findings indicate that medical cannabis decriminalization reduced the likelihood of health-related work absences by about 6.9%, with decriminalization having a larger quantitative effect and greater statistical significance than the commencement of regulated sales. We found no significant effect of recreational cannabis legalization on health-related workplace absenteeism. The absenteeism-reducing effects of medical cannabis decriminalization were notable in occupations (e.g., manual laborers, machine operators) and industries (e.g., manufacturing, agriculture, construction) where conditions more predisposed to cannabis treatment (e.g., chronic pain associated with physical work) are prevalent.

Noneconomic damage caps, a form of medical malpractice law, remain controversial, as several states have enacted such laws since 2010, whereas others have repealed them. The clinical consequences of repealing these caps are poorly understood, and understanding these associations can inform the ongoing debate about medical malpractice reform. To examine whether repealing noneconomic damage caps is associated with changes in maternal care and infant health outcomes. This cross-sectional study adopted a difference-in-differences design, comparing between 2 treated states (Georgia and Illinois) that repealed their noneconomic damage caps in 2008 to 2009 and 16 control states that retained their caps during the entire study period between 2005 and 2019. The Centers for Disease Control and Prevention All-County Natality Files were used to estimate multivariate linear models, controlling for maternal and infant characteristics and county-level and state-level covariates. Estimates were stratified by county rurality and birth risk conditions. Data were analyzed from April 1, 2024, to April 9, 2026. The primary outcomes were 4 measures of maternal care and procedures (physician-attended births, inductions, cesarean delivery births, and prenatal visits) and 3 birth outcomes (low Apgar score, low birth weight, and preterm births). Difference-in-differences models with 2-way fixed effects were estimated, and linear models for the study outcomes were specified. The sample included 20 426 267 live births (mean [SD] gestational age, 38.55 [1.35] weeks). Compared with their counterparts in the control states, rural counties in the treated states experienced a statistically significant increase of 2.92 percentage points (pp) (95% CI, 1.40-4.50 pp; Bonferroni-adjusted P = .01) in physician-attended births. The increase held for both low-risk (3.10 pp; 95% CI, 1.33-4.90 pp; P = .004) and high-risk (2.56 pp; 95% CI, 0.77-4.34 pp; P = .01) births in rural counties. There was no difference between treated and control states for physician-attended births overall or in urban counties. No statistically significant associations were observed for cesarean deliveries, inductions, prenatal visits, or infant health outcomes after adjusting for multiple comparisons. In this cross-sectional study of 20 426 267 live births across 18 states, repealing noneconomic damage caps was associated with increased physician-attended births in rural counties but was not associated with statistically significant changes in other maternal care measures or infant health outcomes. These findings suggest that increased liability risk after repealing the caps may shift the composition of birth attendants in resource-constrained settings without demonstrable changes in infant health.

Direct access to physiotherapy as a care model for Germany? A qualitative analysis of experts' perspectives on relevance and feasibility

A male in his 30s underwent retroperitoneal mass excision. A T8-T9 epidural catheter was placed for postoperative analgesia, infusing 0.0625% bupivacaine and 2 µg/mL fentanyl at 8 mL/h. That evening, the patient left against medical advice (AMA) while declining epidural catheter removal. The patient returned 2.5 hours later for an uneventful epidural removal. We examine the clinical, legal, and ethical considerations of a patient leaving AMA with a neuraxial catheter. While medical ethics and US law guarantee patient autonomy, this situation conflicts with obligations to prevent harm including potential neuraxial infection, hematoma, or retained catheter fragments. We describe our response to this scenario and discuss steps to mitigate this uncommon but high-stakes situation.

A central goal of medical malpractice law is to ensure quality of care by deterring negligent treatment. Although previous research has produced mixed results, much of it finds no clear association between liability exposure and medical treatment. During the COVID-19 pandemic, many states adopted immunity from tort liability for harms to nursing home residents, creating a natural experiment. To examine the association between immunity from tort liability and nursing home staffing. This cohort study using a difference-in-differences model evaluated all US nursing homes reporting data from 2018 to 2023. The data analysis took place between July 2025 to September 2025. State tort immunity law. Nursing home staffing patterns derived from Centers for Medicare & Medicaid Services Nursing Home Compare, Payroll Based Journal Daily Staffing Averages, and weekly nursing home COVID-19 tracking data. During the COVID-19 pandemic, approximately 80% of the US states abruptly implemented some form of tort immunity for nursing homes. Of 13 205 nursing homes in the analysis, 11 382 (86.2%) were subject to tort immunity and 1823 (13.8%) were not. Some of the laws included automatic end dates and others were indefinite. Nursing homes immune from tort liability exhibited less staff time per patient per day than nursing homes in states that did not grant tort immunity: a 2.5-percentage point (pp) reduction (95% CI, -4.3 to -0.6 pp) in overall daily staffing hours and a 1.2-pp reduction (95% CI, -2.3 to -0.1 pp) in overall staffing hours per patient per day with significant reduction in certified nursing assistant hours to patient per day (-2.0 pp; 95% CI, -3.5 to -0.5 pp). In this cohort study of US nursing homes, the introduction of immunity was associated with decreased overall nursing home staffing and staff per resident time. Registered nurse and licensed practical nurse to patient time was not statistically different.

Physician adoption of new information about a medical procedure can affect patient outcomes. Medical malpractice law may influence physician use of such information. We analyze how physician reactions to information shocks regarding vaginal births after cesarean sections (VBACs) in the 1990s were mediated by tort reform and the standard used in malpractice claims to determine a physician's duty of care to patients. Differentiating states according to whether they capped non-economic damages in malpractice claims (Caps) and whether they defined the duty of care using a national or a local reference point, we analyze how physicians under the four legal regimes reacted to a series of adverse information shocks regarding VBACs over the period. Our results suggest that physicians whose duty of care is determined by standard practices nationwide are less likely to adopt innovations which have not yet been incorporated into those practices and more likely to adopt innovations once they are incorporated into those practices. Caps may moderate these effects. Our results also suggest intuitive heterogeneity in the effects of legal regime on physician decisions.

Artificial intelligence (AI) is increasingly used in radiological diagnostics, particularly for screening, detection, and prioritization of imaging exams. While these systems promise efficiency gains and improved diagnostic accuracy, their clinical integration raises important legal questions concerning responsibility and liability in cases of diagnostic error. This article analyzes the legal framework governing AI in radiology and examines the allocation of liability between physicians, health care institutions, and manufacturers within existing medical liability structures. Adoctrinal legal analysis was conducted based on European and German legal sources, including the AI Act and the Medical Device Regulation, as well as provisions of German medical liability law. AI systems in radiology are legally classified as medical tools rather than independent actors. Consequently, they cannot bear legal responsibility themselves. Liability primarily remains with the physician, who must critically review and validate AI-generated outputs within the diagnostic process. Manufacturers may be liable under product liability and regulatory compliance frameworks. The interaction between technological complexity and existing evidentiary standards creates increasing tension within traditional liability doctrines. Despite technological progress, the final diagnostic decision and legal responsibility remain with the physician. AI currently functions as adecision-support tool rather than asubstitute for medical judgment. However, the increasing relevance of autonomous systems suggests that adistinct legal framework for AI in medicine may emerge in the future.

Abstract Artificial intelligence (AI) is increasingly deployed in oncology and pathology to support diagnosis, prognosis, molecular subtyping, and clinical documentation. Although these systems often achieve high predictive accuracy, their integration into clinical workflows exposes a structural mismatch with existing legal frameworks. U.S. medical law is organized around accountable, reason-giving clinicians, yet many clinically deployed AI systems operate as opaque decision engines that cannot articulate the rationale underlying their outputs. This article argues that treating such systems as mere “tools” obscures a growing justification gap resulting from poor explainability and lack of reasoning of AI models: predictive and prognostic artificial intelligence increasingly shapes clinical outcomes without bearing legal responsibility or providing explanations required for malpractice defense, insurance coverage determinations, or regulatory review. Drawing on malpractice doctrine, insurance law, FDA regulation, and professional licensure regimes, this article demonstrates that clinicians cannot fully delegate diagnostic justification to AI systems, even when those systems materially influence clinical decisions. As a result, clinicians remain legally accountable for decisions they do not entirely control. The article reframes clinical autonomy not as an ethical preference, but as a legal necessity arising from justification-centered accountability structures. It concludes by outlining regulatory and institutional approaches for clarifying responsibility in AI-mediated oncology and pathology without undermining clinical judgment.

PurposeDespite growing recognition of the critical importance of physician leadership in delivering safe healthcare, especially in light of the 2023 medical crisis and professional resistance in Korea, existing studies on leadership education have focused predominantly on countries with long-established leadership curricula. This study aims to assess the curricular content of Korean medical schools to provide a quantitative and qualitative baseline of medical leadership training in the undergraduate curriculum.MethodsWe conducted a content analysis of undergraduate medical curricula from 19 Korean medical schools using the Medical Leadership Competency Framework (MLCF) as a guiding framework. Survey questionnaires were distributed to designated faculty at each institution, and 270 courses were analyzed, yielding 504 leadership-related codes that were categorized thematically across the five MLCF domains and by academic year.ResultsOur analysis revealed that 228 codes (45.2%) fell within “Demonstrating personal qualities” and 75 codes (14.8%) within “Setting direction,” with predominant emphasis on medical ethics and law. Training in systems-based practice, self-awareness, emotional intelligence, and team-based approaches was relatively limited. Substantial institutional variation existed, with only eight of 19 schools offering curricula covering all five MLCF domains. Most leadership content was delivered through isolated, single-semester courses rather than longitudinally integrated programs.ConclusionWhile Korean medical schools recognize certain leadership competencies, there is a need for more comprehensive and consistent integration of leadership development, particularly in teamwork and systems-based practice. We recommend longitudinal integration of leadership education across pre-clinical and clinical years to address evolving competencies at different training stages.

ABSTRACT Adolescent pregnancy is a major public health issue in sub-Saharan Africa, including in Zambia. Its occurrence in rural areas is under-researched, and little is known about the factors driving it. This qualitative study explored the drivers of adolescent pregnancy in Kalabo District through 32 in-depth interviews with pregnant adolescents, parents, healthcare providers, traditional leaders, and marriage counsellors. Guided by the social ecological model and the theory of gender and power, thematic analysis examined how gender norms, gender socialisation, socio-economic conditions, and institutional gaps intersect to influence early childbearing. Four interconnected themes were developed: (1) culture and tradition, (2) early marriage, (3) barriers to sexual and reproductive health and rights information and services, and (4) weak legal enforcement. The findings show that the sikenge initiation rite reinforces submissive gender roles and emphasises fertility, while poverty and social pressure promote early marriage and monetary gain. Limited youth-friendly healthcare services, contradictions between sexual and medical consent laws, and inadequate sexuality education restrict adolescents’ and young people’s access to relevant information and services. Weak enforcement of child protection laws and the informal settlement of cases of defilement 1 further compromise adolescents’ rights and safety.

The misuse of antibiotics is widespread in Pakistan and poses a significant risk to public health due to the increasing prevalence of antibiotic resistance. Despite existing regulatory structures, there are numerous challenges affecting their effective implementation. This research paper aims to explore the legal and policy issues related to antibiotic usage by employing ethnographic techniques, including participant observation and interviews. Data were collected from a sample of 26 participants residing in District Khairpur Mir’s in Sindh, selected through purposive and snowball sampling methods. Thematic analysis of the data reveals that negligence by authorities, loss of interest, lack of awareness, and poor enforcement of legal measures contribute to the rise of antibiotic resistance in healthcare facilities across Pakistan. The paper contributes to the field of medical ethics at the intersections of medical practice, law and pharmaceuticals in the context of Pakistan.

This study addresses the violation of informed consent as an autonomous legal category, capable of grounding, by itself, the civil and criminal liability of medical professionals, regardless of the occurrence of physical harm or technical error in therapeutic conduct. The research investigates the theoretical, normative, and jurisprudential foundations that support this new paradigm in contemporary Medical Law, examining the evolution of the informed consent doctrine, its multifaceted legal nature, and the consequences that its violation produces in civil and criminal spheres. A bibliographic and documentary review methodology is adopted, with analysis of doctrinal works, legislation, jurisprudence of the higher courts, and regulations of the Federal Council of Medicine. The results demonstrate that Brazilian doctrine and jurisprudence have progressively recognized the autonomous unlawfulness of the violation of informed consent, establishing that the patient's right to self-determination constitutes an independent legal asset, whose violation generates an obligation to repair even in the absence of bodily harm. Furthermore, it is verified that criminal liability may arise when the absence of valid consent typifies conduct such as bodily harm or illegal coercion. The study concludes that the repositioning of informed consent as a central institution of Medical Law demands a profound reformulation of civil and criminal liability dogmatics, with repercussions on professional training and institutional policies of health services.

In this era of paradigm shift of violence against doctors and medical professionals, it is imperative to educate them about the legal aspect to practice of medicine that will protect them from facing criticism, uphold ethical practices, and encourage doctors to manage potential legal challenges in their day-to-day practice effectively. This study will provide us with valuable insights into the current understanding of medicolegal issues, especially among our junior doctors. It will also help in identifying areas where further education and training are needed. A cross-sectional study among 174 participants was conducted using structured questionnaires and the results were summarized and analyzed using SPSS version 20.0 with descriptive analysis. A significant proportion of the participants demonstrated a good understanding of MLC and the necessary precautions to avoid involvement. Most of the participants had good knowledge about basic understanding of MLC, different MLC scenarios, medicolegal report preparation but a majority of them failed to acknowledge the same in terms of sexual assault cases and certain aspects of consent taking. The study found that there was lack of comprehensive understanding about MLC in some participating doctors. Hence, actions are required in specific areas of medicolegal understanding where a significant gap of knowledge was seen. Measures such as periodic continuing medical education and workshop sessions on medical law and ethics can be organized to ensure that all the doctors from interns to faculty members feel confident to handle their medicolegal issues.

This article analyzes an important rule from the sphere of medical civil law, namely the pre-contractual cognitive duty in the contract of private medical services. In view of the rapid advancement in private healthcare, whose orientation is increasingly becoming commercial and investment-driven, the doctor-patient relationship is not merely human anymore. But its contractual character has become more complex and the knowledge of the parties is imbalanced. The study proposes the duty of disclosure as a pre-contractual phase, disassociating it from the obligation to consult a doctor later, and defining its legal basis as good faith and protection of consent. The research also investigates what details must be revealed, such as who the service provider is, what are their total costs, what risks do the service providers pose, and what possible alternatives the users have. In the final segment of the module, the mechanisms for proving compliance and the role of the judiciary in protecting patients from arbitrary conditions and misleading practices are discussed in detail. All this is based on the general principles of civil law and on specific laws on patient protection and healthcare provision.

Type of the article: Research ArticleAbstractThe integration of AI-enabled medical robots into the medical field has increased the potential risks to which patients may be exposed. To protect patients’ rights, this study aims to explore and analyze the need for mandatory insurance against civil liability of medical robots operating with AI technologies in the United Arab Emirates. Such insurance is intended to ensure adequate compensation, reinforce legal protection, and uphold confidence in medical practice, while also contributing to societal stability and supporting the growth of the insurance sector. The study employed a combination of descriptive and analytical methods. It concludes that smart medical robots are neither inanimate objects nor irrational beings. It recommends legislative regulations granting them digital legal personality under specific controls, recognizing their independent financial status, and enabling them to bear civil liability for actions causing harm. The study showed an upward trend in the number of insurance companies providing liability coverage for damages caused by AI-operated medical robots, increasing from two in 2020 to ten in 2025, and expected to rise further if full legal personality is granted. The research findings suggest amending the UAE Civil Transactions Code and the Medical Liability Law to codify civil liability provisions for autonomous smart medical robots and to mandate liability insurance. Furthermore, as insurers’ obligations depend on establishing the insured’s liability, UAE law should grant the injured party a direct right of action against the insurer.

BackgroundUse of physical restraints in intensive care units (ICUs) creates ethical challenges for nurses and often causes moral distress as they balance patient safety with autonomy and dignity.Research aimTo explore Iranian ICU nurses' experiences of moral distress related to decisions about PR use.Research designAn exploratory qualitative approach was used.Participants and research contextTwenty Persian-speaking ICU nurses with at least two years' clinical experience were purposively recruited from hospitals affiliated with Shahid Beheshti University of Medical Sciences between September 10 and November 14, 2025. In-depth semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using Elo and Kyngäs's three-phase content analysis. Trustworthiness was ensured via Lincoln and Guba's criteria of credibility, dependability, confirmability, and transferability.Ethical considerationsApproved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1404.397). Written informed consent and reconfirmed verbal consent were obtained.ResultsAnalysis generated 323 initial codes; 201 remained after refinement. Two principal categories emerged: (1) Moral suffering in clinical decision-making-ethical conflicts, negative emotions, consequences for the patient, and for nurses; and (2) Adaptation and efforts to reduce moral distress-contextual factors, coping strategies, and suggestions for reducing moral distress. Participants described emotional exhaustion, guilt, reduced motivation, and compromised quality of care. Key contributing factors included staff shortages, workload pressure, and unilateral physician orders. Coping strategies comprised peer support, temporary distancing from the situation, and spiritual or self-soothing practices. Suggestions for reducing moral distress emphasized education on restraint alternatives, clear clinical guidelines, and strengthened interprofessional decision-making.ConclusionMoral distress related to PR use among ICU nurses stems from tensions between patient safety and dignity and is shaped by organizational and contextual factors. While nurses described individual strategies to cope, organizational support, clearer guidance, and collaborative decision-making may reduce ethical burden. Further research should examine applicability in other clinical and cultural contexts.

Scientific research in the field of legal studies intersects with numerous other disciplines—such as commerce, medicine, economics, media, politics, and others. These fields are governed by legal rules, such as commercial law, medical law, and economic relations law, among others, which demonstrates that no field exists outside a regulatory legal framework. Therefore, a researcher must recognize that the quality of their legal research is rooted in the depth of their knowledge of the subject matter with which it intersects. Researchers must also understand that the validity of previous research findings is not absolute; acknowledging their relativity expands the researcher’s intellectual horizons. Likewise, researchers should not venerate other scholars, as doing so undermines the nature and quality of their scientific work when they merely repeat previously reached conclusions. The importance of research lies in the researcher’s awareness of the significance of the scholarly pen in analyzing and understanding any issue within the field of legal sciences. The pen is a tool that stimulates the mind to comprehend the philosophy underlying legal rules, both before and after their formulation, from multiple perspectives, for no legal issue admits an absolute understanding—the differences arise from varying intellectual viewpoints. This means that researchers should not sanctify others’ ideas, and that those who admire the works and ideas of others must, at the very least, avoid committing academic plagiarism, as it contradicts the ethics of scientific research established in international and national legislation. This study employs both analytical and descriptive methods to clarify the relationship between intellect and writing in legal philosophy and to elucidate the issue of academic plagiarism.

Introduction: The escalation of conflicts in the Middle East has led to an increased risk of terrorism resurgence in Europe. During past terrorist incidents, inefficient interagency collaboration has repeatedly been identified as a key obstacle to an efficient response. This study aims to investigate the perspectives of European prehospital emergency medical providers and law enforcement officers on interagency collaboration during terrorist incidents. It seeks to identify barriers, best practices, and opportunities for enhancing collaboration. Methods: Interdisciplinary, international focus group interviews have been conducted online (at time of submission: nine interviews, 45 participants,13 European countries). Each interview has been analyzed using deductive coding for predefined topics, e.g., Command, Communication, and Hot Zone Care. Inductive coding has been used for additional content arising from the discussions. Results: The paucity of joint training opportunities and the need for political guidance were considered the most pressing issues. Interagency miscommunication, disparate situational awareness, and differing mindsets on the scene were identified to significantly impede provider safety on the scene. Within the national protocols of 73% (33/45) of participants, patient care inside the hot zone relied largely on police forces, including special forces. Concurrently, it has been emphasized that, due to a lack of resources, police forces are likely to focus not on patient care or evacuation but on threat elimination during the initial response phase. Additionally, evacuation resources have been identified as a bottleneck in transferring casualties from the hot zone to a safer zone. In summary, these factors create a therapeutic vacuum for casualties with potentially survivable injuries inside the hot zone. Conclusion: This study pronounces the need for joint training opportunities, which are anticipated to increase provider safety. Further, it highlights the urgent necessity of political commitment to set a framework that enables providers to diminish the therapeutic vacuum inside the hot zone.