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The Role of the Criminal Law and The Criminal Process in Healthcare Malpractice in France and England
Melinee Kazarian
[Thesis].The University of Manchester;2013.
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Abstract
This thesis seeks to contribute to the debate about the role of the criminal law in holding health professionals and health institutions to account for malpractice. The research attempts a critical comparison of the role of the criminal law and the criminal process in healthcare malpractice in France, a civil law jurisdiction, and England, a common law jurisdiction. In France, the criminal process is more readily invoked to address failings and malpractice in healthcare. The aim of this research is to see how the comparison of the two jurisdictions sheds light on the now much debated question of how the criminal process should relate to healthcare malpractice. The purpose of the comparative examination of law and process is twofold: (1) to highlight what might be seen as failings within each legal system and identify lessons that might be learned from each other and (2) to locate these differences in an analysis of how (if at all) the criminal process can best engage with healthcare malpractice. The much publicised HIV-contaminated blood episode in France and England is studied as an illustration of a case of systemic healthcare failure and the use of the criminal process in France. It is used to illustrate and explore more fully the questions above and shed light on the overall aim of the thesis, which is to assess what the role of the criminal law should be in the context of healthcare malpractice.The research reveals that particular features of the general substantive criminal law and criminal process go a long way toward explaining differences in the criminalisation of healthcare malpractice as between France and England. The criminalisation of ‘simple’ direct negligence which may result in death or injury in France provides the possibility to criminalise healthcare malpractice more readily than in England, where only gross negligence resulting in death is generally criminalised in the healthcare malpractice context. Features of the French inquisitorial criminal process (notably juges d’instruction and parties civiles) play a central role in providing a greater platform for the criminalisation of healthcare malpractice in France, whereas features of the English adversarial system (in particular the role of the Crown Prosecution Service and the jury) tend to minimise the possibility for a wider criminalisation of healthcare malpractice in England. However, I do not argue that England should follow France in adopting more extensive use of the criminal process in the context of healthcare malpractice. Key lessons drawn from the present study are that the criminal process is not usually an appropriate means to respond to many instances of healthcare malpractice. This is not to say that the criminal process has no role to play where the conduct of the professional has shown no regard for the safety of patients. Features of French criminal law and criminal procedure might be useful to counteract healthcare malpractice using alternative non-criminal proceedings. For instance, it will be argued that the model of thorough investigations conducted by juges d’instruction in the French criminal process could be better achieved outside the criminal law to provide transparency in the healthcare context. The study will point out the limitations of the criminal process in preserving health and safety and will thus highlight the importance of alternatives to the criminal process such as prevention in the healthcare setting and support to victims of healthcare malpractice.