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A Crispr Future for Gene-Editing Regulation: a Proposal for an Updated Biotechnology Regulatory System in an Era of Human Genomic Editing. Crispr基因编辑监管的未来:人类基因组编辑时代更新生物技术监管体系的建议。
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-10-01
Tracey Tomlinson

Recent developments in gene-editing technology have enabled scientists to manipulate the human genome in unprecedented ways. One technology in particular, Clustered Regularly Interspaced Short Pallindromic Repeat (CRISPR), has made gene editing more precise and cost-effective than ever before. Indeed, scientists have already shown that CRISPR can eliminate genes linked to life-threatening diseases from an individual's genetic makeup and, when used on human embryos, CRISPR has the potential to permanently eliminate hereditary diseases from the human genome in its entirety. These developments have brought great hope to individuals and their families, who suffer from genetically linked diseases. But there is a dark side: in the wrong hands, CRISPR could negatively impact the course of human evolution or be used to create biological weaponry. Despite these possible consequences, CRISPR remains largely unregulated due to the United States's outdated regulatory scheme for biotechnology. Moreover, human embryo research, which is likely critical to maximizing the therapeutic applications of CRISPR, is not easily undertaken by scientists due to a number of federal and state restrictions aimed at preventing such research. This Note examines the possible benefits and consequences of CRISPR and discusses the current regulations in both the fields of biotechnology and human embryo research that hamper the government's ability to effectively regulate this technology. Ultimately, this Note proposes a new regulatory scheme for biotechnology that focuses on the processes used to create products using CRISPR, rather than the products themselves, with a focus on enabling ethical research using human embryos to maximize the potential benefits of CRISPR.

基因编辑技术的最新发展使科学家能够以前所未有的方式操纵人类基因组。特别是一项技术,集群规则间隔短Pallindromic Repeat (CRISPR),使基因编辑比以往任何时候都更加精确和经济。事实上,科学家们已经证明,CRISPR可以从个体的基因构成中消除与危及生命的疾病相关的基因,而且,当用于人类胚胎时,CRISPR有可能从人类基因组的整体中永久性地消除遗传性疾病。这些发展给患有遗传相关疾病的个人及其家庭带来了巨大的希望。但它也有不好的一面:如果落入坏人之手,CRISPR可能会对人类进化进程产生负面影响,或者被用来制造生物武器。尽管存在这些可能的后果,但由于美国过时的生物技术监管计划,CRISPR在很大程度上仍然不受监管。此外,人类胚胎研究可能是最大限度地发挥CRISPR治疗应用的关键,但由于联邦和州的一些限制,科学家们不容易进行此类研究。本文探讨了CRISPR可能带来的好处和后果,并讨论了生物技术和人类胚胎研究领域的现行法规,这些法规阻碍了政府有效监管这项技术的能力。最后,本文提出了一个新的生物技术监管方案,该方案侧重于使用CRISPR创建产品的过程,而不是产品本身,重点是使使用人类胚胎的伦理研究能够最大限度地发挥CRISPR的潜在好处。
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引用次数: 0
Dignity and Social Meaning: Obergefell, Windsor, and Lawrence as Constitutional Dialogue 尊严与社会意义:作为宪法对话的奥伯格费尔、温莎和劳伦斯
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-06-18 DOI: 10.2139/SSRN.3153661
S. Sanders
The Supreme Court’s three most important gay and lesbian rights decisions – Obergefell v. Hodges, United States v. Windsor, and Lawrence v. Texas – are united by the principle that gays and lesbians are entitled to dignity. Beyond their tangible consequences, the common constitutional evil of state bans on same-sex marriage, the federal Defense of Marriage Act, and sodomy laws was that they imposed dignitary harm. This Article explores how the gay and lesbian dignity cases exemplify the process by which constitutional law emerges from a social and cultural dialogue in which the Supreme Court actively participates. In doing so, it draws on the scholarly literatures on dialogic judicial review and the role of social meaning in constitutional law. It illuminates how the Supreme Court interprets democratic preferences and constructs social meaning in order to apply fundamental Constitutional norms to emerging legal claims. Contrary to the speculations of some commentators, “dignity” in these cases did not operate as some new form of constitutional right. Rather, the identification and protection of dignitary interests served as the unifying principle for a process, unfolding in three cases over thirteen years, through which constitutional law was brought into alignment with evolving public attitudes and policy preferences. The dignity decisions should be understood as majoritarian, not acts of judicial will. They were broadly accepted, because the Court’s insights about the status of gays and lesbians in American society were consistent with dramatic and long-term changes in culture and public attitudes. As culture and attitudes evolved, so did the social meaning of anti-gay laws. Sodomy laws and marriage restrictions, once accepted as presumptively constitutional protections of tradition and public morality, increasingly came be understood as impositions of stigma and humiliation -- the kind of expressive harms that the Constitution forbids.
最高法院的三项最重要的男女同性恋权利裁决——奥伯格费尔诉霍奇斯案、美国诉温莎案和劳伦斯诉德克萨斯州案——基于男女同性恋有权享有尊严的原则。除了有形的后果外,各州禁止同性婚姻、联邦《婚姻保护法》和鸡奸法的共同宪法弊端是,它们对政要施加了伤害。本文探讨了男女同性恋尊严案件如何体现宪法从最高法院积极参与的社会和文化对话中产生的过程。在这方面,它借鉴了关于对话司法审查和社会意义在宪法中的作用的学术文献。它阐明了最高法院如何解释民主偏好和构建社会意义,以便将基本宪法规范应用于新出现的法律主张。与一些评论家的猜测相反,在这些案件中,“尊严”并不是一种新的宪法权利。相反,识别和保护权贵利益是一个过程的统一原则,在十三年的时间里,这一过程在三个案例中展开,通过这一过程,宪法与不断变化的公众态度和政策偏好相一致。尊严裁决应该被理解为多数主义,而不是司法意愿的行为。他们被广泛接受,因为最高法院对同性恋者在美国社会中地位的见解与文化和公众态度的戏剧性和长期变化相一致。随着文化和态度的演变,反同性恋法律的社会意义也在演变。鸡奸法和婚姻限制曾经被认为是宪法对传统和公共道德的保护,但现在越来越被理解为污名和羞辱的强加——宪法禁止这种明显的伤害。
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引用次数: 1
Race and Assisted Reproduction: Implications for Population Health. 种族和辅助生殖:对人口健康的影响。
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-05-01
Aziza Ahmed

This Article emerges from Fordham Law Reviews Symposium on the fiftieth anniversary of Loving v. Virginia, the case that found antimiscegenation laws unconstitutional. Inspired by the need to interrogate the regulation of race in the context of family, this Article examines the diffuse regulatory environment around assisted reproductive technology (ART) that shapes procreative decisions and the inequalities that these decisions may engender. ART both centers biology and raises questions about how we imagine our racial futures in the context of family, community, and nation. Importantly, ART demonstrates how both the state and private actors shape family formation along racial lines. By placing a discussion about race and ART in the context of access to new health technologies, this Article argues that assisted reproduction has population-level effects that mirror broader racial disparities in health. In turn, this Article intervenes in a bioethics debate that frequently ignores inequalities in access when thinking through the consequences of ART. Part I presents a case study of the Sperm Bank of California (SBC) to demonstrate how ART represents a new mode of governing the family that facilitates and encourages the formation and creation of monoracial families. Part II borrows a public health analytic, the 'burdens of disease," to explain how the (re)production of monoracial families has consequences for health at the population level, especially when placed in the context of racially disparate access to ART services. Ultimately, this Article concludes that ART, as it is currently accessed and utilized, maintains racial orders with regard to health given the inequality in access to these services.

这篇文章出自福特汉姆法律评论研讨会,纪念洛文诉弗吉尼亚案五十周年,该案认定反通婚法违宪。受质疑家庭背景下种族监管的需要的启发,本文研究了辅助生殖技术(ART)周围的分散监管环境,这些环境影响了生育决策以及这些决策可能产生的不平等。ART既以生物学为中心,也提出了关于我们如何在家庭、社区和国家的背景下想象我们的种族未来的问题。重要的是,ART展示了国家和私人行为者如何沿着种族界线塑造家庭的形成。通过在获得新卫生技术的背景下讨论种族和抗逆转录病毒治疗,本文认为辅助生殖具有人口层面的影响,反映了健康方面更广泛的种族差异。反过来,本文介入了一场生物伦理辩论,在思考抗逆转录病毒治疗的后果时,这种辩论往往忽视了获取机会方面的不平等。第一部分介绍了加州精子库(SBC)的案例研究,以展示ART如何代表一种新的家庭管理模式,促进和鼓励单一家庭的形成和创造。第二部分借用了一个公共卫生分析,即“疾病负担”,来解释单一家庭的(再)生产如何在人口层面上对健康产生影响,特别是在获得抗逆转录病毒治疗服务的种族差异的背景下。最后,本文的结论是,鉴于获得抗逆转录病毒治疗服务的机会不平等,目前获得和利用抗逆转录病毒治疗维持了卫生方面的种族秩序。
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引用次数: 0
United States v. Caronia: Off-Label Drug Promotion and First Amendment Balancing. 美国诉卡罗尼亚:说明书外药品促销与第一修正案的平衡。
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-04-01
Daniel P Rabinowitz

Off-label drug promotion is commonplace in the United States, but it is not without its dangers. While the Food, Drug, and Cosmetic Act does not explicitly ban off-label promotion, the Food & Drug Administration (FDA)--in order to protect consumers from unsafe and ineffective drugs--has taken steps to regulate it. The FDA does so through its intended-use regulation, which lists the types of evidence the FDA can consider in determining whether a drug is misbranded. It is a crime to sell a misbranded drug into interstate commerce or to conspire to do so. On September 25, 2015, the FDA proposed an amendment to the regulation, which has drawn opposition from various industry groups due to its potential to restrict the type of speech that is often used in off-label promotion. The First Amendment challenge to the proposed amendment rests on United States v. Caronia, in which the FDA was prevented from using truthful, nonmisleading speech to convict a pharmaceutical representative of a conspiracy to sell a misbranded drug. This Note examines whether the amendment to the regulation is permissible under Caronia. It first contends that the regulation does not facially violate the First Amendment. It further argues that the rule is constitutional and does not pose the same First Amendment issue as was seen in Caronia as long as the FDA implements it with care. This Note concludes by exploring various ways that the FDA can constitutionally regulate off-label drug promotion under the proposed rule.

在美国,标签外药物的推广是司空见惯的,但它并非没有危险。虽然《食品、药品和化妆品法》没有明确禁止标签外促销,但美国食品和药物管理局(FDA)为了保护消费者免受不安全和无效药物的伤害,已采取措施对其进行监管。FDA通过其预期用途规定来做到这一点,该规定列出了FDA在确定药物是否被贴错标签时可以考虑的证据类型。在州际贸易中出售假药或串谋出售假药是犯罪行为。2015年9月25日,FDA对该法规提出了一项修正案,由于其可能限制在标签外促销中经常使用的言论类型,该修正案遭到了各种行业团体的反对。第一修正案对拟议修正案的挑战在于美国诉卡罗尼亚案(United States v. Caronia),在该案中,FDA被禁止使用真实、非误导性的言论来判定一名制药公司代表共谋销售假药。本说明探讨根据《条例》修订规例是否获准。它首先辩称,该规定表面上并没有违反第一修正案。它进一步辩称,只要FDA谨慎执行,该规则是符合宪法的,不会像在卡罗尼亚案中看到的那样构成第一修正案的问题。本文最后探讨了FDA在拟议规则下对超说明书药品促销进行宪法性监管的各种方式。
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引用次数: 0
The Protection of Patients Under the Clayton Act. 根据克莱顿法案保护病人。
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-04-01
Elizabeth S Kraus

The vast consolidation among health-care providers in the aftermath of the Affordable Care Act's enactment has led to much debate over the benefits of mergers in the health-care industry. In 2016, the Federal Trade Commission filed motions in federal court to enjoin three hospital mergers in various parts of the country. This amounted to more challenges to hospital mergers in a single year than any year in recent history. Though two of these motions succeeded at the district court level, both were overturned on appeal, which led many to wonder what the effect of these decisions would be on future health-care mergers. While many fear that hospital mergers lead to higher prices for consumers, there are also those who contend that mergers lead to efficiencies, which allow merging parties to utilize resources more effectively, increase the quality of patient care and coordination, and potentially save lives. This Note argues that the possibility of quality-enhancing or life-saving efficiencies is worth the risk that consumers see increased prices. To allow mergers that may realize these types of efficiencies, antitrust enforcement agencies and courts must begin placing greater weight on merging parties' efficiency arguments by easing the current standard. Additionally, in light of new research suggesting that cross-market health-care mergers, or mergers between providers in different geographic markets, affect bargaining dynamics between providers and insurers, this Note argues that parties' relative bargaining power must be considered in agencies' and courts' analyses of the competitive landscape relevant to a merger.

《平价医疗法案》(Affordable Care Act)颁布后,医疗服务提供商之间的大规模整合引发了有关医疗行业合并好处的许多争论。2016年,联邦贸易委员会向联邦法院提出动议,禁止全国各地的三家医院合并。这相当于在一年中医院合并的挑战比近代历史上任何一年都要多。虽然其中两项动议在地方法院获得了成功,但都在上诉中被推翻,这让许多人怀疑这些决定对未来医疗保健合并的影响。虽然许多人担心医院合并会给消费者带来更高的价格,但也有人认为合并会提高效率,这使得合并方能够更有效地利用资源,提高患者护理和协调的质量,并可能挽救生命。本说明认为,为了提高质量或挽救生命的效率,值得冒着消费者看到价格上涨的风险。为了允许可能实现这些效率的合并,反垄断执法机构和法院必须开始通过放宽目前的标准来更加重视合并方的效率论点。此外,鉴于新的研究表明,跨市场的医疗保健合并或不同地域市场的提供者之间的合并会影响提供者和保险公司之间的议价动态,本说明认为,在机构和法院对与合并有关的竞争格局的分析中,必须考虑各方的相对议价能力。
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引用次数: 0
Regulating Rare Disease: Safely Facilitating Access to Orphan Drugs. 调节罕见病:安全促进孤儿药的获取。
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-03-01
Julien B Bannister

While approximately one in ten Americans suffers from a rare disease, only 5 percent of rare diseases have a U.S. Food and Drug Administration (FDA) approved treatment. Congressional and regulatory efforts to stimulate the development of rare-disease treatments, while laudable, have not resolved the fundamental issues surrounding rare-disease treatment development. Indeed, small patient populations, incomplete scientific understanding of rare diseases, and high development costs continually limit the availability of rare-disease treatments. To illustrate the struggle of developing and approving safe rare-disease treatments, this Note begins by discussing the approval of Eteplirsen, the first drug approved for treating a rare disease called Duchenne muscular dystrophy. After exploring the current drug regulation system and how this impacts the availability of rare-disease treatments, this Note examines the 21st Century Cures Act's patient experience data provisions and the currently pending Trickett Wendler Right to Try Act. Ultimately, the unmet therapeutic needs of rare-disease patients can be met while protecting patient safety. This Note reasons that, if carefully implemented, the 21st Century Cures Act and the Trickett Wendler Right to Try Act could work in tandem to safely facilitate patient access to rare-disease treatments.

虽然大约十分之一的美国人患有罕见疾病,但只有5%的罕见疾病得到了美国食品和药物管理局(FDA)的批准治疗。国会和监管机构为刺激罕见疾病治疗发展所做的努力虽然值得称赞,但并没有解决围绕罕见疾病治疗发展的根本问题。事实上,患者人数少、对罕见病的科学认识不完整以及高昂的开发成本不断限制罕见病治疗的可得性。为了说明开发和批准安全的罕见疾病治疗方法的困难,本文首先讨论批准Eteplirsen,这是第一种被批准用于治疗罕见疾病杜氏肌营养不良症的药物。在探讨了当前的药物监管体系及其如何影响罕见疾病治疗的可用性之后,本文研究了《21世纪治愈法案》的患者体验数据规定和目前待定的《特里克特·温德勒尝试权法案》。最终,可以在保护患者安全的同时满足罕见病患者未满足的治疗需求。本文认为,如果仔细实施,《21世纪治愈法案》和《特里克特·温德勒尝试权法案》可以协同工作,安全地促进患者获得罕见疾病的治疗。
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引用次数: 0
The Role of Direct-Injury Government-Entity Lawsuits in the Opioid Litigation. 直接损害政府-实体诉讼在阿片类药物诉讼中的作用。
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-02-21 DOI: 10.2139/SSRN.3127840
Edgar Aliferov
The opioid epidemic has ravaged the United States, killing over 100 Americans every day and costing the nation upward of $90 billion a year. All branches and levels of the government have pursued measures to combat the epidemic and reduce its societal costs. Perhaps the most interesting response is the emergence of direct-injury government-entity lawsuits, which seek to recover damages from opioid companies that facilitated prescription pill addictions. Cities, counties, and states across the country are suing opioid manufacturers and distributors in unprecedented numbers. This Note explores the role of direct-injury government-entity claims as compared to other forms of civil litigation employed in the opioid crisis. It highlights the obstacles faced by parens patriae actions, individual lawsuits, class actions, and aggregate actions in general. This Note argues that direct injury government claims have important advantages over other forms of civil litigation because they overcome certain defenses related to victim blame worthiness and because they function as inherently representative actions that bypass the certification requirements of traditional aggregate actions.
阿片类药物流行病肆虐美国,每天造成100多名美国人死亡,每年使国家损失超过900亿美元。各级政府各部门已采取措施防治这一流行病,降低其社会成本。也许最有趣的回应是出现了直接伤害政府实体的诉讼,这些诉讼试图从阿片类药物公司那里获得损害赔偿,这些公司助长了处方药成瘾。全国各地的城市、县和州都在以前所未有的数量起诉阿片类药物制造商和分销商。本说明探讨了与阿片类药物危机中采用的其他形式的民事诉讼相比,政府实体直接伤害索赔的作用。它突出了父母诉讼、个人诉讼、集体诉讼和总体诉讼所面临的障碍。本说明认为,与其他形式的民事诉讼相比,直接损害政府索赔具有重要的优势,因为它们克服了与受害者责任价值有关的某些抗辩,并且因为它们作为固有的代表性诉讼而发挥作用,绕过了传统集体诉讼的证明要求。
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引用次数: 0
The Intuitive Appeal of Explainable Machines 可解释机器的直觉吸引力
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-02-19 DOI: 10.2139/SSRN.3126971
Andrew D. Selbst, Solon Barocas
Algorithmic decision-making has become synonymous with inexplicable decision-making, but what makes algorithms so difficult to explain? This Article examines what sets machine learning apart from other ways of developing rules for decision-making and the problem these properties pose for explanation. We show that machine learning models can be both inscrutable and nonintuitive and that these are related, but distinct, properties. Calls for explanation have treated these problems as one and the same, but disentangling the two reveals that they demand very different responses. Dealing with inscrutability requires providing a sensible description of the rules; addressing nonintuitiveness requires providing a satisfying explanation for why the rules are what they are. Existing laws like the Fair Credit Reporting Act (FCRA), the Equal Credit Opportunity Act (ECOA), and the General Data Protection Regulation (GDPR), as well as techniques within machine learning, are focused almost entirely on the problem of inscrutability. While such techniques could allow a machine learning system to comply with existing law, doing so may not help if the goal is to assess whether the basis for decision-making is normatively defensible. In most cases, intuition serves as the unacknowledged bridge between a descriptive account and a normative evaluation. But because machine learning is often valued for its ability to uncover statistical relationships that defy intuition, relying on intuition is not a satisfying approach. This Article thus argues for other mechanisms for normative evaluation. To know why the rules are what they are, one must seek explanations of the process behind a model’s development, not just explanations of the model itself.
算法决策已经成为莫名其妙的决策的代名词,但是什么让算法如此难以解释?这篇文章探讨了机器学习与其他制定决策规则的方法的区别,以及这些特性带来的解释问题。我们证明了机器学习模型既可以是不可理解的,也可以是非直觉的,这些都是相关但不同的特性。要求解释的呼声将这些问题视为一个问题,但将两者分开表明,它们需要截然不同的回应。处理神秘性需要对规则进行合理的描述;解决非直觉性问题需要提供一个令人满意的解释,解释为什么规则是这样的。现有的法律,如《公平信用报告法》(FCRA)、《平等信贷机会法》(ECOA)和《通用数据保护条例》(GDPR),以及机器学习中的技术,几乎完全集中在神秘性问题上。虽然这些技术可以让机器学习系统遵守现有法律,但如果目标是评估决策的基础是否符合规范,那么这样做可能没有帮助。在大多数情况下,直觉是描述性描述和规范性评价之间未被承认的桥梁。但是,由于机器学习通常因其揭示违背直觉的统计关系的能力而受到重视,因此依赖直觉并不是一种令人满意的方法。因此,本条主张建立其他规范性评价机制。要想知道规则为什么是这样,必须寻求对模型开发背后过程的解释,而不仅仅是对模型本身的解释。
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引用次数: 234
Deceptively Simple: Framing, Intuition and Judicial Gatekeeping of Forensic Feature-Comparison Methods Evidence 看似简单:司法特征对比法证据的框架、直觉与司法把关
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2018-01-01 DOI: 10.2139/SSRN.3157122
J. Moriarty
For many decades, prosecutors have relied on feature-comparison methods (FCM) of forensic science evidence, including hair, fingerprints, toolmarks, handwriting, and bitemarks. Since the late 1980s, scholars and practitioners have raised serious questions about the reliability and error rates of such evidence. Two national bodies have published serious criticism of FCM evidence: the 2009 Committee of the National Research Council of the National Academy of Sciences; and the 2016 President’s Council of Advisors on Science and Technology. Despite these concerns and proof from the Innocence Project data that poor quality forensic science evidence has been a substantial component in wrongful convictions, courts continue to admit FCM evidence routinely and with little analysis, generally avoiding application of the Daubert factors related to reliability. This article questions why courts are unreceptive to challenges about the reliability of such evidence and suggests that judges perceive feature-comparison evidence as fairly straightforward and intuitively accurate. As such, courts often unknowingly rely upon heuristic approaches to the evidence — that is, cognitive shortcuts to manage complexity. By using these shortcuts, rather than rigorously evaluating reliability, decisions may inadvertently incorporate cognitive biases, including belief perseverance, confirmation bias, and assumptions of simplicity. If judges can appreciate that feature-comparison “matching” is a complex, multifaceted procedure, they might become more willing to engage in a deeper, science-based review of the evidence and better understand its shortcomings and limitations.
几十年来,检察官一直依赖于特征比较方法(FCM)的法医科学证据,包括头发、指纹、工具痕迹、笔迹和咬痕。自20世纪80年代末以来,学者和实践者对这些证据的可靠性和错误率提出了严重的质疑。两个国家机构发表了对FCM证据的严厉批评:美国国家科学院国家研究委员会2009年委员会;以及2016年总统科学技术顾问委员会。尽管存在这些担忧,而且“无罪计划”的数据也证明,低质量的法医科学证据是错误定罪的重要组成部分,但法院继续常规地承认FCM证据,很少进行分析,通常避免应用与可靠性相关的道伯特因素。这篇文章质疑为什么法院不接受对这类证据可靠性的质疑,并提出法官认为特征比较证据相当直接和直观准确。因此,法院常常在不知情的情况下依赖于启发式的证据方法——也就是管理复杂性的认知捷径。通过使用这些捷径,而不是严格地评估可靠性,决策可能会在不经意间包含认知偏差,包括信念坚持、确认偏差和简单性假设。如果法官能够认识到特征比较“匹配”是一个复杂的、多方面的过程,他们可能会更愿意对证据进行更深入的、基于科学的审查,并更好地了解其缺点和局限性。
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引用次数: 0
The Twenty-Fifth Amendment and the establishment of medical impairment panels: are the two safely compatible? 第二十五条修正案和医疗损害小组的建立:两者是否安全兼容?
IF 0.8 3区 社会学 Q2 Social Sciences Pub Date : 2017-12-01
Robert E Gilbert
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引用次数: 0
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