Material Contribution to Risk in the Canadian Law of Toxic Torts

Causation is acknowledged as the single biggest hurdle to recovery for plaintiffs in toxic tort actions in Canada (and elsewhere). Scientific uncertainty involving questions of both generic and specific causation has frequently precluded recovery for plaintiffs even where defendants have negligently exposed them to toxic risk. Three types of uncertainty have been identified: plaintiff indeterminacy (where we know that the defendant has harmed some proportion of a particular population but no individual can prove causation); defendant indeterminacy (where we know that a group of defendants has harmed a particular plaintiff or plaintiffs but each can escape liability by pointing the finger at the other); and indeterminacy of harm (where plaintiffs have been exposed to a risk that may or may not materialize in the future). In Canada, there is no recovery for risk exposure, unless it produces a measurable psychiatric harm. The problem of plaintiff indeterminacy remains, with a resulting under-deterrence of toxic harms and under-compensation of injured plaintiffs. The Supreme Court of Canada has, however, solved the problem of defendant indeterminacy for Canadian plaintiffs. Taking inspiration from both United Kingdom and American theories of collective liability, the Court, in Clements v. Clements, adopted a uniquely Canadian test for material contribution to risk as a proxy for proof of causation. This article argues that the Clements test is a promising start for causation reform in Canada but does not go far enough towards incentivizing information disclosure and precaution in the manufacture and dissemination of chemical products and pollution

Material Contribution to Risk in the Canadian Law of Toxic Torts

Causation is acknowledged as the single biggest hurdle to recovery for plaintiffs in toxic tort actions in Canada (and elsewhere). Scientific uncertainty involving questions of both generic and specific causation has frequently precluded recovery for plaintiffs even where defendants have negligently exposed them to toxic risk. Three types of uncertainty have been identified: plaintiff indeterminacy (where we know that the defendant has harmed some proportion of a particular population but no individual can prove causation); defendant indeterminacy (where we know that a group of defendants has harmed a particular plaintiff or plaintiffs but each can escape liability by pointing the finger at the other); and indeterminacy of harm (where plaintiffs have been exposed to a risk that may or may not materialize in the future). In Canada, there is no recovery for risk exposure, unless it produces a measurable psychiatric harm. The problem of plaintiff indeterminacy remains, with a resulting under-deterrence of toxic harms and under-compensation of injured plaintiffs. The Supreme Court of Canada has, however, solved the problem of defendant indeterminacy for Canadian plaintiffs. Taking inspiration from both United Kingdom and American theories of collective liability, the Court, in Clements v. Clements, adopted a uniquely Canadian test for material contribution to risk as a proxy for proof of causation. This article argues that the Clements test is a promising start for causation reform in Canada but does not go far enough towards incentivizing information disclosure and precaution in the manufacture and dissemination of chemical products and pollution

Revisiting the Doctrine of Intergenerational Equity in Global Environmental Governance

In the absence of binding international enforcement mechanisms, global environmental governance must rely on a legal framework that has widespread normative force around the world. In addition, such a framework should be sufficiently detailed and pragmatic to allow for effective implementation, should achieve the goal of environmental protection, and should be reasonable in terms of the level of sacrifice expected of the present generation, particularly in the developing world. Itis arguedthat the comprehensive doctrine ofintergenerational equity is an effective and appropriate legal framework for global environmental governance. The doctrine ofintergenerational equityposits thepresent generation of humans as simultaneously beneficiaries of the planetary legacy handed down from past generations, and trustees of that legacy for the future. The doctrine integrates the language of rights and responsibility and incorporates viable implementation mechanisms. As a result, the doctrine of intergenerational equity is superior to the presently hegemonic paradigm of sustainable development. The author concludes that the international community should adopt the doctrine of intergenerational equityas a framework for global environmental governance

Material Contribution to Justice - Toxic Causation after Resurfice Corp. v. Hanke

The vast universe of chemicals in the Canadian environment is presently understood only poorly by science. For many thousands of chemicals, important data regarding chronic toxicity are lacking. As a result, the requirement that the plaintiff in a negligence action prove causation of illness on a but-for standard has frequently been unattainable. In Resurfice Corp. v. Hanke, the Supreme Court of Canada articulated an important exception to the but-for test. In circumstances where but-for causation is unprovable due to limits in scientific knowledge, proof that a defendant materially contributed to the plaintiff\u27s risk of incurring the type of injury that was ultimately suffered will satisfy the causation element. This reform is an important first step in the evolution of a tort regime that is capable of doing justice in the chemical era

Understanding older women's decision making and coping in the context of breast cancer treatment

Background: Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in Deliberation (CODE) framework to gain insight into decision making and coping processes in a group of older women who have faced breast cancer treatment decisions, and to inform the development of a decision support intervention (DSI). Methods: Semi-structured interviews were carried out with older women who had been offered a choice of PET or surgery from five UK hospital clinics. Women's information and support needs, their breast cancer diagnosis and treatment decisions were explored. A secondary analysis of these interviews was conducted using the CODE framework to examine women's appraisals of health threat and coping throughout the deliberation process. Results: Interviews with 35 women aged 75-98 years were analysed. Appraisals of breast cancer and treatment options were sometimes only partial, with most women forming a preference for treatment relatively quickly. However, a number of considerations which women made throughout the deliberation process were identified, including: past experiences of cancer and its treatment; scope for choice; risks, benefits and consequences of treatment; instincts about treatment choice; and healthcare professionals' recommendations. Women also described various strategies to cope with breast cancer and their treatment decisions. These included seeking information, obtaining practical and emotional support from healthcare professionals, friends and relatives, and relying on personal faith. Based on these findings, key questions were identified that women may ask during deliberation. Conclusions: Many older women with breast cancer may be considered involved rather than passive decision-makers, and may benefit from DSIs designed to support decision making and coping within and beyond the clinic setting

Genome-Wide Association Analysis of Soluble ICAM-1 Concentration Reveals Novel Associations at the NFKBIK, PNPLA3, RELA, and SH2B3 Loci

Soluble ICAM-1 (sICAM-1) is an endothelium-derived inflammatory marker that has been associated with diverse conditions such as myocardial infarction, diabetes, stroke, and malaria. Despite evidence for a heritable component to sICAM-1 levels, few genetic loci have been identified so far. To comprehensively address this issue, we performed a genome-wide association analysis of sICAM-1 concentration in 22,435 apparently healthy women from the Women's Genome Health Study. While our results confirm the previously reported associations at the ABO and ICAM1 loci, four novel associations were identified in the vicinity of NFKBIK (rs3136642, P = 5.4×10−9), PNPLA3 (rs738409, P = 5.8×10−9), RELA (rs1049728, P = 2.7×10−16), and SH2B3 (rs3184504, P = 2.9×10−17). Two loci, NFKBIB and RELA, are involved in NFKB signaling pathway; PNPLA3 is known for its association with fatty liver disease; and SH3B2 has been associated with a multitude of traits and disease including myocardial infarction. These associations provide insights into the genetic regulation of sICAM-1 levels and implicate these loci in the regulation of endothelial function

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Relationship Between Risk Factors and Mortality in Type 1 Diabetic Patients in Europe: The EURODIAB Prospective Complications Study (PCS)

OBJECTIVE—The purpose of this study was to examine risk factors for mortality in patients with type 1 diabetes

Novel Blood Pressure Locus and Gene Discovery Using Genome-Wide Association Study and Expression Data Sets From Blood and the Kidney.

Elevated blood pressure is a major risk factor for cardiovascular disease and has a substantial genetic contribution. Genetic variation influencing blood pressure has the potential to identify new pharmacological targets for the treatment of hypertension. To discover additional novel blood pressure loci, we used 1000 Genomes Project-based imputation in 150 134 European ancestry individuals and sought significant evidence for independent replication in a further 228 245 individuals. We report 6 new signals of association in or near HSPB7, TNXB, LRP12, LOC283335, SEPT9, and AKT2, and provide new replication evidence for a further 2 signals in EBF2 and NFKBIA Combining large whole-blood gene expression resources totaling 12 607 individuals, we investigated all novel and previously reported signals and identified 48 genes with evidence for involvement in blood pressure regulation that are significant in multiple resources. Three novel kidney-specific signals were also detected. These robustly implicated genes may provide new leads for therapeutic innovation