Causing Harm: Epidemiological and Physiological Concepts of Causation
Causing Harm: Epidemiological and Physiological Concepts of Causation
In this chapter I shall examine the relations between what appear to be two somewhat different concepts of causation that are widely employed in the biomedical sciences. The first type is what I term epidemiological causation. It is characteristically statistical and uses expressions like "increased risk" and "risk factor." The second concept is more like the form of causation we find in both the physical sciences and everyday life, as in expressions such as "the increase in temperature caused the mercury in the thermometer to expand" or "the sonic boom caused my window to break." In the physical and the biological sciences, such claims are typically further analyzed and explained in terms of underlying mechanisms. For example, accounts in the medical literature of cardiovascular diseases associated with the ischemic myocardium typically distinguish between the risk factors and the mechanisms for these disorders (Willerson 1982). Interestingly, both concepts of causation have found their way into the legal arena, the first or epidemiological concept only relatively recently in both case law and federal agency regulatory restrictions. The second, perhaps more typical, notion of causation has turned out to be not so simple on deeper analysis and led Hart and Honoré, among others, to subject the notion to extensive study in their classic book Causation in the Law. In another paper (Schaffner 1987), I examined some of these issues, in particular the epidemiological concept of causation as it might apply to recent DES cases such as Sinddl and Collins. Reflections on the Sindell case and on one of its legal precedents, the Summers v. Tice case, led Judith Jarvis Thomson to introduce a distinction between two types of evidence that might be adduced to support a claim that an agent caused harm to a person. The two types of evidence parallel the distinction between these two concepts of causation, and 1 shall introduce them by means of a particularly striking example originally credited to David Kaye (Kaye 1982).
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