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Standard of Care swap structure or microstructure of aAmerican law, not philosophy or medicine, is the major force shaping American bioethics. This is both because law at its best fosters individual rights, equality, and justice, and because violation of the legal duty or "standard of care" a physician owes a patient can lead to a malpractice suit. The law has therefore had two conflicting impacts on medical ethics: the positive effect of eroding paternalism and replacing it with a patient centered