In the case of Margaret Kawaauhau, et vir v. Paul W. Geiger, 1997, the U.S Supreme Court was tasked with determining whether a medical malpractice claim could be discharged in bankruptcy as a "willful and malicious injury" under section 523(a)(6) of the Bankruptcy Code. The plaintiffs argued that Dr. Geiger's negligent treatment constituted such an injury because it was deliberate conduct which inevitably led to their harm. However, the court ruled unanimously against them stating that for an act to fall within this exception it must not only be intentional but also necessarily cause harm (i.e., not merely potentially or indirectly). They concluded that while Dr.Geiger may have intentionally chosen his course of treatment knowing there were risks involved; he did not intend to cause harm thereby making his actions dischargeable in bankruptcy.

In the dissenting opinion for Kawaauhau v. Geiger, Justice Ginsburg disagreed with the majority's interpretation of "willful and malicious injury" in relation to bankruptcy law. She argued that their narrow definition was inconsistent with past precedent and could potentially allow debtors to escape responsibility for recklessly or negligently inflicted injuries. According to her, a debtor who causes an injury should not be able to discharge the resulting debt simply because they did not intend specific harm. Instead, she proposed that any act done intentionally which leads to injury should fall under this category unless it is justifiable under law or involves some form of business risk-taking activity.