关于医疗损害赔偿纠纷的法学思考
摘要
医疗损害赔偿纠纷案件已成为目前社会公众普遍关注的热点和焦点问题之一。然而,由于我国在此方面的立法相对滞后和不统一,导致司法实践中观念认识上的差异和法律适用上的混乱,相同性质的案件在不同法院审理常出现差别很大或完全相反的判决结果。本文拟从医疗损害赔偿责任及其归责原则、举证责任分配、鉴定问题、法律理解与适用等若干问题入手,探讨如何正确理解和适用法律及行政法规来妥善处理此类案件。
This thesis plans to begin with compensation liability for medical injury and its principle of bearing responsibility, assignment of burden of proof, identification, understanding and application in terms of law, etc to discuss how to correctly understand and apply law and administrative rules and regulations for properly settling the dispute over compensation for medical injury. This thesis consists of four parts: the first one is about summarization of compensation liability for medical injury with clear concept, quality, structure and principle of bearing responsibility; the second one is about burden of proof of the damage dispute over compensation for medical injury with main discussion on assignment of burden of proof and identification; in the third part, the author mainly discusses understanding dispute over compensation for medical injury in terms of law and application of law and mainly discusses how to settle the problem of application of law, especially how to utilize the General Provisions of the Civil Law and Regulation in practice; The fourth one is about legislative proposals, namely, the author’s legislative idea for the situation of dispute over compensation for medical injury in China.
The first part is about civil liability in compensation liability for medical injury which plays the basic function in the whole text. The author defines the characteristic of civil liability in compensation liability for medical injury currently in china by comparing analysis of characteristic of medical injury done by different theory based on defining medical injury, and defines the structure of its civil liability, principle of bearing responsibility and circle of theory’s different idea toward medical injury through stating its structure. Basing on comparing and analyzing different ideas, the author believes that compensation liability for medical injury should be defined as civil compensation liability that medical establishment should shoulder when medical establishment and its medical personnel violate the law of medical and health management, administrative rules and regulations, departmental regulation, criterion for diagnosis and treat, convention, professional morality for health service and damage sufferer. This definition brings medical accident and others medical mistakes into the scope of civil compensation liability, which is in favor of protecting civil rights of sufferer and accord with the basic principle and spirit of legislation of civil law. Synthesizing the analysis of the characteristic of civil responsibility by different theory, the author believes that the characteristic of Chinese compensation liability for medical injury should be civil infringement since compensation liability for medical injury doesn’t possess the serious characteristic of responsibility in contrast. Secondly, seeing the characteristic of dispute over compensation for medical injury from the point of view of consequence of liability and burden of proof, the author analyzes the composing elements of compensation liability for medical injury, and also defines the principle of assigning responsibly in dispute over compensation for medical injury should be presumption of fault principle. On the one hand, it is necessary to cognize the fault in virtue of presumption of fault principle for protecting the legal rights of sufferer since the complexity and specialty and the difficulty of defining the fault and cause-effect relationship of medical behavior; On the other hand, the burden of proof rests on medical establishment is helpful to investigating the fact and determining the ownership of responsibility since sufferer doesn’t possess professional knowledge about medicine and medical establishment knows the reason of damage.
The second part is about the research on the burden of proof of the damage dispute over compensation for medical injury. Based on the reality of china, the Supreme People's Court formulated the Regulations on Proof of Civil Action, which establishes the principle of inverting the burden of proof of the dispute over compensation for medical injury; However, it doesn’t mean that sufferer is relieved from burden of proof. Although principle of inverting the burden of proof is adopted, accuser still bears the burden of proof, and medical establishment doesn’t bear burden of proof for every thing but just there is no cause-effect relationship between medical behavior and the consequence of damage and there is no medical mistake. In the dispute over compensation for medical injury, sufferers bear burden of proof for the existence, the fact of damage and consequence of damage, and ,they have the right of choosing in terms of burden of proof for that whether there is cause-effect relationship between the consequence of medical injury and whether the medical behavior is right or not, that is to say, sufferers can demonstrate or not as accuser, and they also can give disproof aiming at the burden of proof of burden of proof medical establishment. As for the identification, one of the important proof in dispute over compensation for medical injury, different ideas exist in practice; the author considers that Medical Association isn’t the only one legal institution for appraisal of medical accident and many-sides appraisal is ineluctable; Moreover, there is enough room for many-sides appraisal. There is on final one in appraisal by Medical Association, and the medical accident in practice will be appraised again and again by many sides, even these appraisals conflict. Its cognizance of effectiveness should keeping to the following principles: the effectiveness of appraisal should be emphasized and considered as basic foundation for settle a lawsuit when only appraisal by Medical Association exists; when conclusion of repeated appraisal and many-sides appraisal appears, it is proper to organize both parties for evidentiary hearing, and parties can examine each appraisal until they get agreement. Appraisers should be invited to evidentiary hearing or court for explaining inquiry from parties in order to avoiding appraising afresh; Moreover, parties can apply for one or two persons with special knowledge to the court for explaining some special problems about the case.
The third part is about understanding dispute over compensation for medical injury in terms of law and application of law. The legal characteristic of the relationship between doctor and sufferer and characteristic of civil liability in compensation liability for medical injury determine the method and principle of application of law. Proceeding from the necessary premises of characteristic of civil relationship and structure of civil liability, it is proper to apply the General Provisions of the Civil Law since it covers all disputes over compensation for medical injury; However, its application does not exclude the application of Regulation for reference. Since there is no violation law for settling doctor-sufferer dispute resulting from the limitation of legislation currently, the content in Regulation which does not violate the identity of civil spirit and spirit of civil legislation can be regarded as the detail of the General Provisions of the Civil Law and can be applied for reference. These measures not only maintaining the application of basic law of state, but also carry out the relative unification of compensation in terms of applying laws in the standard and amount of compensation and fully protecting legal rights of sufferers, which is the only one can make up the limitation of law in china and the faultiness of legislation.
The fourth part is about legislative proposals. Based on analysis, the author puts forwards the legislative ideas about how to settle the related problems in the dispute over compensation for medical injury: Firstly, establishing special legislation for dispute over compensation for medical injury; Secondly, establishing the Medical injury Insurance System; Thirdly, establishing the system of medical behavior exemption; Fourthly, establishing the rationed compensation system; Fifthly, unifying cause-effect relationship and bearing responsibility; Sixthly, laying the value-added tax on medical industry and establishing compensation system; Moreover, the author explains these proposals in detail.
This thesis plans to begin with compensation liability for medical injury and its principle of bearing responsibility, assignment of burden of proof, identification, understanding and application in terms of law, etc to discuss how to correctly understand and apply law and administrative rules and regulations for properly settling the dispute over compensation for medical injury. This thesis consists of four parts: the first one is about summarization of compensation liability for medical injury with clear concept, quality, structure and principle of bearing responsibility; the second one is about burden of proof of the damage dispute over compensation for medical injury with main discussion on assignment of burden of proof and identification; in the third part, the author mainly discusses understanding dispute over compensation for medical injury in terms of law and application of law and mainly discusses how to settle the problem of application of law, especially how to utilize the General Provisions of the Civil Law and Regulation in practice; The fourth one is about legislative proposals, namely, the author’s legislative idea for the situation of dispute over compensation for medical injury in China.
The first part is about civil liability in compensation liability for medical injury which plays the basic function in the whole text. The author defines the characteristic of civil liability in compensation liability for medical injury currently in china by comparing analysis of characteristic of medical injury done by different theory based on defining medical injury, and defines the structure of its civil liability, principle of bearing responsibility and circle of theory’s different idea toward medical injury through stating its structure. Basing on comparing and analyzing different ideas, the author believes that compensation liability for medical injury should be defined as civil compensation liability that medical establishment should shoulder when medical establishment and its medical personnel violate the law of medical and health management, administrative rules and regulations, departmental regulation, criterion for diagnosis and treat, convention, professional morality for health service and damage sufferer. This definition brings medical accident and others medical mistakes into the scope of civil compensation liability, which is in favor of protecting civil rights of sufferer and accord with the basic principle and spirit of legislation of civil law. Synthesizing the analysis of the characteristic of civil responsibility by different theory, the author believes that the characteristic of Chinese compensation liability for medical injury should be civil infringement since compensation liability for medical injury doesn’t possess the serious characteristic of responsibility in contrast. Secondly, seeing the characteristic of dispute over compensation for medical injury from the point of view of consequence of liability and burden of proof, the author analyzes the composing elements of compensation liability for medical injury, and also defines the principle of assigning responsibly in dispute over compensation for medical injury should be presumption of fault principle. On the one hand, it is necessary to cognize the fault in virtue of presumption of fault principle for protecting the legal rights of sufferer since the complexity and specialty and the difficulty of defining the fault and cause-effect relationship of medical behavior; On the other hand, the burden of proof rests on medical establishment is helpful to investigating the fact and determining the ownership of responsibility since sufferer doesn’t possess professional knowledge about medicine and medical establishment knows the reason of damage.
The second part is about the research on the burden of proof of the damage dispute over compensation for medical injury. Based on the reality of china, the Supreme People's Court formulated the Regulations on Proof of Civil Action, which establishes the principle of inverting the burden of proof of the dispute over compensation for medical injury; However, it doesn’t mean that sufferer is relieved from burden of proof. Although principle of inverting the burden of proof is adopted, accuser still bears the burden of proof, and medical establishment doesn’t bear burden of proof for every thing but just there is no cause-effect relationship between medical behavior and the consequence of damage and there is no medical mistake. In the dispute over compensation for medical injury, sufferers bear burden of proof for the existence, the fact of damage and consequence of damage, and ,they have the right of choosing in terms of burden of proof for that whether there is cause-effect relationship between the consequence of medical injury and whether the medical behavior is right or not, that is to say, sufferers can demonstrate or not as accuser, and they also can give disproof aiming at the burden of proof of burden of proof medical establishment. As for the identification, one of the important proof in dispute over compensation for medical injury, different ideas exist in practice; the author considers that Medical Association isn’t the only one legal institution for appraisal of medical accident and many-sides appraisal is ineluctable; Moreover, there is enough room for many-sides appraisal. There is on final one in appraisal by Medical Association, and the medical accident in practice will be appraised again and again by many sides, even these appraisals conflict. Its cognizance of effectiveness should keeping to the following principles: the effectiveness of appraisal should be emphasized and considered as basic foundation for settle a lawsuit when only appraisal by Medical Association exists; when conclusion of repeated appraisal and many-sides appraisal appears, it is proper to organize both parties for evidentiary hearing, and parties can examine each appraisal until they get agreement. Appraisers should be invited to evidentiary hearing or court for explaining inquiry from parties in order to avoiding appraising afresh; Moreover, parties can apply for one or two persons with special knowledge to the court for explaining some special problems about the case.
The third part is about understanding dispute over compensation for medical injury in terms of law and application of law. The legal characteristic of the relationship between doctor and sufferer and characteristic of civil liability in compensation liability for medical injury determine the method and principle of application of law. Proceeding from the necessary premises of characteristic of civil relationship and structure of civil liability, it is proper to apply the General Provisions of the Civil Law since it covers all disputes over compensation for medical injury; However, its application does not exclude the application of Regulation for reference. Since there is no violation law for settling doctor-sufferer dispute resulting from the limitation of legislation currently, the content in Regulation which does not violate the identity of civil spirit and spirit of civil legislation can be regarded as the detail of the General Provisions of the Civil Law and can be applied for reference. These measures not only maintaining the application of basic law of state, but also carry out the relative unification of compensation in terms of applying laws in the standard and amount of compensation and fully protecting legal rights of sufferers, which is the only one can make up the limitation of law in china and the faultiness of legislation.
The fourth part is about legislative proposals. Based on analysis, the author puts forwards the legislative ideas about how to settle the related problems in the dispute over compensation for medical injury: Firstly, establishing special legislation for dispute over compensation for medical injury; Secondly, establishing the Medical injury Insurance System; Thirdly, establishing the system of medical behavior exemption; Fourthly, establishing the rationed compensation system; Fifthly, unifying cause-effect relationship and bearing responsibility; Sixthly, laying the value-added tax on medical industry and establishing compensation system; Moreover, the author explains these proposals in detail.
引文
[1]《丰富和完善现代民事审判制度为全面建设小康社会提供司法保障—就全国民事审判工作访最高人民法院副院长黄松有》,人民法院报2003 年 3 月 28 日第四版。
[2]王利明:《违约责任论》,中国政法大学出版社 2003 年 1 月修订版第329 页。
[3]李国光主编:《最高人民法院〈关于适用民事诉讼证据的若干规定〉的理解与适用》中国法制出版社 2002 年出版 第 73 页。
[4]李国光主编:《最高人民法院〈关于适用民事诉讼证据的若干规定〉的理解与适用》中国法制出版社 2002 年出版 第 73 页。
[5]姚欢庆:《2003 年司法考试教程民法》,中国法制出版社 2003 年版,第 93—94 页。
[6]王利明:《民法·侵权行为法》,中国人民大学出版社 1993 年出版第532 页。
[7]王利明主编:《中国民法案例与学理研究—侵权行为篇》,法律出版社1998 年版,第 63 页。
[8]王利明:《民法·侵权行为法》,中国人民大学出版社 1993 年出版第528 页。
[9]王泽鉴:《侵权行为法》第一册,中国政法大学出版社 2001 年版,第227 页。
[10]新美育文:《日本产权责任中的赔偿范围与责任限制》,转引自王旸《侵权行为法上因果关系理论研究》,载于梁慧星主编《民商法论丛》第 9 卷,第 527 页。
[11]王泽鉴:《侵权行为法》第一册,中国政法大学出版社 2001 年版,第 187 页。
[12]龚赛红:《医疗损害赔偿立法研究》,法律出版社 2001 年 9 月版第251 页。
[13]陈聪富:《侵权法上因果关系》,载于《台大法学论丛》,第二十九卷第二期,第 178 页。
[14]王泽鉴:《侵权行为法》第一册,中国政法大学 2001 年版,第 204页。
[15]何颂跃:《医疗纠纷与损害赔偿新释解》,人民法院出版社 2002 年版,第 23-25 页。[16](1969)1QB428;Markesinis /Deakin,Tort Law,p.167.转引自王泽鉴著《侵权行为法》第一册,中国政法大学出版社 2001 年版,第 193 页。
[17]山东省威海市中级人民法院(2001)威民初字第 15 号民事判决。
[18]山东省威海市中级人民法院(2001)威民初字第 23 号民事纠纷。
[19]王利明主编:《民法学》,中央广播电视大学出版社 1995 版,第 525—526 页。
[20]潘善斌:《医疗事故诉讼若干问题探讨》 载于《安徽农业大学学报》(社会科学版)2003 年第 12 卷第 4 期。
[21]《医疗责任加大 催生保险需求》 载于 http//www.allbrightlaw.com.cn/yiliao/04/021105_2.htm。
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1.江苏省高级人民法院民一庭;《关于医疗损害赔偿纠纷案件的调查报告》,载《人民司法》2000 年 10 期。
2.金多才:《关于医患纠纷的法律思考》,载《人民司法》2000 年第 8期。
3.姜军松:《关于医疗纠纷案件审理中法律适用的几个问题》,载《湘潭大学学报》2004 年第 3 期。
4.夏民、刘同君:《医患关系的法理学思考》,载《医学与社会》2000年第 13 卷第 5 期。
5.汪海莹:《医患关系法律适用问题探讨》,载《成都医学》2000 年第26 卷第 3 期。
6.李薇:《日本侵权行为的因果关系理论》,载《外国法译评》1995 年第 4 期。
7.“民商事审判:中国全面建设小康社会的司法保障——访最高人民法院副院长李国光”,《人民司法》2003 年第 1 期。
8.陈聪富:《侵权法上因果关系》,载《台大法学论丛》,第二十九卷第二期。
9.《丰富和完善现代民事审判制度为全面建设小康社会提供司法保障—就全国民事审判工作访最高人民法院副院长黄松有》, 载《人民法院报》2003 年 3 月 28 日第四版。
10.王宇华:《医疗纠纷案件适用法律之我见》,载《健康报》2005 年 12月 9 日第三版。
11.宋晓亭:《论医患关系是民事法律关系的合同关系》,载《法律与医学》,2001 年第 1 期。
12.冯建妹:《论我国医疗事故处理法律制度的不足及其完善》,载《南京大学法律评论》,1996 年春季号。
13.N?M 佳日科娃著,杨文成、黄顺康译:《医务工作者的法律责任》,载《外国法学研究》,1995 年第 4 期。
14.立胜、朱玉明:《论我国医疗损害民事责任的归责原则》,载《河北法学》2000 年 1 期。
15.周 梅:《再论医疗民事责任的构成要件及举证责任》,齐齐哈尔大学学报哲社版 1999 年 1 期。
16.乔世明:《论医疗过失》,《当代法学》2001 年 4 期。
17.陶兆平:《论医疗事故的法律责任》,《安徽法学》1999 年 6 期。
18.张文显、王轶:《构建中国的侵权行为法归责原则体系》──《侵权行为法归责原则研究》介评 ,《法学评论》1995 年 6 期。
[2]王利明:《违约责任论》,中国政法大学出版社 2003 年 1 月修订版第329 页。
[3]李国光主编:《最高人民法院〈关于适用民事诉讼证据的若干规定〉的理解与适用》中国法制出版社 2002 年出版 第 73 页。
[4]李国光主编:《最高人民法院〈关于适用民事诉讼证据的若干规定〉的理解与适用》中国法制出版社 2002 年出版 第 73 页。
[5]姚欢庆:《2003 年司法考试教程民法》,中国法制出版社 2003 年版,第 93—94 页。
[6]王利明:《民法·侵权行为法》,中国人民大学出版社 1993 年出版第532 页。
[7]王利明主编:《中国民法案例与学理研究—侵权行为篇》,法律出版社1998 年版,第 63 页。
[8]王利明:《民法·侵权行为法》,中国人民大学出版社 1993 年出版第528 页。
[9]王泽鉴:《侵权行为法》第一册,中国政法大学出版社 2001 年版,第227 页。
[10]新美育文:《日本产权责任中的赔偿范围与责任限制》,转引自王旸《侵权行为法上因果关系理论研究》,载于梁慧星主编《民商法论丛》第 9 卷,第 527 页。
[11]王泽鉴:《侵权行为法》第一册,中国政法大学出版社 2001 年版,第 187 页。
[12]龚赛红:《医疗损害赔偿立法研究》,法律出版社 2001 年 9 月版第251 页。
[13]陈聪富:《侵权法上因果关系》,载于《台大法学论丛》,第二十九卷第二期,第 178 页。
[14]王泽鉴:《侵权行为法》第一册,中国政法大学 2001 年版,第 204页。
[15]何颂跃:《医疗纠纷与损害赔偿新释解》,人民法院出版社 2002 年版,第 23-25 页。[16](1969)1QB428;Markesinis /Deakin,Tort Law,p.167.转引自王泽鉴著《侵权行为法》第一册,中国政法大学出版社 2001 年版,第 193 页。
[17]山东省威海市中级人民法院(2001)威民初字第 15 号民事判决。
[18]山东省威海市中级人民法院(2001)威民初字第 23 号民事纠纷。
[19]王利明主编:《民法学》,中央广播电视大学出版社 1995 版,第 525—526 页。
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[21]《医疗责任加大 催生保险需求》 载于 http//www.allbrightlaw.com.cn/yiliao/04/021105_2.htm。
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