摘要
医疗事故案件目前在法院系统正在呈逐渐上升的趋势,依照最高人民法院的司法解释,审判实务的法律依据主要是国务院颁布的《医疗事故处理条例》和相关的法律、法学原理,由于法律、法规的零散、琐碎,再加上法官的法律修养参差不齐,这使同一个案件,各个法院的判决结果大相径庭,数额也从几十元到几万元不等。本文力图对医患关系双方的权利义务进行剖析,特别是处于弱势地位的患者的权利如何进行保护,作一些理论上的探讨,具体包括医疗事故的基本概念、医疗法律关系、医患双方的权利义务、医疗事故损害赔偿责任的构成要件、审判实务中的具体总是及立法展望六个方面。对一些模糊认识进行澄清,对未来医疗立法进行一些框架式的探索。受本人学识和能力,再加上本人手头的资料所限,一些观点还显得不太成熟,有待于在今后的学习和实践中不断地充实完善。
Medical accident case tends to increase in our country, while the main laws that deal with medical accident is The Regulation on the Handling of Medical Accidents issued by the state and relevant laws and principles of law. Since laws and regulations are fragmentary, it needs a systematic analysis. The paper conducts a systematic analysis on the present condition of medical accident starting from the principles of law.
Chapter I The Basic Concept of Medical Accident
Japanese jurist Toyoji has expounded the concept of medical accident and holds that except the medical accident that caused by equipment, in all the medical process in the extensive terms which includes doctor’s diagnosis, nurse’s handling, attendance of the patient and indirect measurement and so on, the unexpected deterioration or unpredicted adverse medical consequences are all called medical accident. While in China, it is explained in The Measure of Medical Accident Management and Statute of Medical Accident Management and there are broad sense and narrow sense in the theory circle. The author agrees the view that medical accident should be expound in broad sense, that is, in the process of diagnosis, treatment and attendance and so forth, if medical organizations cause patients’death, disability, function disorder caused by organ damage or other adverse consequence due to nursing defects, it is called medical accident. In addition, the author also distinguishes medical accident and medical mistake form the similarity and difference.
Chapter II Legal Relations of Medical
First of all the author confirm the nature of medical legal relation, holding that in essence, medical legal relation is civil legal relation. The change form The Measure of Medical Accident Management to Statute of Medical Accident Management and from the administrative sue pattern changed to civil sue pattern indicates that the view that medical legal relation is the civil relation from the perspective of civil law have gained the general recognition in legal circle. In the medical process, one party provides medical services and the other part y receives it, allowing the two parties to negotiate and doctors are equal in law. Medical organizations choose medical service by themselves and patients have their freedom to choose own medical organization and doctor and the two partied equally express their intention. From the perspective of law, medical organizations are obligatory to provide the decided medical service and the patient pays according to the medical service. This unity of right and obligation completely confirm with t volunteering, fairness and the Principle of Making Compensation for Equal Value. At the same time, medical legal relation has two special forms: one is compulsory contracting relation which is showed to save and attend patients in danger and the other is compulsory medical relation which is showed in two perspectives of preventing and treating infectious disease and giving up drug. Expounding from elements, subject, object and content, the author analyzes combined with medical contract and the non-cause management in treatment.
Chapter three mainly analyzes the right and obligation of doctor and patient from the theory of informed consent. First, the author introduces the formation and development of the theory of informed consent. According to the Black's Law Dictionary, informed consent is that when doctors conduct medical activities such as operation, they shall first provide medical handling plans which explain in detail about the risk and suitable measures, and on this basis to gain patient’s agreement. From Cardozo’s classic cases to judgment at Nuremberg, it was finally decided in Nuremberg Code. At present, the most complete informed consent theory is in the US and it can be divided into two basic contents, that is, doctor’s informative obligation and patient’s consent rights. The standard of doctor’s informative obligation experiences three stages: professional standard, reasonable patient standard and specific patient standard. The author holds that only reasonable patient standard has a relative good feasibility. Reasonable patient standard maintains that in the case that a doctor knows or should know, a reasonable patient thinks that a kind or some risks play an important role in whether he or she accepts doctor’s advice. Medical treatment themselves is a kind of invasion with certain danger to patient’s life and body. Seen from the form, it is illegal, but it possesses permissive danger and patient’s consent which enable medical treatment to have illegal ground for elimination. Meanwhile, the patient shall provide the history of disease truthfully and completely in order to enable medical staff know patient’s history of disease and the occurrence of disease thoroughly and accurately, with developing the relevant medical information to have an object in view in the process of treatment.
Chapter Four the Elements of Responsibility of Compensation for Damage Caused by Medical Accident
This chapter first introduces four-element theory, five-element theory, three-element theory and four-element theory is conforming to the principle of the unity of subject and object. This theory holds that the composing elements of the compensation include illegal actions, damaging result, the connection between illegal action and damaging result and negligence. What is followed is the analysis from four aspects among which the focus is put on the analyzing the negligence of the responsibility of medical damage from the angle of the principle of imputation and the comparison of fault liability principle, fault presumption principle an non-fault liability principle. The acquisition of medical knowledge proceeds in an orderly way and step by step. Some medical risks are also the price paid by human and it is needed to find a common value between legal adjustment and social security protection. While fault presumption imputation meets this social need. The fault in medical accident, scholars believe, is that during the medical treatment, doctors offend laws, regulations and the obligations required by measure of diagnosis and treatment, which causes the offence to patient’s life and health right. Whereas, the source of duty of precaution is operation procedure and profession convention prescribed by medical management laws and regulations. Medical fault is divided into faults caused by common duty of precaution and those caused by the violation of special duty of precaution which constitute the specific content of duty of precaution of the most prudent person of hospital.
Chapter Five Particular Problems in Trying Cases of Medical Accident Injury Compensation
As for the distribution of responsibility of presenting evidence in medical litigation, since the unbalance of information and technology between doctors and patients, it implements the responsibility inversion to present evidence. According to the prescription of Article 4 Section 8 in Evidence Regulation of the supreme court:”the medical organs shall undertake the responsibly of presenting evidence for non-existing causal relation and non-existing medical fault between medical treatment and injury result in the litigation caused by medical treatment”. We can take the advantages of responsibility inversion theory and spoliation of evidence theory from German laws. Responsibility inversion of presenting evidence theory holds that the responsibility of offering evidence could be inverted and it could invert form plaintiff to defendant and vise versa. Spoliation of evidence theory believes that the judge shall employ responsibility inversion when the doctor deliberately change, destroy and hide evidence. For those injuries which are caused by diagnosis debt incomplete fulfillment by doctors are not caused by doctor’s fault. This shall employ the alteration of responsibility of presenting evidence in Spoliation of evidence theory to distribute the responsibility of presenting evidence. The author believes that the medical dispute on presenting evidence shall be solved by taking the reference of particular cases of medical accident injury compensation so as to get a fair judgment. For the handling of competition and merger in the responsibility of medical injury, there are three models in the world: forbidding competition and merger, allowing competition and merger and restricting competition and merger. For the competition and merger of medical responsibility and according to the prescription of Article 46 in Regulation, the author holds that restricted competition and merger shall be the legal principle for removing medical breaking agreement and violating rights.
In the process of litigation, if the parties have doubts about whether it is a medical accident after the court has conducted a judicial authentication, they can conduct a new judicial Authentication. If the court does not permit a new judicial authentication, after investigating the reason for the rejustification, the parties will incites Article 22 in Regulation. They confuse justification again and new justification. At present, the medical accident technological authenticating conducted by medical societies is only applicable for the situation that the two parties solve medical accident disputes by not resorting to litigation. As for the form of solving medical accident disputes could adopt judicial authentication. For the principle and standard of compensation of medical disputes, except the general principles in Civil Procedure Law, it could also comply with the following special principles: first, attaching importance on both the protection of patients’rights and the development of medical science; secondly, rational prediction of compensation; thirdly, balance on losses and gains; fourthly, fault offset principle. In the practice, it should conscientiously protect the legitimate rights of parties.
引文
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1.张文显主编:《马克思主义法理学——理论、方法和前沿》,高等教育出版社 2004 年 3 月第 1 版。
2.王泽鉴著:《侵权行为法》,中国政法大学出版社 2001 年 7 月第 1 版。
3.王泽鉴著:《民事学说与判例研究》修订版,中国政法大学出版社 2005年 1 月修订版。
4.艾尔肯著:《医疗损害赔偿研究》,中国法制出版社 2005 年 4 月第 1版。
5.侯雪梅著:《患者的权利——理论探微与指南》,知识出版社 2005 年8 月第 1 版。
6.朱晓娟、戴志强编著:《人身权法》,清华大学出版社 2006 年 6 月第1 版。
7.黄文平、王则柯著:《侵权行为的经济分析》,中国政法大学出版社2005 年 4 月第 1 版。
8.肯尼斯·S·亚伯拉罕 阿尔伯特·C·泰特 选编 许传玺主编《侵权法重述——纲要》,法律出版社 2006 年 8 月第 1 版。
9.《月旦民商法研究——侵权行为法之立法趋势》,清华大学出版社 2006年 1 月第 1 版。
10.赵敏、邓虹主编:《医疗事故争议与法律处理》,武汉大学出版社2007 年 1 月第 1 版。
11.陈聪富著:《侵权归责原则与损害赔偿》,北京大学出版社 2005 年 9月第 1 版。
12.杨立新著:《侵权行为法》,中国法制出版社 2006 年 2 月第 1 版。
13.王军著:《侵权行为法比较研究》,法律出版社 2006 年 7 月第 1 版。
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15.王军著:《侵权法上严格责任的原理和实践》,法律出版社 2006 年 4月第 1 版。