我国生前预嘱的法制化研究及相关问题述评

生前预嘱是由患者在意识清醒时作出临终期的治疗决定,是对患者医疗自主权的尊重,在多数发达国家均有应用.我国起步较晚,研究和推广程度较低,核心的法律制度还处于探索阶段.通过文献计量等方法对生前预嘱在我国的应用和研究现状进行分析,着重从立法模式、撤销和公证制度等多个方面对法律制度在我国的相关研究进行述评.     

生命预嘱制度建构初探简

生命预嘱（Living Will）是人们事先也就是在健康或意识清楚时签署的,说明在不可治愈的伤病末期或临终时要或不要哪种医疗护理的指示文件。生命预嘱尊重患者的医疗自主权,强调了医护人员和患者及家属之间在医疗工作中的合作关系,是医学领域中必要的创新。事实上,由于种种原因,在中国临终放弃治疗已经相当普遍,但对临终患者是否可以预立生命预嘱,告诉医护人员他是否想要手术,插管进食或使用呼吸机来维持生命,我国法律尚无此类规定。由于缺少相关法律制度对医师的行为进行有效的保护和约束,临床实践中医师对临终患者的处理做出决策相当困难。就死亡过程而言,社会提出了明确要求,法律就应当认真对待。本文通过介绍国内外的生命预嘱立法及其实践情况,了解实践中生命预嘱在我国的存在空间,探讨我国未来生命预嘱的立法思路,为我国未来生命预嘱的主要制度的构建略尽绵薄之力。     

“生前预嘱”概念体系梳理及立法选择

我国目前正处于生前预嘱概念推广阶段,尚未建立生前预嘱制度及预先医疗指示制度,因此需要我们在立法前做好充分的理论准备。首先要重视生前预嘱概念的准确性,"生前"的表述并不准确,应予重视概念所属制度体系的逻辑性、合理性。有些学者的理论表述并不严谨,将预先医疗指示与生前预嘱等同,其实这对概念是包含与被包含的关系,在对制度进行立法选择时要坚持正确的理论基础。我们还要重视制度内容上的一些特别问题,如孕产妇的生前预嘱效力问题,以及生前预嘱的灵活适用问题,为我国相关制度的立法选择提供帮助。     

绝症背后：“尊严死”引发的是非争议

癌症晚期，回天无力。是想尽办法，不惜金钱不怕痛苦的化疗；还是放弃过度治疗，有尊严地离去？北京一家协会力求通过协议的方式，让人自己选择离开的方式，做到“尊严死”，这其中牵涉了文化、伦理、法律、医疗等太多问题。有人赞同有人反对，也有人充满顾虑，因为除了传统观念，“尊严死”并没有统一标准和法律保障……     

绝症背后“尊严死”引发的是非争议

癌症晚期，回天无力。是想尽办法，不惜金钱不怕痛苦地化疗：还是放弃过度治疗，有尊严地离去？北京一家协会力求通过协议的方式，让人自己选择离开的方式，做到“尊严死”，这其中牵涉了文化、伦理、法律、医疗等太多问题。有人赞同有人反对，也有人充满顾虑，因为除了传统观念，“尊严死”并没有统一标准和法律保障……     

仍在寻求法律支持的尊严死

尊严死的倡导者们认为,他们还是有“好消息”的：即我国法律虽然没有立法支持,但也没有法律来对其明文禁止。 依靠医疗体系抢救，还是选择尊严死，病人死亡的方式由谁来决定？家属、医生，还是其他组织？因为个人情感、政治和经济利益的纠葛，实践中往往拿不出令各方满意的方案。     

和谐社会视角下尊严权的法律保护

在社会矛盾多发期,从法律制度层面对尊严权进行保护对于贯彻依法治国的治国方略和构建社会主义和谐社会具有重要意义。本文在现代心理科学对人尊严的科学理解基础上,对尊严权的法律内涵进行了界定,并从和谐社会建设的视角探讨了对尊严权进行法律保护的重要性,进而对尊严权法律制度构建进行了初步构建。     

论生命尊严与安乐死

我国宪法明确规定,"中华人民共和国公民的人格尊严不受侵犯";2020年出台的《中华人民共和国民法典》中强调"生命尊严"不可侵犯,正是对宪法规定的具体实践.其中,"生命尊严"包含:生的尊严、活的尊严、死的尊严三大方面,而"安乐死"问题,正是"死的尊严"的重要议题.随着科技的不断发展,社会医疗水平的不断提高,以及社会保障体...     

医疗损害赔偿纠纷案件法律适用的冲突与调适

医疗损害赔偿是当今社会的热点问题,也是司法审判实践中的重点、难点问题。由于该类案件处理中现行法律适用原则存在的误区,导致审判实践中同案不能同判的现象时有发生。这不仅损害当事人的合法权益,而且严重损害我国法律的尊严。文中阐述了现行法律适用原则存在的主要问题及由此产生的严重影响,并从理论上通过对现行适用原则中区分对待的医疗事故以及其它医疗损害的剖析,明确了医疗损害的内涵及其责任性质,进而提出对《条     

关于医生主动放弃治疗的法律思考

尽管临床医生一直在为治愈患者的疾病、挽救患者的生命而始终不懈地努力着,但是,我们常常不得不面对放弃的问题。实践中,还真有医生主动放弃治疗的,如1987年江西省某市一个医生在未征得病人及家属的同意就擅自终止了一晚期癌症患者的一切治疗。病人家属为此诉至法院,法院认定医生行为无罪。在此,我们不去论证法院的判决,而是就医生主动放弃治疗所引发的法律问题。作一些深人的探讨和研究。一、对放弃治疗的特定理解放弃治疗是指医生根据病人、病人家属的决定或自己审慎的决定对身患绝症,没有康复可能和治疗价值的病人终止维持其生命的医疗不作为行为。鉴于我国对积极安乐死的争议太大,放弃治疗的合法化应仅限于医生终止治疗的不作为行为。而不应包括采取积极措施(如给病人注射致剂量的针     

Can we handle the truth? Legal fictions in the determination of death

Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. People can be maintained on life-support even after permanently losing the ability to breathe spontaneously and remaining unconscious and unable to interact meaningfully with others. In part because this group of people could help fulfill the growing need for organ donation, there has been a great deal of pressure on the way we determine death. The determination of death has been modified from the old way of understanding death as occurring when a person stops breathing, her heart stops beating, and she is cold to the touch. Today, physicians determine death by relying on a diagnosis of total brain failure or by waiting a short while after circulation stops. Evidence has emerged that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from our biological and common-sense understandings of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. However, the considerable debate over the determination of death in the medical and scientific literature has not informed the public of the fact that our current determinations of death do not adequately establish that a person has died. It seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution of acknowledging the legal fictions involved in determining death. This move in the direction of greater transparency may someday result in allowing us to face squarely these issues and effect the legal changes necessary to permit ethically appropriate vital organ transplantation. Finally, this paper also provides the beginnings of a taxonomy of legal fictions, concluding that a more systematic theoretical treatment of legal fictions is warranted to understand their advantages and disadvantages across a variety of legal domains.     

“I'll Make Them Shoot Me”: Accounts of Death Row Prisoners Advocating for Execution

About 11% of death‐sentenced prisoners executed in the United States hastened executions by abandoning their appeals. How do these prisoners persuade courts to allow them to abandon their appeals? Further, how do legal structures and processes organize these explanations, and what do they conceal? An analysis of Texas cases suggests that prisoners marshal explanations for their desires to hasten execution that echo prevailing cultural beliefs about punishment and the death penalty. The coherence of these accounts is amplified by a non‐adversarial, unreliable legal process. This article contributes to our understanding of legal narratives, and expands their analysis to include not only hegemonic stories and legal rules, but also the legal process that generates them.     

In Search of Common Values Amongst Competing Universals: An Argument for the Return to Value’s Original Meaning

This article presents an argument for the return to the original meaning of the concept value. This is achieved by revisiting the genealogy of the concept and by placing in perspective and questioning the common parlance thereof in contemporary legal discourse. The approach is decidedly against the often casual way in which courts and commentators treat the concept, seemingly as concretisation, validation, exegesis or reinforcement of fundamental norms, but without paying attention to its original meaning and use. It is submitted that we confine our talk of values to the products of valuation, that is, the taste, the will, the esteem and/or perspective of some individual or group. Yet, it is not suggested that we completely discard the use of values discourse in law, the goal is rather to restate the inherent relativity of values language in legal discourse. This will bring necessary order to the current conceptual disarray and will foster mutual understanding and alliance.     

Why Must Legal Ideas Be Interpreted Sociologically?

Sociology of law and socio-legal studies are sometimes declared unable to give insight into the nature of legal ideas or to clarify questions about legal doctrine. The idea that law has its own 'truth'– its own way of seeing the world – has been used to deny that sociological perspectives have any special claim to provide understanding of law as doctrine. This paper tries to specify what sociological understanding of legal ideas entails. It argues that such an understanding is not merely useful but necessary for legal studies. Legal scholarship entails sociological understanding of law. The two are inseparable.     

论期待可能性理论的合理性——基于言伴语境理论的考察

只有在特定语境下才能达成对文本的理解和解释，言伴语境对意义生成具有重要作用。法律解释的言伴语境是当下案件事实。法官处理案件时在其前见的指引下根据法律规定选择、建构案件事实，根据案件事实赋予法律文本以语用意义，并且在语境和文本、案件事实和法律文本之间的多次循环往复中实现解释者和文本的视域融合，使法律文本的意义不断丰富和完善。刑法未规定期待可能性，但对其适用体现了言伴语境对文本意义的作用，因而其存在具有合理性。适用该理论不会打破法律的安定性和灵活性之间的平衡，法官因此而行使自由裁量权不违背现代法治精神。     

司法经验中的生活体验——从典型女性法官形象切入

从典型女性法官的司法经验来看,她们之所以在日常的司法工作中有着突出的表现,以及她们的司法经验更易于获得社会的普遍认同,就在于她们都努力将个人的生活体验融入司法经验之中,不仅善于以"做人"的方式来"做事",而且也习惯于以"过日子"的态度和原则来"工作"。这些典型女性法官的司法经验和形象对于当下中国司法而言,可能意味着不仅要建构一种整体性司法知识观与司法模式,而且也要求中国法官能够运用一种更加实用也更生活化的司法方法。换言之,这些典型女性法官的司法经验对于当下中国的司法及其发展而言,可能意味着要以一种符合现代中国人的生活化眼光和生存性智慧来再造司法的知识理论与实践模式,在促成法律生活与日常生活更加紧密的互动融通的基础上,使司法及其方法更加规范化和生活化,唯此,才可能确保司法在更好地满足社会生活与司法需求的同时推动司法制度的良性发展。     

禁止重复起诉规则之重构:以合同效力的职权审查为背景

我国对合同效力采依职权审查模式,据此作出的生效判决在主文外对合同效力的认定能产生禁止重复起诉的效果。由于不必全面审理潜在争点,大陆法系传统理论认为判决理由原则上不发生既判力。当任一方当事人明确请求确认先决关系效力时,上述两种思路均认可合同效力认定的既判力。我国应将合同效力作为审理焦点,并实现对依职权审查规则的实质化改造,要求法官作出包含既判力范围释明的明确标识。在判断依职权审查规则的既判力效果时,应进一步解释禁止重复起诉规则的要件。这种既判力理解不同于争点效理论并能提供更清晰的识别方案。     

论执行时效制度之理解误区及其矫正

执行时效是指执行依据所载的债权人之私法上请求权的消灭时效,而不应当是指公法上强制执行申请权的存续期限。债权人申请执行时,法院不应主动审查、适用执行时效。执行时效届满后,债务人作出同意履行的意思表示的,应发生时效抗辩权之放弃的法律后果,故法院仍可就债务人为强制执行。执行时效届满后双方对债务重新予以确认或达成新的履行债务协议时,亦发生时效抗辩权之放弃的效果。债权人向法院提出执行申请时,执行时效是否中断和重新计算,应根据情况作具体分析。申请执行之前达成和解协议的,发生时效中断的效果;而执行程序中达成和解协议时,因法院对本案执行程序采取中止执行或终结执行之处置方式的不同,其时效中断效力的认定也存在区别。     

How Reflective and Critical Norm-Usage Paves the Way to the Public Power of Judgement

The purpose of this paper is to demonstrate that Neil MacCormick’s conception of norm-usage makes it necessary to address the concept of the public power of judgement as the key concept for understanding the democratic legitimization of current law. Therefore, firstly I analyse MacCormick’s conception of norm-usage, secondly I demonstrate that it leads to the idea of the institutionalisation of judgemental–interpretative practice, and thirdly, I show that the latter paves the way to the public power of judgement. Finally, I argue that this power needs to be elaborated in terms of competencies which are broader than legal skills and legal reasoning, and, further, that these competencies condition the use of both legal skills and reasoning. Importantly, MacCormick’s contribution to understanding the public power of judgement—when further developed—may indicate the profound role of comprehending the proper significance of law in a democratic polity and its relationship to the citizenry.