Excessive risk disclosure: the effects of the law on medical practice

This article examines the debate surrounding the challenging concept of informed consent. It argues whilst the English courts have effectively excluded the use of the tort of battery as an appropriate mechanism for protecting a patient's right to self-determination, they have left the law in a state of flux due to the uncertainties associated with categorising similar claims within negligence where the onus is on risk disclosure. This confusion may stem firstly from the fact that medical practitioners are unsure exactly which risks to disclose, and secondly, from the way in which both doctors and patients perceive the consent process. The paper suggests this disorder may be having a detrimental effect on medical practice as medical practitioners are taking it upon themselves to disclose excessive information, which patient's may not want or need. A suggestion is also made that in these situations, in order that the law truly respects self-determination, consideration must be given to the patient's desire to waive their right to informed consent.     

论医疗责任保险——从法律经济学的角度切入

医疗责任保险是从国外引入的一种制度,目的之初在于,将医师的过错责任诱发的巨大风险社会化,以期医师安心于治理病患,而病患通过保险获得相应的保险费用保障自身的权益,缓和较为尖锐的医患关系和社会矛盾。但医疗责任保险发展的现实情况却是极其不理想的,学界对于医疗责任改革已有基本共识,具体设计上却甚少有人提出更为细致的建议。可以从法律经济学这个分析的全新视角,借助成本效益、纳什均衡、博弈的思维进路,以期为医疗责任保险制度的设计另辟蹊径。     

Public expectations of health professionals when patients telephone for medical advice

This article focuses on the ethical, social and liability implications of patients obtaining unsolicited medical advice over the phone. The ethical discussion centres on the demise of paternalism and the increase in patient autonomy and individualism and the growing public expectations of health professionals. The article then discusses the advantages and disadvantages of telephone consultations from a social and policy perspective. In light of these considerations it considers what the liability implications are for phone consultations. It argues that the ethic of individualism, coupled with recent Australian tort reforms, suggests that only in limited circumstances would a doctor be found liable for negligence in relation to telephone consultations. However, the increasing expectations being placed on medical personnel, as evidenced by the increase in unsolicited telephone consultations, if left untempered, may lead to a situation with which the health care system is ill equipped to deal.     

析缔约过失责任的性质

本文对将缔约过失责任归属于债权的责任或合同责任的观点进行了评述,指出了其弊端,提出将缔约过失责任作为一个独立的民事责任。     

英美法对医疗过失的判定原则及对我国的启示

过失是医疗损害责任认定中最为重要的条件,如何确定过失是医疗纠纷和诉讼中最为关键的问题。我国在该问题上的研究及实践均存有欠缺之处,而英美国家在过失判定原则中,其注意义务标准的设定和认定具有一定的合理之处,对我国医疗过失理论研究和司法实践均有借鉴作用。     

医师注意义务的概念及其与医疗过失行为的关系--医师的注意义务系列研究(1)

医疗过失问题,是医患纠纷的焦点.医师的过失行为本质是一种客观过失,是对医师注意义务的违反,因为任何医师在自己从事特定的医疗行为时都必须达到相应的医疗水准.医师的注意义务是指医师在医疗行为时依据法律、法规、规章制度和具体操作规程,以及职务和业务上的习惯和常理、接受期约或委托的要求等保持足够的小心谨慎,以预见医疗行为的结果和避免损害结果发生的义务.     

论美国医疗过失案件中注意标准的确定——从历史的视角纵向分析

医疗注意义务是整个医疗过失理论的核心，而注意标准概念则是重中之重。本文从不同时期的判例着手，重点展示美国的注意义务标准的历史发展过程和总体趋势：合同还是侵权，单一程式标准还是多因素可变标准，提高病人安全还是控制医疗费用。通过分析不同时段内法理与司法实践的主要特点，本文将美国医疗注意标准的各种影响因素逐步列出，突出行业惯例和地域因素在整个体系内的辉煌与落败。如今美国的医疗注意义务标准也面临挑战，即医疗保健体系与医疗保险改革背后对医疗费用控制的政策对它产生了冲击。     

Limiting Liability for Automobile Accidents: Are No-Fault Tort Thresholds Effective?

"No-fault" automobile insurance plans are designed to supplant the tort system by requiring motorists to purchase no-fault insurance and allowing victims to file liability insurance claims and tort suits only if their injuries exceed a legislated "tort threshold." While thresholds vary among states, many are satisfied if the victim incurs medical expenses as low as a few hundred dollars. Using insurance claims data, we estimate the effectiveness of several states' thresholds. We find that tort thresholds are surprisingly effective: modest tort thresholds reduce the number of successful tort claimants by half, and the strictest thresholds may exclude nine-tenths of potential claimants. Moreover, we find little evidence of claimants "padding" their claims to exceed the dollar thresholds.     

医疗责任保险的思考

大力发展医疗责任保险,对医疗执业过失给患者造成的损害进行充分赔偿,在保障患者和医疗机构及其医务人员的合法权益,优化医疗环境和医疗公共秩序方面有重要的促进作用。由于我国医院主体是公立医院,侵权法人身损害赔偿相对于综合医院尚未到重大程度,并且综合性医院每年发生的医疗过失案件基本确定,选择满足面临危险的医院财务安全需要的医疗责任保险模式,如医疗责任保险信托等,才能促进医疗责任保险的发展。实践表明,商业性医疗责任保险不宜成为我国医疗责任保险的主体。建立独立的医疗过失纠纷调解鉴定机构,才能保证医疗责任保险顺利开展。     

Is there an acceptable answer to rising medical malpractice premiums?

This article explores the key issues involved in the attempts at reform of the present medical malpractice system. Investigating the effects that federal tort reform legislation would have on physicians, patients, lawyers, and the medical malpractice insurers, Dr. Gunnar succinctly outlines the issues surrounding the present "crisis in healthcare" and explores the separate interests involved. The article examines the economic forces influencing the medical malpractice insurance industry, reviews previous tort reform, and predicts the future of federal tort reform legislation. Dr. Gunnar concludes by proposing alternatives for malpractice reform.     

医疗差错认定与Res Ipsa Loquitur

ＲｅｓＩｐｓａＬｏｑｕｉｔｕｒ是拉丁文的法律专业术语 ,在英美法系多用于处理民事纠纷已经有一百多年历史 ,在医疗差错的认定上常被应用。我国司法与医疗卫生工作者对医疗差错的认定多有争议 ,分析了解英美法系对ＲｅｓＩｐｓａＬｏｑｕｉｔｕｒ应用的历史、案例和有关学说 ,与我国的现行法律制度进行比较 ,相信会有所帮助。一、医疗差错与中国的相关法律近年来因医疗纠纷到法院起诉的损害赔偿案件越来越多[1] ,因而法庭将面对如何质证被告是否侵害原告身体并造成伤害 ,已经确认被告的行为是否有过错 ,是否与损害后果之间具有因果关系 ,…     

Administrative compensation of medical injuries: a hardy perennial blooms again

Periods in which the costs of personal injury litigation and liability insurance have risen dramatically have often provoked calls for reform of the tort system, and medical malpractice is no exception. One proposal for fundamental reform made during several of these volatile periods has been to relocate personal injury disputes from the tort system to an alternative, administrative forum. In the medical injury realm, a leading incarnation of such proposals in recent years has been the idea of establishing specialized administrative "health courts." Despite considerable stakeholder and policy-maker interest, administrative compensation proposals have tended to struggle for broad political acceptance. In this article, we consider the historical experience of administrative medical injury compensation proposals, particularly in light of comparative examples in the context of workplace injuries, automobile injuries, and vaccine injuries. We conclude by examining conditions that may facilitate or impede progress toward establishing demonstration projects of health courts.     

Procreative torts: enhancing the common-law protection for reproductive autonomy

Roe v. Wade's twenty-fifth anniversary is likely to herald widespread scholarly commentary on the decision's continued vitality and the future of abortion in the United States. However, if such commentary focuses solely upon the constitutional dimensions and political aspects of a woman's right to privacy, an important dimension of this right will be overlooked. Few commentators have considered the extent to which tort law safeguards a woman's interest in reproductive autonomy. In this article, Professor Northern argues that the interest in reproductive autonomy has not yet received the full protection to which it is entitled and that tort law is poised to evolve distinct causes of action for the interference with procreative autonomy interests. Professor Northern begins with an overview of the medical and psychological literature on abortion-related risks. She goes on to discuss current trends in abortion malpractice litigation. The author then reviews the three basic types of malpractice causes of action--battery, negligence, and lack of informed consent--and explores their application to abortion malpractice claims. The focus of the article then shifts to the development of specialized procreative torts, and Professor Northern contends that courts should go beyond previous decisions to redress any substantial interference with procreative autonomy. Finally, the author asserts that legislative alternatives to the common-law development of procreative torts, such as right-to-know statutes, are less protective of women's interests. Professor Northern concludes that tort law could and should be used to more fully protect women's interests in procreative autonomy.     

共同过失命题之证伪

共同过失这个命题是共同侵权制度据以扩张解释的一个理论假设。然而目前所有关于共同过失的观点及其论证都是不成立的。共同过失就其实质而言,属于无意思联络的数人过失侵权,按照目前侵权责任法的规定,数人应对受害人承担按份责任。然而共同过失这个理论假设不适当地扩张了共同侵权行为的范围,并导致了连带责任制度被滥用。     

防御性医疗的经济分析——兼评《侵权责任法》第63条

防御性医疗是医疗服务提供者基于"经济人"理论与预期效用理论的理性选择。风险厌恶与预期效用最大化是防御性医疗的经济学基础。医疗过失判断的不确定性及巨额的责任风险是防御性医疗的法律制度基础。信息的不对称性及供给与需求的非市场性是防御性医疗的市场基础。它是医疗过失诉讼制度在市场经济体制下不可剥离的副产品。纯粹的禁止性立法不足以制止防御性医疗。《侵权责任法》第63条很难收到预期的立法效果,建议对医疗过失诉讼制度的运用及医疗损害赔偿的额度进行合理限制。     

论过度医疗侵权行为及其法律规制

过度医疗一般是指,在医疗过程中,医师对患者的疾病实施不必要的诊疗措施,致使患者的医疗费用明显超过疾病诊疗实际需求的医疗行为或医疗过程。过度医疗认定的关键,在于把握过度医疗行为与适度医疗行为的界限,并且应将其与保护性医疗和防御性医疗加以严格区分。从法律意义上讲,过度医疗是一种发生在医疗过程中的特殊民事侵权行为,是指医疗机构及其医务人员在医疗活动中,以获取一定经济利益为目的,违法实施不必要的诊疗从而造成患者明显人身、财产损害并应承担相应法律责任的行为。过度医疗侵权应适用过错推定责任进行归责。《侵权责任法》立法上将过度医疗的范围,仅局限在"实施不必要的检查",不足以充分保护患者的合法权益,立法上应进一步做出扩充解释。     

Tort Law Culture: Image and Reality

This article highlights two contrasting images of tort. The first reflects the traditional portrayal of justice, depicting tort as an independent ‘natural’ system of rules of universal application forming the foundation of a just society. The second is more recent and relates to the perceived development of a damaging compensation culture. Focusing on personal injury litigation, we show how these portrayals differ from the reality of tort. In practice it is heavily influenced by institutional arrangements: the importance of both welfare provision and liability insurance is highlighted, and the effects of a ‘no‐win no‐fee’ claims market are examined. The operation of tort is very much affected by commercial interests and the economic demands of the institutions which surround it. Overall we conclude that the images of tort fail to reflect how the personal injury compensation system actually operates.     

共同危险行为争议问题探析

共同危险行为属于责任者不明型共同侵权,其与份额不明型共同组成客观共同侵权之类型。此类共同侵权中连带责任的正当化基础为可能因果关系,故当行为人证明自己的行为与损害间不存在因果关系时,便可免于承担责任。共同危险行为制度同样可以适用于无过错责任领域。共同危险行为与共同过失型共同侵权的区分,主要看行为人是否具有共同过失,共同过失表现为基于一致的行为安排而作出一定行为,而该行为中含有可预见并可避免的致害可能性。     

Rethinking Injunctions in Tort Law

This article considers the way in which injunctions have generallybeen made more freely available in tort in connection with theprotection of property and property-like interests. It arguesthat this prioritization of property can be viewed as underminingthe generally accepted hierarchy of protected interests. Itthen argues that if negligence law were seen as a tort thatembraces not just careless, but also deliberate and recklessconduct, it could be used as a basis for granting injunctionsin a number of important circumstances that would help to restorethe right to bodily integrity to its rightful place at the topof the hierarchy of protected interests in tort law.     

Australian tort law reform: statutory principles of causation and the common law

By mid-2004, Parliaments in each Australian jurisdiction will either complete or will be in the process of partial codification of the law of torts. The reforms, including those to the law of negligence, are extensive. This article focuses on codification of the law of causation as an element of the cause of action in negligence. It examines the background to "tort reform", as the process has been labelled, and discusses the common law paradigm of negligence and various approaches to causation. It then analyses and compares the causation provisions in each jurisdiction.