对生前预嘱相关问题的探讨

生前预嘱是指人在意识清楚时签署一份文书来事先表达出自己在生命末期的医疗意愿。本文针对生前预嘱的理解和适用中存在的相关问题作出探讨。本文以尊严死在我国的提出以及生前预嘱在我国的推广现状为基础,从法律的视角分析了生前预嘱的合法性和必要要件,并阐明了在目前的法律框架下生前预嘱还不是生效的法律文件,生前预嘱的落实还需要亲属的同意。本文借鉴其他国家和地区对生前预嘱的立法状况并结合我国的实际,提出了对于放弃治疗和尊严死的理解,以及针对医疗实践中放弃治疗的困惑提出了对放弃治疗应该严格遵循的原则。     

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。     

美国成年病人放弃治疗机制对于中国的启示

美国倡导清醒有自决能力的成年人用预先指示的方式表明自己在丧失自决能力时的医疗选择。预先指示主要分为生前遗嘱和持续性医疗授权书两种形式。美国联邦和各州有相对完善的法律制度,规定预先指示的形式内容及预先指示不存在时能为病人作出决定的人群和权限。医院也会有程序指南为医务工作者提供指导原则。中国可借鉴美国经验在转变大众对于死亡的观念、尊重病人自主权、出台相应法律法规、行业指南、增强医务工作者的沟通技巧和人文关怀等方面作出积极改变,完善放弃治疗的程序,满足病人要求,解决医务工作者的两难困境。     

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。     

医疗损害技术鉴定主体执业状态选择：职业化抑或兼职化

当前我国医疗纠纷处理存在二元化的医疗损害技术鉴定模式,这造成了医疗纠纷民事处理的混乱,因而成了法律界难以解决而又必须要解决的问题。两种鉴定模式的利弊并不具有互补性,因而不可能将两种鉴定模式做简单融合。对司法鉴定人管理实行理论创新、制度创新,构建包含职业鉴定人、兼职鉴定人、临时聘任鉴定人的司法鉴定人制度模式,对医疗损害技术鉴定人实行兼职化管理,由医学会对医疗损害技术鉴定机构和鉴定人实施直接管理同时报同级司法行政机关备案的管理模式,是解决当前医疗损害技术鉴定二元化的唯一办法。     

21世纪中国高校法学系列教材——《医事法学》出版

长期以来,我国医事法学的概念处于定义不清、界定不明的状态,常常有专家、学者将卫生法学与医事法学混为一谈,以至于有关医事法学、卫生法学的专著、教材、论文,在法律体系和理论内容上,雷同较多。事实上,医事法学应当是专门研究和探讨与医疗事务相关的法律体系、法律理论和法律制度的法律学科,而卫生法学的概念的外延要远大于医事法学,其所涉及的内容不仅包含了医事法学,更包括一系列与人的健康相关的法律体系、法律理论和法律制度。本着这样的区别,本教材在写作过程中立足于我国的医疗实践,针对医疗执业过程中涉及的相关法律理论和法律问题进行探讨,并注重对其他国家和地区的相关研究成果进行介绍和借鉴,以开拓学生的学习视野,启迪学生的科学思维。     

对我国医事法律中患者自主决策权相关规定的质疑与建议

本文对我国医事法中医疗决策主体的规定和对临终患者保护性医疗提出了质疑,并建议赋予患者预先指示权,建立医疗声明卡制度。     

医疗立法探讨

医疗立法是保障公民健康权的重要途径，是我国卫生法制建设的重要内容，是保证新医改关于医疗服务体系健全和公立医院改革顺利进行的重要保障之一，是依法卫生行政的内在要求。在分析医疗法立法的依据和-原则后，借鉴Et本、德国、台湾医疗立法经验，建议以总则、医疗法人制度、医疗安全保障、病人权益保护、信息公开制度、监督管理体制、法律责任作为医疗法的基本框架，并就我国医疗立法的相关问题进行探讨。     

医疗合同的立法研究

我国医疗领域的立法不完善,存在诸多问题,因此本文对医疗合同予以专门立法调整的必要性进行了论证,并从立法的指导思想、基本原则到具体制度内容等方面提出了明确的立法建议。     

《侵权责任法》确立医疗损害责任制度的意义

我国《侵权责任法》第七章确立的医疗损害责任制度全面体现了平等保护医患双方合法权益的立法精神;该法使用“医疗损害责任”的概念充分体现了民事权利保护法和救济法的性质;医疗损害责任制度的确立构建了一元化的医疗损害责任体系,彻底改变了对医疗纠纷案件法律适用“二元化”的现象;医疗损害责任归责原则体系的确立,有利于公正、合理的裁判各种医疗损害纠纷案件;医疗损害责任制度的确立推动我国最高司法机关修订了《民事案件案由规定》,从而明确了医疗纠纷案件的案由;对有效解决医疗损害责任的赔偿范围和标准的法律适用等问题产生了积极的意义。     

The law and practice associated with advance directives in Canada and Australia: similarities, differences and debates

This article is a summary of research that investigated the Canadian and Australian legislative framework associated with advance directives in health care. The research focused on the context in which older people are encouraged to use advance directives. These are directions about refusal of medical treatment given in advance of incompetence. An advance directive may be given in a written document (living will) expressing one's wishes, by appointing another person (proxy) to make the decisions, or as a combination of the two. A lack of consistency and clarity about the terminology was found in both countries. This could be a barrier for older people to express their wishes in advance. Several confusing issues were also identified with the legislation related to advance directives. There appears to be a move towards appointing a substitute decision-maker, but with significant differences across the Australian States and in Canadian Provinces. The "conversation" about future decisions emerged as an important theme, together with an emphasis on the process of "advance care planning" replacing the focus on advance directive forms.     

Advance directives as an instrument in an ageing Europe

Advance directives are written or oral statements that are intended to govern healthcare decision-making for their authors, for both positive and negative decisions, should they lose decisional capacity in the future. In a Europe which is facing an ageing population, advance directives play an increasing role to (help) formulate the wishes from elderly patient once they start losing the capacity to decide independently. Advance directives should not only be used as a formulation of the patients' previously made decision, but can also be used as guidelines to better understand the previous expressed wishes of the patient. If the advance directive is formulated in too vague form, the healthcare proxy and/or the healthcare trustee can help the physician interpret the directive. This broader approach towards advance directives is reflected in the case-law of the European Court of Human Rights, as well as on the European legislative level.     

Medical: advance health care planning. Final rule

This document amends VA medical regulations to codify VA policy regarding advance health care planning. The final rule sets forth a mechanism for the use of written advance directives, i.e., a VA living will, a VA durable power of attorney for health care, and a State-authorized advance directive. The final rule also sets forth a mechanism for honoring verbal or non-verbal instructions from a patient when the patient is admitted to care when critically ill and loss of capacity may be imminent and the patient is not physically able to sign an advance directive form, or the appropriate form is not readily available. This is intended to help ensure that VA acts in compliance with patients' wishes concerning future health care.     

法律期间制度的功能与建构

作为一种法律现象 ,法律期间之所以出现在众多的法律之中 ,是由其内含的制度功能决定的。现行立法尽管已对法律期间有所重视 ,但仍然存在着相当的立法缺陷。学界应当积极培育法律期间立法的理论资源 ,立法者对法律期间进行立法规制时 ,也必须遵循相应的设置规则     

论私法合同中意志的物化性——一个被我国立法、学理与司法忽视的决定合同生效的因素

具有行为能力的当事人基于意思表示一致所订立的合同是否当然具有法律效力 ?这一问题被我国的学理、立法和司法实践忽视了。我们的概念常常是 :意思表示真实是合同的核心问题。但实际上 ,没有任何一个国家的制度认为纯粹的意志可以决定一切 ,合同的交易本质不容忽视。大陆法系许多国家的原因理论与普通法系国家的约因理论都是决定合同义务是否可以履行的重要条件。     

Advance Refusals of Life-Sustaining Medical Treatment: The Relativity of an Absolute Right

English law gives the competent patient a right to refuse life-saving treatment, either contemporaneously or in an advance directive. This means that the patient's autonomous choice that in an anticipated situation his/her interests are better served by rejecting life-saving treatment needs to be respected. However, this right is undermined in practice by the courts' approach of applying a presumption in favour of preserving the patient's life whenever the validity and applicability of an advance directive is questioned. The article argues that the patient's right to refuse life-saving treatment only receives the respect it deserves if the decision whether or not a valid and applicable advance directive exists in a given case is instead be approached in an unbiased, disinterested way, and it analyses how this can be achieved in different scenarios.     

A line already drawn: the case for voluntary euthanasia after the withdrawal of life-sustaining hydration and nutrition

When life-sustaining hydration and nutrition is withheld from an incompetent and immobile patient like Terri Schiavo, death comes to the patient by dehydration within about two weeks. Americans should be permitted to arrange for euthanasia at that point, as opposed to merely dehydrating to death, and should be able to incorporate their desire for euthanasia into an advance directive. A state constitutional right of privacy could provide the legal avenue permitting effectuation of such a choice.     

行政程序地方先行立法的主体、模式与规范

行政程序地方先行立法具有试验性。作为试验立法,需探讨立法主体、模式和运作规范三个问题。行政程序应该属于中央立法事项,按照“试验立法权逐级下放”原则,应由地方性法规先行立法,地方政府规章先行立法有越权之嫌。试验立法的对象是实体与程序法律规范,不是法的表达形式,选择立法模式应综合考虑可操作性、立法效率与评估可能性等因素。据此,“法典模式”虽备受关注,但未必是最妥帖的方式,行政程序地方先行立法的恰当模式应当是“类行为法模式”。行政程序地方先行立法的自主、自发性在一定程度上导致了无序性,将来可在鼓励地方自主自发立法的基础上,围绕立法计划,由全国人大及其常委会和国务院有计划地安排和推进,并建立相应的运作规范。