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。     

临终患者自主权研究——以境外近期立法为切入

近年来,韩国和美国加州分别通过了关于临终患者自主权的立法。临终患者自主权可分为拒绝维生治疗权和要求死亡权两大类型。拒绝维生治疗权来源于身体不受他人干涉的自由,属于个人的基本权利,大多数法域都予以认可。要求死亡权的实质是要求医生杀人或帮助自杀,违背了"不得杀人"的基本法则,因此仅有个别法域承认其合法性。为应对人口老龄化,我国应当建立由临终关怀与临终患者自主权共同构成的临终医护法律制度。在临终患者自主权的立法模式的选择上,我国的法律制度和司法实践决定了我国不宜采用要求死亡权;相反,我国应当采用拒绝维生治疗权,因为我国具有建立该模式的法律基础与社会基础。     

从“埃鲁阿娜”案看植物人生死决定问题

医疗技术的进步催生了植物人这一新现象,它给传统法律制度带来了诸多挑战。在与植物人有关的法律问题中,最重要的是终止维生治疗的问题,由于这个问题涉及对人的生命的"剥夺",与人们传统的价值观、伦理观矛盾,因而很难取得统一意见。意大利司法界以患者的医疗自决权为基础,用推定的方式还原植物人就自己的生死的意志的方法较好地解决了这一问题。我国立法可借鉴这种做法。     

我国廉租房法律制度评析与完善

在构建和谐社会的过程中,廉租房法律制度的健全与否直接关系到我国住房保障制度是否完善,中国政府目前就这个问题制定了一些部门规章和地方性法规,但由于立法层次较低,同时廉租房立法起步较晚,因此在实际运行中出现了一些问题,本文通过对我国廉租房法律制度的现状进行评析和对国外经验的借鉴的基础上提出对该制度予以完善的相关建议.     

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。     

法律功能实现效果的影响因素之分析

法律的生命就在于其功能的实现,法律的功能仅是法律发挥作用的能力,它仍停留在一种可能而非必然的状态,而法律究竞是否发挥了作用又或是法律究竞发挥了怎样的作用,是需要在法律功能实现后再现其效果的.法律功能实现效果的影响因素主要有立法、社会、经济因素,此外,我国社会结构的转型也对法律功能的实现有着不可忽视的影响.     

建立立法听证制度之必要

为何要建立立法听证制度建立立法听证制度是完善立法监督的需要。立法监督是指“立法主体依法或依授权对有关的法律、法规、规章及其他规范性文件是否违法(违反宪法、上位法或者其他上位规范性文件)进行审查的活动。”根据我国现行宪法和《立法法》规定,我国立法监督的主体包括全国人民代表大会及其常委会、国务院、地方享有立法权的人大及其常委会。虽然在《立法法》中就立法监督未规定立法听证程序,但立法听证程序并非不     

论我国无过错医疗损害补偿制度的构建

无过错医疗损害是指医务人员进行的医疗行为不符合侵权行为的构成要件所造成的损害。在医疗行为造成患者损害,且该医疗损害具有不可归责性时,才可以适用无过错医疗损害补偿制度。在法律层面建立无过错医疗损害补偿制度对于合理分担医疗风险,有效化解医疗纠纷,引导患方合法维权,维护医疗机构的合法权益,促进医疗技术革新和医学事业的发展,填补医疗损害救济制度的立法空白具有重要的意义。我国应当借鉴发达国家和地区的立法经验,总结地方立法及实践,采取制定专门法律的形式确立无过错医疗损害补偿制度,构建以国家补偿为主、强制保险和社会救济为辅的无过错医疗损害补偿体系。     

试论债权保全制度

债权保全制度是一项有效地保障债权人权益的法律制度。债权保全制度在世界各国的法律制度中均有规定,如法国民法典、日本民法典等。我国合同法第七十三条和第七十四条分别规定了代位权和撤销权,确立了我国的债权保全制度。债权保全制度的建立,填补了我国长期以来在债法立法中的一个重大空白,对完善我国债权立法和有力保障债权人权益具有重要意义。一、债权保全制度的法律意义在合同法实施以前的债权法律制度中,对债权的保障有两种制度。一是民事责任制度,即当债务人不履行债务时,就应承担民事责任,债权人或基于合同约定,或基于法律…     

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.     

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.     

Medical: advance healthcare planning--VA. Proposed rule

This document proposes to amend the VA medical regulations to codify VA policy regarding advance healthcare planning. The proposed 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 proposed rule also sets forth a mechanism for honoring verbal or nonverbal 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 healthcare.     

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。     

Refusing medical treatment after attempted suicide: rethinking capacity and coercive treatment in light of the Kerrie Wooltorton case

The inquest into the death of Kerrie Wooltorton in Norfolk, England, ignited extensive public debate on the scope of the common law right to refuse medical treatment where a patient is distressed, depressed or actively suicidal. In Australia, a patient's wishes need not be honoured if the patient is not legally competent, if he or she falls within the ambit of the compulsory treatment provisions in the mental health legislation, and possibly also if there is a recognised public interest in preventing suicide which is sufficient to override the patient's choice. This article argues that decisions about whether to give medical treatment despite an apparent refusal should be based solely on a determination of the patient's competence to make their own choice. However, the test for legal competence must take into account the person's agency in making the decision, and decisions which will effectively end the person's life must be shown to be thought through.     

Law, autonomy and advance directives

The principle of autonomy underpins legal regulation of advance directives that refuse life-sustaining medical treatment. The primacy of autonomy in this domain is recognised expressly in the case law, through judicial pronouncement, and implicitly in most Australian jurisdictions, through enactment into statute of the right to make an advance directive. This article seeks to justify autonomy as an appropriate principle for regulating advance directives and relies on three arguments: the necessity of autonomy in a liberal democracy; the primacy of autonomy in medical ethics discourse; and the uncontested importance of autonomy in the law on contemporaneous refusal of medical treatment. This article also responds to key criticisms that autonomy is not an appropriate organising principle to underpin legal regulation of advance directives.     

Medicare and Medicaid programs; advance directives--HCFA. Interim final rule with comment period

This interim final rule amends the Medicare and Medicaid regulations governing provider agreements and contracts to establish requirements for States, hospitals, nursing facilities, skilled nursing facilities, providers of home health care or personal care services, hospice programs and prepaid health plans concerning advance directives. An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under State law, relating to the provision of health care when an individual's condition makes him or her unable to express his or her wishes. The intent of these provisions is to enhance an individual's control over medical treatment decisions. This rule implements sections 4206 and 4751 of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), Public Law 101-508.     

Medicare and Medicaid programs; advance directives--HCFA. Final rule

This final rule responds to public comments on the March 6, 1992 interim final rule with comment period that amended the Medicare and Medicaid regulations governing provider agreements and contracts to establish requirements for States, hospitals, nursing facilities, skilled nursing facilities, providers of home health care or personal care services, hospice programs and managed care plans concerning advance directives. An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under State law, relating to the provision of health care when an individual's condition makes him or her unable to express his or her wishes. The intent of the advance directives provisions is to enhance an adult individual's control over medical treatment decisions. This rule confirms the interim final rule with several minor changes based on our review and consideration of public comments.     

The capacity to execute an advance directive for psychiatric treatment

When advance directives are used to reject standard psychiatric treatment they have the potential to place civilly committed patients in a catch-22 where they need psychotropic medication to ameliorate their symptoms in order to regain liberty but are bound by their previously expressed wish that medication be withheld. The capacity to make an advance directive is higher than that required to make a contemporaneous treatment decision. Furthermore, unlike the assessment of contemporaneous capacity, it is very difficult to determine a person's capacity retrospectively or to determine if an advance directive was meant to apply in changed circumstances. The author argues that when an advance directive demands a course of action that is contrary to a person's best interests the onus should fall on the person rejecting the care to demonstrate that he or she was capable when executing the directive and that the directive is meant to apply in the current circumstances.