民法典编撰对医疗代理决定刑法效力的影响

《民法总则》在“监护”的内容中，明确了“尊重被监护人意愿”“最有利于被监护人”的原则，增加了“意定监护”等新规定。《民法典各分编（草案）》在“医疗损害责任”中，则进一步强调了“患者的知情同意权”。这意味着我国的医疗代理正由“法定主义”向“意定主义”转变。对无“自我决定”能力的患者实行医疗行为，除满足“医学适应性”“医术正当性”外，还要具备用以替代“患者的知情同意”的“医疗代理同意”这个要件才能实现刑事正当化。依据法秩序统一性原理，此时的“医疗代理同意”既不能简单等同于“患者家属的同意”，也不应是“医务人员的同意”，而应当是最为接近患者真实想法的“患者的推定同意”。

The Criminal Effect on the Medical Consent and Surrogate Decision Making under the Development of the Civil Code

The “General Provisions of Civil Law” clarifies the principle of “respecting the will of the ward” as “the most beneficial to the ward,” and adds new regulations such as “Voluntary Guardianship” section in the chapter of “Guardianship”. In the “Drafts of the Civil Code (Draft)”, the “informed consent of patients” is further emphasized in the “responsibility for medical damage”. This indicates that the consent and surrogate decision making system in China is shifting from “legislation” to “voluntary” custody system. Thus, the implement of medical behaviors for the patients who lack the “self-determine” ability not only needs to satisfy “medical adaptability” and “legality of medical skills”, but also requires the “medical surrogate consent” instead of simply the “informed consent of patients”. Only when both conditions have been met, the medical behavior can be criminally justified. According to the principle of the unity of law and order, the “medical surrogate consent” at this time is not just “the consent of the patient’s family members”, nor “the consent of the medical staffs”, but should be the “presumed consent of the patient” as it is the closest to the patient’s true thoughts.