论我国患者隐私权的法律保护——以侵犯患者隐私权的民事责任为视角

近年来,患者在医院就诊被侵犯隐私权的现象频繁发生,继<侵权责任法>第62条直接将侵犯患者隐私权的情况纳人到医疗损害赔偿范围之后,患者隐私权纠纷成为医疗纠纷的另一热点诉讼.本文试图通过一则真实案例分析我国现有的患者隐私权法律保护状况,并同时提出一些其他对策和建议.     

The Human Rights Act 1998 and the individual's right to treatment

The right to demand treatment--even when life-saving--is not recognised by English common law. The courts have consistently stated that they do not have the jurisdiction to order a doctor to perform a particular treatment. This article considers whether the impending Human Rights Act 1998 can be interpreted so as to allow this right. While a general right to treatment is discussed the argument focuses on life-saving treatment. As an illustration, the David Glass case will be analysed and the impact of the Human Rights Act will be examined by considering how the judgment might have differed had the Act been in force.     

Who should determine what is best for children in state custody who object to psychotropic medication?

This article explores a child's right to refuse medical treatment, in contrast to giving the state or the parents this choice. The article specifically explores a child's right to refuse psychotropic drugs, which are more limiting of personal liberty than physical restraints and can have long-lasting side effects. With a focus on children's competence and the significant side effects of psychotropic drugs, the author concludes that caseworkers do not know the best interests of children in state custody and thus adolescents should be allowed to make their own decisions about psychotropic medications.     

Who should pay for bad genes?

Parents have long been able to influence the genetic composition of their children through their choice of a reproductive partner, if only very approximately. They are, however, increasingly able to determine the genetic make-up of their children in other, more precise ways, such as by selecting a particular gamete or embryo or by genetically modifying an embryo prior to artificial implantation. This Article discusses parents' obligations to their children and other members of the community stemming from their children's genes. In a just state, it argues, parents would be responsible for redressing any genetic disadvantage their children suffer as a result of parents' voluntary actions. Within the context of a liberal egalitarian account of distributive justice, this responsibility might most fairly be discharged through a compulsory insurance plan that provides compensation to genetically disadvantaged children when they might have had non-disadvantaged children instead would in some circumstances incur greater liability, because they could not fairly push the cost of their choices off on other members of the insurance pool. The Article also asks whether parents wrong a child by allowing it to be born with a genetic impairment when, had they taken steps to remove the impairment, the unimpaired child they had would have been a different person from the genetically disadvantaged child because the better-off child's capacities and experiences differed considerably from those that the disadvantaged child would have had. Contrary to many people's moral intuitions, the Article argues that parents do not wrong such a child. Nevertheless, parents remain morally obligated to bear any added costs occasioned by the child's impairment. Any other approach would allow them unjustly to shift the burden of their choices to other parents. Finally, the Article takes up the much debated question of whether parents harm a child by allowing it to be born with a life not worth living when they could have prevented its birth. It suggests that the answer to this question should be irrelevant to parents' legal liability. Acting on behalf of the parental insurance pool, the state may nonetheless adopt a variety of measures to help potential parents avoid giving birth to such children, which one can assume virtually all would prefer.     

Transforming Breach of Confidence? Towards a Common Law Right of Privacy under the Human Rights Act

This article examines the development of a remedy for unauthorised publication of personal information that has resulted from the fusion of breach of confidence with the limited 'horizontal' application of Article 8 of the ECHR via the Human Rights Act. Its analysis of Strasbourg and domestic post-HRA case law reveals the extent to which confidence has in some areas been radically transformed into a privacy right in all but name; however it also seeks to expose the analytical and normative tensions that arise in the judgments between the values of confidentiality and privacy as overlapping but not coterminous concepts, due in part to the failure to resolve decisively the horizontal effect conundrum. This judicial ambivalence towards the reception of privacy as a legal right into English law may, it will argue, also be seen in the prevailing judicial approach to the resolution of the conflict between privacy and expression interests which, it will suggest, is both normatively and structurally inadequate.     

Changing the support system for asylum seekers

The issues of asylum and the treatment of asylum seekers have once again hit the headlines in the UK. The recent problems in Kosovo in the former Yugoslavian territory have made the problem of dealing with asylum claims more acute. The past arrangements for asylum seekers have been inadequate and piecemeal and have developed as a result of changes made in 1996 and the subsequent intervention by the judiciary. The cost to the British taxpayer of the pre-1999 Act asylum arrangements has been over 500 million per year, 80 per cent of which has been spent on accommodating and supporting asylum seekers. There is also a huge backlog of cases and current figures are indicative of a system that is unable to cope. It is in the light of these problems that the Government has passed the 1999 Immigration and Asylum Act. This Article examines the changes that will be made to UK asylum law by the 1999 Act and assesses the problems that may be caused by those changes in the areas of housing and other forms of assistance and the effect that these may have on families and children seeking asylum in the UK.     

Automated decision-making in the EU Member States: The right to explanation and other “suitable safeguards” in the national legislations

The aim of this paper is to analyse the very recently approved national Member States’ laws that have implemented the GDPR in the field of automated decision-making (prohibition, exceptions, safeguards): all national legislations have been analysed and in particular 9 Member States Law address the case of automated decision making providing specific exemptions and relevant safeguards, as requested by Article 22(2)(b) of the GDPR (Belgium, The Netherlands, France, Germany, Hungary, Slovenia, Austria, the United Kingdom, Ireland).The approaches are very diverse: the scope of the provision can be narrow (just automated decisions producing legal or similarly detrimental effects) or wide (any decision with a significant impact) and even specific safeguards proposed are very diverse.After this overview, this article will also address the following questions: are Member States free to broaden the scope of automated decision-making regulation? Are ‘positive decisions’ allowed under Article 22, GDPR, as some Member States seem to affirm? Which safeguards can better guarantee rights and freedoms of the data subject?In particular, while most Member States refers just to the three safeguards mentioned at Article 22(3) (i.e. subject's right to express one's point of view; right to obtain human intervention; right to contest the decision), three approaches seem very innovative: a) some States guarantee a right to legibility/explanation about the algorithmic decisions (France and Hungary); b) other States (Ireland and United Kingdom) regulate human intervention on algorithmic decisions through an effective accountability mechanism (e.g. notification, explanation of why such contestation has not been accepted, etc.); c) another State (Slovenia) require an innovative form of human rights impact assessments on automated decision-making.     

The right to choose to die with dignity

Advances in medical science have done much to improve the quality of life but in some cases medical treatment may result in the prolonging of death rather than the enhancement of life. Patients may wish to refuse or withdraw from medical treatment even though they realise that this will lead to an early death. Medical attendants may, however, see it as their legal or ethical duty to impose medical treatment in the interest of preserving life. At a broad level two crucial interests come into headlong conflict--the patient's right to self-determination and society's interest in the preservation of human life. In this article the legal principles which are invoked to resolve this conflict both at common law and under recent Victorian legislation, the Medical Treatment Act 1988, are discussed and the thesis advanced that, in relation to competent patients, the law favours the right to self-determination.     

Disclosure of children's free and reduced price meals and free milk eligibility information in the child nutrition programs. Final rule

This final rule establishes requirements for the disclosure of children's free and reduced price meals or free milk eligibility information under the Child Nutrition Programs. The Child Nutrition Programs include the National School Lunch Program, School Breakfast Program, Special Milk Program, Summer Food Service Program, and Child and Adult Care Food Program. Within certain limitations, children's free and reduced price meal or free milk eligibility information may be disclosed, without parental/guardian consent, to persons directly connected to certain education programs, health programs, means-tested nutrition programs, the Comptroller General of the United States, and some law enforcement officials. Additionally, officials also may disclose children's free and reduced price meal or free milk eligibility information to persons directly connected with State Medicaid (Medicaid) and the State Children's Health Insurance Program (SCHIP) when parents/guardians do not decline to have their information disclosed. These regulations affect State agencies and local program operators that administer the Child Nutrition Programs and households which apply for and/or are approved for free and reduced price meals or free milk. The final rule reflects the disclosure provisions of the Healthy Meals for Healthy Americans Act of 1994 and comments received on the proposed rule published in anticipation of implementing those provisions. Additionally, this final rule includes the regulatory disclosure provisions implementing the Agricultural Risk Protection Act of 2000 and comments received on the interim rule issued to implement those provisions. This final rule also implements nondiscretionary provisions of the Child Nutrition and WIC Reauthorization Act of 2004, allowing certain third party contractors access to children's eligibility status and will allow school officials to communicate with Medicaid and SCHIP officials to verify that children are eligible for free and reduced price school meals or free milk. The disclosure provisions are intended to reduce paperwork for administrators of certain programs that target low-income households and for low-income households which may benefit from those programs by allowing some sharing of household's free and reduced price meal eligibility information. This rule also includes several technical amendments.     

The semblance of autonomy: treatment of persons with disabilities under the Uniform Health-Care Decisions Act

This Article illuminates the dangers of the Uniform Health-Care Decisions Act, which provides a set of model rules designed to clarify and expedite end-of-life health-care decisionmaking for incapacitated patients. The uniform commissioners and many scholars who have commented on the Act have touted the legislation as a model for defending patient autonomy. As this Article will reveal, the impression of autonomy is an illusion. In fact, the Act privileges the perspectives of the able-bodied over those of persons with disabilities, endangers the autonomy of incapacitated patients, and empowers proxy decisionmakers who have incentives to terminate treatment. These risks have become all the more significant with the rise of managed-care programs that create pressures to minimize care. After highlighting the serious risks to vulnerable patients under the Uniform Health-Care Decisions Act, the Article offers alternative rules and stronger safeguards to better protect patient autonomy and defend against wrongful health-care decisions. This Article urges states seeking improved end-of-life health-care procedures to codify these or similar protections in order to avoid the lethal shortcomings of the Uniform Health-Care Decisions Act.     

Keeping the Family Together: Why New York Must Amend Evidence Rules to Protect a Parent's Right to be a Parent

In New York, hearsay statements made by children may be admissible in a child protective proceeding. Under Article 10 of the Family Court Act, an out‐of‐court statement only requires corroboration to support the statement's reliability. The Family Court has the choice to determine what evidence will be sufficient for corroboration. In comparison to other statutes from different states, New York's statute is very broad. This Note proposes amending the current evidence statute under Article 10 of the Family Court Act to strengthen the standard for admitting hearsay statements in child protective proceedings.     

Humans in the GDPR and AIA governance of automated and algorithmic systems. Essential pre-requisites against abdicating responsibilities

The GDPR mandates humans to intervene in different ways in automated decision-making (ADM). Similar human intervention mechanisms can be found amongst the human oversight requirements in the future regulation of AI in the EU. However, Article 22 GDPR has become an unenforceable second-class right, following the fate of its direct precedent -Article 15 of the 1995 Data Protection Directive-. Then, why should European policymakers rely on mandatory human intervention as a governance mechanism for ADM systems? Our approach aims to move away from a view of human intervention as an individual right towards a procedural right that is part of the culture of accountability in the GDPR. The core idea to make humans meaningfully intervene in ADM is to help controllers comply with regulation and to demonstrate compliance. Yet, human intervention alone is not sufficient to achieve appropriate human oversight for these systems. Human intervention will not work without human governance. This is why DPIAs should play a key role before introducing it and throughout the life-cycle of the system. This approach fits better with the governance model proposed in the Artificial Intelligence Act. Human intervention is not a panacea, but we claim that it should be better understood and integrated into the regulatory ecosystem to achieve appropriate oversight over ADM systems.     

Comparative effectiveness research under the Patient Protection and Affordable Care Act: can new bottles accommodate old wine?

The Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010, initiated comprehensive health reform for the healthcare sector of the United States. PPACA includes strategies to make the American healthcare sector more efficient and effective. PPACA's comparative effectiveness research initiative and the establishment of the Patient-Centered Outcomes Research Institute are major strategies in this regard. PPACA's comparative effectiveness research initiative is one in a long line of federal initiatives to address the rising costs of healthcare as well as to obtain better value for healthcare expenditures. The key question is whether the governance and design features of the institute that will oversee the initiative will enable it to succeed where other federal efforts have faltered. This Article analyzes the federal government's quest to ensure value for money expended in publically funded healthcare programs and the health sector generally. This Article will also analyze what factors contribute to the possible success or failure of the comparative effectiveness research initiative. Success can be defined as the use of the findings of comparative effectiveness to make medical practice less costly, more efficient and effective, and ultimately, to bend the cost curve.     

The directive on the legal protection of computer programs

Conclusion Other matters which are essentially left to national provisions include issues of fair use (apart from Article 5), moral rights, authorship and ownership. However, the bland terms of Article 2 (dealing with authorship) was only reached after one of the more controversial proposals was rejected. This was the suggestion that the ownership of a program which has been commissioned should belong to the commissioner rather than the author. This would have been a provision which would have been out of step with most countries' copyright legislation. In any case, it is probably a matter best dealt with by contract. The author, or his employer, will be able to negotiate so that their creativity can be retained in the organisation while the commissioner can ensure that the product can be fully and beneficially used in his organisation. if that requires a transfer of the full copyright then the assignment must be contracted.Article 10(1) requires that member states shall implement the provisions of the Directive by 1st January 1991. Given that many of the requirements are already in place in the Copyright, Designs and Patents Act 1988, it will be a nice matter of judgment for the United Kingdom to decide how that implementation is to occur. There are certainly a sufficient number of differences from our present law, and ambiguities as to their effect, to require some substantive modification of the scheme of the 1988 Act.     

Reconciling Quinlan and Saikewicz: decision making for the terminally ill incompetent

One of the most perplexing problems in the medicolegal field concerns the criteria on which decisions not to treat terminally ill incompetent patients should be made. These decisions traditionally have been made by physicians in hospitals--sometimes with the assistance of the patient's family--on the basis of their perceptions of the patient's "best interests." Recently, two state supreme courts have ruled on this question. The New Jersey Supreme Court, in the Quinlan case, developed a medical prognosis criterion, and permitted the patient's guardian, family, and physicians to apply it with the concurrence of a hospital "ethics committee." The Massachusetts Supreme Judicial Court, in the Saikewicz case, adopted, on different facts, the test of "substituted judgment" to be applied by a probate court after an adjudicatory hearing. The two cases have been interpreted by many in the medical profession as representing conflicting viewpoints--one supportive of traditional medical decision making and the other distrustful of it. It is the thesis of this Article that Quinlan and Saikewicz are in fundamental agreement and can be reconciled by the next state supreme court that rules on this question. Both courts enunciate a constitutional right to refuse life-sustaining treatment, based on the right to privacy. They agree that incompetents should be afforded the opportunity to exercise this right, and that certain state interests can overcome it. They agree also that physicians should be permitted to make medical judgments, and that societal judgments belong in the courts. The differences in how the opinions are perceived result from the interplay of several factors: the differences in the facts of the cases; the inarticulate use of the term "ethics committee" by the Quinlan court; the literal interpretation of the role of such a committee by the Saikewicz court; a desire for 100 percent immunity on the part of physicians and hospital administrators in Massachusetts; and advice from their counsel on how such immunity can be guaranteed. It is the author's hope that this Article will help to dispel much of the misinformation surrounding these two cases, and to refocus the debate on how decisions should be made for the terminally ill incompetent patient on the real issues regarding criteria and the decision-making process that remain to be resolved.     

Operation of guardianship laws in the emergency ward

Enduring and workable legislative schemes typically include (a) a balanced approach to the rights and duties of all parties under their purview; and (b) consideration of all major consequences that may flow from the codification of underpinning doctrines. This column examines the 1999 amendments to the Guardianship and Administration Act 1986 (Vic) regulating patients' consent to medical treatment focusing on their application in modern emergency departments. The legislation needs to reconcile the human rights principle that humane and appropriate treatment is a fundamental right of all those who suffer from ill health and disease, with the principle that all patients (including those with impaired, but not totally absent, decisional capacity) have an absolute right to refuse life-saving treatment. Consent and refusal of treatment provisions should be based on the notion of reasonableness, including recognition that the mental and emotional states experienced by physically ill people may, in the short-term, adversely affect their decision-making capacity. Unless the consent legislation factors in the realities of modern emergency practice and resources, statutory thresholds for decisional competence, instead of affording protection, may result in much worse outcomes for vulnerable patients.     

Modernizing Medicaid eligibility criteria for children with significant disabilities: moving from a disabling to an enabling paradigm

Children with significant disabilities may qualify for Medicaid benefits, regardless of household income, if their state elects to offer the Tax Equity Fiscal Responsibility Act (TEFRA) option. However, a significant number of children with serious medical problems presently are being denied eligibility for, or terminated from, this Medicaid program. This Article describes the ways in which the existing health insurance system inadequately meets the needs of children with significant disabilities, recounts the history and development of the TEFRA Medicaid coverage option, and analyzes the eligibility criteria used by the various states. It proceeds to consider how disability should be legally defined in the health care context and proposes reforms to modernize the eligibility standards so that these benefits can be more effectively, efficiently, and fairly allocated. To accomplish this goal, the federal statute and regulation that define disability, as well as corresponding state laws, must be reformed so that the law can keep pace with advances in modern medical science, and people with disabilities are not, in effect, penalized for receiving currently accepted preventative care that maintains health but will never cure the underlying disease.     

法学发展的“十字现象”——以物权行为制度与《合同法》第51条为说明主体

由于我国法学发展忽略“十字现象”,民法典不采物权行为制度似已成定论,并决定采用意思主义辅之以交付、登记制度;惟此一制度确有窒碍难行之处,是否即应采用,兹事体大,仍值再予辨证。本文论述不限于理论,并提出数例说明;此外《合同法》第51条规定之误,亦一并叙之。文中分别介绍不采物权行为制度的主要见解,及本文对其之评释;并分举数例以说明不同制度的优劣;同时探讨意思主义下的物权变动模式,其内容涉及法国民法模式、日本民法模式,与我国学者所创设的模式;最后并以法律经济分析法,探究是否应采用物权行为制度与《合同法》第51条规定的交易成本辨析,以为我国民法典立法应采用物权行为制度之佐证。     

Accommodating Children's Rights in a Post Human Rights Act Era

This article considers why so little case law currently acknowledges that children have recognisable rights under the European Convention on Human Rights and argues that the family courts are not meeting the demands of the Human Rights Act 1998 in this regard. It suggests that a reinterpretation of the 'paramountcy principle' in the Children Act 1989 should be accompanied by a radically different judicial approach to evidence relating to children's best interests. The article considers the difficulties that such an approach might produce when applied to teenagers intent on refusing life-saving medical treatment. It further argues that the courts should call on the substantial body of rights jurisprudence to provide legal and moral support for this revised approach.     

The Human Rights Act 1998: research,freedom of speech and academic freedom

This article will consider rights to receive and express information and ideas from the perspective of the researcher, the researched, the researcher's institution and the wider community. It will also consider how the courts will resolve the inevitable conflicts between these rights. It does not address the right to education enshrined in Article 2 of the First Protocol² but rather the other Convention Articles, particularly Article 10, particularly relevant to the conduct of intellectual inquiry. It is intended to underline the potential reach of the Act for all public bodies which seek to be learning organisations, and the consequent need for such bodies to review their practices and procedures before the Act comes into force on 2 October 2000.