对医疗责任事故犯罪案件中若干问题的思考

医疗责任事故由于涉及到极强的专业性和技术性,长期以来司法机关对医疗责任事故案件的认定和处理,常常因为对医疗责任事故的界定含混不清,以及受鉴定活动和证据的收集中存在的若干问题的影响导致司法办案人员不能正确的进行立案、起诉和审判活动。因此,正确界定医疗责任事故犯罪案件,研究医疗事故鉴定和证据收集中的有关问题,有利于司法机关正确的处理案件,保护公民的合法权益。     

医疗事故诉讼中过失认定

医疗事故属于医疗执业侵权。医疗执业侵权中医方的过失来自于其违反了法律要求的照护义务。美国的医疗执业侵权法从“医疗常规标准”已经发展出了“群体接受的标准”,以及在此基础上的过失认定原则。在程序上,美国的原告依赖于专家证人举证证明医方过错。我国的医疗事故诉讼的过失标准是“医疗常规标准”,存在着许多法律缺陷;程序没有专家证人制度,但实行单一举证责任倒置。事实上,过失的认定上交给了医疗事故技术鉴定,成为了医疗事故诉讼的核心。“医疗常规标准”和举证责任、医疗事故鉴定存在很多法律上的冲突。医疗事故鉴定和医疗事故诉讼间的关系,现有法律存有许多待讨论的问题;鉴定人的欠缺法律责任的规范。但现有达到专家辅助人和可能有的医学专家充当陪审员,很可能有助于解决我国医疗事故诉讼中的专业问题。     

法院对医务人员过失判断依据之辨析——以《侵权责任法》施行以来相关判决为主要考察对象

法院在判断医务人员过失时对相关依据的适用多有偏差,实践中的结果常常与理论中的预设相左。因此,应妥当适用相关依据:医疗常规和法律、行政法规、规章及其他有关诊疗规范,不得仅以是否与之相符为由全然判定过失,其通用性规定可推定过失,但如行为符合患者利益可予推翻。鉴定意见限于提供法官裁判素材,不能做出过失鉴定。关于医疗水平,应确定与当事医方条件相符的参照对象,并以个案情况确定其行为模式,即斟酌患者情况、诊疗行为的风险、收益、成本、发病概率及损害后果。然后将当事医方的行为与之相比以判定过失。总之,对过失的判断不仅要依据医疗常规、法律规范等通用性规定,更要考察个案的具体情况,没有统一内容的模式可循。     

公共政策、医疗行为与责任配置——关于医疗损害责任制度绩效的观察和评论

从法政策学的角度对侵权责任的制度绩效进行观察和验证,是后侵权责任立法时期中国民法学的重要学术使命之一。本文以医疗损害责任为分析对象,竭力展示公共政策与责任配置之间的微妙关系。研究表明,现阶段公共卫生政策的实质是通过加强管制约束来提高医疗服务的质与量。在此背景下,医疗损害责任的功能定位只能是激励而非补偿;且由于医疗服务自身的特性,相关责任配置的隐性激励作用更加突出。我国现行医疗损害责任在归责原则、责任形态和损失分摊方面分别存在激励不足、不当管制和风险无关的缺陷,极有可能导致制度失灵、立法目的落空,亟需加以改进。     

论医疗注意义务与医疗过失的认定

无论基于医疗契约还是医疗侵权关系，医疗过失的认定标准、考量因素、考察范围都趋于一致。应确定相对客观的医疗过失判定标准，在具体考量时还应兼顾医疗水准等诸多主客观因素。应立足于医院作为医疗损害赔偿责任的“一元”主体，分别从医疗行为和医疗辅助行为去查找医疗过失。审判实务中对医疗过失的认定过分依赖鉴定的流弊应当予以矫正，而应将医疗过失的认定权回归法庭，并辅之以组建专业审判庭、引入专家证人制度作为法庭认定医疗过失的专业保障。     

医疗损害证明责任分配规则研究

证明责任在医疗损害赔偿纠纷中发挥着风险分配的重要作用,我国近十年的立法充分利用证明责任分配规则来体现立法政策的转变。早期立法体现的证明责任倒置规则导致了大量的非合理性医疗行为,这在更大范围内损害患者的利益。《侵权责任法》矫正了这种倾向,《侵权责任法》根据各种具体情形,规定了更为详细的归责要件,相应地,证明责任分配规则也更加详细具体,较好地分配了医疗风险,平衡了医患双方的诉讼负担。     

医疗过失犯的限缩——以注意义务阻却事由为视角

医疗过失的本质在于对医疗注意义务的违反。注意义务阻却事由主要包括被允许的危险和信赖原则。鉴于医疗行为较之其他业务行为具有更高的风险性,因而更有必要在医疗过失犯的认定中适用注意义务阻却事由。在对医疗危险进行合理分配的基础上,被允许的危险和信赖原则通过对行为人注意义务的否定,阻却了行为人的过失责任。从价值理念来说,体现了刑法的谦抑性;从适用效果来看,就是医疗过失犯的限缩。     

Prosecuting 'Gross' Medical Negligence: Manslaughter, Discretion, and the Crown Prosecution Service

This article examines prosecutions of health care professionals for gross negligence manslaughter following fatal errors committed in the course of their work. Unease has long surrounded the use of 'gross negligence' as a form of criminal liability, and particularly as it applies to health care professions operating in high-risk settings. The recent dramatic rise of such prosecutions calls for a closer understanding of the processes by which important prosecutorial decisions are made. In particular, this calls for an investigation into the exercise of discretion by prosecutors in interpreting the loosely defined and contested concept of gross negligence. This article analyses data obtained from a statistical analysis of 'medical manslaughter' cases and also from interviews with crown prosecutors. Discussion of the main findings leads to the conclusion that the offence of gross negligence manslaughter is incapable of any objective and fair measurement and ought to be abolished.     

Riegel v. Medtronic, Inc.: Revisiting Pre-emption for Medical Devices

The recent United States Supreme Court decision in Riegel v. Medtronic, Inc. affirmed the doctrine of pre-emption protection only for those medical devices reaching U.S. markets via the PMA (premarketing approval) process and preserved the previous Lohr v. Medtronic decision's lack of preemption protection for those medical devices marketed via the generally more abbreviated 510(k) clearance mechanism. This paper reviews the logic and faults of the Riegel decision and discusses the implications of the Riegel decision for pre-emption protection for other classes of FDA-approved medical products.     

安娜法的权威解释：英国米勒案和德纳森案

尽管1709年英国颁行了现代著作权制度起源的安娜法,然而却并没有解决著作权制度的基本理论问题,而只“是为书商的关于永久性著作权主张的法律争论打基础。”现代著作权制度的基本理论问题在迟至半世纪后英国米勒诉泰勒案(下称米勒案)     

The Quest for Recompense: Claimants' Experience of Medical Negligence Compensation in Victoria,Australia*

This paper reports a study investigating the experiences of people who perceived that they had suffered a health or medical care injury in Victoria, Australia. A particular focus was their experience with the process of seeking compensation. The research strategy involved a preliminary questionnaire and in-depth interviewing of the participants and, where possible, their families. We describe the type of injury reported by the participants, experiences with health care providers and lawyers and attitudes to the current system of compensation. The severity of injury sustained by these participants was often severe, involving permanent incapacity and psychological distress. We conclude that the quest for recompense is fraught with difficulties for claimants. The present system of compensation neither provides adequate financial compensation nor - even where claimants are successful - acknowledgement of the legitimacy of their claim.