医疗损害赔偿诉讼难题及审判对策

《侵权责任法》第七章留下诸如当事人选择、案由确定、医疗过错和因果关系判断标准、病历证据属性、鉴定体制等许多实践操作的难题。对这些司法实践难题的解决．最高人民法院目前已经出台了部分司法解释,但实质性的问题都没有得到解决。由于最高人民法院出台司法解释有一个过程．在司法解释尚未出台之际,地方高级人民法院针寸当地的司法实践的具体情况。可以因地适宜出台地方司法审判指导文件。我们现在看到的浙江、江苏、上海、北京四个省市的地方审判指导文件,解决了各地审理医疗损害赔偿纠纷案件中的一些难题,在制度上有创斯之处,且具有极强的可操作性。地方司法审判指导文件的出台,既解决了当前地方上医疗损害赔偿案件审理的困境．也为最高人民法院制定司法解释积累经验。     

The medical provision of hydration and nutrition: two very different outcomes in Victoria and Florida

Decisions to withhold or withdraw medical hydration and nutrition are amongst the most difficult that confront patients and their families, medical and other health professionals all over the world. This article discusses two cases relating to lawful withdrawal and withholding of a percutaneous endoscopic gastrostomy tube (PEG) from incompetent patients with no hope of recovery. Victoria and Florida have statutory frameworks that provide for advance directives, however in both Gardner; Re BWV and Schindler v Schiavo; Re Schiavo the respective patients did not leave documented instructions. The article analyses the two cases and their outcomes from legal, medical and ethical perspectives.     

Autonomy and the competent patient's right to refuse life-prolonging medical treatment--again

This article discusses the recent decision of the Court of Appeal of the United Kingdom in Re B (Adult: Refusal of Medical Treatment) [2002] 2 All ER 449, which confirmed the common law right of a competent patient to refuse medical treatment, even though exercise of the right would (and later did) result in the patient's own death. Re B indicates that if a competent refusal is not respected, health professionals and hospitals face the prospect of awards of damages being made against them for unlawful trespass.     

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.     

Re Herrington: aboriginality and the quality of human rights jurisprudence in end-of-life decisions by the Australian judiciary

In Re Herrington [2007] VSC 151 (King's Case) the partner and family of an Aboriginal woman (diagnosed as being in a persistent vegetative state after an accident) sought an order from the Victorian Supreme Court that the decision of her treating doctors to withhold further medical treatment be opposed. The resultant judicial decision contains a very brief review of the now considerable case law in this area, does not mention the increasingly important role of clinical ethics committees in this context, or discuss the relevance of recently passed human rights legislation in Victoria. Given the statutory requirement for judicial reference to international human rights norms in jurisdictions such as Victoria and the Australian Capital Territory, and their increasing importance in other developed nations, the authors highlight the need for the Australian judiciary to lift the quality of their jurisprudence in relation to end-of-life cases.     

死刑控制与最高人民法院的功能定位

死刑控制与最高人民法院的关系是社会各界关注的热点问题。分析表明,2007年以来最高人民法院全面收回死刑复核权,对其自身造成了一系列影响;最高人民法院的内部结构与实际功能,由此发生了深刻变化。这些变化并不完全符合现代法治理念下最高人民法院的功能定位。未来应该在考虑政治与社会条件的基础上,有步骤地改造最高人民法院在死刑控制方面的工作职能与方式,以减轻最高人民法院不必要的工作负担与资源消耗,促进最高人民法院将更多的资源用于应对更加宏观、复杂的问题。     

Autonomy and death

In this Article, Professor Clark explores the contours of the current debate over physician-assisted death. She beings by focusing on the legal issues raised by statutory attempts to either legalize or criminalize physician-assisted death, with particular emphasis on the constitutional questions that are currently before the United States Supreme Court. She then examines physician-assisted death from both medical and societal perspectives. Professor Clark uses a thought experiment in which assisted death is facilitated by persons other than physicians, and in doing so, questions whether physicians are the proper persons in whom to rest power over assisted death. She points out the irony in a process that would set up physicians as protectors of individual autonomy, and ultimately concludes that by deferring to the medical profession in this process, we risk losing the very autonomy that assisted death is designed to effectuate.     

A bad trip for health-related human rights: implications of Momcilovic v The Queen (2011) 85 ALJR 957

Momcilovic v The Queen (2011) 85 ALJR 957; [2011] HCA 34 arose from a prosecution for drug trafficking brought under the Drugs, Poisons and Controlled Substances Act 1981 (Vic). The Australian High Court held that the Charter of Human Rights and Responsibilities Act 2006 (Vic) (the Charter) validly conferred a power on the Victorian Supreme Court and Court of Appeal to interpret legislation in a manner consistent with a defined list of human rights. By a slim majority it also held that the Charter validly created a judicial power to "declare" a law inconsistent with one or more enumerated human rights. In reaching its decision, however, the majority supported a narrow interpretation likely to undermine the intended capacity of the Charter to act as a remedial mechanism to reform laws, regulations and administrative practices which infringe human rights and freedoms. Although Momcilovic involved interpretation of a specific State human rights law, the High Court judgments allude to significant problems should the Federal Government seek to introduce a similar charter-based human rights system. Momcilovic, therefore, represents a risk to future efforts to develop nationally consistent Australian human rights jurisprudence. This has particular relevance to health and medically related areas such as the freedom from torture and degrading and inhuman treatment and, in future, enforceable constitutional health-related human rights such as that to emergency health care.     

Interpreting Statutory Purpose – Lessons from Yemshaw v Hounslow London Borough Council

Yemshaw v Hounslow LBC is a significant case in the fields of housing and family law, as well as giving rise to important issues as to the judicial role and statutory interpretation more broadly. This note critically analyses the reasoning of the Supreme Court in Yemshaw, in which the principal issue was whether the definition of ‘violence’ for the purposes of the Housing Act 1996 extended to non‐physical as well as physical forms of harm. In rejecting the view of the Court of Appeal, the Supreme Court adopted a wider definition of violence to encompass emotional and psychological as well as financial abuse. This commentary adopts a fresh stance by examining closely the context surrounding the enactment of the Housing Act 1996 and how this informs the question of statutory interpretation. In so doing, the author suggests that the interpretation employed by the court is significantly undermined.     

The Role of the United States Supreme Court in Shaping Federal Drug Policy

Through judicial review, the United States Supreme Court has played a pivotal role in deciding and/or interpreting the constitutionality of legislation. Since the passage of the Pure, Food and Drug Act in 1906, the Supreme Court’s role has been integral in formulating drug policy. In some instances, the Court’s decisions have limited the authority of the federal government, while in others have greatly expanded this authority. As a direct result of the decision-making of the Supreme Court, limitations have periodically been placed on Congress to regulate controlled substances. Many people, who were perceived as medical patients, became criminal drug users. The Court has restricted and later approved of the use of drugs during the free exercise of religion. Lastly, the Court has continually reinforced the supremacy of the federal government over the states, in turn limiting the ability of the states to consider marijuana legislative reform.     

Case Baiting

In 2014, New Jersey passed the Sports Wagering Act, permitting sports betting at state casino and racetrack venues, in direct conflict with the federal Professional and Amateur Sports Protection Act. In 2017, South Dakota passed Senate Bill 106, requiring that certain e-commerce retailers collect and remit sales tax, in violation of federal law. The two U.S. Supreme Court decisions arising from challenges to these state statutes—South Dakota v. Wayfair and Murphy v. NCAA—exemplify U.S. Supreme Court “case baiting.” Case baiting is a tactic states implement to challenge federal directives by passing state legislation that directly conflicts with federal law to lure the Court into granting certiorari and ruling in their favor. This article argues that South Dakota's and New Jersey's triumphs pave the way for other jurisdictions to pursue similar strategies across multiple legal issues such as abortion restrictions and immigration law. In addition, this article suggests that case baiting invites further scholarly exploration of important policy considerations, including the use of this tactic as a novel approach to the application of law and strategy, whether case baiting promotes the Court's progression toward a more quasi-legislative role, and whether passing conflict legislation violates state legislators’ oaths of office.     

Brief for bioethicists for privacy as amicus curiae supporting appellees

Amicus, an ad hoc group of philosophers, theologians, attorneys, and physicians, believe that adults should consult their doctor when making personal decisions. The doctor-patient relationship would be protected under the Constitution. In "Griswold v. Connecticut," the Supreme Court said that a state law which forbid married couples from using contraceptives was unconstitutional; that the couples should have a right to privacy. In "Roe," the Supreme Court recognized that a patient and her doctor should have privacy. In "Doe v. Bolton," the Supreme Court found that the State of Georgia was violating the patients' and physician's freedom. In "Planned Parenthood of Missouri v. Danforth," the Supreme Court said that a general informed consent provision was alright because it did not take away the abortion decision. The post- Roe state laws were ways to control doctors and patients so that a particular philosophical view could be imposed. The major question in Webster is whether personal decisions should be made by doctors and patients or the state. Both parties must agree to the decision. Section 188.205 of the Missouri law was before the Court in Webster. This section makes it illegal for public funds to be used to encourage a woman to have an abortion that wasn't necessary to save her life. There are medical conditions for which abortion is reasonable - Tay-Sachs disease, for instance. The child usually dies by 3 years of age. Without genetic screening, many at-risk couples would abort all pregnancies. 95% of all prenatal screenings are negative. State medical treatment decisions are arbitrary and impersonal. Having control over important personal decisions is necessary for freedom.     

Oregon's guidelines for physician-assisted suicide: a legal and ethical analysis

Oregon's Death with Dignity Act was first passed by a ballot initiative in 1994, but numerous judicial challenges delayed implementation of the Act. In November of 1997, following the United States Supreme Court decisions in Vacco v. Quill and Washington v. Glucksberg, which left the states' power to regulate physician-assisted suicide undisturbed, the Oregon voters upheld their law. Oregon remains the only state in the nation to authorize physician-assisted suicide. The Task Force to Improve the Care of Terminally Ill Oregonians published a Guidebook for health care providers on the Oregon Act, and the New England Journal of Medicine recently issued a special report on the first year's experience under the Act. This paper analyzes the legal context of the Oregon Death with Dignity Act, discusses the efficacy of the tenets in the Guidebook, and explores ethical issues underlying the guidelines, particularly those pertaining to the meaning of a patient's request for assisted suicide and processes supporting informed consent.     

Compensation for disability resulting from hospitalization, treatment, examination, or vocational rehabilitation--VA. Interim final rule with request for comments

This document amends Department of Veterans Affairs (VA) adjudication regulations concerning compensation for disability or death resulting from VA hospitalization, medical or surgical treatment, or examination. Previously, the regulations required that VA be at fault or that an accident occur to establish entitlement to compensation for adverse results of medical or surgical treatment. This rule deletes the fault-or-accident requirement and instead provides that compensation is not payable for the necessary consequences of proper treatment to which the veteran consented. This amendment is necessary to conform the regulations to a recent United States Supreme Court decision.     

U.S. Industries v. Director: "claim" versus "condition" in the analysis of workers' compensation cases

Under most workers' compensation statutes, an injury must "arise out of " and "in the course of" employment in order to qualify as a compensable disability. In U.S. Industries v. Director, the Supreme Court held that the Longshoremen's and Harbor Workers' Compensation Act must be strictly construed to avoid transforming the compensation system into a form of social insurance. In U.S. Industries, the Court denied a disability claim based on an arthritic condition which was manifested while the worker was at home in bed. This Note contends that the Supreme Court neglected to consider pertinent medical realities when analyzing the causation question. Thus, the decision undermines the overall rationale behind workers' compensation legislation. Nonetheless, the Note argues that the case does not relax the requirement of adequately scrutinizing the causative elements underlying any reasonable claim for disability benefits. An analysis adequately accommodating both medical and legal facts, instead of relying upon the vagaries of statutory interpretation, is necessary to improve the efficiency and fairness of workers' compensation disability determinations.     

“Our People in General Have a High Degree of Freedom”

This article considers the United States Supreme Court’s ruling in National Federation of Independent Business et al v Sebelius, which questioned the constitutionality of President Obama’s signature healthcare reforms of 2009, which have become colloquially known as ‘Obamacare’. Although the Supreme Court upheld the Act as constitutional, this article contends that the Supreme Court’s reasoning can be read as another battle in the long-standing debate in American politics over the correct size and limits of the Federal Government. In upholding the healthcare reforms as a tax, rather than under the Constitution’s Commerce Clause, the Supreme Court has endorsed a view of limited government in line with the principles of classical liberalism. This has the potential to greatly restrict the scope of the Federal Government to pursue large scale expansive social welfare programmes in the future.     

"Chartering" the limits of involuntary psychiatric treatment in Victoria: interpreting the Mental Health Act 1986 (Vic) in the age of the Charter of Human Rights and Responsibilities Act 2006 (Vic)

The Mental Health Act 1986 (Vic) allows for individuals with a serious mental illness to be treated on an involuntary basis either in a psychiatric hospital (on an involuntary treatment order) or in the community (on a community treatment order). The Act also establishes the Mental Health Review Board with the authority to review these orders within eight weeks of those orders being made and at least once every 12 months thereafter. This article analyses a recent decision of the board, Re Appeal of 09-085 [2009] VMHRB 1, in which the appellant challenged a decision of a psychiatrist to extend his community treatment order for a further 12 months. The appellant argued that aspects of his involuntary treatment under the Act amounted to "cruel, inhuman or degrading" treatment and therefore breached his right to freedom from "cruel, inhuman or degrading" treatment under s 10(b) of Victoria's recently enacted Charter of Human Rights and Responsibilities Act 2006 (Vic). Thus, the board was asked to consider whether the definition of "treatment" under the Act was compatible with the rights and freedoms enacted by the Charter. This was the first time that a Victorian court or tribunal had considered the impact of the Charter on involuntary psychiatric treatment. The decision was also a prelude to the Victorian Government's announcement that it would comprehensively review its mental health legislation, now the oldest in Australia. As this case highlights, in determining the future direction of mental health legislation and policy in Victoria, the Charter has been crucial.     

The First Amendment Right to Receive Online Information in Public Libraries

A decade after the Supreme Court of the United States upheld the Children's Internet Protection Act, which mandated Internet filters in public libraries, filtering problems have not been resolved, and the disabling of Internet filters upon the requests of adults does not seem to be as easy or automatic as the justices had presumed. In upholding CIPA, the Supreme Court seemed to misunderstand the parameters of the disabling provision, ignored the right-to-receive doctrine, and missed the opportunity to update public forum doctrine to include the Internet. This article concludes that the Court needs to reevaluate public forum doctrine in the context of twenty-first century technology and designate Internet access in public libraries as a metaphysical public forum.     

RR v Secretary of State for Work and Pensions: Empowering Tribunals to Enforce the Human Rights Act 1998

In RR v Secretary of State for Work and Pensions – follow-on litigation from the high-profile bedroom tax cases – the Supreme Court handed down a judgment which has significant implications for social security law, the interpretation of the Human Rights Act, the tribunals system, the judicial control of delegated legislation, and access to justice. Central, however, was the issue of the enforceability of human rights. We argue that the Supreme Court was not only justified in its interpretation of the Human Rights Act but that it has made the protections of the Act more easily enforceable.     

Is state power to protect health compatible with substantive due process rights?

Public health laws may mandate drastic limitations on individual liberty, such as forced medication and quarantine. This results in a tension between public health laws and guarantees of liberty such as the Due Process Clauses of the Fifth and Fourteenth Amendments to the United States Constitution. The Supreme Court has resolved this tension in favor of one or the other of these legal principles, depending on the facts and issues involved. Nevertheless, Supreme Court jurisprudence is internally consistent. The Court has applied a level of scrutiny that, while rigorous, is more flexible than strict scrutiny. I denote this as "enhanced public health scrutiny." Applying this scrutiny, the Court will uphold public health legislation if it protects an inchoate class of people who may not yet be identifiable, who will incur a specific disease or injury absent the law, but who will not experience this disease or injury if the law is enforced. If this doctrine were explicit, it would constitute a clear guideline to courts seeking to balance health and liberty concerns. This guideline would be consistent with current case law, and would not impact on law affecting reproductive liberty.