反思与完善:医疗纠纷中的多元法律治理

近些年在医疗卫生领域,医疗纠纷事件多有发生,呈现出明显的违法犯罪化之时代变迁。医疗纠纷多元法律治理有其价值,但从当前实践看,关键问题是"治乱"与"治软",亟需用法治统一理念和方式来强化、协调医疗纠纷的治理机制。根据我国医疗纠纷治理的现实情况,其"手段与功能"的治理模式色彩深厚,其治理效果显著的同时仍然存在一些问题。应当树立法律权威,发挥法律刚性约束力;协调法律机制,实现法律公平正义价值,并推进标本兼治,提升医疗纠纷法律治理的效果。     

昆明地区医疗争议死亡事件的流行病学和法医学鉴定研究

目的回顾性分析研究昆明地区涉及医疗争议死亡事件的流行病学特点,探讨医疗争议死亡事件的法医学鉴定问题,为有效预防医疗纠纷、医疗争议死亡事件的法医学鉴定和相关立法提供重要的实践和理论依据。方法收集昆明医学院司法鉴定中心1998年至2003年间受理的昆明地区涉及医疗争议的死亡事件160例(包括医疗纠纷和非法行医死亡案件)的法医病理鉴定资料进行统计学分析研究,应用法医病理学死因分析理论,对医疗争议死亡事件的司法鉴定问题进行探讨。结果昆明地区医疗争议死亡事件呈逐年上升趋势,其中以育龄妇女发生死亡所占比率最高;其次是5岁以下小儿发生死亡;分娩中或分娩后胎儿迅速死亡居第三位;在后两者中男性死亡发生率高于女性。在非法行医死亡案件中,医疗过错参与死因构成的比率为88.89%。结论昆明地区医疗争议死亡事件的临床诊断符合率和医疗过错发生率与国内外相关报道基本一致。法医学鉴定采用"六等九级法"对医疗争议死亡事件中医疗过错对死亡发生的作用及其参与度进行分析和评价,具有较强的可操作性和实用性。     

医疗纠纷与赔偿责任体系建立——法国医疗赔偿制度最新发展及其启示

20世纪90年代以来,法国最高行政法院从维护公民权益的角度出发,通过一系列判例降低了公立医疗机构承担赔偿责任的门槛,不仅在医疗行为领域用一般过错归责原则代替了以往的重过错归责原则,还承认在特殊情况下医疗机构可以基于风险承担无过错赔偿责任。2002年的《患者权利及医疗质量保障法》对上述判例原则加以确认,形成了统一的适用于公私立医疗机构的、以一般过错原则为主、无过错原则为辅的医疗赔偿责任体系。     

德国、法国医疗纠纷诉讼外解决机制及启示

德国和法国通过建立和完善医疗纠纷诉讼外解决机制,不但提高了纠纷解决的效率,减少了当事人纠纷解决成本,还有效地维护及修复了医患之间的信赖关系。目前,出于医疗纠纷的特殊性,包括我国在内的很多国家正在探讨如何构建和完善医疗纠纷诉讼外解决制度,德国和法国的经验给我国带来了有益的启示。     

我国医疗服务市场失灵分析与对策思考

医疗服务市场与完全和完善市场相去甚远,存在着严重的市场失灵。治理医疗服务市场失灵,引入政府干预应谨慎合理,要充分重视市场自身矫正和其他非市场力量,以免伤害市场自身的修复能力,导致“大政府”模式以及政府失灵带来的效率下降。我国医疗服务市场失灵情况错综复杂,应该具体问题具体分析,不加区别地简单的“一刀切,”将政府的作用神话和盲目地要求政府介入并非解决问题的明智之举。     

Medical and Familial Claims to Long‐Term Care: Institutional Gaps and Shifting Jurisdictions

In light of the contemporary long‐term care crisis, Sandra Levitsky's book Caring for Our Own examines why there has been no movement to secure state support for caregivers. Speaking to sociolegal and social movement audiences, Levitsky reveals how lack of collective identity, the power of family‐based ideologies, and the separation of support organizations from political ones help to repress mobilization. In this essay I refract Levitsky's findings through the lens of organizational theory and medical sociology. I argue that the social problem of long‐term care is caught in an institutional gap since it does not readily fall under the purview of either medicine or family. I also discuss the implications of lay caregivers' provision of sophisticated medical care for theories of professional jurisdictions and gatekeeping.     

The Legal Status of Afghan Refugees in Pakistan, a Story of Eight Agreements and Two Suppressed Premises

Over 25 per cent of present day refugees enjoy asylum in Pakistan,most of them having been there for more than a quarter of acentury. Pakistan is not, however, a party to either the 1951Convention relating to the Status of Refugees or the 1967 Protocolrelating to the Status of Refugees. The legal status of theAfghan refugees it hosts is therefore not a foregone conclusion,even though they were considered to be refugees on a prima faciebasis during the first two decades of their exile in Pakistan.This article identifies the legal status of the Afghan refugeeson the basis of a series of agreements Pakistan concluded withUNHCR and also occasionally with Afghanistan. By virtue of thelast of the series of agreements, Afghan refugees can returnto Afghanistan under a UNHCR-assisted voluntary repatriationprogramme until December 2009. In view of the fact that allAfghans have been granted leave to stay in Pakistan until thesame date, many are expected to stay in Pakistan rather thanreturn with the assistance of UNHCR. Unlike the preceding agreements,the last one does not address the fate of those who will stillbe in Pakistan upon completion of the voluntary repatriationprogramme. It seems therefore imperative to identify the legalstatus and corresponding entitlements of the Afghan refugees.It is argued that the prima facie recognition of refugee statuscan be sustained on the basis of the agreements referred to.In addition it is argued that the current ‘profiling’exercise of UNHCR, even while presumably beneficial for themost vulnerable refugees, is irreconcilable with the statusand entitlements of the Afghan refugees, and the same holdstrue with respect to the usual practice of ‘screening’those refugees who have opted not to return under a voluntaryrepatriation programme. An alternative that would be reconcilableis a collective cessation of refugee status if and when thesituation in the country of origin so warrants, provided individualrefugees may contest this.     

Divergent Perspectives: Exploring a Multiple Informant Approach to Cyberbullying Victimization and Perpetration

The present research adopts a multiple informant approach to identify victims and perpetrators of cyberbullying. Similar approaches have been successfully applied in the field of traditional bullying, and they are highly relevant for studying cyberbullying as well. Three informants can provide key perspectives on cyberbullying incidents: victims, perpetrators, and bystanders. To collect data on these actors, all eighth-grade students in 11 secondary schools were invited to participate in a survey. In total 1458 respondents completed peer-nomination questions on cyberbullying involvement. The results indicated that the prevalence of cyberbullying varied depending on the type of informants that was consulted. In addition, limited overlap was observed between the reports of different informants, resulting in different profiles of victims and perpetrators, depending on the informants that identified them. In sum, different informants tended to have divergent views on cyberbullying, which has important implications. It warrants accurate reporting and critical reflection on the sources of data in cyberbullying research. Moreover, it demonstrates the need to study a more diverse set of informants to advance the understanding of cyberbullying and to enhance prevention efforts.     

法律援助关爱民生、服务和谐的探索与实践

近年来，南京市法律援助工作紧紧围绕关爱民生、服务和谐的要求，坚持以满足人民的需要，实现人民的愿望，维护人民的利益高度为出发点，从人民群众最关心、最直接、最现实的利益问题入手，不断加强和改进法律援助这一政府职能，以“应援尽援、应援优援”为工作目标，努力实现好、维护好、保障好最广大人民群众的根本利益，为构建和谐社会和法治南京的建设发挥了积极的作用。     

A Tale of Two Debtors: Responding to the Shock of Over‐Indebtedness in France and England – a Story from the Trente Piteuses

England and France have developed distinct treatment systems to address the shock of a substantial increase in over‐indebted individuals since the mid‐1980s. In France, Over‐Indebtedness Commissions, with the Bank of France playing a central role in their management, now dominate the system. A more fragmented system of private and public providers of remedies developed in England, with innovation driven by private actors modifying existing commercial procedures and increased access to bankruptcy relief a side‐effect of government promotion of entrepreneurialism. This article explains the differences between these countries in terms of the influence of interest groups, including state actors, and ideologies. Historical contingency also plays a role. The distinct responses were not hard‐wired to legal origins and the article argues that analysis of the interaction of interest groups, state actors and ideology in shaping institutions, which in turn structure future change, provides a productive approach for future comparative research in this area.     

防止和克服审判和执行中地方保护主义的两点建议

提出用提高当事人异地民事案件管辖法院级别的方式,克服审判上的地方保护主义;用授予权利 人对执行法院选择权的方式,克服执行上的地方保护主义。     

上海地区非法行医致孕妇死亡案例回顾性研究

目的研究上海地区非法行医致孕妇死亡案例并分析其特点,探究其形成原因及预防机制。方法收集本研究所2001～2005年接受上海市公安机关委托非法行医致孕妇死亡案例11例,按照孕妇情况、死亡原因及非法行医者的诊疗措施等进行分类整理分析。结果非法行医致孕妇死亡的原因多为产后大出血、羊水栓塞,多伴软产道裂伤。孕妇多未进行正规产前检查,到缺乏必要医疗条件的个体非法行医者处或者家中分娩,非法行医者往往存在不正当应用催产素,强行分娩,未采取及时有效抢救措施。     

Let's Make a Brand New Start of it in Old New York: Using Mediation to Resolve Open Adoption Disputes

There is no general consensus of how to handle disputes arising from open adoption agreements. Some states have statutes mandating mediation, but New York does not. This Note proposes that New York enact a statute that mandates adoptive and birth parents use mediation for disputes arising from open adoption agreements. The proposed statute provides a comprehensive approach to mediation by setting forth when mediation is appropriate and when it is not. The statute will also provide when the child's preference can be taken into consideration, and who will pay for mediation.