试论医疗事故的民事法律问题

医疗事故的法律责任是指医疗事故的行为人对其导致的医疗事故所应承担的法律后果.根据《医疗事故处理办法》(下称"办法")和《医疗机构管理条例实施细则》以及《民法通则》(下称"民法")、《刑法》的有关规定,医疗事故的行为人应当承担行政责任、民事责任、刑事责任。目前,医疗事故的行为人应当承担行政责任,或者医疗事故罪的行为人应当承担刑事责任,在法理上和实践中都争议不大。争议比较多的是集中在民事法律上。本文为此探讨之。一、医疗事故适用的民事违法范围生命健康权是指公民对自己的生命安全、身体组织器官的完整以及身体的生理机能和心理状态的健康所享有的权利,包括生命权、身体权和健康权。生命、身体、健康是每一个公民最高的人格利益,是个人自身存在的前提,也是公民进行一切社会活动不可缺少的条件。因此,我国民法将生命健康权列于人格权之首,体现了法律对人的最基本最重要     

医疗事故技术鉴定与法医学鉴定的区别及证明力

医疗事故罪是1997年修订刑法新增加的罪名,是指医务人员由于严重不负责任．造成就诊人死亡或者严重损害就诊人身体健康的行为。近年来,随着医疗事故的频频发生,医患纠纷日益突出,医疗事故犯罪案件也呈明显的上升趋势。在医疗事故罪的认定中,医疗事故的鉴定具有举足轻重的地位和作用,它是明确医患双方当事人责任、妥善解决诉讼争议的关键环节．其结论决定着医疗事故的定性,也决定着是否立案侦查、     

论医疗事故罪的构成要件

医疗事故罪的构成要件为:犯罪的客体是国家的医疗工作秩序和就诊人的生命、健康权利;犯罪的客观方面是医务人员在医疗护理过程中违反医疗规章制度,违章行为造成就诊人死亡或严重损害身体健康,违章行为与危害结果之间存在因果关系;犯罪的主体是广义上的医务人员;犯罪的主观方面是过失.     

医疗事故罪若干问题探讨

医疗事故罪是 1997年第八届全国人大五次会议修订刑法时新增加的罪名 ,原刑法对医务人员由于严重不负责任 ,造成就诊人死亡或者严重损害就诊人身体健康的 ,没有直接规定刑罚。少数重大医疗责任事故是比照适用玩忽职守罪等罪名处罚。虽然新刑法增加了医疗事故罪 ,但通过近几年来的司法实践 ,对《刑法》“医疗事故罪”中的“严重不负责任”“严重损害就诊人身体健康” ,以及医疗事故罪的有关鉴定问题争议颇多 ,认识比较混乱。作者结合国务院《医疗事故处理条例》的颁布与实施 ,现就医疗事故罪在认定上的几个问题 ,提出个人的探讨意见。一、医…     

医疗事故罪若干问题探讨

医疗事故罪是1997年第八届全国人大五次会议修订刑法时新增加的罪名,原刑法对医务人员由于严重不负责任,造成就诊人死亡或者严重损害就诊人身体健康的,没有直接规定刑罚. 少数重大医疗责任事故是比照适用玩忽职守罪等罪名处罚.虽然新刑法增加了医疗事故罪, 但通过近几年来的司法实践,对<刑法>"医疗事故罪"中的"严重不负责任""严重损害就诊人身体健康",以及医疗事故罪的有关鉴定问题争议颇多,认识比较混乱.作者结合国务院<医疗事故处理条例>的颁布与实施,现就医疗事故罪在认定上的几个问题,提出个人的探讨意见.     

医疗事故罪客观要件探析

认定医疗事故罪,在客观上首先必须存在合法的医疗行为。其次必须在合法的医疗过程中出现严重不负责任的行为。认定严重不负责任,应当主要结合医务人员的注意义务,把违反常规性、常识性的注意义务,以及常发性的过失行为认定为严重不负责任。再次,严重损害就诊人身体健康应当根据《刑法》所规定的重伤标准去判断。最后,严重不负责任是就诊人死亡或严重损害就诊人身体健康的后果的主要原因力。     

对认定医疗事故罪客观要件的思考

本文从四个方面分析了医疗事故罪的客观要件。建议我国应确立脑死亡标准和传统死亡标准同时并存的制度 ,提倡适用《人体重伤鉴定标准》来衡量是否达到“严重损害就诊人身体健康” ,并赞成采用“相当因果关系说”来判定医务人员严重不负责任的行为与就诊人死亡或身体健康严重受损的结果之间是否存在着刑法上的因果关系。     

医疗事故罪客观要件探析

认定医疗事故罪，在客观上首先必须存在合法的医疗行为。其次必须在合法的医疗过程中出现严重不负责任的行为。认定严重不负责任，应当主要结合医务人员的注意义务，把违反常规性、常识性的注意义务，以及常发性的过失行为认定为严重不负责任。再次，严重损害就诊人身体健康应当根据《刑法》所规定的重伤标准去判断。最后．严重不负责任是就诊人死亡或严重损害就诊人身体健康的后果的主要原因力。     

严重损害就诊人身体健康的认定标准

被告人未取得医生执业资格,擅自为他人进行摘取节育器手术,致人重伤。公诉机关认为重伤属于严重损害就诊人身体健康;法院认为严重损害就诊人身体健康的认定标准在刑法体系中是统一的,应根据伤残等级,参照卫生部《医疗事故分级标准(试行)》进行判定,不能以重伤替代严重损害就诊人身体健康。     

刍议基层医疗卫生机构医疗纠纷的防范

国务院颁布的《医疗事故处理条例》(以下简称《条例》)已于2002年9月1日实施,毫无疑问,该《条例》的实施对于卫生行政部门与人民法院处理医疗侵权现象有了切实可行的法律依据,对于普通百姓来说,手中多了一把维护自己生命健康权的尚方宝剑。但是基层医务人员普遍反映     

Health law and mental health law courses in US medical schools

Results of a recent survey of all 127 medical schools in the United States indicate that about two fifths of medical schools offer a separate course that focuses on topics in medicine and law and a number of medical schools integrate health law topics into other courses. Presumably reflecting concern over temporary medical malpractice litigation, most health law courses include informed consent, medical malpractice, privileged/confidential information, and patients' rights. In contrast, schools that offer a course on psychiatry and law are clearly in a minority. It is elective at all but two of the 13 schools with such a course. Although the hours allotted and the format of these courses vary greatly, courses typically cover most of the topics listed on the questionnaire. Most of the courses are led or co-led by a member of the American Academy of Psychiatry and the Law. Information from two additional surveys suggests two related factors that may influence a medical school to present a separate course on health law. Medical licensing boards were surveyed to determine which states require physicians to be examined on health law. In two states that require physicians to pass a separate medical jurisprudence examination for licensure, all four-year medical schools offer a course on health law for medical students. Medical malpractice companies providing coverage in all 50 states and the District of Columbia were surveyed to determine which states have the highest claim rates. The claim rate per 1,000 physicians insured per year was significantly greater in states with health law courses than was the rate in states without such courses.     

Medical malpractice as reflected by the forensic evaluation of 4450 autopsies

A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases.     

论医疗纠纷诉讼中的证据协力义务

由于医疗活动的高度专业性，因而在医疗纠纷诉讼中存在证据偏在、医患武器不平等严重问题。证据协力义务是居于“准确”、“公正”、“和谐”、“效率”等的价值基础。共在医疗纠纷诉讼中的适用具有正当性。建议通过医疗机构的阐明病历义务，对证人、鉴定人违反证据协力义务的制裁，证人拒绝提供证言权等规范来弥补医疗纠纷诉讼中证据协力义务的结构性缺失，以增加医疗纠纷诉讼中证据协力义务规范的可预测性。     

威慑与矫正--论法律对医疗事故的预防作用

医疗事故应当"以防为主".法律对医疗事故的预防作用主要有两条思路一是传统的过错责任体系,强调对于个别医生的威慑,促使其提高注意力标准从而避免医疗事故;二是正在研究的"无过错补偿制度",其关注的是整个医疗行业,试图矫正现行的医疗体制,利用制度的记忆来避免医疗事故的发生.由于无过错责任真正从根源上探寻医疗事故的原因,所以它将是有效的预防措施.但是要实现无过错机制的预防功能,必须建构起相应的配套制度,从而从根本上降低医疗事故的发生率.     

肿瘤患者医疗纠纷法医病理学鉴定74例分析

目的 从法医学角度分析肿瘤患者医疗纠纷的发生原因,明确医疗责任并提出相关应对措施.方法 对2000-2009年在四川华西法医学鉴定中心进行法医病理学检验的74例肿瘤患者医疗纠纷案例资料进行回顾性分析.结果 近年来肿瘤患者医疗纠纷有明显增多的趋势.常见医疗责任有漏诊、误诊、不合理的化疗、并发症的未预见等.不同级别医疗机构肿瘤相关医疗纠纷成因有所区别.外科、妇产科等科室所占比例较高.结论 通过法医病理学尸体解剖查明死亡原因,明确医疗责任,已成为肿瘤患者医疗纠纷的重要解决手段.增强服务意识,获取患者信任;加强硬件建设,改善医疗条件;重视法律法规,强化注意与告知义务,能够减少与防范医疗纠纷的发生.     

论强制性医疗损害赔偿保险制度的建立

通过对我国医疗损害赔偿给付现状的分析,对国外医疗责任保险及给付的比较,认为:只有通过立法来建立一种强制医疗损害赔偿保险制度才能较合理地解决医疗损害受害人损害赔偿的兑现问题,同时,又不使医疗法人的正常医疗行为因此受到影响;并进一步指出了建立该种保险制度所存在的问题和对策。     

医疗责任保险的思考

大力发展医疗责任保险,对医疗执业过失给患者造成的损害进行充分赔偿,在保障患者和医疗机构及其医务人员的合法权益,优化医疗环境和医疗公共秩序方面有重要的促进作用。由于我国医院主体是公立医院,侵权法人身损害赔偿相对于综合医院尚未到重大程度,并且综合性医院每年发生的医疗过失案件基本确定,选择满足面临危险的医院财务安全需要的医疗责任保险模式,如医疗责任保险信托等,才能促进医疗责任保险的发展。实践表明,商业性医疗责任保险不宜成为我国医疗责任保险的主体。建立独立的医疗过失纠纷调解鉴定机构,才能保证医疗责任保险顺利开展。     

浅谈《侵权责任法》对医疗纠纷诉讼规则之影响

文章通过对两个医疗纠纷诉讼案件生效判例的分析,例举医疗纠纷诉讼中三个常见问题,即案由二元化、法律适用二元化以及举证倒置对纠纷处理的负面影响,并通过比较而探讨《侵权责任法》对医疗纠纷诉讼规则的影响。     

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。     

The structure of medical malpractice decision-making in Japan

The article summarises the problems in the medical malpractice litigation systems in the United Kingdom and Japan, demonstrating the similarities and identifying the length of time between initiating an action and its decision and other factors responsible for lengthy litigation. Based on analysis of decisions of medical malpractice cases between 1986 and 1998 in Japan, the functioning of the Japanese medical malpractice litigation system is discussed. Lengthy litigation is shown to be correlated with outcome and implies that the Japanese medical dispute resolution mechanism favours those who can endure lengthy litigation, namely the defendants, who are physicians or hospitals. In view of the similarities between the two systems, it is likely that the same bias--that the wealthier party in the litigation is more likely to win the case--also occurs in medical malpractice litigation in the United Kingdom and Australia.