论我国医疗损害责任制度的修改与完善——以《民法典·侵权责任编草案(三审稿)》的规定为视角

我国正在起草和制定的《民法典·侵权责任编草案(三审稿)》修订和完善了医疗损害责任的部分规则,使医疗损害责任规则体系更具有科学性和可操作性。为了满足司法实践的需要,保持法律规范的先进性和前瞻性,有必要完善知情同意规则、规定医疗技术损害责任的认定标准和考虑的因素、多个医疗机构的损害责任、误诊损害责任、医师外出会诊损害责任、完善医疗产品责任、远程医疗损害责任、医疗机会丧失损害责任、医疗管理损害责任以及医疗损害限额赔偿责任等方面的法律规则。我国立法机关应当利用制定民法典的契机,采纳司法实务界和学术界提出的有效解决医疗损害责任纠纷的建议,修改和完善《侵权责任法》确立的医疗损害责任制度,构建科学的医疗损害责任法律体系,为健康中国战略目标的实现提供法律保障。     

《人体损伤程度鉴定标准》研制的基本思路

对《人体损伤程度鉴定标准》研究和制定过程中有关问题的思考进行了全面、系统的总结，包括标准制定的基本原则、基本结构、主要内容以及重点关注的几个问题。重点介绍了标准制定的基本原则，即充分体现标准的法律性和适用性、系统性和完整性、科学性和先进性、客观性和实用性以及符合性和关联性。简要介绍了标准的基本结构和主要内容，即损伤程度的分级以颅脑、脊髓、头面、颈、胸、腹、盆、脊柱、四肢、体表等解剖部位，并按重伤一级、重伤二级、轻伤一级、轻伤二级和轻微伤为序罗列出人体组织结构破坏和功能障碍损伤程度鉴定的具体条款，并以附录的形式规定组织器官功能障碍的评定技术和方法。并对标准关注的几个主要问题，如伤病关系、医疗干预、内源性疾病、多部位同性质损伤等处理原则进行了深入的讨论．对于法医临床鉴定人及有关法律工作者进一步学习和理解标准，具有重要的现实意义和指导意义。     

中世纪欧洲法医学溯源

法医学是应用病理学、生物学、生物化学和其他医学科学理论和技能解决法律问题,为侦查和审判提供证据的科学。法医学学科属性是医学,其目的是解决法律问题,因而法医学同时具有自然科学和人文科学属性。现今,我们对于法医学的研究往往局限在自然科学领域,而对其人文学科属性却有所忽视。当代西方法医学起源自中世纪的欧洲大陆,当时罗马法和教会法占统治地位,它们没有设立陪审团制度,而且允许对嫌疑人进行刑讯逼供,而英美法系的司法审判程序设立了陪审团制度。在这两种司法体制下,法医医学证言、证词逐步形成了两种形式：英美法系控诉式诉讼体制下的言辞证据形式和罗马法诉讼中纠问体制下的书证形式。本文将对中世纪欧洲的法医学进行溯源研究,从欧洲法医学的起源和发展角度,完善法医学史研究内容,为世界法医学史比较研究提供借鉴。     

Evolution of the Psychological Autopsy: Fifty Years of Experience at the Los Angeles County Chief Medical Examiner‐Coroner's Office

The origin of the psychological autopsy was in the late 1950s and the result of a collaboration between the Los Angeles County Chief Medical Examiner‐Coroner's Office and the Los Angeles Suicide Prevention Center. It was conceptualized as a thorough retrospective analysis of the decedent's state of mind and intention at the time of death. It was used initially in “equivocal” deaths where the manner of death was possibly either suicide or accident. Later, it was used in cases where a party (primarily family members) protested the Medical Examiner‐Coroner's suicide determination. Over the past 25 years, the University of Southern California Institute of Psychiatry, Law, and Behavioral Science has served as the psychiatric/psychological consultants to the Coroner's Department. Research findings, the use of this approach in high‐profile cases, and the most recent manner in which the psychological autopsy is conducted are discussed.     

一起非医学需要鉴定胎儿性别及终止妊娠手术案引发的思考

笔者通过对一起非医学需要鉴定胎儿性别及终止妊娠手术案件的评析,提出在卫生行政处罚案件的处理过程中涉及到多个行政执法部门、多部法律竞合的问题并阐述了自己的看法,旨在探讨通过部门联动、无缝隙的行刑对接,对各种形式的非法行医行为进行严厉的打击,维护法律的尊严。     

从犯罪构成分析追究医疗卫生监督员玩忽职守

近年来因非法行医致人死亡进而追究卫生监督员玩忽职守罪的事件屡屡发生。本文结合案例,从犯罪构成的角度分析此类案件的过失、危害行为、因果关系、主体的认定,从中找寻此类案件的辩护要点,避免在辩护中陷入误区。     

论与拐卖妇女、儿童犯罪相关联的渎职犯罪构成要件的司法认定

不解救被拐卖、绑架妇女、儿童罪和阻碍解救被拐卖、绑架妇女、儿童罪的犯罪客体是国家机关解救被拐卖妇女、儿童的正常活动;犯罪主体是负有解救被拐卖妇女、儿童职责的国家机关工作人员,具体包括各级人民政府中主管解救工作的工作人员、公安机关中的工作人员,以及负有会同公安机关解救被拐卖妇女、儿童职责的其他单位中的工作人员。不解救被拐卖、绑架妇女、儿童罪的主观罪过形式既可以是故意,也可以是过失;阻碍解救被拐卖、绑架妇女儿童罪的主观罪过形式是故意。对本类犯罪的客观方面应结合最高人民检察院《关于渎职侵权犯罪案件立案标准的规定》的相关规定来理解。     

The Effect of Medical Marijuana Laws on the Health and Labor Supply of Older Adults: Evidence from the Health and Retirement Study

Older adults are at elevated risk of reducing labor supply due to poor health, partly because of high rates of symptoms that may be alleviated by medical marijuana. Yet, surprisingly little is known about how this group responds to medical marijuana laws (MMLs). We quantify the effects of state medical marijuana laws on the health and labor supply of adults age 51 and older, focusing on the 55 percent with one or more medical conditions with symptoms that may respond to medical marijuana. We use longitudinal data from the Health and Retirement Study to estimate event study and differences‐in‐differences regression models. Three principle findings emerge from our analysis. First, active state medical marijuana laws lead to lower pain and better self‐assessed health among older adults. Second, state medical marijuana laws lead to increases in older adult labor supply, with effects concentrated on the intensive margin. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. Findings highlight the role of health policy in supporting work among older adults and the importance of including older adults in assessments of state medical marijuana laws.     

Acute arsenic poisoning: clinical, toxicological, histopathological, and forensic features

This report describes a suicide case by acute arsenic intoxication via intravenous injection. A 30-year-old woman injected arsenic As (V) (sodium arseniate disodique: Disodium Hydrogena Arsenik RP) in a successful suicide attempt. Three hours following administration, the woman developed severe digestive symptoms. She was admitted to a hospital and transferred to the intensive care unit within 12 h of the massive administration of arsenic. Despite therapeutic efforts, over the next 2 h she developed multiorgan failure and died. A postmortem examination was performed. Pulmonary edema and congestion of liver were apparent. As (V) and As (III) were determined by high performance liquid chromatography and inductively coupled plasma mass spectrometry after mineralization of samples by concentrated nitric acid. Toxicological analysis revealed high concentrations of arsenic in biological fluids as well as in organs. Histopathological examination showed a typical indication of myocarditis. These findings were in agreement with acute arsenic poisoning. The symptoms developed by this young woman (intoxication by intravenous administration) were comparable to oral intoxication. The clinical signs, survival time, and administration type are discussed in light of the literature on acute and chronic arsenic poisoning.     

Axonal injury in young pediatric head trauma: a comparison study of β-amyloid precursor protein (β-APP) immunohistochemical staining in traumatic and nontraumatic deaths

We tested the independent utility of β-amyloid precursor protein (β-APP) immunohistochemical staining as evidence of brain trauma in the deaths of young children. Blinded reviewers retrospectively reviewed immunostained brain tissues from homicidal deaths, age-matched control cases without evidence of trauma, as well as cases of sudden infant death syndrome (SIDS). The reviewers correctly identified five of the seven cases with documented inflicted head trauma. However, one of seven age-matched control cases and one of 10 SIDS/sudden unexplained death in infancy (SUDI) cases demonstrated staining patterns similar to those seen in cases of inflicted trauma. We discuss these cases and the circumstances surrounding them with the intent to explain the difficulties associated with immunohistological interpretation of axonal injury. Although the utility of β-APP is quite powerful if not confounded by global hypoxic-ischemic injury, ultimately, β-APP studies should be only one piece of information in the determination of cause and manner of death.