论医疗损害技术鉴定危机与改革

法律规定的不完善以及法官对鉴定结论的依赖性造成了目前医疗鉴定中,医疗事故技术鉴定与法医学医疗鉴定共存的二元化局面。侵权责任法在民事赔偿上否定了医疗事故的概念,提出以医疗损害责任为核心的民事责任制度,使医疗鉴定面临了新的问题。医疗事故技术鉴定机制和法医学医疗鉴定机制都存在种种缺陷,不能完全满足侵权责任法对医疗鉴定的新的需求。无论是鉴定结论的固有属性还是侵权责任法的新的技术内容都要求对现有的医疗事故技术鉴定模式进行改革,建立起符合《侵权责任法》要求的医疗损害技术鉴定制度。     

论重新架构我国医患纠纷的多元化处理机制

综观我国现行医患纠纷处理机制,医患双方协商多隐含非公平、非自愿成分,卫生行政调解基本处于闲置状态,民事审判的权威与效率难以实现,而医疗责任鉴定的公平与权威备受质疑,因此,该机制不能适应妥善处理医患纠纷这一社会热点问题的需求。多元化纠纷解决机制（ADR）的发展及运行表明,多种性质、功能、程序不同的纠纷解决机制,各有其运行空间,且能形成功能互补,而非诉讼纠纷解决机制本身具备的意思自治、非对抗性、开放性等特点决定其对处置医患纠纷具有较强的适用性。重新架构与配置我国医患纠纷多元化处理机制的设想为：保留但限制医患双方自行和解,设立医事仲裁和医患纠纷第三方专业调解制度,以医、法结合的原则对医患纠纷的审判及鉴定机制加以改进,并建立审判机关与鉴定机构在医疗事实认定与过错责任确认方面的协同机制,形成多元化机制并存、互补的良性结构。     

彭真同志的“严打”思想研究

＂严打＂思想是彭真同志首先提出来的。在将彭真＂严打＂思想转化为党中央＂严打＂决策的过程中,起关键作用的是邓小平。彭真＂严打＂思想的主要内容包括：＂严打＂政策的提出是由客观形势决定的;＂严打＂的对象是严重刑事犯罪和经济犯罪,措施是依法从重、从快严厉打击,原则是实事求是,因地制宜;＂严打＂要想取得全面胜利,必须和综合治理同时进行,特别是要做好劳改、劳教工作;＂严打＂斗争具有长期性、艰巨性和复杂性,必须紧密依靠党的领导,走专门机关和群众路线相结合的道路。彭真＂严打＂思想中所体现的思想方法和工作方法,所包括的许多反映了社会治安规律的结论,对于我们做好社会治安工作具有重要的现实指导意义。     

国际海运温室气体减排法律问题探析

近年来,国际海运温室气体排放问题逐渐引起了国际社会的广泛关注,国际海事组织在《联合国气候变化框架公约》及其《京都议定书》的授权下进行了包括立法在内的诸多努力并取得了一定的成果。本文在对国际海事组织构建的国际海运温室气体减排法律框架进行厘清的基础上,就其框架中体现出的"不优惠待遇"原则及相关的减排机制进行分析,认为相关制度还有待调整以符合大多数国家的利益。     

Mitochondrial DNA Validation in a State Laboratory*,†

Abstract: Because of the inception of the FBI Regional mitochondrial DNA (mtDNA) laboratories, many do not see establishing state/local mtDNA processing laboratories as a priority. Yet there is a long‐term need for mtDNA processing that will exceed the capabilities of the FBI Regional mtDNA laboratories and the few other laboratories that are currently processing mtDNA, and that need can be fulfilled by state/local laboratories. Thus, the DNA Unit of the Delaware Office of the Chief Medical Examiner (OCME‐DNA Unit) completed validation of in‐house mtDNA testing in January 2007. The validation plan for mtDNA processing included the following sections: preliminary research, sensitivity and contamination studies, ExoSAP‐IT^® optimization, BigDye^® optimization, sequencing and 310 optimization, sample preparation and extraction optimization, heteroplasmy, mixtures, and reproducibility. All sections of the validation were successfully completed, and mtDNA processing of skeletal remains, teeth, and hairs, as well as blood and buccal reference samples was adopted by the OCME‐DNA Unit.     

Explaining the Effectiveness of Heroin-assisted Treatment on Crime Reductions

This study examines the relationship between heroin-assisted treatment versus methadone maintenance and the criminal activity of 1,015 individuals participating in a German model project. The main objective is to investigate how these treatments contribute to a decline of criminal behavior. The analyses are based upon self-reported criminal offence and police data on alleged criminals. Logistic regression is employed to explain the variance in the 12-month prevalence 1 year after program admission. The results clearly show a decline of criminal offences among participants receiving maintenance treatment; this decline was significantly greater in the heroin group with respect to property crimes and drug offences. The multivariate analysis reveals that the effects are due to a decrease of illegal drug use and absence from the drug scene.     

不平等——农民问题的解读

平等是人类社会成员基于人的属性应当受到一致性尊重和满足的待遇,包括平等享有和平等对待两个方面。农民问题就是不平等的问题,表现为农民在资源享有上存在的差距超过了社会公平的底限,以及农民在生活中被不平等对待突破了道德标准。     

医疗事故技术鉴定专家出庭质证问题阐释

医疗事故技术鉴定专家出庭接受质证是法院审查、认定鉴定结论以及克服医疗事故技术鉴定自身中立性不足和程序不完善等问题的必然要求。鉴定专家出庭接受质证程序要体现交叉询问原则,同时,要引入专家辅助人、专家陪审员制度以构建均衡合理的质证主体结构。质证的内容应该围绕鉴定专家资格,鉴定结论的相关性、科学性、事实材料充分性、证明过程符合逻辑性等来展开。     

医疗诉讼证据问题研究

诉讼的关键在于证据本身及其规则。一般来说,解决医疗诉讼的方式是:通过对各种医疗诉讼证据的运用来认知医疗争议事实,从而认定争议事实的客观真相,以此分辨出这争议事实中的是与非,从而顺利解决该纠纷;当出现证据不足或者证据灭失而导致无法认识医疗争议的客观真相时,就只能依靠医疗诉讼中证明规则来解决纠纷。病历真实、客观的疑问以及鉴定结论对因果关系认定的困难,使案件事实真相的认定出现障碍。应该改革病历的制作与管理,实行专家证人制度。我国现行的医疗诉讼实行举证责任倒置的证据规则,使医疗诉讼迅速增加,致使医院因赔偿导致的费用支出也大幅上涨。从而导致医疗费用的上涨以及医方为了减少医疗诉讼而采取防御性医疗措施,进一步加深了医患双方之间的矛盾。应该对举证责任倒置规则有所限制。     

An attempt to objectify the condition of cervical spine distortion injury in traffic accident victims for court purposes

Introduction

According to morphological criteria, cervical spine injuries include, among others, contusion, distortion, luxation and fracture. Distortion of the intervertebral articulations occurs when the force of movement exceeds the physiological range, and the articular/joint capsule, cartilage and ligaments are damaged. While within the articulation a haematoma is formed, which produces clinical manifestations such as localised idiopathic pain, tenderness to palpation and analgesic limitation on both the passive and active joint mobility (i.e., a syndrome of subjective painfulness), as reported by the patient, the diagnostic imaging techniques (i.e., regular radiograph pictures) typically applied in such cases do not show any post-traumatic changes. Distortion of the cervical spine, resulting in a post-traumatic feeling of pain, usually occurs indirectly as a result of transmission of the force of injury onto the spine, as in the case of a traffic accident. Frequently, in cases of abuse, arriving at a hasty clinical diagnosis of post-traumatic cervical spine distortion apparently presents a serious problem in giving medical opinions for court purposes; thus encouraging the authors to attempt objectifying the condition of cervical spine distortion.

Methods

In a retrospective investigation, the authors analysed the medical opinions given by the Department of Forensic Medicine, Medical University of Silesia, for court purposes.

Results

Among nearly 5500 opinions in the past 5-year period, we analysed 167 cases related to cervical spine injury.

Conclusions

An attempt is made to either substantiate or negate the clinical diagnosis issued for court purposes by assessing the following: the findings of the physical examination of the person involved, the condition of the person involved in the accident from the period prior to accident (radiograph findings confirming the level of the already existing degenerative changes; age and sex of the person involved; positive or negative history of injuries sustained prior to accident), the course of treatment after the accident (character of symptoms reported and their evolution with time; co-existence of other bodily injuries; outpatient treatment instituted, including the application of Schantze collar, rehabilitation) and also the circumstances in which the accident occurred.