精神障碍医学鉴定制度设计及相关问题探究

《精神卫生法》对于精神病人合法权益的保障、社会安全防卫作用的实现具有重要意义,其不仅能为精神病患者和监护人提供非自愿住院治疗的救济渠道,在一定程度上避免“被精神病”现象的发生,同时能够保障社会公共秩序和社会公众人身安全.在对精神障碍医学鉴定的制度设计及作用进行分析的基础之上,正确辨析精神障碍医学鉴定的实施主体以及管理模式、并对精神障碍医学鉴定的实施主体、要求、委托主体等有关内容进行阐述,以期为精神障碍医学鉴定制度的良性运行提供保障.     

Characteristics of Medical Examiner/Coroner Offices Accredited by the National Association of Medical Examiners

The National Association of Medical Examiners accredits medical examiner and coroner offices. Approximately 60 offices were fully or provisionally accredited as of late 2011, and these offices serve one‐quarter of the U.S. population. The calculated average population served was 1.6M but ranged from 0.3 to 10.5M. The calculated mean death rate was 794 deaths/100K population, and the mean homicide rate was 7.2 homicides/100K population. The calculated mean budget was $4.35M, but budgets ranged from $0.67 to $26.8M. The calculated mean budget/capita was $3.02 but ranged from $0.62 to $10.22. The average size of the facility was under 30,000 sq. ft. The calculated average staffing was found to include five forensic pathologists, four and a half autopsy technicians, and nine investigators. The mean forensic pathologists/1M population was 3.7. Calculated workload indices included 222 autopsies/pathologist and an autopsy rate of 77.6/100K population. These results show that offices of every size can achieve accreditation.     

A Case of Toxic Shock due to Clandestine Abortion by Misoprostol self‐administration

Maternal mortality and morbidity are the leading causes of death and illness, respectively, among women of reproductive age in many countries throughout the world. Of all maternal deaths, those related to unsafe abortions are the most widely underestimated, but they are also the most largely preventable. Medical abortion is a safe and reliable method for termination of a pregnancy in early gestation, although it is important to be aware of signs and symptoms of severe infection and toxic shock syndrome after the medical termination of pregnancy; case studies in literature are rarely fatal events. We report the first case of septic shock syndrome following a clandestine pregnancy termination with a misoprostol‐only regimen (12 tablets 200 μg each). Autopsy findings and histopathological examination proved that the woman died from septic shock. This case suggests to improve the forensic investigations in case of unsafe, often clandestine, abortion is suspected.     

当前医疗损害鉴定“二元化”模式的对策讨论

医患纠纷是一个复杂的社会问题,它掺杂了众多的社会矛盾。解决医患纠纷的核心是如何进行医疗损害鉴定,由于中国现实国情的复杂性,要想短时间内一劳永逸予以解决是不现实的。笔者提出应对医疗损害鉴定“二元化”模式的对策：近期将两个鉴定平台整合为一,成立医疗损害司法鉴定机构;中期成立医患纠纷特别法庭或仲裁庭并引进专家证人制度;远期设立医疗损害鉴定委员会,成立中国医疗损害鉴定协会。     

论我国医疗损害技术鉴定制度构建

《侵权责任法》仍未解决我国医疗鉴定体制的二元化问题。医学会医疗事故技术鉴定和法医医疗损害司法鉴定两种模式各有利弊,法医鉴定模式并不比医学会鉴定模式优越。在专业技术问题的判断上,日本、德国、荷兰、美国的医疗损害鉴定模式都采同行评价的原则。构建我国医疗损害技术鉴定制度应坚持充分利用现有鉴定资源、尽可能融合当前两种鉴定的优点、法律问题与技术问题分离的宏观理念,并坚持公开、救济、辩论、鉴定专家半职业化、鉴定方法科学和法律指导的基本原则。在制度的具体构建上,鉴定名称应选择医疗损害鉴定或医疗损害技术鉴定;新的鉴定机构应在现有医学会医疗事故技术鉴定机构的基础上组建,并要求法医专家参与。调整鉴定专家来源、专家鉴定组和鉴定专家库组成,完善鉴定程序,确定鉴定理论、鉴定方法．明确鉴定原则,扩充医疗：愤害技术鉴定的内容;也可以借鉴日本的鉴定模式,由医学会建立专家库,由法院启动、组织鉴定。     

医疗损害鉴定主体改革刍议

医疗损害鉴定主体,包括鉴定机构及鉴定人,是医疗损害鉴定制度改革的起点。医疗事故鉴定模式中的专家组并不是鉴定主体,但其合议制的实质对鉴定结论的科学性具有重要作用,应予保留。应改革鉴定结论形成机制,允许出具多样化的鉴定结论。医疗损害鉴定制度的改革应采取司法行政部门主管、司法鉴定机构组织鉴定工作、医学会推荐鉴定人的模式。由于医学的专业性极强,鉴定人应当来自于现任专职医务人员。在保证鉴定人中立性、公正性的同时,要重视保证医务人员参与鉴定工作的积极性。     

新生儿呼吸系统疾病死亡的法医病理学分析

目的分析和探讨呼吸系统疾病引起新生儿死亡的病理学特点,为法医学死亡原因鉴定和相关医疗纠纷鉴定提供科学依据。方法回顾性总结分析1993～2008年16年间攀枝花市公安局尸检档案中85例新生儿死亡案例。结果呼吸系统疾病是引起新生儿死亡的首要因素（共56例,占65.88%）,其中新生儿吸入性肺炎20例（23.53%）、新生儿感染性肺炎14例（16.47%）、新生儿窒息12例（14.12%）、新生儿肺透明膜病6例（7.59%）、新生儿肺出血4例（4.71%）。结论新生儿尸检应重视呼吸系统的检查,根据新生儿发病特点和肺部病理变化明确临床诊断和死亡原因。     

意大利医疗事故立法简介及借鉴意义

意大利的公共卫生体系综合绩效在世界排名第二，意大利在处理医疗事故的立法和实践有着先进经验。意大利医生面临刑事责任和民事责任的双重风险，常规医疗程序中医师负有举证责任，并且意大利具有完善的医师保险体系。我国应在司法实践中加重医生医疗事故罪的刑事诉讼的比例，区分不同情况分配举证责任，并逐渐建立和完善医师保险体系。     

我国医疗广告监管制度的缺陷及其完善

目前，我国对于医疗广告实行政府主导型的管理模式，主要分为事前审查与事后监管两邵分，此做法带来审查权与管理权相分离，造成“执法真空”。在立法方面，存在处罚依据不明，适用法律混乱的情况。为此，笔者试图从完善行政执法、加强监管以及明确法律适用的角度分析问题，努力寻找与之相对应的措施，对完善我国医疗广告监管制度做出初步探讨。     

The regulation of cognitive enhancement devices: extending the medical model

This article presents a model for regulating cognitive enhancement devices (CEDs). Recently, it has become very easy for individuals to purchase devices which directly modulate brain function. For example, transcranial direct current stimulators are increasingly being produced and marketed online as devices for cognitive enhancement. Despite posing risks in a similar way to medical devices, devices that do not make any therapeutic claims do not have to meet anything more than basic product safety standards. We present the case for extending existing medical device legislation to cover CEDs. Medical devices and CEDs operate by the same or similar mechanisms and pose the same or similar risks. This fact coupled with the arbitrariness of the line between treatment and enhancement count in favour of regulating these devices in the same way. In arguing for this regulatory model, the paper highlights potential challenges to its implementation, and suggests solutions.