英联邦国家医疗侵权诉讼中因果关系之证明及评价

在因果关系的证明上，英联邦国家司法总体上贯彻了法律与科学有别、司法者与医学专家有别的观念。传统的因果关系证明规则在医疗诉讼中面临挑战和困境。在寻找解决此类困境的方法中．“举证负担转移”方法因其操作生硬、对传统规则的过于颠覆以及可能对医学、医疗诉讼和医疗保险产生不良影响而未能在英联邦司法中获得普遍认可：“风险的实质性增加”方法和“机会丧失”视为损害的方法能否适用于医疗侵权案件尚未得到确定。与前些方法相比，“因果关系的推断”在英联邦司法中获得了较大程度的认可。该方法的优势在于弹性强、对传统规则的偏离较为缓和且充分利用了法庭的事实认定过程。它进一步增加了法院的自由裁量．减弱了对医疗专家意见的依赖。

Appraisal on Commonwealth Jurisdictions' Approaches on Proof of Causation in Medical Malpractice Lawsuits

To alleviate the patient＇s burden of proof, the commonwealth countries have drawn distinctions between law and science and between fact-finders and medical experts. The traditional causation rules face challenges in the area of medical malpractice. Among the approaches that are designed to alleviate the burden of proof imposed on plaintiffs, the ＂shift of burden of proof＂ approach did not win popularity in the Commonwealth jurisdictions because of its inflexibility, extreme nature and risks on medical practices; the ＂material increase of risk＂ approach and the ＂loss of chance＂ approach have not yet definitely been applied to medical cases. By contrast, ＂drawing of an inference of causation＂ has the advantage of flexibility. It is more lenient and uses the standard fact-finding process. It further increases the court＇s discretion, and further decreases the dependence of medical judgment.