医患关系中患方知情同意权的法律保障机制研究

发布时间：2018-01-19 07:35

本文关键词： 医疗行为医疗知情同意权保护性医疗过度性医疗　出处：《上海师范大学》2017年硕士论文　论文类型：学位论文

【摘要】：医疗知情同意制度能够保障患者在医疗行为中得到医生的尊重,更加自由地选择和决定医疗方案。目前,我国现有法律对医疗知情同意权的规定相对比较薄弱,医生职业的专业性、技术性又相对强势,弱势的患者很难依靠原则性的法律对抗侵权的医生,从而保护自身权益。另外,尽管围绕医疗知情同意权的学术研究不胜枚举,但大多都单一地选择从保障患者知情同意权、强调医生履行告知义务的角度切入,这就使得医疗知情同意权的学术研究始终停留在表面,无法深入拓展。基于此,笔者另辟蹊径,不局限于对医患双方权利义务相统一的分析,从法哲学角度出发,将医疗知情同意权归属于患者的人格权,为医疗知情同意权提供强有力的法理基础;结合知情同意侵权的特殊医疗行为,尝试分析特殊医疗行为与知情同意权的冲突,探究知情同意权的限制与保护,提出完善现有法律体系并构建专门性法律保障机制的建议。本文主要分为五个部分:第一部分医疗知情同意权的界定与制度化历程。最初的医患关系中患者处于被动地位,医生凭借其职业神秘性绝对主导患者的生命健康,这种服从关系实质上是双方地位不平等、信息不对称,治疗手段的不透明必然会导致医患矛盾加剧。随着人权得到重视保障、医疗技术进步发展,知情同意制度逐步得到构建,从而保障患者对治疗方案的自由选择和对生命健康的自主决定。第二部分医疗知情同意权的法理基础。结合学者的理论研究以及笔者的理解,论述医疗知情同意权的权利来源,引据康德“无条件地尊重人是目的”的法哲学思想,强调医疗知情同意权的本质属性,将其归属于人的自由选择和人的尊严,为我国医疗知情同意权的法律保障机制提供法理基础。第三部分医疗知情同意权的立法不足与实践困境。在立法层面上,对比外国法律对医疗知情同意权的法律规定,探讨我国法律止步于宣示性意义,权利行使主体以及告知义务标准欠缺具体明确的规定,立法的普遍主义更是导致条文之间冲突矛盾,患者难以确定法律适用位阶。在实践层面上,结合具体案例,分析患者知情同意制度运行的困境,一方面医方违反告知义务,实施知情同意侵权行为,缺乏明确的惩罚制度;另一方面,患方积极救济权利无法可依或者消极救济权利。第四部分特殊医疗行为与知情同意权的冲突。结合具体法律规定,分析紧急医疗行为、保护性医疗行为、过度性医疗行为的特殊性,探讨特殊医疗行为中知情同意侵权的责任承担以及抗辩事由,强调患方知情同意权既要依靠完善的法律体系保护,也要受到严格的法律限制。不区分特殊医疗行为的侵权形态,片面强调权利保护必然导致医疗知情同意制度构建的单一性,难以保障患者生命健康利益的最大化。第五部分医疗知情同意权法律保障机制的构建。构建法律预防机制,完善现有法律体系,明确相关内容的内涵外延;同时,比照《消费者权益保护法》,建议制定专门性的《患者权益保护法》。构建实践运行机制,完善患方签字同意制度,确立生命健康权最高性原则。构建权利救济机制,明确举证责任,提出多途径权利救济。
[Abstract]:Medical informed consent system to protect the patients in the medical behavior to get a doctor's respect, more freedom to choose and determine the medical scheme. At present, China's existing laws and regulations on medical informed consent is relatively weak, the doctor's professional occupation, technology and relative strength of vulnerable patients is difficult to rely on the principle of law against the infringement of the doctor, in order to protect their own interests. In addition, although the academic research on medical informed consent to be too numerous to enumerate but mostly single choice, from the protection of patients' right of informed consent, emphasizing the obligation angle, which makes the medical informed consent right of academic research always stay on the surface, to further expand. Based on this, the author tries not limited to the rights obligations analysis, starting from the perspective of philosophy of law, the right of informed consent of home medical To the patient's right of personality, provide strong theoretical basis for medical informed consent; informed consent with special medical tort behavior, try conflict analysis special medical behavior and the right of informed consent, restriction and protection of the right of informed consent of the inquiry, put forward to perfect the existing legal system and the construction of special legal protection mechanism is proposed. This paper is divided into five parts: the first part is the definition of the right of informed consent and medical institutionalization process. Patients in the passive position the doctor-patient relationship, with its mysterious doctor occupation dominated the life and health of patients, this subject relationship is essentially the status of inequality, asymmetric information, opaque treatment will inevitably lead to patient with the intensified conflicts. Human rights are attached great importance to the protection, medical technology development, informed consent system has been constructed, in order to protect the patient for treatment The freedom to choose the scheme and to the lives and health of self-determination. The second part is the legal basis of medical informed consent. According to scholars of theoretical research and the author's understanding of the source of the right of informed consent, according to Kant's "idea of unconditional respect for the purpose of people" philosophy of law, emphasizing the essential attribute of medical informed consent the freedom of choice and will be attributed to human dignity, to provide the legal basis for the legal protection mechanism of China's medical informed consent rights. The third part is the lack of legislation and practice of medical informed consent. The dilemma on the legislative level, compared with foreign legal laws and regulations on medical informed consent, to explore the law of our country stop at the declarative meaning, right and obligation of the lack of the standard of subject specific legislation, universalism is led to the conflict between the provisions, patients with difficult In order to determine the applicable law. In practice, combined with the specific case analysis, informed consent system operation difficulties, a prescription of violating the obligation of informed consent, the implementation of tort, the lack of a clear punishment system; on the other hand, the patient could be negative or positive relief rights relief rights. The fourth part of the special medical behavior the right of informed consent and conflict. Combined with the specific provisions of the law, analysis of emergency medical treatment, protection of the medical behavior, the particularity of the excessive medical behavior, explore the special medical informed consent in tort liability and defenses, emphasizing the patients right of informed consent is to rely on perfecting the legal protection system, but also by the law strictly limited. Tort can not distinguish the special medical behavior, will inevitably lead to one-sided emphasis on the protection of the rights of informed consent of a single system, it is difficult to Ensure the maximum interests of the patient's health and life. The construction of part of the medical informed consent of the legal safeguard mechanism fifth. Construction of legal prevention mechanism, improve the existing legal system, clear connotation and extension of relevant content; at the same time, according to "consumer protection law", recommended the development of "special rights protection law. With construction practice operation mechanism perfect, patient sign system, the establishment of the right to life and health of the highest principles. Construction of right relief mechanism, clear the burden of proof, put forward ways of right relief.

【学位授予单位】：上海师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D922.294

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