论医疗过错的认定及证明

发布时间：2018-02-10 14:32

本文关键词： 医疗过错不确定性一般标准注意义务举证缓和　出处：《西南政法大学》2015年硕士论文　论文类型：学位论文

【摘要】：在当前形势下,医患矛盾已成为社会的热点问题之一,有关医患纠纷的案件数量也不断攀升,其在法院审理案件中占了很大一部分比重。法院在解决医疗纠纷的案件时,主要是以医方是否存在“医疗过错”为中心进行审理。对“医疗过错”的把握不仅决定着医疗纠纷能否公平、公正的解决,还对维护双方的利益,尤其是弱势一方的利益更能得到极大保护。然而,自从《侵权责任法》颁布实施以来,医患矛盾得到很大的改善,但医疗侵权仍然在理论和实践中存在些许不足。医疗过错是医疗损害责任的核心构成要件,但对医疗过错的认定不能达成理论上的一致性。医疗过错认定在理论上的不确定性和模糊性,很可能会阻碍实践中医疗冲突的解决,在一定程度上反而会加剧医疗纠纷。理论最终是应用于实践的,为了更好地解决患者和医方的矛盾,做到最大程度的利益维护,十分有必要对医疗过错进行深入的探讨,全面去把握医疗过错,对医疗过错作出明确的认定,这正是写作此文的最终目的。本文主要从三部分详细探讨了有关医疗过错的认定和证明:第一部分主要分析了医疗过错认定的一般标准,医疗过错的一般认定标准属于抽象标准,对于这一部分,目前学术界仍未达成以一致意见,笔者在本部分充分分析了目前我国对医疗过错一般认定标准的情况。先从过错的认识再过渡到医疗过错,并结合《侵权责任法》的第“54”条、“57”条“58”条的相关规定以及国外对医疗过错抽象认定标准的情况进行了具体分析,提出了对“当时诊疗水平”要综合各种因素进行判定,不能单一认定的观点。第二部分主要介绍了医疗过错的具体认定标准,医疗“注意义务”作为医疗过失的具体认定标准,首先,笔者引用了小案例对概念进行了相关解释,重点研讨了如何认定医疗注意义务以及医疗注意义务的例外情况;而且还针对当前认定“医疗注意义务”的复杂情况,提出对其认定要先看有无医疗注意能力。本部分采用了定性分析法,全方位统筹把握医疗注意义务。另外,为了做到理论与实践相结合,还采用典型案例详细说明了认定医疗过失的过程。除此之外,笔者对几种特殊情形探讨了其是否属于违反医疗注意义务,并说明了自己的理由与看法。最后针对医疗注意义务内容的概括化,主张要将其细化。第三部分内容是有关医疗过错的证明,包括诊疗过错的证明责任、组织性过错的证明责任;对其举证,笔者主张采取一般归责,即“谁主张谁举证;在难以举证的特殊情况下,笔者建议采用举证责任转移制度和举证责任缓和制度。另外分析了医疗鉴定机制的不足,并提出要建立统一的医疗鉴定机构。
[Abstract]:Under the current situation, the contradiction between doctors and patients has become one of the hot issues in the society, and the number of doctor-patient disputes has also been increasing, which accounts for a large proportion of the cases tried by the court. When the court resolves the cases of medical disputes, It is mainly about whether the medical side has a "medical fault" as the center of the trial. The assurance of the "medical fault" not only determines whether the medical dispute can be resolved fairly and fairly, but also protects the interests of both sides. In particular, the interests of vulnerable parties can be greatly protected. However, since the enactment and implementation of the Tort liability Law, the doctor-patient contradictions have been greatly improved. However, there are still some deficiencies in the theory and practice of medical tort. Medical fault is the core component of medical damage liability. However, the identification of medical fault can not reach theoretical consistency. The uncertainty and ambiguity of medical fault identification in theory may hinder the solution of medical conflict in practice. On the contrary, to some extent, medical disputes will be aggravated. The theory is finally applied to practice. In order to better solve the contradiction between patients and doctors and to maintain the interests to the greatest extent, it is very necessary to deeply discuss medical mistakes. To comprehensively grasp the medical fault, to make a clear determination of the medical fault, This is the ultimate purpose of writing this article. This paper discusses the identification and proof of medical fault in detail from three parts: the first part mainly analyzes the general standards of medical fault identification. The general standard of medical fault is an abstract standard, for this part of the academic community has not yet reached a consensus, In this part, the author makes a full analysis of the current situation of the general standard of medical fault in our country. First of all, from the understanding of fault to the transition to medical fault, Combined with the relevant provisions of "54", "57" and "58" of the Tort liability Law, as well as the foreign abstract identification standard of medical fault, this paper makes a concrete analysis, and puts forward that the "level of diagnosis and treatment at that time" should be judged by various factors. The second part mainly introduces the specific identification standard of medical fault, medical "duty of care" as the specific identification standard of medical negligence. First, the author cited a small case to explain the concept. Focusing on how to identify the duty of medical care and the exceptions to the duty of care, and also focusing on the complex situation of recognizing the duty of care. In this part, the qualitative analysis method is used to grasp the duty of care in all aspects. In addition, in order to combine theory with practice, In addition, the author discusses whether the medical negligence is in violation of the duty of care in several special cases. Finally, aiming at the generalization of the content of the duty of medical care, the author argues that it should be refined. The third part is about the proof of the medical fault, including the burden of proof of the fault of diagnosis and treatment. The burden of proof of the organizational fault; for its proof, the author advocates to adopt general imputation, that is, "who claims to prove the burden of proof; under the special circumstances where the proof is difficult to prove," The author suggests to adopt the system of transferring the burden of proof and the system of easing the burden of proof. In addition, this paper analyzes the deficiency of the medical appraisal mechanism and puts forward the establishment of a unified medical appraisal institution.
【学位授予单位】：西南政法大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：D923

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