论我国医疗过失的认定标准

发布时间：2018-04-01 02:09

本文选题：医疗损害责任纠纷　切入点：医疗过失认定　出处：《西南政法大学》2015年硕士论文

【摘要】：我国医患关系一直以来都是社会生活中较为紧张的关系,也是全社会关注的焦点。2010年《侵权责任法》开始实施,医疗损害责任得以统一规制,我国现行法律确立了《侵权责任法》为主,其他法律、行政法规、规章、医疗常规为辅的医疗过失认定标准。但在司法实践中,医疗过失认定难的问题却一直未能有效解决,法院认定的过失结论也让医患双方异议颇多,医患关系仍处于紧张之态。为解决司法实践中的这一难题,寻求一个合理、科学且易于司法实践操作的医疗过失认定标准,本文通过分析我国现行法律确立的医疗过失认定标准与收集的194份医疗损害责任纠纷案例,在对立法与司法实践中有关医疗过失认定标准之现状进行剖析的基础上,结合国内外学术界和司法实务界相关研究成果,提出构建我国医疗过失认定模式的观点:即在对医疗注意义务进行类型化划分基础之上,针对诊疗活动中的技术性注意义务、职业活动中的伦理性注意义务和医疗机构的组织性注意义务,采用不同的判断标准。本文第一部分研究我国现行医疗过失认定标准。现行法律确立了《侵权责任法》为主,其他法律、行政法规、规章、医疗常规为辅的医疗过失认定标准;而笔者收集了北京、上海、重庆、四川四省市、共194份医疗损害责任纠纷案例,分析了人民法院在审理此类案件时,认定医疗过失所采用的具体标准以及考虑的相关因素。第二部分在第一部分研究的基础上剖析了我国现行医疗过失认定标准在司法实务中存在的问题。从医疗过失认定依据、认定主体、认定规则三方面进行了分析,得出了现行法律所确立的医疗过失认定标准适用困难,法官裁量为专业性所限,过失认定主导权错位,医疗过错司法鉴定规则没有统一的现状。第三部分笔者提出了构建我国医疗过失认定模式的主张。该部分分析了日本、德国、英国、美国的医疗过失认定标准,以及我国学术界关于医疗过失认定标准的探讨,医疗过失的判断即是对医疗机构及其医务人员在诊疗活动中医疗注意义务的判断,因此,医疗注意义务是认定医疗过失认定的关键;构建我国医疗过失认定模式应将医疗注意义务作类型化划分,针对诊疗活动中的技术性注意义务、职业活动中的伦理性注意义务和医疗机构的组织性注意义务,采用不同的判断标准。第四部分针对笔者提出的构建医疗过失认定模式的主张,进一步论述了该模式中的具体标准和客观标准。统一的医疗注意义务具体标准即是“一个理性医师”所应达到的标准,是医疗机构及其医务人员的最低标准,主要规定于法律、行政法规、规章、医疗规范中,是一种法定标准;诊疗活动中技术性注意义务的客观标准,是在具体标准的基础上进一步判断,从医疗水平、医院级别、医师差别、医疗风险和疾病的自然转归等方面进行考量。
[Abstract]:The doctor-patient relationship in China has always been a tense relationship in social life, and is also the focus of attention of the whole society. In 2010, the Tort liability Law was put into effect, and the liability for medical damage was unified. The current law of our country has established the standard of medical negligence identification, which is based on the Tort liability Law, and is supplemented by other laws, administrative regulations, rules and regulations. However, in judicial practice, the problem of the difficulty of medical negligence determination has not been effectively solved. The conclusion of negligence found by the court also makes both doctors and patients disagree quite a lot, and the doctor-patient relationship is still in a tense state. In order to solve this difficult problem in judicial practice, we should seek a reasonable, scientific and easy to operate standard of medical negligence in judicial practice. Based on the analysis of the standards of medical negligence and 194 cases of medical injury liability disputes established by the current law of our country, this paper analyzes the current situation of the standards of medical negligence in legislation and judicial practice. Based on the related research results of academic circles and judicial practice at home and abroad, this paper puts forward the viewpoint of constructing the pattern of medical negligence in our country: that is, on the basis of the classification of medical care obligation, aiming at the technical duty of care in diagnosis and treatment activities, The ethical duty of care and the duty of organizational care of medical institutions adopt different standards of judgment. The first part of this paper studies the existing standards of medical negligence in China. Other laws, administrative regulations, rules and regulations, and medical practices are supplemented by standards for the determination of medical negligence; and the author collected 194 cases of medical injury liability disputes in four provinces and cities of Beijing, Shanghai, Chongqing and Sichuan. It is analyzed that when the people's court tries such cases, The second part, on the basis of the research in the first part, analyzes the problems existing in the judicial practice of the current medical negligence standard in China. Through the analysis of the main body and the rules, it is concluded that it is difficult to apply the standard of medical negligence established by the current law, that the judge's discretion is limited by profession, and that the dominant power of fault determination is misplaced. In the third part, the author puts forward the idea of constructing the pattern of medical negligence in China. This part analyzes the standards of medical negligence in Japan, Germany, Britain and the United States. The judgment of medical negligence is the judgment of medical institution and its medical staff's duty of care in the diagnosis and treatment activities. The duty of care is the key to the identification of medical negligence, and the construction of the mode of medical negligence identification in China should classify the duty of care as a type and aim at the technical duty of care in the diagnosis and treatment activities. The ethical duty of care and the duty of organizational care of medical institutions adopt different standards of judgment. The concrete standard and objective standard in this model are further discussed. The unified concrete standard of duty of care is the standard that "a rational doctor" should meet, and it is the minimum standard of medical institution and its medical personnel, which is mainly stipulated in the law. In administrative regulations, regulations, and medical standards, it is a statutory standard; the objective standard of technical duty of care in diagnosis and treatment activities is to further judge on the basis of specific standards, from the level of medical treatment, hospital level, and doctors' differences. Medical risk and natural outcome of the disease are considered.
【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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