医疗过失行为的刑法规制研究

发布时间：2018-06-10 16:23

本文选题：医疗行为 + 过失　；参考：《华东政法大学》2014年博士论文

【摘要】：从刑法史学的角度来考察对重大医疗过失过失行为的刑法规制，相关立法可谓历史久远，上溯到公元前18世纪，古巴比伦的《汉谟拉比法典》就已经有了相关规定，而我国《唐律疏议》则最早规定了医疗过失犯罪，此后历代相沿，直至清末修律。晚近以来，医疗过失犯罪研究一直是德日为主大陆法系刑法的重要分支——医事刑法学的重要内容，英美法系也不排除重大医疗过失行为的刑事责任。本文在对两大法系的代表国家刑事医疗过失理论研究和司法实践的成果充分比较和借鉴的基础上，通过实证研究指出我国刑事医疗过失立法与司法的困境，积极构建我国的刑事医疗过失研究的理论体系，以期更好的完善相关刑事政策、立法和司法。除了导论以外，本文共分为五章，分别为医疗行为的考察与概览，刑事医疗过失的理论基础和实证分析，刑事医疗过失的因果关系与责任分配，医疗过失刑民边界之厘清，医疗过失刑事政策、立法与司法完善。导论部分分别就刑事医疗过失问题研究的缘起、研究现状、研究的方法和本文的主要观点进行了阐述。研究的缘起主要从历史、现状和未来阐明研究重大医疗过失行为刑法规制的重要意义。通过比较和分析，指出我国刑事医疗过失研究的不足。希望通过对刑事医疗过失系统化的研究，从而在理论和实践上弥补这一领域的缺憾。第一章“医疗行为的考察与概览”。本章是本文的破题所在，同时也是本文研究的理论前提和逻辑起点，共分为三节。第一节主要界定医疗行为的概念与特征。厘清医疗行为概念的内涵和外延，是医疗过失行为的违法性判断的前提和基础。本节分别考察了中国古代、台湾地区、日本对医疗行为的学理和实践中的概念，并一一回应了医疗行为目的、行为主体、行为对象、行为的危险性等国内外理论争议的焦点。笔者提出了广义和狭义的医疗行为概念与分类方法，提出医疗行为主体的特定性、目的的正当性、行为的业务性、医疗手段的伤害性、医疗水平的适切性和行为效果的有限性特征；第二节阐述了医学伦理发展对医疗行为的影响，生命科技与医学模式的改变给现代刑法带来的诸多问题和挑战。提出了法律不应该是科学技术的旁观者，而应成为科学技术不误入歧途的引路人，应加大对新兴科技犯罪及重大过失犯罪的惩罚力度；第三节主要围绕两大法系理论上长期存在争议的医疗行为“伤害说”和“非伤害说”，进行了系统的归纳和评述，提出我国应坚持医疗行为“伤害说”的理由和根据，以及当下科技发展、医学模式更迭和医疗信息化背景下的刑法应对。第二章“刑事医疗过失的理论基础和实证分析”。本章是构建本文理论脉络的依据和事实基础。第一节首先确定刑事医疗过失作为业务过失犯的本质，进而从各国的法律规范和学理研究，探讨其作为业务过失犯的属性和特征，通过对过失犯、业务过失犯概念的梳理和厘定，从而确立刑事医疗过失的概念和内容，以及肯定其作为业务过失犯应较普通过失加重处罚的依据，并结合案例具体阐述了临床上造成重大医疗过失常见的医疗行为的样态。驳斥了医疗过失“刑事豁免”理由，提出对重大医疗过失的刑法规制的必然性和谦抑性；第二节主要介绍医疗过失刑事立法。本节选取两大法系代表国家和地区医疗过失的刑事立法现状和趋势，系统了回顾了我国历史上医疗过失犯罪立法的演进与嬗变，以及现行刑法第335条专设医疗事故罪的由来与发展；第三节主要是针对我国1997年医疗事故罪设立以来刑事判例的实证分析，系统阐述了医疗事故罪立法和司法面临的困境。第三章主要阐述“刑事医疗过失中的因果关系与责任分配”。本章重点介绍了刑事医疗过失因果关系的特点、刑事医疗过失因果关系的判断和医学鉴定对医疗因果关系的影响以及对医疗过失刑事责任分配进行了阐述。第一节阐述了刑事医疗过失因果关系的特点；第二节阐述刑事医疗过失因果关系的判断。重点阐述了大陆法系“因果关系条件说”、“相当因果关系说”在刑事医疗过失中具体适用，及论证疫病学因果关系在刑事医疗过失中的可采性；第三节阐述了刑事医疗过失鉴定在因果关系判定中的地位和作用。分析域外两大法系关于刑事医疗过失鉴定的主要经验、我国二元制鉴定模式的成因和困境，提出了刑事医疗过失的判断应以医疗事故鉴定为主和积极构建我国刑事医疗过失鉴定制度的构想；第四节“医疗过失刑事责任的分配”，主要以危险分配理论为基础，探讨在刑事医疗过失领域被允许的危险法理、危险分配理论、信赖原则、监督过失理论及其适用，为恰当的限缩医疗过失的刑事责任提供理论依据。第四章“医疗过失刑民边界之厘清”。本章主要从刑法中的二次违法理论和刑法第335条医疗事故罪的构成要件，从法规范的角度探讨医疗过失的刑民边界之所在，为刑事责任判断提出标准。第一节重点阐述医疗过失刑民边界的法律依据。本文认为医疗过失的刑民边界的法律基础在于现行刑事和民事立法，系统回顾了我国医疗过失刑事和民事立法的演进及两者的主要区别；第二节重点阐述在现行刑法第335条的框架下，探讨医疗过失刑民边界的分野。分别从损害事实分野、违法行为的边界和主观罪过的边界进行了厘定；第三节主要从经济学视角阐述医疗过失的刑民边界。本文借用汉德公式从经济学视角分析注意义务与成本之间的关系，分析经济学上刑民过失的边界之所在；第四节从医疗过失中常见的造成患者死亡或重伤、但不应当承担刑事责任的情形进行了归纳和排除。第五章“医疗过失刑事政策、立法与司法完善”。本章重点介绍了对各国医疗过失犯罪刑事政策的考察，提出了我国医疗过失刑事政策的应对，以及完善我国医疗过失刑事立法与司法的建议。第一节介绍了对各国医疗过失刑事政策的考察。本文通过对两大法系代表国家的刑事政策的考察，认为目前世界各国对重大医疗过失刑事政策趋于严厉，对于医疗新技术的刑事政策因利益考量多有反复，并分析了我国恶性医疗纠纷不断增多的原因；第二节关于我国医疗过失刑事政策的应对。本文同意李斯特“最好的社会政策就是最好的刑事政策说”，提出应从强化刑法的预防功能、重建医疗道德秩序、刑事责任主体适度扩张和完善医疗保障制度、完善医疗损害的救济途径等五个方面进行应对；第三节提出了完善我国医疗过失的刑事立法和司法建议。本文主张废弃专设罪名的立法模式，在“侵害公民人身权利、民主权利”一章，设立业务过失犯罪，在立法上统一该类犯罪的刑法规制。即便保留专设罪名，也应冠之以“重大医疗过失罪”，并归入“侵害公民人身权利、民主权利”一章，，增加法人犯罪的规定。关于刑事医疗过失鉴定制度，建议设立两级体系，在省级医疗事故鉴定委员会的框架下设刑事医疗鉴定委员会；关于医务人员违反注意义务的标准，本文主张吸收“医疗水平论”，即以当时之医疗水准为判断注意义务的标准。法条修正应该提高法定最高刑、增设罚金刑和资格刑，罪状应修改为：“医务人员严重违反注意义务或偏离医疗水准，导致就诊人死亡或者重伤的，处五年以下有期徒刑或者拘役，单处或并处罚金。单位犯前款的，对于单位判处罚金，并对直接负责的主管人员和其他直接责任人员，依照前款处罚。”
[Abstract]:From the perspective of the history of criminal law, the criminal law regulation of major negligence in medical negligence is examined. The relevant legislation is a long history. It has been traced to the eighteenth Century B.C., the Cuban code of Hammurabi, Cuba, has related provisions, and the "Tang law" in our country first stipulates the crime of medical negligence, followed by the subsequent dynasties until the end of the Qing Dynasty. Since late, the study of medical negligence crime has been an important part of the criminal law of medical affairs, which is an important branch of the criminal law of the civil law of the mainland of Germany and Japan. The common law system does not exclude the criminal responsibility of the major medical negligence. The results of this paper are fully compared to the results of the theoretical research and judicial practice of the two major legal systems. On the basis of the reference, through empirical research, it points out the dilemma of criminal medical negligence legislation and judicature in our country, and actively constructs the theoretical system of criminal medical negligence research in our country, in order to better improve the relevant criminal policy, legislation and judicature.
In addition to the introduction, this article is divided into five chapters, which are the investigation and survey of medical behavior, the theoretical basis and empirical analysis of criminal medical negligence, the causal relationship and responsibility distribution of criminal medical negligence, the clarification of the border of medical negligence, the criminal policy of medical negligence, the establishment of law and the perfection of the judicature.
The introduction part expounds the origin of the study of criminal medical negligence, the present situation, the method of research and the main points of this article. The origin of the study is mainly from the history, the status quo and the future to clarify the significance of the criminal regulation of major medical negligence. Through comparison and analysis, the study of criminal medical negligence in China is pointed out. In order to make up for the defects in this field, we hope to make a systematic study of criminal medical negligence.
The first chapter is the theoretical premise and logical starting point of this article, and it is divided into three sections. The first section mainly defines the concept and characteristics of medical behavior. The definition and extension of the concept of medical behavior is the premise and basis of the illegality judgment of medical treatment negligence. This section examines the concepts of the theory and practice of medical behavior in ancient China, Taiwan, and Japan, and responds to the focus of theoretical disputes at home and abroad, such as the purpose of medical behavior, the subject of behavior, the object of behavior, the danger of behavior, and the author puts forward the concept and classification method of medical behavior in the broad and narrow sense, and puts forward the medical treatment. The specific character of the subject, the justification of the purpose, the business of the behavior, the harm of the medical means, the appropriateness of the medical level and the limited characteristics of the effect of the behavior; the second section expounds the influence of the medical ethics development on the medical behavior, the changes of the life science and technology and the medical model to the many problems and challenges brought by the modern criminal law. The law should not be a spectator of science and technology, but should be a guide for science and technology, and should increase the punishment of new science and technology crime and major negligence crime. The third section focuses on the system of "injury theory" and "non injure", which have been disputed for a long time in the two legal systems. The reasons and bases for the "injure theory" of medical behavior, as well as the current scientific and technological development, medical model change and the criminal law under the background of medical information should be put forward and reviewed.
The second chapter is the theoretical basis and empirical analysis of criminal medical negligence.
The first section first determines the essence of criminal medical negligence as the criminal of business negligence, and then discusses the attributes and characteristics of criminal negligent offense from the legal norms and academic studies of various countries. By combing and defining the concept of negligent offense and business negligence, the concept and content of criminal medical negligence are established, and it is affirmed as the industry. The crime of negligent offense should be heavier than ordinary negligence, and the cases of medical negligence which cause major medical negligence are explained in detail. The reason for the "criminal exemption" of medical negligence is refuted, the necessity and modesty of the criminal law regulation of major medical negligence are put forward. The second section mainly introduces the medical negligence punishment. This section selects the status and trend of the two legal systems to represent the criminal legislation of medical negligence in the state and region, systematically reviews the evolution and evolution of the legislation of the medical negligence crime in the history of our country, and the origin and development of the 335th articles in the current criminal law for medical accidents. The third section is mainly aimed at the crime of medical accidents in China in 1997. The empirical analysis of criminal precedents has systematically expounded the predicament faced by legislation and judicature of medical malpractice crime.
The third chapter mainly expounds the causality and responsibility distribution in criminal medical negligence. This chapter focuses on the characteristics of the causality of criminal medical negligence, the judgment of the causality of criminal medical negligence and the influence of medical identification on the medical cause and effect, and the distribution of the criminal responsibility of medical negligence.
The first section expounds the characteristics of the causal relationship between criminal negligence and negligence; the second section expounds the judgment of the causality relationship in criminal medical negligence. It focuses on the "causation condition theory" in the continental law system, the specific application of "the equivalent causality theory" in the criminal medical negligence, and the demonstration of the possibility of the causal relationship in the criminal medical negligence in the criminal medical negligence. The third section expounds the position and function of the criminal medical negligence identification in the determination of causality. It analyzes the main experience of the two major legal systems in the field of criminal medical negligence identification, the causes and difficulties of the two yuan system identification model in China, and puts forward that the judgment of the criminal medical negligence should be based on the identification of medical accidents and the construction of our country punishment actively. The fourth section of "the distribution of criminal liability for medical negligence", based on the theory of dangerous distribution, discusses the permissible legal theory, the theory of risk distribution, the principle of trust, the theory of Supervision Negligence and its application, and provides the appropriate criminal liability for the limitation of medical negligence. Theoretical basis.
The fourth chapter is "the clarification of the boundary of the criminal negligence of the people". This chapter mainly from the two illegal theories of the criminal law and the constituent elements of the 335th medical accident crimes in criminal law, and from the angle of law to discuss the location of the border of the criminal negligence of medical negligence, and put forward a standard for the judgment of criminal responsibility.
The first section focuses on the legal basis of the boundary of the criminal negligence of the people. This article holds that the legal basis of the criminal and civil boundary of the medical negligence lies in the current criminal and civil legislation, and systematically reviews the evolution of the criminal and civil legislation of medical negligence in China and the main differences between the two; the second section expounds the framework of the 335th article of the current criminal law, The division of the boundary of the criminal negligence of the medical negligence is discussed. The boundary of the violation of the facts, the boundary of the illegal act and the boundary of the subjective crime are determined respectively. The third section mainly expounds the boundary of the criminal people of the medical negligence from the economic perspective. The fourth section, which is common in medical negligence, causes death or serious injury in medical negligence, but it should not be summed up and excluded from the case of criminal responsibility.
The fifth chapter "criminal policy of medical negligence, legislation and judicial perfection". This chapter focuses on the investigation of the criminal policy of medical negligence in various countries, and puts forward the Countermeasures of the criminal policy of medical negligence in China, and the suggestions for perfecting the criminal legislation and judicature of medical negligence in China.
The first section introduces the investigation of the criminal policy of medical negligence in various countries. Through the investigation of the criminal policy of the two legal systems representing the country, it is believed that the criminal policy of major medical negligence tends to be severe in the world at present, and the criminal policy of the new medical technology is repeated because of its interest, and the malignant medical disputes in our country are analyzed. The second section about the criminal policy of medical negligence in China. This article agrees that Lester's "best social policy is the best criminal policy". It is proposed that the prevention function of the criminal law should be strengthened, the medical moral order should be rebuilt, the subject of criminal responsibility should be properly expanded and perfected the medical security system, and the medical damage should be perfected. In the third section, we put forward the criminal legislation and judicial suggestions to improve the medical negligence in our country. This article advocates the abolition of the legislative mode of the specific crime, the chapter of "infringing on the rights of citizens, democratic rights", establishing business negligence crime and unifying the criminal law of this kind of crime on the legislative basis, even if it is reserved. Special charges should also be called "crime of major medical negligence", and belong to the chapter "infringement of the personal rights of citizens, democratic rights" and the provision of legal person crime. On the criminal medical negligence identification system, a two level system is proposed to establish a criminal medical appraisal committee under the framework of the Provincial Medical Accident Identification Committee; In violation of the standard of duty of attention, this article advocates the absorption of "the theory of medical treatment", that is, the standard of paying attention to the duty of attention at the level of medical treatment at that time. The amendment of the law should increase the maximum penalty, increase the penalty and the qualification penalty, and the crime should be amended as: "medical staff Yan Zhongwei's anti attention obligation or deviation from the medical standard, leading to the doctor. If a person is dead or seriously injured, he shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention. The preceding paragraph of the unit shall be fined, and the person directly in charge and other persons directly responsible shall be punished in accordance with the preceding paragraph. "
【学位授予单位】：华东政法大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：D924.3

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