医事过失犯罪中的注意义务研究

发布时间：2018-07-22 19:29

【摘要】：注意义务作为过失犯罪中的经典问题,将其置于医事犯罪的语境下进行研究,可以进一步揭示过失犯理论随着科学技术的进步而更迭的共时性。基于此,也可以深入探究过失犯理论与医疗之间的关系。从传统的医学领域来看,如果能够确定因果关系存在于医疗行为和治疗后果之间,那么,医疗过失的存在与否并不难认定。然而,高风险性质的治疗行为在现代医学领域之中运用广泛,其必然的影响是单纯的结果无价值论意义上的旧过失论本身不再能够适应现代医学的要求。而采用新过失论则将对过失的认识转向二元的行为无价值,更有利于鼓励医生履行结果回避义务,尽可能地使用对患者最有利的诊断和治疗手段,最大限度地维护患者的生命健康法益。但是,基于风险社会背景之下的超新过失论,抽象化地处理结果预见义务,并不利于对过失犯罪的认定。本论文的基本观点如下：第一、注意义务从抽象的角度来讲,是指不使得发生有害结果,而使意识集中谨慎行为的义务。过失必须是行为人具备预见可能性,不能是不可预见(unforeseeable)或者是意想不到(unexpected),换句话说,当行为人负有注意义务的时候,违反义务的标准就是指行为人的行为是否在所有情况下都是合理的,行为合理就没有过失可言,这样的判断采纳的是“理性人标准”但是,这个标准在具有专业技术知识领域的场合下,就会转变为“合理专业标准”。因此,囿于现有的技术,而导致无法预料的后果出现,或者属于不可抗力造成的不良后果,都不是注意义务的范围。第二、医术规则存在的目的,不仅仅是作为医师治疗疾病与伤痛的医术指导,更是为了保护病人避免受到不正确或者不正当的医疗行为的损害。因此,医师违反医术规则而进行医疗行为,就意味着医师超越了容许范围的风险而进行医疗行为。换句话说,医师在违背医疗准则的时候,应该对于非容许范围的额外风险具有预见可能性,对于额外风险的预见可能性是论证医疗过失能否成立的关键所在。第三、医疗水准只是一个抽象判断医师注意能力的标准,但是在医疗技术高度专门化的今天,必须考虑到医疗专门化因素。对于专科医师的注意义务标准,不能依照全科医师的注意义务标准,而应该以平均同科的医疗水平作为标准。专科医师对于专科之外的疾病,应该有说明转科就医的义务。第四、在治疗上应当要求医师采取当时医学上以及临床经验上证明具有实效性的措施,这是依照医学上所确保的基准,而这种基准是针对具有平均能力的专业医师所要求的义务,也就是所谓的“一个有经验的专业医师之基准”(Standard eines erfahrenden Facharztes) 本论文的创新之处有如下几点：第一,通过剖析与医事注意义务相关联的案例,将医学上的临床经验与注意义务的相关的各项指标有机结合,以此对具体的涉医疑难刑事案件进行探讨。第二,在不同医疗环境下,细致考量医疗习惯、医学新知、并发症、紧急医疗等一系列问题与注意能力的关系,将注意义务的规定作为规制医事犯罪的刑事策略进行优化,说明医疗行为的注意义务是符合医疗水准的诊疗义务。第三,通过北大法宝、中国裁判文书网、我国台湾地区法源法律网以及日本国会图书馆、美国West-law等成熟的论文与案例数据库,试图立足中国现实生活条件而非简单地顺应世界潮流,以一种“中国语境”的态度破解中国问题。本文拟运用历史考察法、比较分析法、案例分析法等研究方法,结合各国家和地区历年来的疑难事案,通过对法律规范与刑事政策进行有机衔接,落实刑事一体化的研究路径；通过事实发现——理论嵌入——对策提供的论证模式,对医事犯罪中的注意义务作全景敞视式考察。本论文大致分为七个部分：第一部分为绪论,明确问题意识,设定范畴,并给出论文总体进路。第二部分：研究医事过失犯罪的核心是注意义务的界定。在本章中,首先,阐述刑法典中的犯罪过失和刑法理论上的业务过失,对于犯罪过失的理论进行梳理,对业务过失进行理论归纳。明确在因果行为理论的影响之下,认为过失犯的成立只不过是行为与结果之间的因果连结现象而已。也就是说,有谁在因果链条可以表现出来的意义之下引起了社会有害结果的发生,就符合了过失犯的要求。过失犯的成立,是由于行为人没有采取适当的回避法益侵害结果的措施,而违反了注意义务,且行为人对于这种法益侵害的结果具有预见可能性也有回避的可能。更需要说明的是,过失犯的成立还是需要二者之间因果关系链条存在与否的判断。其次,明确医疗行为的定义,探讨医事过失行为能否纳入业务过失的范畴。如果要求行为人对于可能发生一定结果的危险行为具有回避义务,应在其能力范围内使其尽到注意义务,以避免结果的发生。即使其属于从事业务的人员,也不能仅仅因为其具备从事一定业务的身份而不管其具体的注意能力如何,一概对其要求较高的注意义务,从而对其过失加重处罚。最后,结合一些案例,对于医疗行为除罪化的对立观点进行展示,但我国目前并没有医疗行为除罪化的空间。第三部分：在本章之中,对医事注意义务进行了模件化厘定。首先强调注意义务是犯罪过失的核心要素,明确了注意义务的内涵和预见可能性的内容；其次对注意义务的理论演变进程做了一些梳理,说明旧过失论中的注意义务是强调结果预见可能性的实现,而新过失论中的注意义务体现的是结果回避可能性的要求,对于超新过失论中的注意义务来说,更多地强调危惧感这一模糊的概念；复次,对医事注意义务进行整体鸟瞰,说明了医事注意义务的依据有：违反有约束力的规定是违背医事注意义务的标志,对医疗准则的违背亦构成对医事注意义务的违反,现有的医学文献、医学新知作为医事注意义务的基准以及具体的医疗水平、医疗习惯作为医事注意义务的判断基准。第四部分：本章主要阐述医事注意义务的判断基准。主要强调医事注意义务是符合医疗水准的诊疗义务。首先对于遵循医疗水准与承担医事过失犯罪责任的关联进行阐述,其次明确医疗水准的判断标杆是常规诊疗,对于常规诊疗的意义要旨进行了探讨,并着重说明对病情判断以及治疗决定有重要影响的是医师的亲自诊疗义务。探讨遵循医疗准则与承担医事过失犯罪责任之间的关联问题,必须明确的是医疗准则的意义以及医疗准则的征表机能；明确医疗水准的判断标杆是常规诊疗,在这里需要呈现的是犯罪过失中的注意义务判断基准之争论,然后界定医疗行为与犯罪过失责任的评价标准。本章探讨了医师违反亲自诊疗义务是否成立医事过失犯罪的问题,论述了对病情判断以及治疗决定有重要影响的医师亲自诊疗义务,并举出了医师违反亲自诊疗义务而成立刑事过失责任的相关实例。第五部分：本章中对医事过失犯罪进行了类型化考察,探讨了竞合过失类型与监督过失类型这两种过失犯罪类型。并对医疗行为之中的信赖原则进行了探讨,列举了相关案例进行说明。信赖原则的作用更明显地体现在医疗团队内部的责任分担之上,因为分工而形成的信赖是合作的必要前提,分工的依据是医院的内部组织制度和临床病案中的具体约定。根据医疗参与者之间的关系,可以将医疗分工分为水平分工和垂直分工两种模式。在医疗活动中,信赖原则的适用必须受到相当的限制,从而避免其被滥用。在组织医疗之中,在医疗分工者之间适用信赖原则,必须符合一系列的基本条件,可以分别从积极条件到消极条件两个方面加以说明。在本章之中,特别提到了对于医疗团队的误诊与信赖原则之适用问题,以案例为基础对之进行了分析。第六部分：医生的说明和病人的自我决定,可以在医患双方明确无碍的交流中得以实现。然而,在现实的人际互动中,医生应当说明的具体事项和说明的程度,医患双方对于医疗资讯信启、的理解分歧等等,是客观存在而且不容回避的问题。因视角的不同,可以将说明义务的判断标准分为医生标准、患者标准和折中标准三类。医师的裁量权与患者的自我决定权之间也存在紧张关系。医师的裁量权是基于医疗水准的范围之内,不能超出此界限,如果充分尊重自我决定权,那么,患者的一些特别要求就有可能超出医疗水准的范畴,可能会导致一些问题出现。这两者之间的关系可以用“P-E-C模式”进行说明。第七部分为结语,强调衡量和确定医事犯罪中的注意义务需注意的要点。
[Abstract]:The duty of attention, as the classic problem in the negligent crime, is studied in the context of medical crime, which can further reveal the synchronic of the negligent crime theory with the progress of science and technology. Based on this, it can also deeply explore the relationship between the negligent crime theory and the medical treatment.
From the traditional medical field, it is not difficult to identify the existence of medical negligence if the causal relationship exists between the medical behavior and the therapeutic consequences. However, the treatment behavior of high risk nature is widely used in the field of modern medicine, and its inevitable effect is the old result of the value of the axiology. The loss of theory itself is no longer able to adapt to the requirements of modern medicine. And the adoption of the new theory of negligence will turn the cognition of negligence to two yuan, which is more conducive to encouraging doctors to perform the obligation of avoidance, and to use the most favorable diagnosis and treatment means to the patients as far as possible, and to maintain the health benefits of the patient in the most limited manner. In the context of risk society, the theory of supernova negligence is not conducive to the identification of negligent crimes.
The basic views of this paper are as follows:
First, the duty of attention, from an abstract point of view, refers to the obligation not to make harmful results and to make the conscious mind be careful. It must be the perpetrator with a foreseeable possibility, not an unforeseeable (unforeseeable) or an unexpected (unexpected), in other words, when the perpetrator bears the duty of attention, it violates the obligation. The standard means that the behavior of the perpetrator is reasonable in all circumstances, and that the behavior is reasonable without fault. This judgment adopts the "rational standard", but this standard will be transformed into a "reasonable professional standard" in the field of professional knowledge. Unforeseen consequences, or adverse consequences resulting from force majeure, are not the scope of attention obligation.
Second, the purpose of the medical rules is not only as a doctor's medical guidance for the disease and pain, but also to protect the patient from the harm of incorrect or improper medical behavior. Therefore, the physician's violation of the medical rules means that the physician conducts medical treatment beyond the permissible risk and carries out medical treatment. In other words, doctors should have a foreseeable possibility for non permissible additional risks when they are violating medical standards, and the foreseeable possibility of additional risks is the key to proving whether medical negligence can be established.
Third, medical standards are only an abstract criterion for judging physicians' ability to pay attention, but in today's highly specialized medical technology, medical specialization must be taken into consideration. The standard of attention to the duty of care for specialists should not be in accordance with the standard of attention obligation of the general practitioner, but the standard of the medical level of the average department should be taken as a standard. Doctors should have the obligation to transfer medical treatment to diseases outside the specialist.
Fourth, the treatment should require physicians to take measures to prove effective at the time of medical and clinical experience, which is based on a medical basis, which is a duty required by an average professional physician, the so-called "benchmark of an experienced professional physician" (Standard Eines erfahrenden Facharztes)
The innovations of this paper are as follows:
First, through the analysis of the cases associated with the medical attention obligation, the clinical experience of medicine and the related indexes of the duty of attention are combined organically, so as to discuss the specific criminal cases. Second, in different medical environment, careful consideration of medical habits, medical new knowledge, complications, emergency medical treatment, and so on. The relationship between the problem and the ability to pay attention is to optimize the criminal strategy of the duty of attention as the regulation of the medical crime. It shows that the duty of attention of the medical behavior is in accordance with the medical standard of diagnosis and treatment. Third, through the North French treasure, the Chinese referee's document network, the legal net of Taiwan area in China and the Library of Congress of Japan, West-la, USA W and other mature papers and case databases try to solve the Chinese problem with a "Chinese context" attitude, based on China's real living conditions rather than simply adapting to the world trend.
This paper uses historical investigation method, comparative analysis method, case analysis method and other research methods, combining the difficult cases of various countries and regions over the years, through the organic connection between the legal norms and criminal policy, the implementation of the research path of criminal integration; through the fact discovery theory embedded - the demonstration model provided by the countermeasures, to the medical treatment. The duty of care in a crime is examined by panoramic view.
This paper is divided into seven parts:
The first part is the introduction, clarifying the problem consciousness, setting the category, and giving the general route of the thesis.
The second part: the core of the study of medical negligence crime is the definition of the duty of attention. In this chapter, first, it expounds the criminal negligence in criminal code and the business fault in the theory of criminal law, combing the theory of criminal negligence and summarizing the theory of business negligence. It is only a causal link between behavior and result, that is, who has caused the occurrence of harmful social results in the meaning of the causal chain, which conforms to the requirements of the negligent offender. The establishment of a negligent criminal is a measure that the perpetrator does not take appropriate measures to evade the results of the legal interest and violates the result. Against the obligation of attention, and the perpetrator has the foreseeable possibility of the result of the infringement of the legal interest, it is more necessary to explain that the establishment of the negligent crime is still necessary to judge whether the chain of causality exists between the two. Secondly, to define the definition of medical behavior and to discuss whether the negligent behavior of medical care can be incorporated into the business negligence. Category. If the perpetrator is required to have an avoidance obligation to a dangerous act that may result in a certain result, it should be made to the duty of attention within the scope of his ability to avoid the occurrence of the result. Even if it is a person engaged in the business, it can not only be able to be engaged in a certain business, regardless of its specific ability to pay attention. At the same time, it requires a higher duty of attention, thus aggravating the punishment of its negligence. Finally, some cases are combined to show the opposite view of the medical behavior except for the crime, but there is no room for the elimination of the crime in our country at present.
The third part: in this chapter, the duty of paying attention to medical care is defined. First, it emphasizes that the duty of attention is the core element of the criminal negligence, and defines the content of the duty of attention and the content of the foreseeable possibility; secondly, it makes some combs on the evolution process of the duty of attention, which shows that the duty of attention in the old fault theory is emphasized. As a result of the realization of the foreseeable possibility, the duty of attention in the new theory of negligence embodies the requirement of the possibility of avoidance, and more emphasis is placed on the vague concept of the sense of fear for the duty of attention in the supernova's theory of negligence. The stipulation of the binding force is a sign that violates the duty of attention of the medical matter. The violation of the medical standards also constitutes a violation of the duty of care of the medical matter. The existing medical literature, the new knowledge of medicine as the reference of the duty of care of the medical matter and the specific medical level, and the medical habit as the basis for the judgment of the medical attention.
The fourth part: this chapter mainly expounds the judgement datum of the duty of care of medical matter. It mainly emphasizes that the duty of attention of medical care is the duty of diagnosis and treatment which conforms to the standard of medical treatment. First, it expounds the connection between the medical standard and the responsibility of taking on the negligent crime of medical affairs. Secondly, it is clear that the mark of the medical standard is the conventional diagnosis and treatment, and the meaning of the routine diagnosis and treatment. The purpose of this article is to be discussed, and it is emphasized that the doctor's personal diagnosis and treatment obligation is important to the judgment of the disease and the decision of treatment. It is necessary to clarify the significance of the medical standards and the function of the medical standards and the standard of medical treatment. Judging the benchmarking is a routine diagnosis and treatment. Here we need to present a debate on the basis of the duty of attention in the criminal negligence, and then define the evaluation standard of the medical behavior and the responsibility of the criminal negligence. This chapter discusses whether the doctor's breach of the personal diagnosis and treatment obligation is to establish a medical negligence crime, and discusses the judgment of the illness and the decision of the treatment. The physician who has the important influence is personally responsible for the diagnosis and treatment, and cites examples of the establishment of a criminal negligence liability by a physician who violates the obligation of personal diagnosis and treatment.
The fifth part: in this chapter, the medical negligence crime is typed, and two types of negligent crimes are discussed, and the trust principles in the medical behavior are discussed, and the relevant cases are illustrated. The role of trust principle is more evident in the internal medical team. According to the relationship between the medical participants, the division of labor can be divided into two modes: the horizontal division of labor and the vertical division of labor. In the medical activities, the application of the principle of trust is applicable. It must be limited to avoid being abused. In organizing medical care, the principle of reliance among the medical workers must be applied to a series of basic conditions, which can be explained from two aspects of positive and negative conditions. In this chapter, the principle of misdiagnosis and trust of the medical team is particularly mentioned. The problem of application is analyzed on the basis of a case.
The sixth part: the doctor's explanation and the patient's self determination can be realized in the clear and unhindered communication between the doctors and the patient. However, in the actual interpersonal interaction, the doctor should explain the specific items and the extent of the explanation, the medical information letter and the disagreement between the doctors and patients, and so on, are objective and unavoidable questions. According to the different perspectives, the standard of judgment of the obligation can be divided into three categories: the standard of doctors, the standard of the patient and the standard of compromise. There is also tension between the discretion of the physician and the self determination of the patient. The discretion of the physician is based on the scope of medical standards, which can not be overtaken, if the right of self-determination is fully respected, then the right of self determination is fully respected. Some special requirements of the patient may be beyond the level of medical standards and may lead to problems. The relationship between the two can be explained in the "P-E-C model".
The seventh part is the conclusion, emphasizing the key points to be noted in measuring and determining the duty of care in medical crimes.
【学位授予单位】：西南财经大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：D924.3

【参考文献】