论预先指示制度及其在我国的构建

发布时间：2018-05-15 19:56

本文选题：预先指示 + 医事法　；参考：《华东政法大学》2014年硕士论文

【摘要】：在我国，当患者丧失意思能力时，，应当按照谁的意愿来为患者做医疗决定，由谁、根据何种规则来做出此决定，法律都没有明确规定，这造成患者医疗事务的决定权被全然交与家属或医师，患者的自己决定权被“家长制”（paternalism）所淹没。预先指示是有意思能力的患者对自己将来丧失意思能力时的医疗事务做出安排的法律工具。预先指示制度为患者在将来丧失意思能力时仍能主导自己的医疗事务提供了路径，无意思能力患者的自己决定权将依此制度得到最大程度的伸张。预先指示有指令型和代理型两种类型。指令型预先指示直接表达患者的医疗意愿，代理型预先指示则来源于英美法中的持久授权制度。指令型预先指示与代理型预先指示各有利弊，因此以二者同时使用为宜。生前预嘱是一种以临终医疗决策为内容的指令型预先指示，其体现了尊严死的法理。患者自己决定权与主体同一性原理是预先指示制度的理论基础。患者自己决定权涉及了医学伦理中的允许原则与尊重自主原则以及知情同意原则。对于主体是否同一，出现了“黑盒子”理论与“陌生人”理论的否定见解，需要对此进行澄清，并肯定主体同一性原理。患者预先指示发源于美国，并已经成为了一项较成熟的法律制度。克鲁赞诉密苏里卫生部长案使得预先指示受到了全美国的关注，并促使美国通过了《患者自己决定法》。针对各州关于预先指示规定的不统一性，美国统一州法律委员全国会议通过了《统一医疗决定法》。随后，预先指示波及欧洲国家，英国的《意思能力法》对此有专门的规定，《德国民法典》、《奥地利普通民法典》、《瑞士民法典》也于近年将患者预先指示制度明确纳入其中。德国在2010年出现了该国首个确认预先指示的法律效力的判决。构建预先指示制度对维护我国患者自己决定权、处理无意思能力患者的医疗事务具有重大意义。我国《精神卫生法》及新修订的《老年人权益保护法》的颁布，北京生前预嘱推广协会的成立及北京老年医院等多家医院对生前预嘱的试点，为我国建立预先指示制度提供了现实条件。预先指示制度的具体构建包括预先指示的做成、生效和效力、撤销、保存、侵权责任等方面，涉及以下内容：预先指示的主体、见证人、形式、内容；已有效做成的预先指示于何时开始生效，已生效的预先指示对医师和医疗代理人产生何种效力；预先指示在哪些情况下可以被患者本人撤销；预先指示的保存制度，特别是登记制度；预先指示所涉及的侵权责任问题。
[Abstract]:In our country , when the patient loses the ability , the patient should be determined according to who wishes to make medical decisions for the patient , who , according to the rules to make this decision , the law does not specify , this causes the patient ' s medical affairs decision right to be completely delivered to the family or the doctor , the patient ' s own discretion is covered by " paternalism " . In advance , the system provides the path for the patient to lead his medical affairs when he loses the meaning ability in the future . The self - determination of the patient with no meaning will be extended to the maximum extent according to the system .

There are two types of instruction type and agency type . The instruction type preindicates the patient ' s medical intention directly , and the agent type of pre - instruction comes from the persistent authorization system in Anglo - American law .

In 2010 , the German Civil Code , the Austrian Common Civil Code , and the Swiss Civil Code , have clearly incorporated the pre - instruction system in the country . Germany emerged in 2010 the country ' s first judgement in the country ' s first confirmation of legal effects .

In order to establish a pre - directed system , we have provided realistic conditions for the establishment of the pre - instruction system in China , including the main subject , witness , form and content , which are pre - indicated , effective and effective , withdrawal , preservation and tort liability .
a pre - directed indication of when the entry into force of the medical agent has been effectively made and what effect has been made in advance of the physician and the medical agent ;
pre - indicate which cases may be revoked by the patient himself ;
Pre - directed preservation systems , in particular the registration system ;
Pre - indicate the question of tort liability involved .

【学位授予单位】：华东政法大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D923;D922.16

【参考文献】