法学博士毕业论文：《输血感染民事责任研究》

发布时间：2017-07-17 16:48

中文摘要
由于本文关注的主要是实践中关于输血感染病毒而产生的诸多较为棘手的问题，并试图为这些问题的解决提供体系化的解决方案，因此，本文的论述将从实践中所遇到的问题展开，层层深入，剖析其法理，并结合社会政策、法经济学、医学技术和伦理方面等方面，以期建立起较为完备的关于输血感染病毒的责任体系。
遵循上述思路，本文首先在引言中介绍了实践中因输血行为感染病毒而产生的种种难以解决的问题，因为输血是严重疾病最直接有效的救治手段(尤其是很多的血液疾病)，医院临床上需要的血液愈来愈多。可是，输血具有较大的危险性。因此，本身输血行为就存在无法避免的危险因素，如病人对所输血液的排异情况和因输血所引起的并发症等。另外，输血的危险性还在于输血极易造成病人被感染严重疾病。因此如何去预防的关键就在于，最初输入病人体内的血液，一定要通过采集血液、检验、分离、加工、包装等等使用前的检验、使用时应当认真审核。此程序中的所有环节一个都不允许出现纰漏，以及受医学标准的限制(如很多疾病尚处于窗口期无法被医疗试剂检测出来)，这些都可能造成血液被感染严重的病菌，这种血液一旦输入进病人身体就立刻会被感染很严重的疾病，甚至无法被治愈。并以此为切入点，提出本文拟研究的问题、国内外关于此问题的研究现状以及本文的研究方法和写作框架。由于输血受到传染的疾病，比如甲、乙、丙肝、梅毒、艾滋病等等，通常都存在严重威胁病人的健康生命且无法完全被治愈有的也会涉及到生命安全并存在传染性的特征。病人在医院输血的过程中，原本只是为了治疗自身所患的疾病，如果输血被感染，就一定会造成受害者的愤怒情绪继而无穷无尽追究医院的责任以及索赔纷争。这类纠纷会牵涉到医学、法学等多层面的问题。人们对这些案件的定性为民事纠纷、打官司、责任方、归责标准、索赔金额等，缺乏一致的共识，学术界对血液的法律认识(能否作为产品)、供血的有偿无偿等因素也缺乏基本一致的论证。笔者对其作出具体的讨论，有待今后发生输血感染案件时，病人申诉有门、法院断之有据。
在此基础上，本文首先运用比较法的方法，在这一章首先分析了血液与血液制品区分的法律意义，为了使因输血受到感染的患者可以尽早的获得治疗和救济，血站、医疗单位可以继续保持其自身的日常工作秩序，维护社会的稳定，一定要详细研究分配输血造成感染的法律追究，实现公正、公平以及公开。而法律分配的责任前提条件是清晰认定血液制剂和血液的法律定义，即血液制剂和血液能否作为“产品”。这涉及到适用法律的选择标准。若是血液制剂与血液符合“产品”属性，则血站变成了“产品”的“经营者”，医疗单位变成了“产品”的“销售者”，根据我国的法律，可应用《消费者权益保护法》以及《中华人民共和国产品质量法》等相关产品责任的规定。若是血液制品和血液不属于“产品”，因输血而造成病人感染疾病的定义为对病人健康生命权利的侵害，医疗单位与血站一定要承担主要的侵权责任。在规定血液制品以及血液能否作为“产品”之前，我们需要先从它们之间的因果关系进行分析。首先应予清楚的是血液制品与血液是不同的两个观念。血液包含了免疫球蛋白(液体成分)、血球(有形成分)和血清组成，文章中指用于临床的成分血、全血和用于生产血液制品的血浆原料。血液制品属于特殊的血浆蛋白制品。血液制品与血液在管理到生产再到经营等许多方面具有诸多不同之处。接着讨论了血液制品的法律属性，从血液制品以及血液的不同观点能够看出，两者之间是截然相反的观念。法律所规定的血液制品，视为产品的范围。大部分的国家像德国、日本、法国在其血液制品相关的法律规定中均同意血液制品作为“产品”的范畴，应适用《产品责任法》和《制造物责任法》 。血液制品的属性是产品，而血液的属性是不是产品，笔者觉得，认定的重点在于血液是不是适合产品的组成要件，假设适合产品的组成要件，血液必然属于产品的范畴：若是不适合产品的组成要件，那么血液应当不属于产品范畴。笔者觉得，可以把产品的组合要件归结为如下几点：一为动产；二为利用制作与加工：三为存在流通性。是不是以盈利为手段(即用于销售)，排除在产品的认定范围之外。而经过医院和血站加工后的血液通过病人的等价交换变成了产品。然后介绍了输血感染民事责任的现状。这主要是因为这一问题的研究在一些域外立法、理论以及实践中已经进行得较为深入，探讨此现状，有助于对此问题进行深入的理解，也可以知晓输血感染民事责任主要存在三种形式：产品责任、合同责任以及一般侵权责任。
第三章是将输血感染所致民事责任的性质认定为产品责任。遵循这样的思路，本文首先分析了是否应当将输血感染民事责任认定为一种产品责任，或者只应当将一部分输血感染民事责任认定为一种产品责任，以及这种认定的原因。这里面可能涉及很多问题，例如血液是否构成产品、损害是否因输血造成（血液制品是否存在缺陷）、输血行为产品责任主体是医院还是血站等，还要探讨如果输血行为构成产品责任法律后果，以及这种法律后果在实践中是否是合适的。
本文在第四章接着探讨是否应当将输血感染民事责任认定为一种一般侵权责任，或者只应当将一部分输血感染民事责任认定为一种一般侵权责任，以及这种认定的原因。这里面也涉及很多问题，首先是归责原则的问题，学术间存在很多争议，过错责任，无过错责任与公平责任标准。本文认为确定了血站应对其提供的血液给患者造成的感染承担侵权的损害赔偿责任之后，我们通过比较再来看一看血站承担责任的归责标准是什么。血液是产品，血站承担的是产品责任，而血站的产品责任又是产品的侵权责任。在侵权责任体系中，医院在输血感染中承担的责任归责原则应当是依无过错致使感染输血侵权责任的归责认定。而笔者建议，病人承担责任应符合过错责任的归责标准，即病人仅对因自已的过错产生的损害结果负全部的责任；若是病人对损害结果不具有过错，就不需要独自承担责任。至于病人的主观过错，笔者觉得，应当实施举证责任倒置标准，病人不要求其证明其主观上是不是具有过错，由医疗单位和血站进行举证证明病人的过错。若是血站与医疗单位无法证明输血感染是由于病人的主观过错所导致的，病人就不需要承担责任。因为基于病人对专业的医疗知识非常欠缺和了解，所以当病人身患疾病迫切等待救治的危险处境下，病人是不可能对其以前身体的全部症状清清楚楚的一一讲述，当中肯定会有遗漏之处。而医师却可以对病人的临床症状有所了解及把握。刑法理论上，被告人以及犯罪嫌疑人不需要证明自己是否实施犯罪；公诉单位以及原告人一定要可以证明被告人或者犯罪嫌疑人是有罪的，若是其无法举证对方有罪．则法院会判定被告人以及犯罪嫌疑人无罪。医院单位、血站和病人，就等同于血液产品的“销售者”、“生产者”以及“消费者”。因此，在血站、医院和病人三者之间的法律义务是如何来区分的呢?根据《民法通则》的规定，一方对给他方所导致的损失有过错的，必须由有过错一方赔偿受害方的全部损失：双方对产生的损失都存在过错的，则应按其实际的过错大小共同分摊损失。假设医院单位、血站与病人三者中，有一方对输血感染有过失，则由该方独自承担损害结果：若是三者中的两者有过失，则应由该二者按其过错的认定标准共同分摊损失：若是三方都存在过错，则由三方根据过错的认定标准共同分摊损失；若是三方都没有过失，应基于公平范围内由三方承担一部分的责任。笔者认为，尽管供血者、血头对病人感染负有责任，可是，法律上不应将其列入病人的追究范围之中，也即，病人因输血受到感染后，不能要求血头以及献血者承担损害赔偿责任。理由在于：首先，病人无法得知供血者的具体信息。献血者卖血时都会在血站留下相关的记录，但因各种原因，此等记录有可能是捏造的甚至已被遗失，就算血站留有这些信息资料(血站应当把这些信息资料储存10年)，病人也无法取得，更无法得知供血者的详细情况。另外，献血者通常都家境不济，因生活贫穷所迫才去卖血。就算病人可以找到献血者，献血者也完全没有经济实力独自承担赔偿损害的责任。而且，我国目前大量的献血昔都被血头有组织的带领着，想要寻找血头，绝非易事。就算最终找到血头，因其常常拥有一定的黑社会性质，病人处于弱势群体，根本无法与之理论。鉴于具有以上诸多困难，笔者建议应把献血者、血头清除在法律赔偿损害范围之外。若是确因献血者原因导致病人感染．可推定血站存在过失，由血站对病人承担责任。血站在采供血关系中，存在一系列责任，如为献血者提供所有安全、便利与卫生的设施：血站在采血自口一定要对供血者依照健康检查标准实施身体检查：并且血站应当审核供血者的信息，不允许接受冒名顶替者的血液，不允许采集过量的血液、以及频繁采集血液；最后．血站还应对采集到的血液实施严格的病菌抗体检测，并使用严格的化学药剂和检测仪器对血液通过分离、加工与制作、储存和包装。血站如果采集了不合格的血液没有及时检测出来，造成病人感染，则表示血站存在过错，则必须让血站承担全部的赔偿损害责任。血头、献血者不需要对病人承担损害赔偿的法律责任。血站、医院和卫生行政主管部门应当提高对血液质量的监管机制，坚决不允许私自采购非法的血源，提高对血液的检测标准和严格的法律规定；公安单位、检察单位应及时打击违法供血活动的发生：若是由于供血者、血头造成严重的血源性感染时，司法单位应追究其有关的所有刑事责任。此外本文还探讨了输血感染病毒是否构成损害、是否必须采取过错责任作为归责原则、以及因果关系的认定等问题，还需要探讨，将输血感染病毒责任认定为一般侵权责任的利弊，以及在实践中是否合适。
同样地，本文在第五章探讨是否应当将输血感染民事责任认定为一种违约责任，或者只应当将一部分输血感染民事责任认定为一种违约责任，以及这种认定的原因。在患者向医疗机构就诊的过程当中，双方达成了一种默认的医患合约。这份契约合同拥有以下诸多特征：实际上医患之间是具有合法地位的契约形式。医院要求患者在医院挂号就诊，便形成了契约；医疗部门根据患者的要求对其进行治疗的做法，是一种双方都默认的承诺，故此双方相互公平的医疗服务合同关系的成立。此外，就彼此之间的合同来说，医疗机构提供给患者可靠及安全的服务诊疗，输血的行为应当属于治疗行为的一部分，而病人也因此给予了一定的经济付出。在病人接受输血的过程之中，医疗部门如果给患者注射了被细菌感染或是受到污染的血液，从而造成病人输血感染的后果，事实上是医疗机构若是不能严格遵守合同规章，则必须承担一切的违约后果。因而，输血感染的矛盾可以通过《合同法》进行适当的调整。笔者觉得，医疗输血行为是应用于医患之间的一种极为普遍的手段，因为这种举措能够在医患之间有效促进医疗服务合同并无不同的态度，不过笔者并不主张患者因输血感染损害赔偿依据契约合同的性质从而提起诉讼的请求，利用合同法调整两者之间的关系会使患者与医疗机构之间导致负面的影响。违约责任的赔偿认定也极大的限制了患者损害请求权的展开。违约的赔偿认定仅限于物质的损害赔偿范围，也就是说，只有部分可以合理预见的损失财产才可以由违约方承担相关的赔偿。而由于医务工作人员的过错所致使的患者输血感染或者在治疗过程中的附加损害等，最主要的还是受害人的身体和精神上的巨大痛苦，不仅仅是物质上的损失，这不可以构成违约赔偿的条件，固然，如果以违约提起输血感染诉讼，赔偿责任一般认定难度较大。违约责任符合严格责任的规定，它的赔偿范围很小，即便是患者可以得到些许的赔偿，但是却无法补偿受害者遭受的损失，这些无疑是对受害人极为不公平。
最后，本文在以上几章讨论的基础上，综合社会政策、法经济学考虑、医学技术和伦理方面的考虑，为我国立法对于此问题的应然选择做出体系化构建。现行立法方面因无过错输血感染疾病的案件的产生，，侵害了病人的身体健康，也提高了病人的经济压力。由于缺乏具体统一的法律法规对该案件予以规范，导致各地的法院判决结果不尽相同，因此造成医患之间的纠纷日益恶化。我国当前针对解决无过错输血感染的法律尽管颁布了《侵权责任法》，但是该法律对输血问题的规定并不充分，无法有效应用于目前医疗损害赔偿案件的审判标准。国家需要尽早出台相应的司法解释，对于无过错输血感染侵权损害赔偿适用无过错责任原则予以具体的规定。同时，应建立规范的输血感染社会保障制度，完善有关的法律法规，使输血的危险在社会范围内分担，以有效保护病人、血站及医疗单位的合法权益。社会政策方面建议建立医疗责任保险制度、严格执行采血供血全面检测和用血安全制度、建立政府无过错输血感染补偿基金、完善输血医疗机构相关管理制度、并进行医学技术和伦理方面的考虑，比如预防输血感染的技术措施、输血感染后的救济。更重要的是我国立法的应然选择，完善输血感染相关立法，建立输血及使用血液制品感染艾滋病病毒及病毒性肝炎患者的法律诉讼维权“绿色通道”、 将流行病学数据作为确定被告方责任的重要证据、国家的救助不能代替侵权人赔偿责任、医疗费的赔付方式及标准应以立法的形式做出规定、应该就感染艾滋病患者是否应获得残疾赔偿金及死亡补偿费应作出规定等。还要建立输血保险体系。
关键词：输血；感染；侵权；产品责任；违约；归责

Abstract
Due to the focus of this article is mainly of blood transfusion infection and produce practice more difficult problems, and tries to provide the solution of these problems systematic solution, therefore, this article discusses the problem from practice, layer upon layer, analyzes its legal theory, and combining the method of social policy, economics, medical technology and ethical aspects and so on, in order to establish a relatively complete system of liability for blood transfusion infected with the virus.
Following the above ideas, this article first introduces the practice in the introduction of infection due to blood transfusion behavior and produce a variety of difficult to solve the problem, because blood transfusion is the most direct and effective means of treatment for severe disease (especially a lot of blood diseases), blood more and more hospital clinical need. However, blood transfusion has great risk. Behavior itself, therefore, blood transfusion is unable to avoid risk factors, such as the patient to lose blood rejection and complications caused by blood transfusion, etc. In addition, the risk of blood transfusion is a blood transfusion easily cause infected patients with serious diseases. So the key lies in how to prevent, first enter the patient's blood, must through the blood collected, inspection, separation, processing, packing and so on use before the test, when using should carefully examine and verify. This program all the links in a are not allowed to slip, and restricted by medical standards (e.g., a lot of disease is still in the window cannot be detected medical reagent), might be caused by serious pathogen infected blood, the blood once and immediately enter into the patient's body will infection is very serious, even can't be cured. As the breakthrough point, this paper puts forward the paper studies the problem of domestic and foreign research on this problem, present situation and research methods of this article and writing framework. Due to blood transfusion of contagious diseases, such as a, b, hepatitis c, syphilis, AIDS and so on, usually there is a serious threat to the life of the patient's health and cannot be cured some will also involve the safety of life and the existence of infectious characteristics. In the process of hospital blood transfusion patients, and was to treat their illness, if infected blood transfusion, will cause the victim's anger and endless responsibility shall be investigated for hospitals and claims disputes. Such disputes will involve the multifaceted issues such as law, medicine,. For the cases of civil disputes, lawsuits, responsibility, imputation criteria, claim amount, etc., the lack of consensus, academic understanding of the laws of the blood (whether as a product) and blood in paid for free also lack basic consistent. The author makes a concrete discussion to it, in case of in the future of blood transfusion infection, the patients can complaint, and the court can judge it.

On this basis, this article first USES the method of comparative law in this chapter first analyzes the legal significance of blood and blood products to distinguish, in order to make the due to blood transfusion infected patients can access to treatment and relief as soon as possible, blood stations and medical units can continue to maintain its own daily work order, maintaining the social stability, distribution of blood transfusion infection must be detailed research of the criminal law, justice, fair and open. The legal responsibility assigned premise condition is clear that blood products and the legal definition of blood, blood or blood products and can be as a "product". It involves the choice of applicable law standard. If blood products and blood conforms to the "product" attribute, the blood stations into a "product" of "operator", medical units into a "product" of the "seller", according to the law of our country, can be used "consumer rights and interests protects a law" and "product quality law of the People's Republic of China" and other relevant regulations of the product liability. If the blood, and blood does not belong to the "products", the definition of patients due to blood transfusion infection disease for violation of the right to life, to the patient health medical units and blood stations must bear the main tort liability. Whether in blood and blood as a "product" before, we need to start with the causal relationship between them is analyzed. First of all should be clear that the blood and the blood are two different concepts. Blood contains immunoglobulin (liquid), blood (visible part) and serum, the article element of middle finger used for clinical blood, whole blood and plasma raw material for production of blood products. Blood products belong to special plasma protein products. Blood and blood in many aspects such as the management to the production and operation have many differences. Then discussed the legal attribute of blood products, from the blood and different point of view to see the blood, is opposite between ideas. The blood products stipulated in the law, as the range of products. Most countries like Germany, Japan, France, in their blood products related laws and regulations agreed to blood products as "products" category, shall apply to the product liability act and the manufacturing material liability act. Blood products attribute is the product, and properties of the blood products, the author think, that is focused on the blood isn't suitable for products of major constituents, hypothesis is suitable for products of major constituents, blood must belong to the category of product: if you are not suited to the product composition elements, then blood should not belong to the category of products. I think, can you have your product combination of elements due to the following points: one is personal property; Secondly, using the production and processing: there are three for liquidity. Whether by means of profit (for sale), excluded from the cognizance of the product. And after hospitals and blood Banks and processing of blood through the patient's equivalent exchange into products. Then this paper introduces the present situation of blood transfusion infection civil liability. This is mainly because the research of this problem in some extraterritorial legislation, theory and practice has been more thorough, discusses the status quo, contribute to an understanding of the problem in-depth, also can know blood transfusion infection civil liability mainly exists in three forms: product liability, contractual liability and general tort liability.

The third chapter is the blood transfusion infection caused by the nature of civil liability of product liability. Whether follows the train of thought, this paper first analyzes the blood transfusion infection civil liability shall be regarded as a kind of product liability, or only a part of blood transfusion infection civil liability shall be regarded as a kind of product liability, and the cause of that. If it might involve many problems, such as blood products, whether the damage caused by blood transfusion (whether there is defect of blood products), blood transfusion is product liability subject hospital or blood stations, etc., to discuss product liability legal consequences if the act constitutes a blood transfusion, and this is the right legal consequences in practice.
In the fourth chapter in this paper then discusses whether the blood transfusion infection civil liability shall be regarded as a kind of general tort liability, or only a part of blood transfusion infection civil liability shall be regarded as a kind of general tort liability, and the cause of that. It also involves a lot of problems, first is the problem of imputation principle, there are a lot of disputes between the academic, fault liability and no-fault liability and fair liability standard. This paper argues that determines the blood stations shall be provided to patients blood infection caused by damages of tort liability, and through the comparison we take a look at what is blood stations responsibility imputation criteria. Blood is the product, is the product liability blood stations, and the product liability of blood stations is product tort liability. In tort liability system, the hospital in the blood transfusion infection of responsibility imputation principles should be in accordance with the no-fault causes blood transfusion infection tort liability imputation. Responsibility and the author suggested that the patient should comply with the fault liability imputation criteria, namely the patient only for their own fault of harmful consequences to bear full responsibility; If the patient does not have the result of the damage fault, don't need to take responsibility alone.
As for the patient's subjective fault, the author think, should implement standard of onus probandi inversion, the patient is not to prove its subjective fault, by medical treatment units and blood stations to carry on the proof to prove the patient's fault. If you can't prove blood stations and medical units blood transfusion infection is caused by the patient's subjective fault, patients do not need to assume responsibility. Because it is based on the patient to professional medical knowledge and lack of understanding, so when a patient with a rare disease called urgently waiting for the treatment of dangerous situation, the patient is not possible for the whole body before symptoms clear about one by one, there will certainly be omissions. And the physician is can to understand the patient's clinical symptoms and grasp. The criminal law theory, and whether the suspect does not need to prove the defendant committing crimes; Public prosecution unit and the plaintiff must prove the defendant or a criminal suspect is guilty, if you can't show the guilty. The court will decide the defendant and the suspect not guilty. Hospital unit, blood stations and patients, as blood products "seller", "producer" and "customers". Therefore, in the blood stations and the legal obligations between hospitals and patients is how to distinguish? According to the general principles of the civil law "regulation, on the other party to the other party has fault, the loss that causes must be have the fault of one party to compensate all loss of injured party: loss of both parties at fault, should according to its actual fault size together share the loss. Assuming that the hospital unit, blood stations and patients of the three, one party has negligence to the blood transfusion infection, is borne by the party alone harmful consequences: if our faults, two of the three should be from the both according to the standard of fault, to contribute ratably to the loss in common: if the three parties are at fault, by three parties according to the standard of fault, to contribute ratably to the loss in common; If the three parties have no fault, should be based on fair by the three parties within the scope of responsibility for the part. The author thinks that, although the blood flow, blood infection to the patient responsible for, however, the law should not be included in the investigated range of patients, namely, patients infected by blood transfusion, cannot ask head and blood donors be liable for damages. The reason is: first, the patient not privy to the details of the donor. Selling blood donors in relevant records in blood stations, but for various reasons, these records may be fabricated has been lost, even if blood stations with this information (blood stations shall store this information with 10 years), patients cannot obtain, more not privy to the details of the donor. In addition, blood donors are usually family circumstances, because of the poor are forced to sell blood. Even if the patient can find blood donors, blood donors also have no economic strength alone bear the liability for compensation for the damage. And, at present a lot of blood donation blood yesterday were first organized led, want to look for blood, is not easy. Even if finally found blood head, because of its often have some underworld property, patients in the vulnerable groups, cannot with the theory. In view of the above has many difficulties, the author suggest remove blood donors, blood head should be outside the scope of legal compensation for damage. If because of blood infection causes. Truly presumption can be blood stations exist faults by blood stations shall undertake liability for the patient. Blood stations in CaiGongXie relations, there is a series of responsibility, such as for the blood donors to provide all the safety, convenience and sanitation facilities: blood stations in pursuance of the mouth must implement physical examination for blood donor in accordance with the health inspection standards, and blood on blood stations shall audit information, are not allowed to accept imposter blood, not allowed to collect too much blood, and frequent blood collected; Finally. Blood stations also collected in dealing with strict blood virus antibody detection, and use of chemical reagents and strict testing instrument of blood through separation, processing and production, storage and packaging. Blood stations if collected unqualified blood wasn't detected in time, cause patient infection, said blood stations at fault, then you must let blood stations take full damage liability to pay compensation. Head, blood donors do not need to be liable for damages to the patient's legal responsibility. Blood stations, hospitals and the health administrative departments should improve the supervision mechanism of the blood quality, resolute don't allow to purchase illegal blood source, increase the blood test standard and strict laws and regulations; Public security units, prosecution should be timely to crack down on illegal blood activities happened: if caused by a blood donor, head of serious blood-borne infections, judicial unit should all the criminal responsibility shall be investigated for the relevant. In addition this paper also discusses whether the blood transfusion infection constitutes damage, whether must take fault liability as the imputation principle, and the cognizance of causality, also need to be examined, the blood transfusion infection responsibility as the pros and cons of general tort liability, and whether it is proper in practice.

Similarly, in this paper, in the fifth chapter discusses whether the blood transfusion infection civil liability shall be recognized as a liability for breach of contract, or only a part of blood transfusion infection civil liability shall be recognized as a liability for breach of contract, and the cause of that. In the process of patient visits to medical institutions, the two sides forming doctor-patient contract contract. The contract has some characteristics as follows: first, doctor-patient contract main body of the two sides are on an equal status. In addition, the patient medical units in attendance register actively, produce the offer; Medical units in accordance with the requirements of the patient to the diagnosis and treatment of behavior, amounts to a promise, so the equality of medical service contract relationship between both sides. Secondly, in terms of both sides of the content of the contract, medical units to provide safe and reliable medical services to patients, blood transfusions nature is a part of the activities of the diagnosis and treatment, and others pay the price. In clinic blood transfusion in patients with stage, medical treatment unit for patient input contains bacteria and virus pollution lead to blood transfusion infection, is actually a medical treatment unit not enforce the contract and shall bear the liability for breach of contract. So, blood transfusion infection dispute "contract law" to be able to apply to adjust. The author thinks that, blood transfusion service as a common behavior of medical service, based on the service between doctor and patient can form the medical service contract, there is no opposition, but I don't agree with the patient's blood transfusion infection for damages in accordance with the contract filed, and by the law of contract law to adjust the relationship of patients and medical units have negative influence on both sides. Scope of liability for breach of contract damages restricted the patient damage to the exercise of the right of claim. Default compensation standard is limited to property damage compensation, in other words, only those who can reasonably foreseeable damage to property can be carried out by the breaching party compensation. And because of the medical staff caused by the fault of the patients' blood transfusion infection, and other accidental damage, in the treatment of phase is the key physical and psychological pain, rather than physical abuse, this does not apply to the compensation of default category, therefore, if the default bringing the blood transfusion infection, the liability for compensation is more difficult. Liability for breach of contract as a kind of strict liability, it damages the space is lesser, even if the patient can get part of the compensation, cannot make up for the loss of the patient all, this is very adverse to the patient.

Finally, the article discussed in the above chapters, on the basis of comprehensive social policy, economics, medical technology and ethical considerations, for our country legislation to make systematic construction should be the choice of this problem. Current legislation because there was no fault of blood transfusion infection cases, against the patient's health, and improve the economic pressure of the patient. Due to lack of specific laws and regulations in the case of uniform standard, lead to court rulings across different, thus causing disputes between doctor and patient are getting worse. The current law to solve no-fault blood transfusion infection despite enacted the tort liability act, but the regulation of the legal problems of blood transfusion is not fully, cannot be effectively applied to the medical damage compensation cases judgment standard. Countries need to introduce the corresponding judicial interpretation as soon as possible, for no fault of blood transfusion infection tort damages no-fault liability principle to specific provisions shall be applicable. At the same time, should establish standard of blood transfusion infection of the social security system, perfecting the relevant laws and regulations, make share the risk of blood transfusion in the social scale, to effectively protect the legitimate rights and interests of patients, blood stations and medical units. Social policy Suggestions to set up the medical liability insurance system, strictly implement the system of blood supply of blood comprehensive detection, and safety in blood, to set up the compensation fund government no-fault blood transfusion infection, improve the system of transfusion related to management of medical institutions, and medical technology and ethical considerations, such as technical measures to prevent blood transfusion infection, blood transfusion infection after relief. More important is to should be the choice of legislation in our country, perfect the relevant legislation of blood transfusion infection, blood transfusion and use of blood products infected with HIV and viral hepatitis patients' legal rights protection "green channel", the epidemiological data as an important evidence to determine the defendant liability, the state aid does not take the place of the infringer liability to pay compensation, medical treatment compensation methods and standards shall be made in the form of legislation regulation, should be infected HIV/AIDS patients should get the disability compensation and compensation for death should make provision. Must build transfusion insurance system.
Key words: blood transfusion; Infection; Infringement; Product liability; Breach of contract; imputation

目  录
中文摘要 错误！未定义书签。
ABSTRACT VII
引  言 1
一、研究背景与意义 1
（一）输血感染的高发率 1
（二）国内外有关立法对此问题的应对 2
（三）上述立法所引发的法律问题 11
二、国内外研究现状 12
三、研究方法 16
（一）比较法研究的方法 16
（二）历史研究的方法 16
（三）类型化研究的方法 16
四、写作框架 16
第一章 输血感染民事责任理论概述 18
第一节 血液与血液制品区分的法律意义 19
一、生产者和经营者不同 19
二、是否属于药品的范围不同 20
三、是否能够独立承担民事责任不同 20
四、生产过程不同 20
五、导致感染时所造成的危害后果不同 20
第二节 血液制品的法律属性 21
第三节 血液的法律属性 22
一、各国关于产品的规定 22
二、我国存在的争论 22
三、本文的观点 24
四、血液的特殊性 26
第四节 输血感染的含义和原因 27
一、输血感染的定义 27
二、感染输血的原因 28
三、输血感染的分类 29
四、输血感染的危害 29
第五节 输血行为的法律属性界定：产品提供与服务提供 30
第二章 输血行为产品责任分析 34
第一节 输血行为产品责任构成要件分析 35
一、血液构成产品 35
二、损害是否因输血造成（血液制品是否存在缺陷） 35
三、输血行为产品责任主体 37
第二节 输血行为构成产品责任法律后果分析 52
一、输血行为产品责任概述 52
二、民事责任的构成要件 55
三、民事责任的赔偿范围 55
四、民事责任的赔偿原则 57
五、赔偿项目和赔偿标准 58
六、争议解决途径 59
七、注意问题 60
第三节 学者观点和法院判决 61
第三章 输血行为侵权责任分析 70
第一节 输血感染侵权责任的归责原则 71
一、关于输血感染侵权责任的归责原则的争论 71
二、血站侵权责任的归责原则 72
三、医院的归责原则 74
四、患者的过错责任 76
五、血站责任、医院责任和患者责任的关系 77
六、供血者、血头的责任 80
第二节 输血行为侵权责任构成要件分析 82
一、医院和血站的违法行为 82
二、损害事实 83
三、因果联系 86
四、过错 88
第三节 输血感染侵权损害赔偿责任主体89
一、输血感染侵权损害赔偿责任主体类型 89
二、患者请求权的选择问题 92
三、医院和血站的免责 95
第四节 输血感染侵权损害举证责任 97
一、举证责任的含义 97
二、我国输血感染纠纷举证责任倒置的应用及举证范围的划分 98
第五节 输血感染侵权损害赔偿范围 100
一、确立输血感染人身伤害损害赔偿的必要性 100
二、输血感染侵权损害赔偿范围和数额的限定规则 101
三、输血感染人身损害赔偿的范围 102
第六节 输血行为认定为一般侵权责任利弊分析 105
一、利 105
二、弊 106
第四章 输血行为违约责任分析 107
第一节 输血行为违约形态分析 107
一、当事人关系 107
二、前提条件 108
三、合同法下的严格责任是否适用血液感染 109
四、政策上的理由比较中国与美国现行法优劣 113
第二节 输血行为违约责任法律后果分析 116
第五章 我国输血感染民事责任制度构建 117
第一节 我国现行立法相关规定 117
第二节 社会政策考虑 117
一、建立医疗责任保险制度 117
二、严格执行采供血全面检测和用血安全制度 119
三、建立政府无过错输血感染补偿基金的建议 120
四、完善输血医疗机构相关管理制度 121
第三节 医学技术和伦理方面的考虑 131
一、预防输血感染的技术措施 131
二、输血感染后的救济 132
第四节 我国立法应然选择 133
一、完善输血感染相关立法 133
二、建立输血保险体系 140
结  语 141
参考文献 144
 
引  言

一、研究背景与意义
（一）输血感染的高发率
血液作为人体的重要组成部分，也被称为“生命之水”，被广泛应用于医疗活动之中。随着医疗技术的不断提升，临床用血量不断增大，血液制品的种类不断增加，因输血而感染病毒（如丙肝、艾滋病等）的情况层出不穷。输血感染是指患者在医疗过程当中被输入了带有病毒或者细菌（诸如艾滋病，各种病毒性肝炎，败血症，痢疾，肺结核，梅毒等传染性病毒或者细菌）的血液或者血制品，给身体带来了巨大的损害。实践中出现比较多的就是病毒性肝炎和艾滋病的传播。卫生部1993年8月《关于进一步加强当前肝炎防治工作的通知》指出当时中国丙型肝炎感染严重。根据调查表明：血站和单采血浆站、血库、医疗是造成丙型肝炎流行的高危单位；供血、输血、静脉吸毒、经常静脉注射的人群等为高危人群，一旦感染和发生病毒性肝炎，极其可能导致慢性肝炎、肝硬化、肝癌等严重后果。目前全世界公认的艾滋病传播途径是：性接触、血液传播、母-婴传播。世界上艾滋病传播的主要途径是性传播，但是输血感染也越来越多，因该说人类从认识艾滋病病毒一开始，就已经认识到了艾滋病病毒可以通过血液和血液制品传播的这一特点。截止2007年10月底，累计报告的艾滋病感染者和病人22万3千5百余例，其中，注射毒品传播占38.5%；既往采供血传播占19.3%；异性性传播占17.8%；同性性传播占1.0%；输血及使用血制品传播占4.3%；传播占母婴1.2%；传播途径不详占17.9%。也就是说输血感染者的绝对人数从2001年到2007年的几年时间里爆炸性地增加了20余倍（22.3*4.3/3.0*1.5-1）。
1982年6月，美国CDC发现了新情况:一位59岁的血友病患者发生了艾滋病感染症状，揭示了血液（经输血）传播在发病种的作用这无疑使人们不得不开始正视现实。

结  语

输血感染民事责任一直以来都是一个比较争议的话题，争议的关键原因在于血液的法律定性以及输血所导致的众多的社会不安因素和血液的安全性等一系列的难题，这些问题的重点主要集中在如下多个部分：输血感染适用哪种责任体系，如果适用侵权，那么侵权损害赔偿责任的归责标准问题，医院单位及血站所承担法律责任的法律性质和理论依据的问题包括患方请求权的选择问题。
针对学界有关血液的法律属性定位，学界持两种意见，同意是产品的看法以及反对是产品的看法，这两种看法是完全相反的观点，笔者持反对的意见认为血液不应该属于产品的范畴，那些同意血液是产品看法的学者也是有其存在的观点，可是笔者觉得无论是从《产品质量法》所规定的针对产品的认定或者是从医院的作用及性质上、包括平等责任标准、维护弱势地位的人群需求而言，都不宜把血液认定为产品。
从法律所界定的血液属性而导致的输血感染损害侵权责任赔偿的归责标准的观点也都各不相同，有专家提出输血感染损害侵权责任赔偿必须符合无过错责任标准，也有学者建议可以符合过错责任标准，只是无论是否符合过错责任标准或是符合无过错责任标准，在输血感染损害侵权赔偿案件中都是行不通的，笔者利用研究无过错责任标准和过错责任标准的不足，认为，在侵权人有过错时，应符合过错推定责标准，其兼容了过错责任标准和无过错责任标准的特点，更有利于对病人合法权益的维护，在侵权人不存在过错时，笔者觉得符合公平责任标准去补偿病人所受到的伤害，能够有效安慰病人的情绪，在医患纠纷紧张的状况下能够实现社会的安定。
法律对血站承担责任的性质或者医院承担责任的认定依据，在学界的看法也各有不同，其中对血站承担法律责任的性质主要有不同的三种看法：第一种看法认为血站 必须承担侵权责任赔偿，第二种看法认为血站必须承担损害违约责任赔偿，第三种看法认为血站必须承担违背契约责任的损害责任赔偿。笔者赞同第一种看法，理由是血站和病人之间不存在合同的约束关系，第三种看法即便是符合法理的，可是它把病人的法律权益认定为感染输血案件的第三方，这增加了病人的维权困难，限制了维护病人的合法权益。对医院所承担责任的依据理论，学界也有诸多意见不合的观点：侵权责任说,加害给付说，违约责任说。笔者赞同加害给付说的建议，加害给付说其实就是说医院在输血感染损害侵权责任赔偿中，其做法既是侵权活动也是违约活动，形成侵权活动和违约活动的竞合。
在病人选择权请求的挑选方面，笔者建议病人可以选择侵权请求权更有利 于对其合法权益的维护，由于病人选择侵权请求权，病人对医院的挑选范围相对较大，其举证难度相对也降低，而且挑选侵权请求权，病人应当要求医方负责精神损害
赔偿，由于按照违约责任是不可以要求医方负责全部的损害精神赔偿。
总之，在实际的生活里，输血存在很大的风险性，甚至会严重损害患者的健康。因为目前的医学技术非常的有限，很多通过血液方式传播的严重疾病，人们缺乏足够的了解，艾滋病、各种肝炎等严重的疾病在初期传染的时候是很难被检测出来。因此，在目前有限的医学技术条件下，不管是再发达的国家，都会遇到因输血感染而造成严重疾病的可能性，输血感染的风险性一直得不到完全的预防，输血感染在法律上又具有很大的争议，如果可以健全有关输血方面的法律条文、成立输血保险责任以及社会保障制度，建立补偿输血风险基金，输血感染便拥有了良好的可控性。为了增强输血的安全性，降低输血感染事故产生风险，笔者觉得一定要采取应对的措施实施预防。首先，建立和输血感染有关的法律法规。制定输血感染有关的法律，能够有效的降低这类案件的产生机率。我国原有的立律规定缺少了针对输血感染的明确规定和清晰定位，因此一定要通过重新制定法律或者修改现行的法律来明确医疗单位、血站和受血者在进行治疗输血的时候所拥有的权利以及承担责任，对感染输血案件的矛盾性质、归责标准以及怎样适用法律等实行规范。此外，提高血源安全的管理，保护血液安全的可靠。血站要求对釆供血的整个过程进行安全监督，致力倡导健康的人无偿献血，努力降低或者消除卖血，采血的非法单位，从而提高血液检测技术分析，减少病毒感染的“窗口期”。医院当为病人输血时需要履行用血手续完备，严格遵守操作规范，坚决不使用非正规途径获得的血源，医院在进行输血前一定要了解血液的全部信息 包括供应血液的血站是不是存在采供血资质。此外，法律应当提高对血站与医院的血液进行有效监督。增强在管理血液方面有诸多丰富的经验值得人们参考，例如其在国内创建了国家血液安全委员会，由17位成员构成，主席是1位血液病领域的权威专家，其他委员分别从护士、社会学家、公众利益代表者、卫生专家、医院检验师、经济卫生学家、输血医生、律师、麻醉师、医院血库等挑选，除一位专职委员外，其余均为兼职。NBSC的活动经费来源于联邦政府。这一外部监督系统可以收集到来自四面八方的信息，尽早发现血液管理中存在的严重问题,并及时的上报，在提高对血液监督或是管理方面非常奏效。我国也应该借鉴其的成功经验，确保血液的质量。最后，创建一个统一的输血感染的社会保障机制。参照现行的民事法理论，我国目前处于经济飞速发展中的阶段 在不断进步中或许无法避免很多未知的危险所导致的损害，需要由社会集体来一起承担。在欧洲，对受害者的人身伤害赔偿金额绝大多数可以让社会保险来承担。在英国，帕特里克•阿蒂亚建议在人身伤害法律范围取消现行的全部侵权法，全面实行以保险的方式来处理，不需要去考虑受害人在损害中的原因力的多少以及过错标准，都可以得到赔偿。也有甚者提出通过无过错的赔偿保险制度更好的代替侵权法，到目前为止，还没有任何的国家通过并执行了这个意见,但是，新西兰的处理方法却正好相反，新西兰制定了统一的人身社会伤害保险机制，而对伤害的形成因素 不进行具体的考虑，对前述做法更接近于全盘接受。笔者觉得上述所说的几个国家和地区的做法有些不妥，因为不可能对不是以完美健康状况离开医院的人都进行补偿，医疗保险则不能将交易成本控制在适当的范围内。但是不难看出建立输血感染的社会维护制度，有利于输血感染风险的分摊，尤其是在无过失输血感染侵权损 害赔偿案件中，更有利于维护患者权益的实现，也能够有效降低血站与医院的负担风险。

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