器官移植民法基本问题研究

【作者】 邾立军；

【导师】 段匡；

【作者基本信息】 复旦大学 ， 民商法学， 2010， 博士

【摘要】 随着器官移植医学技术的发展,人的生命得以延长。器官移植手术需要的是器官,而器官一般来自人们的捐赠。目前有关器官移植法律问题的研究,主要集中在器官的来源与分配上,并就相关问题作出探讨。器官捐赠者的自已决定权往往被忽视,因为所讨论的问题都是假定其已捐赠的前提。事实上,器官捐赠自已决定权是人格权,在私法自治的空间内如何行使,应当受到重视。本文拟从器官捐赠自已决定权的客体、主体以及私法自治与国家规制等几个方面作出探讨,以期对此问题作一系统研究。全文由引言、结论以及正文五章构成。引言通过理论与现实中存在的器官捐赠者自已决定权未受重视问题入手,引出器官捐赠自已决定权研究的必要性,并提出研究思路。第一章,器官的法律属性研究。作为器官捐赠的客体,国内外有关器官法律属性定性究竟为大陆法系的人格权范畴还是物权范畴、英美法系的财产权范畴还是私生活权范畴的争议,主要涉及到关于器官的处分规则、保护以及救济规则,通过对大陆法系的人格权与物权以及英美法系中的财产权与私生活权的理论与实践比较分析,认为人体内的活体器官、脱离人体的器官与尸体器官属于人格权范畴,为捐赠者自已决定权如何行使提供理论支持。第二章,器官捐赠自已决定权的理论基础。自已决定权不仅仅是医学伦理学原则的体现,而且也是法理学上有关人权的重要的基本权利。在行使该权利时,应当尊重人的生命权以及自由原则的界限。随着器官移植技术的发展,面对器官捐赠的问题,涉及到生命伦理与法律上的难题,它并不是一个简单的利益问题,而是涉及到生命问题,利益有大小之分,利益损失事后可以补救或赔偿,而生命则不同,因为其不存在大小多少之分,具有唯一性,个体之间完全是等价的,因而不能用功利主义和契约主义对待利益的方式对待生命。任何人都没有捐赠器官的义务。如果一个人出于行善目的自主决定捐赠器官,但导致自身严重伤害甚至死亡,不应属于自已决定权的权限,避免伤害或对伤害的限制是符合伦理和法理的。法律上要求尊重人的身体以及人的尊严,因而应当区分器官捐赠者的自已决定权与生命健康权,以便当自已决定权与生命健康权发生冲突时,法律在一定范围内优先保护前者。与患者自已决定权为的是自已利益不同的是,捐赠者的自已决定权不是为了自已的利益,而是为了他人,正因为此,不能机械地认为,捐赠者捐赠器官,医生就摘取器官。国家对此进行干预,要求医生履行告知义务,以保证其正确行使自已决定权。当然,也要防止这里的告知异化为保护医师而非捐赠者,应当互相交流、信任,免于流于形式。第三章,器官捐赠自已决定权的私法自治与国家规制。通过对器官捐赠与相关概念的比较以及对其法律性质分析,其不是法律行为,可定性为准法律行为,为限制行为能力人与无行为能力人捐赠器官组织提供了法理依据。因为其对财产处分上的承诺,要具备处分能力与处分权限,须为法定代理人同意；而对人格权加害行为的承诺,要求有识别能力,即须有理解承诺的内容及其承诺意义的能力。违反法律规定或违背公序良俗的器官捐赠无效。同时,对捐赠对象作了深入探讨。通过对各国法律器官移植与捐赠法律的分析比较,器官捐赠者在满足国家法律规定条件的前提下,可以行使自已决定权,体现私法自治的理念。其中一个重要条件是医生必须履行告知义务后,并经过特定机构审查,作出的捐赠决定方为有效。第四章,自已决定权行使与医生的告知义务。器官捐赠自已决定权的实现有赖于医疗单位,法律规定医师对捐赠者有说明告知的义务,是医师摘除器官的免责理由,也是捐赠者自已决定权行使的有效前提,否则医师就要承担过失责任。有关告知主体,各国或地区规定不一,由参与还是不参与移植的医师告知,有法律对具体告知主体没有做出明确规定,有法律明确规定由不参与器官移植手术的医师告知。告知的对象,原则上应当向器官捐赠者本人告知。从公正的角度看,为了捐赠者的自已决定权避免受到移植手术医师的影响,应由不参与器官移植手术的医师告知。告知义务要求医师在履行义务时,符合法律规定的告知内容,确保捐赠者理解告知的内容,以使捐赠者正确行使自已决定权。器官捐赠中,医师告知的标准采取理性医师说与具体个人折中说,最大限度内实现个人在私法上的自治。第五章,自已决定权行使与同意的权利。捐赠者自已决定权的同意范围,法律上对此作出了底线规定,对于造成严重伤害或死亡的捐赠,不予允许。捐赠者作出有效同意并摘除器官后,能否以侵害身体为由,要求医师进行人身损害赔偿,司法实践中,一般将此种捐赠行为视为侵权法上的营救行为,不得请求损害赔偿。捐赠者自已决定权除了同意的权利之外,还包括拒绝捐赠的权利和撤销权,从而最大化实现个人的自已决定权。一般而言,器官移植所用的器官应以尸体器官为原则,当其他医疗途径以及尸体器官来源穷尽后,即在合理的期限内,得不到尸体器官,活体捐赠才是例外。在活体器官捐赠中,对完全行为能力人和未成年人以及无同意能力的成年人有无同意能力的判断标准作一研究,认为完全行为能力人有权在法定范围内独立行使自已决定权；未成年人和无同意能力的成年人从其最佳利益出发,允许代理人在法定的范围内代其捐赠器官组织,对曾有过同意能力的成年人还可运用替代判断标准。而尸体器官捐赠,各国或地区规定不一,主要在于死者生前未作是否捐赠器官或未反对过的表示,能否摘除尸体器官,能否运用代理。其中的推定同意与自愿同意捐赠,哪种方式能够体现死者生前的意志表达,是私法自治还是私法“被自治”,代表了不同的价值取向,论文认为,死者生前未作出是否捐赠的表示,不宜适用推定同意,因为推定同意有违私法自治理念,侵犯了死者捐赠器官的自已决定权。死者生前未作任何表示,由其亲属依法代为捐赠,为各国的一般共识。是否采纳脑死亡标准,各国或地区法律对此争议很大,有脑死亡替代传统心死亡标准、坚持心死亡标准、坚持心死亡与脑死亡并重以及选择心死亡与脑死亡的“二元死亡”标准四种立法模式,其中“二元死亡”标准与传统的“一元死亡”标准相比,颇有争议,因为涉及个人选择生存还是死亡的两难境地。植物人不是脑死者。尸体器官捐赠一般不能有条件捐赠。对于人身受限制自由者或死刑犯的捐赠自已决定权应当限制捐赠条件,使其受到尊重和法律的保障。关于人工流产胎儿的器官利用,有所争议,其同意捐赠的主体一般认为是准母亲,但为了避免对其滥用,应当坚持同意人工流产的决定与同意对胎儿组织的利用决定相分离原则。因而,器官捐赠自已决定权作为人格权,应当受到重视和尊重,当然,在器官移植中,尊重捐赠者的自已决定权并不是最终目的,其根本目的在于保护捐赠者。为了使一个人避免盲目、被强迫、被欺骗等不是出自真实自愿的捐赠,国家通过规制,规范其做出决定的能力,规定医生的告知义务,确保其理解告知的内容,并有专门的机构对之进行审查,以保证自已决定权的正确行使,体现出私法自治与国家干预的平衡。更多还原

【Abstract】 With the development of medical technology on organ transplantation, man’s life is prolonged. Organs, which are needed in the transplantation operation, are usually are donated by people. The present research on the transplantation focuses on the organs’ procurement and distribution, not donors’self-determination, because organs are always presumed to be donated in advance. In fact, the self-determination on organ donation is a personality right, which should be valued in civil law. The research mainly focuses on the object, subject and the balance between the individual’s autonomy and the regulation of the state in the paper, in order to realize the self-determination of organ donation systemically.The paper is comprised of the preface, the conclusion and the main body made of five chapters.The preface discusses the problems of the donation self-determination in the theory and the practice and the necessity of the research. And then analyze the thought of the research.Chapter One focuses on the legal nature of organ. As object, there are controversies on the organ’s legal nature, which are about the personality right or the real right in the civil law and the property right or the privacy right the common law. Its nature involves the rules of its management, safeguard and relief. Through the discussion on its theory and practice, we conclude it is the personality right in the civil law and the privacy right in the common law, no matter whatever. The use of donation self-determination must base on it.Chapter Two is about the theoretical basis of the donation self-determination. Self-determination is not only the embodiment of principle in ethics, but also the main basic right in the jurisprudence. You must restrict its use in order to infringe the rights to life and freedom. Life is different from interest, because life is sole. We don’t treat the life as the interest in the angle of Utilitarianism or Contractarian. We must also realize that organ donation is not our duty. One can donate one’s organ for other’s health in the purpose of charity, unless donation injuries him or her seriously or makes him or her die. We must respect one’s dignity and body, so we respect one’s self-determination and the rights to one’s life and health respectively in the law. And then, we can safeguard the self-determination prior to the right to health when they are conflicted in the legal scope. We must distinguish between the donor’s self-determination for others and the patient’s self-determination for oneself, so that the law enforces the doctors’duty of disclosure to avoid the donor’s wrong decision, to make sure that the self-determination is correctly used.Chapter Three mainly discusses the autonomy of private law and national regulation in donation self-determination. Donation isn’t a legal act, but regards as quasi-legal act. It needs their recognition, not their action capacity and disposition authority. Thus, it makes the incompetent adults and minors enable to donate their organs. The donation doesn’t violate the law and public order and good morals. And the paper studies the donees in details. In comparison to countries and districts, donors may use their self-determinations when the conditions are satisfied legally. One important condition is the doctor’s duty to disclosure information.Chapter Four analyzes the relationship between the exercise of the donor’s self-determination and the doctor’s duty to disclosure information. To realize the self-determination, the hospital takes part, and the law enforces the doctor’s duty to disclosure certain information regulated by law to make sure that the donor understands, which absolves the doctor from legal responsibility, and constitutes the valid premise on the exercise of the self-determination. The disclosure standard compromises rational doctors with the specific individuals. The purpose is to safeguard the donor’s self-determination in civil law’s autonomy.Chapter Five analyzes the relationship in the exercise of the donor’s self-determination and the right to donor’s consent in detail. The law restricts the scope of donation to avoid the donor’s serious injury or even death. If the donor’s act is valid, he/she can’t petition the doctor to indemnify his harm and damage. In the law, his/her donation act is regarded as rescue in tort law. The right to donor’s consent is extensive, including the rights to refuse and to rescind. The following discusses the judging criteria about the competency in organ donation among competent adults, incompetent adults and minors, in the living donor. Competent adults can donate their organ in the legal scope. Incompetent adults and minors can’t donate their organs unless it’s certain for their best interests complying with the law. As cadaveric organ, the focus of controversies is on whether organs are regarded as being donated by the so-called donor, if the deceased has not expressed his/her donation intent or been opposed to organ donation. There are two ways of consent in legislation, namely voluntary consent and presumed consent, due to different values among these countries. But the presumed consent isn’t on behalf of the deceased’s expression of intent, since the deceased didn’t express his/her intent of donation, and was expressed. There are two ways to define death in the law, the cardiopulmonary definition of death and a definition of death based on cessation of brain function. The brain death criterion is rejected by some countries due to the beating heart donor. At present, there are four kinds of death legislation, respectively brain death, heart death, brain death and heart death, the option of brain death or heart death. The last is named as two-way death criterion, as compared with the traditional death criterion——heart death, the option to choose life or death isn’t accepted. Incidentally, a vegetative patient isn’t a person of brain death. The detainee and the condemned are protected to exercise their organ donation self-determinations, but they should be restricted due to their unfavorable situations. The use of fetal organ and tissue through induced abortions is challenged, different from spontaneous abortions. However, the quasi-mother is considered as the agent to give donation consent. To avoid abusing the fetal organ and tissue, the consent to use and the abortion decision from use of the fetal tissue should be separated.In conclusion, the organ donation self-determination is respected as a human right and a personality right. The states regulate its right to exercise through legislation, in order to ensure it to be exercised correctly, not erroneously or involuntarily. The doctor’s disclosure and the certain authority’s censorship ensure the exercise of the donor’s self-determination. It embodies the balance between the autonomy in private law and the state compulsion.更多还原