医师注意义务探讨

【作者】 林玲彬；

【导师】 段匡；

【作者基本信息】 复旦大学 ， 法律， 2008， 硕士

【摘要】 近几年来我国医疗纠纷呈逐年升高的增长趋势,医患关系紧张,成为社会公众的关注焦点。法律的介入,是调整医患关系的必然趋势,且越来越体现它的重要作用。医疗过失的认定是医疗纠纷解决的核心问题之一,而注意义务则是医疗过失的判定依据。本文将法学理论和临床医疗紧密结合,立足于民法的基本理念,从分析医患法律关系出发,以医患权利平衡为中心,明确医患关系属民事法律关系。在此基础上,引出注意义务的概念。通过比较法,分析注意义务在侵权行为法上的重要地位——对侵权责任的认定往往是从注意义务的存在开始的。在医疗过程中,因医疗行为是一种针对患者身心而展开诊查治疗的高技术、高风险行为,医师对患者承担着高度的注意义务。医师注意义务是基于医学伦理道德、医患间的信赖关系以及诚实信用原则而形成的。法律法规、诊疗护理规范及常规、医学文献、医疗习惯、契约均是医师注意义务的渊源。一般认为,医师注意义务涵括两方面的内容:医师结果预见的义务和医师结果避免的义务。在医师注意义务的履行中,法律不可能要求医师去认识自己未知的疾病,因此还应考虑医师注意能力的问题。具备注意能力是医师履行注意义务的前提。本文认为,判断医师注意义务的标准宜采用医疗水准说,同时考虑地域性、专门性、医疗损害程度等因素。医师注意义务框定了医师在法律上进行选择的行为模式,是医疗过失的判定依据。由于我国医疗侵权诉讼实施举证责任倒置制度,医方应对其医疗行为无过失进行举证。本文通过对举证责任倒置的理性分析,肯定了其法律价值以及在实际操作中的积极意义,并着眼于侵权行为法的利益平衡功能,探讨医方应以充分履行注意义务进行抗辩。同时,由于医疗行为的特殊性,考虑公平和合理性等因素,在紧急情况、告知后同意、符合最佳判断原则、患者过错等情况下,应当给予必要的免责。笔者系医院职能部门的一名工作人员,联系工作实际,结合医院管理,本文还特别提到医院的注意义务。医院是一切医疗活动的载体,有保障社会大众健康价值的义务。医院注意义务主要形成于医院的社会责任及医患间的一种商业利益关系,可看作是医师注意义务的延伸。本文将医院注意义务分为内部管理注意义务和外部管理注意义务。相对于医师注意义务,医院注意义务主要体现为组织性的注意义务。本文的最后,指出从一个长远的角度来考察,医患双方的权利与义务无疑还是对立统一的。注意义务的充分履行,是注意义务问题的归宿。给予患者合理而充分的注意,维护患者的利益;同时,规范医疗行为,规避医疗风险,也是对医院和医师权利的保护。这样,是对缓和医患之间矛盾的必要保障,有利于医学更好地服务公众健康。更多还原

【Abstract】 In recent years, the number of medical disputes in China has constantly increased. The tension between doctor and patient relationship is increasing that it has become a public attention in nowadays society. Legal intervention is an inevitable trend to adjust the doctor-patient relationship and it reflects the increasingly important role.The determination of medical negligence is one of the core problems of medical disputes and duty of care is always the criterion for judging negligence. Based on the concept of Civil Law and take the balance of right and obligation between doctor and patients as central issues, this paper closely combines the theory of jurisprudence and clinical care to identify that the doctor-relationship belongs to civil code relationship. Thus, the concept of Duty of Care is introduced and is analyzed its importance in Tort Law by way of comparison method, namely the determination of tort responsibility begins with duty of care. As medical practice is a kind of high-tech and high-risk examination and treatment for the patients physically or mentally, doctors are taking a high degree of commitment to duty of care. The doctor’s duty of care results from the medical ethic moral, the reliance relationship between doctor and patients, and the principle of honesty and credit. Law and regulation, diagnosis and nursing, medical literature, treatment custom and contract are the source of doctor’s duty or care. It is generally believed that doctor’s duty of care includes the obligation to foresee and avoid the outcome of medical practice. As law can not requires doctor to recognize the unknown disease, ability of attention should be therefore considered in the fulfillment of doctor’s duty of care. Having the ability of attention is a prerequisite for fulfillment of doctor’s duty of care. We think that the medical level theory should be used in criteria of doctor’s duty of care with factors like region, specialty and extend of medical damage considered. The behavior pattern of doctors to be chosen in law is framed by doctor duty of care, a judgment of medical negligence in dispute. In China, as the inverted evidence-providing system is implemented in medical infringement lawsuit, the hospital is responsible to provide the no-fault evidence for their medical practice. This paper confirms the law value and positive significance of inverted evidence-providing system in the actual operation through a rational analysis. At the same time, the counterplea of duty of care that should be fully complied by the doctors is explored from the angle of benefit equilibrium function of Tort Law. Due to the specificity of the medical practice and consideration of fair and rationality, cases of emergency, informed consent, in line with optimal judgment, patient’s fault can be exempted from necessary duty.The author is staff working in administrative department in a hospital that the managerial and medical information is available. In this paper, the hospital duty of care is mentioned. Hospital is the carrier of all the medical activity that it has the obligation of protecting the public health. Hospital’s duty of care is mainly formed of social responsibility and commercially beneficial relationship between doctor and patients. It can be seen as the extent of doctor’s duty of care. Hospital duty of care can be divided into internal and external duty of care. Compared with the doctor’s duty of care, hospital’s duty is mainly embodied as duty of care of organization.From a long point of view, the right and obligation of doctor-patient is unity of opposites. The fully implementation of duty of care is the end-result of the problem as well as the effective protection of alleviating the doctor-patients issues. Reasonable and adequate attention should be given to patients to safeguard their interests. Meanwhile, modify the medical norms to avoid medical risks is also a protection for the rights of hospital and doctor’s duty of care. It is a necessary guarantee to relieve the tension of doctor-patient relationship so as to fore medicine to better serve the public health.更多还原