医疗损害责任中过错的判定研究

论文总字数：26547字

摘 要

医疗损害责任具有特殊性，过错的判定存在法律规定的不足，加之理论和实践中审判的标准不一等问题，医疗损害责任中过错的研究便具有必要性。医疗损害责任的归类方式为四分法；归责原则为三元论归责原则。针对医疗技术过错的判定标准，理论上有医疗常规说、医疗水平说、注意义务说等，司法上主要为“注意义务”、“诊疗规范”和“医疗常规”；针对医疗伦理过错的判定标准，理论上为合理患者说、知情同意说，司法上主要是“告知义务”、“知情权、同意权”、“沟通”；对医疗管理过错的判定标准，理论上主要为管理职责或管理规范违反说，司法上主要是“管理规范”、“管理职责”；对医疗产品缺陷，理论上多以合理危险说作为判定依据，司法上主要为“国家标准”和“采血规范”。通过理论与实践的结合，医疗损害责任中各类型的判定标准应当为：技术过错为“医疗水平 地区差异”；管理过错为“管理规范 管理职责”；伦理过错为“知情同意”；产品缺陷为“国家标准 采血规范”。

关键词：医疗损害责任 归责原则 过错 判定标准

Abstract

The liability for medical damage is of a special nature. There are legal deficiencies in the determination of faults. In addition to the problem of unequal trials in theory and practice, the study of faults in medical damage liability is necessary. The categorization method for medical damage liability is the quarantine method; the principle of Responsibility includes three liabilities. As for the criteria for medical technology fault determination, there are theoretically theories of medical care, medical level, and attention obligation. The main judicial issues are “attention obligation”, “treatment standard” and “medical practice”; Theoretically speaking, it is reasonable for patients to say and informed consent to say that the judiciary mainly deals with “informing obligations”, “right to know and consent”, and “communication”; the criteria for judging the faults of medical management are theoretically mainly management responsibilities or management norms. According to violations, the judicial system mainly includes “management norms” and “administrative responsibilities.” In the case of faults in medical products, theoretically, more reasonable risk statements are used as the basis for judging. The judicial system mainly includes “national standards” and “blood sampling norms”. Through the combination of theory and practice, the criteria for determining the types of faults in the medical damage liability shall be: technical faults as “medical level regional differences”; management faults as “management norms management responsibilities”; ethical faults as "informed consent"; Product faults are “national standards blood sampling specifications.”

Key words: medical damage liability,principle of imputation,fault,judgement standard

目 录

摘 要………………………………………………………………………………………………………Ⅰ

Abstract………………………………………………………………………………………………………Ⅱ

引言………………………………………………………………………………………………………1

一、问题所在…………………………………………………………………………………1

（一）医疗损害责任的特殊性……………………………………………………………………1

1.概念辨析…………………………………………………………………………………………1

2.医疗损害责任的构成要件……………………………………………………………………2

（二）医疗损害责任中过错的判定问题………………………………………………………2

1.法律规范方面……………………………………………………………………………………2

2.理论研究方面……………………………………………………………………………………2

3.司法裁判方面……………………………………………………………………………………3

二、医疗损害责任的类型及归责原则……………………………………………………………………4

（一）医疗损害责任的类型………………………………………………………………………………4

1.三分法…………………………………………………………………………………………………4

2.四分法…………………………………………………………………………………………………4

（二）医疗损害责任的归责原则……………………………………………………………………5

1.一元论…………………………………………………………………………………………………5

2.二元论………………………………………………………………………………………………6

3.三元论………………………………………………………………………………………………7

三、医疗损害责任中过错的理论判定……………………………………………………………………7

(一）医疗技术过错的理论判定…………………………………………………………………8

1.医疗常规说………………………………………………………………………………………8

2.医疗水平说………………………………………………………………………………………8

3.医疗水平 地区差异说…………………………………………………………………………8

4.注意义务说………………………………………………………………………………………8

5.合理医师说………………………………………………………………………………………9

（二）医疗伦理过错的理论判定……………………………………………………………………9

1.合理患者说………………………………………………………………………………………9

2.知情同意说…………………………………………………………………………………………9

（三）医疗管理过错的理论判定……………………………………………………………………10

（四）医疗产品缺陷的理论判定……………………………………………………………………10

四、医疗损害责任中过错的司法判定……………………………………………………………………11

（一）医疗技术过错的司法判定……………………………………………………………………12

1.数量分布…………………………………………………………………………………12

2.裁判文书分析……………………………………………………………………………………12

3.典型案例……………………………………………………………………………………………13

（二）医疗伦理过错的司法判定……………………………………………………………………13

1.数量分布………………………………………………………………………………………14

2.裁判文书分析……………………………………………………………………………………14

3.典型案例……………………………………………………………………………………………14

（三）医疗管理过错的司法判定……………………………………………………………………15

1.数量分布………………………………………………………………………………………15

2.裁判文书分析……………………………………………………………………………………15

3.典型案例…………………………………………………………………………………………15

（四）医疗产品缺陷的司法判定……………………………………………………………………16

1.数量分布………………………………………………………………………………………16

2.裁判文书分析……………………………………………………………………………………16

3.典型案例……………………………………………………………………………………………16

五、结论………………………………………………………………………………………………………17

参考文献…………………………………………………………………………………………………………18

致谢………………………………………………………………………………………………………………21

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