医方违反说明义务损害赔偿责任的认定

发布时间：2018-06-26 05:59

本文选题：说明义务 + 损害赔偿责任　；参考：《浙江大学》2017年硕士论文

【摘要】：医方的说明义务源于医疗伦理的要求,伴随患者自主意识的觉醒及患者权利保障的浪潮,各国法律相继明确医方的说明义务和患者的知情同意权,我国《侵权责任法》第五十五条第一款规定了医方说明义务的内容,第二款则确立了因前款义务违反所引致的损害赔偿责任。就侵权责任的构成要件来看,将知情同意权受损本身认定为侵权责任构成要件中的损害事实符合《侵权责任法》第五十五条的规范意旨及一般人格权保障的倾向,人身损害事实则是知情同意权受损所引发的二次损害。因果关系构建中,针对不同的损害事实,应采不同的因果关系理论。对于知情同意权受损,证明标准从"必然"走向"可能",未充分告知的行为可能影响患者的自我决定即损害了患者知的权利和参与意思决定的机会。人身损害事实与医方未充分告知行为之间天然联系薄弱,因果关系的构建应更为慎重,其证立应以患者获悉充分信息必然选择不同的医疗措施且该医疗措施下患者的利益得以提升或损害能够避免或减轻为前提,实务中可通过数据化不同医疗决定下的损益结果搭建因果关系证成的二层结构。利益差难以确定情况下,适用举证责任倒置规则,由医方承担不能举证的不利后果。医疗鉴定意见是法官认定因果关系的重要证据,但并不等同于法官对因果关系的判断。医方未充分告知之行为是否侵害患者的知情同意权,造成精神损害,与医疗鉴定并无关系,是法官依法裁判的问题。此外,对于法官的自由心证来说,重要的并不是医疗鉴定意见的最终结论,而是其中所载的各项实证医学数据。过错要件的认定呈现客观化的趋势,违反法律关于说明义务的规定,过失即被推定,因此说明义务范围的界定系过错要件评判的前提。说明义务不断扩张的大背景下,可通过汉德公式的应用及对患者接受医疗服务目的的区分重新审视医方违反说明义务案件中过错要件的证立。
[Abstract]:The obligation of medical explanation originates from the requirement of medical ethics. With the awakening of patient's consciousness of autonomy and the wave of patient's right protection, the law of every country defines the duty of explanation and the right of informed consent of the patient. The first paragraph of Article 55 of our country's Tort liability Law stipulates the content of the medical party's obligation to explain, and the second paragraph establishes the liability for damages caused by the breach of the obligation mentioned in the preceding paragraph. As far as the constitutive elements of tort liability are concerned, the fact that the damage of informed consent right itself is regarded as the constitutive element of tort liability is in accordance with the normative intent of Article 55 of Tort liability Law and the tendency of general personality right protection. The fact of personal injury is the second damage caused by the damage of informed consent right. In the construction of causality, different causality theories should be adopted for different damage facts. When the right of informed consent is impaired, the standard of proof changes from "inevitable" to "possible", and the behavior of not fully informing may affect the patient's self-decision, that is, the patient's right to know and the opportunity to participate in the decision of will. The natural link between the fact of personal injury and the behavior of the medical authorities is weak, and the construction of causality should be more careful. Its evidence should be based on the premise that the patient must choose different medical measures when he is informed of sufficient information and that the patient's interests can be enhanced or the damage can be avoided or mitigated under the medical measure, In practice, a two-layer structure of causality can be established by digitizing the results of different medical decisions. If the difference of interest is difficult to determine, the adverse consequences of the failure to prove shall be borne by the medical side by applying the rule of inversion of the burden of proof. Medical expertise is an important evidence for judge to determine causality, but it is not equal to judge's judgment on causality. Whether the behavior that the doctor has not fully informed infringes the patient's right of informed consent and causes mental damage has nothing to do with medical appraisal and is a problem for the judge to judge according to law. In addition, it is not the final conclusion of the opinion of medical expertise that is important to the judge's free evidence, but the empirical medical data contained therein. The cognizance of fault elements shows an objective trend. In violation of the provisions of the law on the obligation of explanation, the fault is presumed, so the definition of the scope of the obligation is the premise of the judgment of the fault elements. Under the background of continuous expansion of duty, the application of Hande formula and the distinction between the purpose of receiving medical service for patients can be used to re-examine the evidence of fault elements in cases of breach of obligation of explanation.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D923

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