诊疗规范在医疗损害责任纠纷中的应用

发布时间：2018-12-24 16:07

【摘要】：我国的《侵权责任法》有三处明确提及诊疗规范：一是第五十八条第一项关于推定医疗过错的情形之一的规定；二是第六十条第一项的关于患者对医疗机构依照诊疗规范进行的诊疗不配合，造成损害的，是医疗机构得以免责的情形之一；三是第六十三条医疗机构实施不必要检查的标准是医疗机构及其医务人员违反诊疗规范实施的检查。然而，，虽然立法条文中明确的规定了诊疗规范，但何为诊疗规范及其在医疗损害责任纠纷案件中的应用不管在理论还是实务上都很少甚至几乎没有详细的研究。另外，《侵权责任法》把诊疗规范作为推定医疗机构有过错的依据之一，但到现在我国还没有统一颁布的能够指导医疗机构及其从业人员遵守和适用的诊疗规范，更别说有能够统一供医疗损害纠纷处理直接查询的确定的诊疗规范。发生医疗过错造成医疗损害时，很大程度上违反的是有关诊疗规范的规定。因此文章认为，在法律明确对诊疗规范做出规定的情形下，面对司法实践中在医疗损害责任纠纷案件中诊疗规范的应用困难，所以要对模糊不清的诊疗规范进行厘清，笔者认为有效的方法是制定一部统一的诊疗规范来供医疗损害案件审判适用。当然由于学界对此问题的研究十分匮乏，更凸显了该问题的棘手但同时也证明该研究的重大意义。因此，笔者在此背景下确定思路，首先从法律意义上对诊疗规范进行解读，梳理了我国法律法规中涉及的诊疗规范的规定，认为诊疗规范应从不同层面进行解读；接着分析我国医疗卫生法律规范中诊疗规范的规定，特别是《侵权责任法》中的规定，诊疗规范的属性、查明途径等；然后着重论述在医疗过错客观化的规定下诊疗规范在医疗行为和医疗损害责任纠纷处理中的意义及其适用的难题；最后提出的对策是制定全国统一的诊疗规范，并且发挥对诊疗规范的解释以及医疗伦理规范的作用。除引言外，文章由四部分构成：第一部分，法律意义上的诊疗规范。此部分是文章的开头，梳理了我国法律法规中涉及诊疗规范的规定，试图对诊疗规范进行定义，并且初步厘清医学意义上的诊疗规范及法律意义上的诊疗规范之间的关系。第二部分，我国医疗侵权法律规范中的诊疗规范。主要分析《侵权责任法》中诊疗规范的规定以及诊疗规范的查明。第三部分，诊疗规范在医疗损害责任纠纷处理中的意义及适用难题。这部分是文章的重点论述部分。第四部分，现行诊疗规范存在难题之对策及未来展望。此部分提出解决诊疗规范在医疗损害纠纷处理中应用局限性的治本之策在于制定统一的诊疗规范，并且对未来我国诊疗规范的执行及医疗损害案件处理的展望。
[Abstract]:The Tort liability Law of our country has three clear references to the diagnosis and treatment norm: the first item of Article 58 is about one of the cases of presuming medical fault; Second, the first paragraph of Article 60 concerning the patient's failure to cooperate with the medical institution in accordance with the criteria for diagnosis and treatment, resulting in damage, is one of the circumstances in which the medical institution may be exempted from liability; Article 63 the standard of unnecessary inspection in medical institutions is that medical institutions and their staff violate the standard of diagnosis and treatment. However, although the provisions of the legislation clearly stipulate the diagnostic and treatment norms, but what is the diagnosis and treatment norms and its application in medical damage disputes cases, there is little or no detailed research either in theory or in practice. In addition, the Tort liability Law regards the norms of diagnosis and treatment as one of the bases for presuming that medical institutions are at fault, but there is no unified standard of diagnosis and treatment that can guide medical institutions and their practitioners to abide by and apply to them. Not to mention there are definite diagnostic and therapeutic norms that can be unified for direct inquiry into medical injury disputes. When medical malpractice results in medical damage, it violates the rules of diagnosis and treatment to a great extent. Therefore, the article holds that, under the circumstance that the law clearly prescribes the diagnostic and therapeutic norms, facing the difficulty of applying the diagnostic and therapeutic norms in medical injury dispute cases in judicial practice, we should clarify the vague diagnostic and therapeutic norms. The author thinks that the effective method is to establish a unified diagnosis and treatment standard for medical injury cases. Of course, the academic research on this issue is very scarce, which highlights the thorny problem but also proves the significance of the study. Therefore, the author in this context to determine the thinking, first of all from the legal significance of the interpretation of the norms of diagnosis and treatment, combing our laws and regulations involved in the rules of diagnosis and treatment, the diagnosis and treatment of norms should be interpreted from different levels; Secondly, it analyzes the regulations of diagnosis and treatment in the legal norms of medical care and health, especially the provisions in the Tort liability Law, the attributes of the norms of diagnosis and treatment, and the ways to find out. Then discusses the significance and the difficult problem of the diagnosis and treatment standard in the medical behavior and the medical damage liability dispute settlement under the stipulation of the medical fault objectification; Finally, the countermeasure is to make the unified diagnosis and treatment standard of the whole country, and give play to the explanation of the diagnosis and treatment norm and the function of the medical ethics standard. In addition to the introduction, the article consists of four parts: the first part, the legal significance of diagnosis and treatment norms. This part is the beginning of the article, combing the laws and regulations of our country about the rules of diagnosis and treatment, trying to define the standard of diagnosis and treatment, and preliminarily clarify the relationship between the standard of diagnosis and treatment in the sense of medicine and the standard of diagnosis and treatment in the sense of law. The second part, the diagnosis and treatment norm in our country medical treatment tort legal norm. This paper mainly analyzes the rules of diagnosis and treatment in Tort liability Law. In the third part, the significance and application of diagnosis and treatment norms in medical damage liability disputes are discussed. This part is the key part of the article. The fourth part, the present diagnosis and treatment standard exists the difficult problem countermeasure and the future prospect. In this part, the author points out that the solution to the limitation of diagnosis and treatment norms in the treatment of medical injury disputes lies in the formulation of unified diagnosis and treatment norms, and the prospect of the future implementation of diagnosis and treatment norms and the treatment of medical damage cases in China.
【学位授予单位】：西南政法大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：D923;D922.16

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