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醫(yī)方違反說(shuō)明義務(wù)損害賠償責(zé)任的認(rèn)定

發(fā)布時(shí)間:2018-06-26 05:59

  本文選題:說(shuō)明義務(wù) + 損害賠償責(zé)任; 參考:《浙江大學(xué)》2017年碩士論文


【摘要】:醫(yī)方的說(shuō)明義務(wù)源于醫(yī)療倫理的要求,伴隨患者自主意識(shí)的覺(jué)醒及患者權(quán)利保障的浪潮,各國(guó)法律相繼明確醫(yī)方的說(shuō)明義務(wù)和患者的知情同意權(quán),我國(guó)《侵權(quán)責(zé)任法》第五十五條第一款規(guī)定了醫(yī)方說(shuō)明義務(wù)的內(nèi)容,第二款則確立了因前款義務(wù)違反所引致的損害賠償責(zé)任。就侵權(quán)責(zé)任的構(gòu)成要件來(lái)看,將知情同意權(quán)受損本身認(rèn)定為侵權(quán)責(zé)任構(gòu)成要件中的損害事實(shí)符合《侵權(quán)責(zé)任法》第五十五條的規(guī)范意旨及一般人格權(quán)保障的傾向,人身?yè)p害事實(shí)則是知情同意權(quán)受損所引發(fā)的二次損害。因果關(guān)系構(gòu)建中,針對(duì)不同的損害事實(shí),應(yīng)采不同的因果關(guān)系理論。對(duì)于知情同意權(quán)受損,證明標(biāo)準(zhǔn)從"必然"走向"可能",未充分告知的行為可能影響患者的自我決定即損害了患者知的權(quán)利和參與意思決定的機(jī)會(huì)。人身?yè)p害事實(shí)與醫(yī)方未充分告知行為之間天然聯(lián)系薄弱,因果關(guān)系的構(gòu)建應(yīng)更為慎重,其證立應(yīng)以患者獲悉充分信息必然選擇不同的醫(yī)療措施且該醫(yī)療措施下患者的利益得以提升或損害能夠避免或減輕為前提,實(shí)務(wù)中可通過(guò)數(shù)據(jù)化不同醫(yī)療決定下的損益結(jié)果搭建因果關(guān)系證成的二層結(jié)構(gòu)。利益差難以確定情況下,適用舉證責(zé)任倒置規(guī)則,由醫(yī)方承擔(dān)不能舉證的不利后果。醫(yī)療鑒定意見(jiàn)是法官認(rèn)定因果關(guān)系的重要證據(jù),但并不等同于法官對(duì)因果關(guān)系的判斷。醫(yī)方未充分告知之行為是否侵害患者的知情同意權(quán),造成精神損害,與醫(yī)療鑒定并無(wú)關(guān)系,是法官依法裁判的問(wèn)題。此外,對(duì)于法官的自由心證來(lái)說(shuō),重要的并不是醫(yī)療鑒定意見(jiàn)的最終結(jié)論,而是其中所載的各項(xiàng)實(shí)證醫(yī)學(xué)數(shù)據(jù)。過(guò)錯(cuò)要件的認(rèn)定呈現(xiàn)客觀化的趨勢(shì),違反法律關(guān)于說(shuō)明義務(wù)的規(guī)定,過(guò)失即被推定,因此說(shuō)明義務(wù)范圍的界定系過(guò)錯(cuò)要件評(píng)判的前提。說(shuō)明義務(wù)不斷擴(kuò)張的大背景下,可通過(guò)漢德公式的應(yīng)用及對(duì)患者接受醫(yī)療服務(wù)目的的區(qū)分重新審視醫(yī)方違反說(shuō)明義務(wù)案件中過(guò)錯(cuò)要件的證立。
[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.
【學(xué)位授予單位】:浙江大學(xué)
【學(xué)位級(jí)別】:碩士
【學(xué)位授予年份】:2017
【分類號(hào)】:D923

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