發(fā)布時間：2018-05-08 17:46

  本文選題：過度醫(yī)療 + 侵權責任��； 參考：《西南大學》2013年碩士論文

【摘要】：過度醫(yī)療行為是一種在醫(yī)療活動中普遍而長期存在的不法行為,《中國人民共和國侵權責任法》(以下簡稱《侵權責任法》)第一次對過度醫(yī)療行為進行了明確的規(guī)定。但是,該法仍然存在著各種問題,例如僅對過度檢查有明文規(guī)制、缺乏過錯認定權威標準、被侵權人訴訟負擔過大、被侵權人維權動力不足等。針對上述問題,學界對完善《侵權責任法》過度醫(yī)療侵權行為提出了不少建議。有學者建議盡快進行法律修改或司法解釋,以使《侵權責任法》能夠明示地規(guī)制所有的過度醫(yī)療行為；也有學者認為由于《侵權責任法》存在對過度醫(yī)療行為規(guī)制并不全面、歸責原則適用困難等問題,還不如通過對相關法律法規(guī)中有關過度醫(yī)療侵權行為進行有效調整。但是筆者認為,這些都是對《侵權責任法》一定程度上的誤讀,要有效地解決《侵權責任法》在立法和實踐中所存在的問題,并以此來推動我國過度醫(yī)療侵權行為的立法進步,我們應當立足于現(xiàn)有的法律現(xiàn)狀,對其進行合理而靈活的解釋、修正和適用。 第一部分,過度醫(yī)療侵權基本理論概說。本部分主要對過度醫(yī)療的概念和構成兩個方面進行一定的論述,闡明過度醫(yī)療的相關基本理論,通過對這些理論的介紹來明確對過度醫(yī)療行為進行有效、準確地規(guī)制所需要注意的問題。 第二部分,過度醫(yī)療侵權責任之法律適用現(xiàn)狀及其不足。該部分首先采用與過去立法對比的方式,闡明了我國現(xiàn)行的《侵權責任法》對過度醫(yī)療侵權行為進行規(guī)制的基本規(guī)定,包括：《侵權責任法》能夠依法調整所有的過度醫(yī)療侵權行為；過度醫(yī)療侵權行為僅適用過錯責任原則；醫(yī)療機構一方的抗辯和免責事由主要有醫(yī)療機構一方沒有違反相關診療規(guī)范,醫(yī)方盡到了說明和告知義務,醫(yī)療損害是由患者一方的原因所造成的等；賠償范圍包括財產、人身損害賠償以及精神損害賠償。然后,該部分提出了《侵權責任法》所存的三個缺陷：第一,現(xiàn)行的《侵權責任法》第63條僅禁止了過度檢查這一種過度醫(yī)療侵權行為,這樣的立法行為反而使得實踐中醫(yī)患雙方都對其他的過度醫(yī)療侵權行為不太重視,這就使得《侵權責任法》規(guī)制所有過度醫(yī)療侵權行為的立法本意落空。第二,《侵權責任法》存在歸責原則不夠完善的問題,這主要包括法律所規(guī)定的損害和過錯的概念不清,導致被侵權人無法在實踐中清楚的認識何為過度醫(yī)療侵權中的損害和過錯；依法作為過錯認定標準的診療規(guī)范由于沒有法律的授權而不夠權威,無法成為判斷過度醫(yī)療侵權過錯的標準；《侵權責任法》規(guī)制過度醫(yī)療侵權僅適用過錯責任原則,這雖然可以緩解醫(yī)療機構過分擔心訴訟風險的問題,降低其進行防御性醫(yī)療的可能,但過錯責任原則卻實際加重了被侵權人的負擔,有偏袒醫(yī)方利益的嫌疑。第三,在現(xiàn)有醫(yī)療保險制度下,醫(yī)療保險機構僅對門診和住院費用報銷申請進行形式審查,這就使得就醫(yī)人員一方認為即使發(fā)生了過度醫(yī)療侵權,這種侵權行為對自身所產生的損害也是比較小的,因而就醫(yī)人員寧可采取忍讓的態(tài)度,也不愿與醫(yī)療機構一方產生過大矛盾而耽誤治療,這就勢必會導致《侵權責任法》難以有效地規(guī)制過度醫(yī)療侵權行為。 第三部分,《侵權責任法》規(guī)制過度醫(yī)療侵權的完善建議。本部分對《侵權責任法》在規(guī)制過度醫(yī)療侵權行為中所存在的不足提出了以下的具體建議：第一,對《侵權責任法》第54條進行司法解釋,明示該法對過度醫(yī)療侵權行為的全面規(guī)制,這樣的做法可以回避對第63條進行立法修改所必須經歷的繁雜而冗長的立法修改過程,也可以避免對第63條進行擴大解釋有違立法意圖之嫌疑的問題。第二,通過立法和司法手段完善歸責原則。主要包括將損害界定為超出了“平均標準”而支付的醫(yī)療費用或遭受的身體損害,將過錯界定為缺乏醫(yī)療資料記載的合理醫(yī)學判斷仍進行不必要的診療活動,在此基礎上,通過案例指導的方式將這些內容進行一定程度的公示,以幫助歸責原則的具體實踐；通過立法來明確授權專門的機構編纂權威的診療規(guī)范,并在此基礎上將該診療規(guī)范在全國范圍內推廣,指導過度醫(yī)療侵權的過錯認定；引入舉證責任緩和制度,舉證責任緩和制度不同于過錯推定原則,它并不會在事前就硬性的規(guī)定醫(yī)療機構與就醫(yī)人員雙方之間對過錯的認定責任(過錯推定原則還改變了過錯責任原則的過錯認定責任分配),它是在事中合理的分配雙方之間的責任,以此來確保過錯責任原則之適用既不會使醫(yī)療機構過于擔心訴訟風險,也不使就醫(yī)人員的訴訟負擔過于沉重。第三,完善醫(yī)保制度和《侵權責任法》的銜接。首先,通過專門制度的構建,讓醫(yī)療保險機構對門診和住院費用報銷的申請進行一定的實質審查,以此來有效地識別過度醫(yī)療侵權行為；其次,如果醫(yī)療保險機構審查出報銷申請中存在過度醫(yī)療侵權行為,則其必須依法對審查的內容進行說明,并要求醫(yī)療機構就其不存在過度醫(yī)療侵權行為進行一定的說明；最后,上述的說明都可以作為被侵權人提起訴訟的有力證據。
[Abstract]:Excessive medical behavior is a common and long-standing misconduct in medical activities. The tort liability law of the people's Republic of China (hereinafter referred to as the tort liability law) is the first to make a clear regulation of excessive medical behavior. However, there are still various problems, for example, there are only clear regulations and lack of fault for overchecking. In view of the above problems, the academic circles put forward a lot of suggestions on perfecting the tort liability law and the excessive medical tort, and some scholars suggest that the legal amendment or judicial interpretation should be carried out as soon as possible so as to enable the "power and responsibility law" to clearly regulate all excessive medicine. As a result, the author believes that these are misunderstandings to the tort liability law to a certain extent, because the "tort liability law" is not fully regulated and the application of the principle of imputation is difficult to be adjusted effectively by the relevant laws and regulations. In order to effectively solve the problems existing in the law of tort liability in the legislation and practice, and in order to promote the legislative progress of our country's excessive medical tort, we should be based on the existing legal status and make a reasonable and flexible explanation to it, and to amend and apply it.
The first part is a general introduction to the basic theory of excessive medical tort. This part mainly discusses the concept and composition of over medical treatment in two aspects, clarifies the basic theories of excessive medical treatment, and through the introduction of these theories to make clear the effectiveness of excessive medical behavior, and accurately regulate the problems needed to be paid attention to.
The second part, the current situation and shortcomings of the legal application of over medical tort liability. This part firstly uses the way of comparison with the past legislation to clarify the basic regulations of the current tort liability law of China on the regulation of excessive medical tort, including: the tort liability law can adjust all over medical Torts according to law; Excessive medical tort is only applicable to the principle of liability for fault; the defense and exemption of one party of the medical institution mainly have the medical institution one party does not violate the relevant diagnosis and treatment norms, the medical party has done the explanation and the notification obligation, the medical damage is caused by the reason of the patient one party; the compensation scope includes property, personal injury compensation and Then, this part puts forward three defects in the tort liability law: first, the current "tort liability law" and the sixty-third article only prohibit excessive inspection of this kind of excessive medical tort, which makes the practice of Chinese doctors and patients do not pay much attention to his excessive medical tort. The legislative original intention of "tort liability law" to regulate all over medical torts is lost. Second, < tort liability law > is not perfect for the principle of imputation, which mainly includes the unclear concept of damage and fault stipulated in the law, which leads to the inability of the infringed to know clearly in the practice of the damage and over the excessive medical tort. Wrong; the standard of diagnosis and treatment in accordance with the law, as the standard of fault identification, can not be the standard for judging the fault of excessive medical tort because there is no legal authorization, and the tort liability law is only applicable to the principle of fault liability, which can alleviate the problem of excessive concern for the risk of litigation by medical institutions and reduce its progress. The possibility of defensive medical care is possible, but the principle of fault liability actually aggravates the burden of the infringed and has the suspicion of favouring the interests of the doctors. Third, under the existing medical insurance system, the medical insurance institutions only examine the application for reimbursement for outpatient and hospitalization expenses, which makes the medical staff think that even if there is an excessive medical invasion. Right, this kind of tort has little damage to itself, so the medical staff would rather take the attitude of forbearance, and do not want to delay the treatment with the medical institution, which will lead to the tort liability law, which is difficult to effectively regulate the excessive medical treatment.
The third part, < tort liability law > regulations for the regulation of excessive medical tort. This part puts forward the following specific suggestions on the shortcomings of the tort liability law in the regulation of excessive medical tort: first, the judicial interpretation of the fifty-fourth articles on the tort liability law, and the comprehensive regulation of the law on excessive medical tort It can avoid the complicated and lengthy legislative revision that must be experienced in the legislative revision of the sixty-third articles, and also avoid the question of the suspicion that the sixty-third article should be expanded to explain the legal picture. Second, through legislative and judicial means, the principle of imputation is perfected. The main inclusion of the damage is to define the damage as beyond the "average standard". While the medical expenses paid or the physical damage suffered, the fault is defined as the irrational medical judgment which is not recorded by the medical data, and on this basis, the contents are given to a certain extent by the way of case guidance to help the concrete practice of the principle of imputation, and to make clear authorization through legislation. Specialized agencies compiling authoritative diagnosis and treatment norms, and promoting the diagnosis and treatment norms throughout the country on this basis, guiding the fault identification of excessive medical tort; introducing the system of burden of proof mitigation, the system of burden of proof is different from the principle of presumption of fault, and it does not stipulate both medical institutions and medical personnel before the matter. The responsibility for identifying the fault between the parties (the principle of presumption of fault also changes the allocation of fault identification responsibility of the fault liability principle), it is reasonable to allocate the responsibility between the two parties in order to ensure that the application of the principle of fault liability does not cause the medical institution to worry too much about the litigation risk, nor does it make the medical staff too heavy on the burden of litigation. Third, improve the connection between the medical insurance system and the tort liability law. First, through the construction of a special system, the medical insurance institutions have a certain substantive review of the application for reimbursement for outpatient and hospitalization expenses, in order to effectively identify the excessive medical tort; secondly, the medical insurance agency has examined the existence of a reimbursement application. It is necessary to explain the contents of the examination according to law, and require the medical institutions to give a certain description of the non existence of excessive medical tort. Finally, the above description can be used as a powerful evidence for the infringers to bring a lawsuit.

【學位授予單位】：西南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：D923

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本文編號：1862378