本文選題：過度醫(yī)療 + 侵權(quán)責(zé)任�。� 參考：《西南大學(xué)》2013年碩士論文

【摘要】：過度醫(yī)療行為是一種在醫(yī)療活動(dòng)中普遍而長(zhǎng)期存在的不法行為,《中國(guó)人民共和國(guó)侵權(quán)責(zé)任法》(以下簡(jiǎn)稱《侵權(quán)責(zé)任法》)第一次對(duì)過度醫(yī)療行為進(jìn)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(duì)過度檢查有明文規(guī)制、缺乏過錯(cuò)認(rèn)定權(quán)威標(biāo)準(zhǔn)、被侵權(quán)人訴訟負(fù)擔(dān)過大、被侵權(quán)人維權(quán)動(dòng)力不足等。針對(duì)上述問題,學(xué)界對(duì)完善《侵權(quán)責(zé)任法》過度醫(yī)療侵權(quán)行為提出了不少建議。有學(xué)者建議盡快進(jìn)行法律修改或司法解釋,以使《侵權(quán)責(zé)任法》能夠明示地規(guī)制所有的過度醫(yī)療行為；也有學(xué)者認(rèn)為由于《侵權(quán)責(zé)任法》存在對(duì)過度醫(yī)療行為規(guī)制并不全面、歸責(zé)原則適用困難等問題,還不如通過對(duì)相關(guān)法律法規(guī)中有關(guān)過度醫(yī)療侵權(quán)行為進(jìn)行有效調(diào)整。但是筆者認(rèn)為,這些都是對(duì)《侵權(quán)責(zé)任法》一定程度上的誤讀,要有效地解決《侵權(quán)責(zé)任法》在立法和實(shí)踐中所存在的問題,并以此來推動(dòng)我國(guó)過度醫(yī)療侵權(quán)行為的立法進(jìn)步,我們應(yīng)當(dāng)立足于現(xiàn)有的法律現(xiàn)狀,對(duì)其進(jìn)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(quán)基本理論概說。本部分主要對(duì)過度醫(yī)療的概念和構(gòu)成兩個(gè)方面進(jìn)行一定的論述,闡明過度醫(yī)療的相關(guān)基本理論,通過對(duì)這些理論的介紹來明確對(duì)過度醫(yī)療行為進(jìn)行有效、準(zhǔn)確地規(guī)制所需要注意的問題。 第二部分,過度醫(yī)療侵權(quán)責(zé)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(duì)比的方式,闡明了我國(guó)現(xiàn)行的《侵權(quán)責(zé)任法》對(duì)過度醫(yī)療侵權(quán)行為進(jìn)行規(guī)制的基本規(guī)定,包括：《侵權(quán)責(zé)任法》能夠依法調(diào)整所有的過度醫(yī)療侵權(quán)行為；過度醫(yī)療侵權(quán)行為僅適用過錯(cuò)責(zé)任原則；醫(yī)療機(jī)構(gòu)一方的抗辯和免責(zé)事由主要有醫(yī)療機(jī)構(gòu)一方?jīng)]有違反相關(guān)診療規(guī)范,醫(yī)方盡到了說明和告知義務(wù),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(cái)產(chǎn)、人身損害賠償以及精神損害賠償。然后,該部分提出了《侵權(quán)責(zé)任法》所存的三個(gè)缺陷：第一,現(xiàn)行的《侵權(quán)責(zé)任法》第63條僅禁止了過度檢查這一種過度醫(yī)療侵權(quán)行為,這樣的立法行為反而使得實(shí)踐中醫(yī)患雙方都對(duì)其他的過度醫(yī)療侵權(quán)行為不太重視,這就使得《侵權(quán)責(zé)任法》規(guī)制所有過度醫(yī)療侵權(quán)行為的立法本意落空。第二,《侵權(quán)責(zé)任法》存在歸責(zé)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(cuò)的概念不清,導(dǎo)致被侵權(quán)人無法在實(shí)踐中清楚的認(rèn)識(shí)何為過度醫(yī)療侵權(quán)中的損害和過錯(cuò)；依法作為過錯(cuò)認(rèn)定標(biāo)準(zhǔn)的診療規(guī)范由于沒有法律的授權(quán)而不夠權(quán)威,無法成為判斷過度醫(yī)療侵權(quán)過錯(cuò)的標(biāo)準(zhǔn)；《侵權(quán)責(zé)任法》規(guī)制過度醫(yī)療侵權(quán)僅適用過錯(cuò)責(zé)任原則,這雖然可以緩解醫(yī)療機(jī)構(gòu)過分擔(dān)心訴訟風(fēng)險(xiǎn)的問題,降低其進(jìn)行防御性醫(yī)療的可能,但過錯(cuò)責(zé)任原則卻實(shí)際加重了被侵權(quán)人的負(fù)擔(dān),有偏袒醫(yī)方利益的嫌疑。第三,在現(xiàn)有醫(yī)療保險(xiǎn)制度下,醫(yī)療保險(xiǎn)機(jī)構(gòu)僅對(duì)門診和住院費(fèi)用報(bào)銷申請(qǐng)進(jìn)行形式審查,這就使得就醫(yī)人員一方認(rèn)為即使發(fā)生了過度醫(yī)療侵權(quán),這種侵權(quán)行為對(duì)自身所產(chǎn)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(jī)構(gòu)一方產(chǎn)生過大矛盾而耽誤治療,這就勢(shì)必會(huì)導(dǎo)致《侵權(quán)責(zé)任法》難以有效地規(guī)制過度醫(yī)療侵權(quán)行為。 第三部分,《侵權(quán)責(zé)任法》規(guī)制過度醫(yī)療侵權(quán)的完善建議。本部分對(duì)《侵權(quán)責(zé)任法》在規(guī)制過度醫(yī)療侵權(quán)行為中所存在的不足提出了以下的具體建議：第一,對(duì)《侵權(quán)責(zé)任法》第54條進(jìn)行司法解釋,明示該法對(duì)過度醫(yī)療侵權(quán)行為的全面規(guī)制,這樣的做法可以回避對(duì)第63條進(jìn)行立法修改所必須經(jīng)歷的繁雜而冗長(zhǎng)的立法修改過程,也可以避免對(duì)第63條進(jìn)行擴(kuò)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(zé)原則。主要包括將損害界定為超出了“平均標(biāo)準(zhǔn)”而支付的醫(yī)療費(fèi)用或遭受的身體損害,將過錯(cuò)界定為缺乏醫(yī)療資料記載的合理醫(yī)學(xué)判斷仍進(jìn)行不必要的診療活動(dòng),在此基礎(chǔ)上,通過案例指導(dǎo)的方式將這些內(nèi)容進(jìn)行一定程度的公示,以幫助歸責(zé)原則的具體實(shí)踐；通過立法來明確授權(quán)專門的機(jī)構(gòu)編纂權(quán)威的診療規(guī)范,并在此基礎(chǔ)上將該診療規(guī)范在全國(guó)范圍內(nèi)推廣,指導(dǎo)過度醫(yī)療侵權(quán)的過錯(cuò)認(rèn)定；引入舉證責(zé)任緩和制度,舉證責(zé)任緩和制度不同于過錯(cuò)推定原則,它并不會(huì)在事前就硬性的規(guī)定醫(yī)療機(jī)構(gòu)與就醫(yī)人員雙方之間對(duì)過錯(cuò)的認(rèn)定責(zé)任(過錯(cuò)推定原則還改變了過錯(cuò)責(zé)任原則的過錯(cuò)認(rèn)定責(zé)任分配),它是在事中合理的分配雙方之間的責(zé)任,以此來確保過錯(cuò)責(zé)任原則之適用既不會(huì)使醫(yī)療機(jī)構(gòu)過于擔(dān)心訴訟風(fēng)險(xiǎn),也不使就醫(yī)人員的訴訟負(fù)擔(dān)過于沉重。第三,完善醫(yī)保制度和《侵權(quán)責(zé)任法》的銜接。首先,通過專門制度的構(gòu)建,讓醫(yī)療保險(xiǎn)機(jī)構(gòu)對(duì)門診和住院費(fèi)用報(bào)銷的申請(qǐng)進(jìn)行一定的實(shí)質(zhì)審查,以此來有效地識(shí)別過度醫(yī)療侵權(quán)行為；其次,如果醫(yī)療保險(xiǎn)機(jī)構(gòu)審查出報(bào)銷申請(qǐng)中存在過度醫(yī)療侵權(quán)行為,則其必須依法對(duì)審查的內(nèi)容進(jìn)行說明,并要求醫(yī)療機(jī)構(gòu)就其不存在過度醫(yī)療侵權(quán)行為進(jìn)行一定的說明；最后,上述的說明都可以作為被侵權(quán)人提起訴訟的有力證據(jù)。
[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(xué)位授予單位】：西南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：D923

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