發(fā)布時間：2018-09-12 14:10

【摘要】：本文旨在重新劃分醫(yī)療糾紛訴訟、針對不同類型案件的要件事實(shí)重新探索舉證責(zé)任分配,除導(dǎo)論外,正文由四章組成,共計6萬余字。第一章醫(yī)療糾紛訴訟概述。本章界定了醫(yī)療糾紛訴訟的概念,并深入分析了醫(yī)療糾紛訴訟的特點(diǎn)。醫(yī)療糾紛訴訟在我國被分為醫(yī)療事故糾紛和醫(yī)療過錯糾紛,存在很多問題。從合同和侵權(quán)的角度去構(gòu)建醫(yī)療糾紛訴訟的類型似乎更為合適。醫(yī)療服務(wù)合同糾紛訴訟包括一般醫(yī)療服務(wù)合同糾紛、特殊醫(yī)療服務(wù)合同糾紛以及臨床醫(yī)學(xué)試驗(yàn)糾紛;而醫(yī)療侵權(quán)糾紛、醫(yī)療倫理糾紛以及醫(yī)療產(chǎn)品責(zé)任糾紛屬于醫(yī)療損害責(zé)任糾紛的范疇。第二章醫(yī)療糾紛訴訟中的要件事實(shí)。本章介紹了要件事實(shí)的概念、特征和訴訟機(jī)能,針對不同類型的醫(yī)療糾紛訴訟的要件事實(shí)進(jìn)行了有針對性的分析。醫(yī)療服務(wù)合同糾紛訴訟中的請求權(quán)發(fā)生事實(shí)要求當(dāng)事人雙方意思表示真實(shí),掛號行為可以視為締結(jié)醫(yī)療服務(wù)合同的標(biāo)志。醫(yī)方的抗辯事實(shí)可以阻止患方請求權(quán)的發(fā)生。醫(yī)療損害責(zé)任糾紛訴訟中的請求權(quán)發(fā)生事實(shí)包括了過錯、損害和因果關(guān)系,醫(yī)方的過錯表現(xiàn)為醫(yī)療服務(wù)提供者的行為違反了注意義務(wù)的規(guī)定;患者的損害包含實(shí)際權(quán)益的損害和期待利益的損失;因果關(guān)系包括責(zé)任成立的因果關(guān)系和責(zé)任范圍的因果關(guān)系,通常將相當(dāng)因果關(guān)系說作為認(rèn)定因果關(guān)系成立的標(biāo)準(zhǔn)。第三章醫(yī)療糾紛訴訟中要件事實(shí)的證明責(zé)任分配。結(jié)合實(shí)體法上對醫(yī)療糾紛訴訟侵權(quán)責(zé)任的歸責(zé)原則以及法律要件分類說的觀點(diǎn),在醫(yī)療損害責(zé)任糾紛訴訟中應(yīng)由患方對醫(yī)方的過錯及其所受到的損害承擔(dān)證明責(zé)任;為實(shí)現(xiàn)攻擊防御雙方訴訟上的對等與平衡,采取舉證責(zé)任轉(zhuǎn)換或減輕的方法有利于減輕患方的證明責(zé)任負(fù)擔(dān)。法官可以根據(jù)不同的案件情況對醫(yī)療糾紛訴訟中雙方當(dāng)事人的舉證責(zé)任進(jìn)行裁量分配,對于證明妨礙等特殊情形利用自由心證對案件進(jìn)行綜合性考量。第四章完善醫(yī)療糾紛訴訟中要件事實(shí)證明責(zé)任分配的方法。實(shí)現(xiàn)醫(yī)療糾紛訴訟中證明責(zé)任的合理分配需要從民事訴訟和醫(yī)學(xué)的角度考量多種因素,平衡雙方當(dāng)事人的權(quán)益。具體做法是,應(yīng)當(dāng)以法律要件分類說作為基本原則,醫(yī)療合同糾紛訴訟中的特殊構(gòu)成要件屬于權(quán)利發(fā)生規(guī)范,由患方提供證據(jù)證明;而一般構(gòu)成要件則屬于權(quán)利妨礙規(guī)范,由醫(yī)方就不存在該項(xiàng)事實(shí)承擔(dān)證明責(zé)任。由于合同糾紛實(shí)行無過錯原則,患方在以醫(yī)療服務(wù)合同糾紛訴訟為案由要求醫(yī)方承擔(dān)責(zé)任時無須證明醫(yī)方過錯。在因果關(guān)系的證明方面,由患方承擔(dān)事實(shí)真?zhèn)尾幻鲿r的敗訴風(fēng)險,但為了充分保障患方利益,司法實(shí)踐中應(yīng)當(dāng)通過表見證明、存在重大診療過失時轉(zhuǎn)換舉證責(zé)任、賦予醫(yī)方文書提出義務(wù)等方法輔助處于弱勢地位的患者,促使法官對侵權(quán)事實(shí)的成立易于達(dá)到蓋然性的心證。
[Abstract]:The purpose of this paper is to reclassify the medical dispute litigation and to re-explore the distribution of the burden of proof according to the facts of different types of cases. Except for the introduction, the text consists of four chapters, with a total of more than 60,000 words. Chapter one: summary of medical dispute litigation. This chapter defines the concept of medical dispute litigation, and deeply analyzes the characteristics of medical dispute litigation. Medical dispute litigation in our country is divided into medical malpractice dispute and medical fault dispute, there are many problems. It seems more appropriate to construct the type of medical dispute litigation from the angle of contract and tort. Medical service contract dispute litigation includes general medical service contract dispute, special medical service contract dispute and clinical medical trial dispute; and medical tort dispute, Medical ethics dispute and medical product liability dispute belong to the category of medical damage liability dispute. Chapter two: essential facts in medical dispute litigation. This chapter introduces the concept, characteristics and litigation function of essential facts, and analyzes the important facts of different types of medical disputes. The fact that the right of claim occurs in the dispute litigation of medical service contract requires the parties to express their intention truthfully and the registered act can be regarded as the sign of the conclusion of the medical service contract. The facts of the defense of the medical side can prevent the occurrence of the right of claim of the patient. The fact that the right of claim occurred in the lawsuit of medical damage liability dispute includes fault, damage and causality. The fault of the medical side is that the medical service provider's behavior violates the duty of care. The damage of patients includes the damage of actual rights and interests and the loss of expected interests. Causality includes the causality of the establishment of liability and the causality of the scope of liability, which is usually regarded as the criterion of determining the establishment of causality. Chapter III assignment of burden of proof of essential facts in medical dispute litigation. According to the principle of liability attribution and the classification of legal elements in substantive law, the patient should bear the burden of proof to the fault of the doctor and the damage suffered in the lawsuit of medical damage. In order to achieve the equality and balance between the two sides of the attack, the burden of proof can be reduced by changing or reducing the burden of proof. According to different cases, the judge can distribute the burden of proof of both parties in the medical dispute litigation, and use the free evidence to consider the case synthetically for the special circumstances such as proof hindrance. The fourth chapter consummates the method of burden of proof in medical dispute litigation. To realize the reasonable distribution of burden of proof in medical dispute litigation, it is necessary to consider many factors from the angle of civil action and medicine to balance the rights and interests of both parties. The specific practice is that the classification of legal elements should be taken as the basic principle. The special constitutive elements in medical contract disputes belong to the norms of the occurrence of rights, which are proved by evidence provided by the patients, while the general constitutive elements belong to the norms of obstruction of rights. The doctor bears the burden of proof that the fact does not exist. Due to the principle of no-fault in contract dispute, the patient does not need to prove the fault of the medical party when the lawsuit of medical service contract dispute is taken as the reason for requiring the medical party to bear the responsibility. In the aspect of proof of causality, the patient should bear the risk of losing the lawsuit when the facts are not clear, but in order to fully protect the interests of the patient, the judicial practice should prove that the burden of proof should be changed when there is a major fault in diagnosis and treatment. Giving medical documents and other methods to assist patients in a weak position, to promote the establishment of the facts of infringement is easy to achieve psychological evidence of inevitability.
【學(xué)位授予單位】：華東政法大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：D925.1

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