现行《医疗事故处理办法》的修改探析

现行《医疗事故处理办法》颁布实施１０ 年之久,新形势下需要对其进行修改和完善。“办法”的修改应该体现平等保护医患双方合法权益原则,合理界定医疗事故范围,调整医疗事故鉴定委员会的组成,建立完善的证据管理制度,明确医疗事故损失赔偿的范围和额度。     

现行《医学事故处理办法》的修改探析

现行《医疗事故处理办法》颁布实施１０年之久，新形势下需要对其进行修改和完善。“办法”的修改应该体现平等保护医患双方合法权益原则，合理界定医疗事故范围，调整医疗鉴定委员会的组成，建立完善的证据管理制度，明确医疗事故损失赔偿的范围和额度。     

医疗事故鉴定制度向何处去

《侵权责任法》实施后,在医疗损害民事纠纷领域,医疗事故鉴定制度失去了实体法基础,应当废除;在追究医疗行为行政及刑事责任领域,医疗事故鉴定有继续存在的必要,且应当对现行医疗事故鉴定制度进行重大改革,建议成立“医疗鉴定”专门机构,将“医疗鉴定”作为一个独立的司法鉴定类别,将医疗事故鉴定作为医疗鉴定的一个子项目;医疗事故鉴定专家应当由临床医学专家、法医与法律专家共同组成;鉴定结论由鉴定专家以个人名义做出,从而为追究违法医疗行为的行政责任和刑事责任提供科学依据.     

《医疗事故处理条例》的进步与争议

国务院 2 0 0 2年 4月 14日以第 35 1号国务院令的形式公布了《医疗事故处理条例》(以下简称《条例》) ,该法于 2 0 0 2年 9月 1日施行 ,其前身就是争议纷纷的《医疗事故处理办法》(以下简称《办法》)。这次修改不仅仅体现在名称上从办法变为条例 ,在内容上更是做了大幅度的修改、调整和完善。修改的内容主要体现在医疗事故的界定、患者知情权、医疗事故鉴定制度、医疗事故的赔偿制度等方面。1　医疗事故的界定医疗事故是医疗事故处理制度中的一个核心概念。因为 ,只有当某一医疗事件被鉴定为医疗事故时 ,医疗机构才承当赔偿责任 ;如果某一…     

完善我国医疗事故技术鉴定制度的思考

在我国,如何建立一个科学、完善、认同性高的医疗事故技术鉴定制度是社会各界十分关注的焦点.新<医疗事故处理条例>中关于医疗事故技术鉴定的相关规定较之旧<医疗事故处理办法>有了很大的进步.但随着实践的不断深入,发现现行鉴定制度存在医疗事故技术鉴定的组织者尚未真正的独立、鉴定组成人员实质没有改变、专家回避制度操作性差、集体鉴定制有悖法理的弊端,对此提出了相应的对策.     

医疗事故技术鉴定公正性初探

医疗事故技术鉴定是解决医患纠纷的重要环节,鉴定公正与否直接关系到医患双方的合法权益能否得到有效的保护,关系到社会的和谐与稳定。医疗事故技术鉴定在解决医患纠纷上发挥了积极的作用,但也存在一些缺憾。对目前鉴定的公正性进行了分析,并提出相应的对策。     

医疗事故技术鉴定公正性初探

医疗事故技术鉴定是解决医患纠纷的重要环节,鉴定公正与否直接关系到医患双方的合法权益能否得到有效的保护,关系到社会的和谐与稳定.医疗事故技术鉴定在解决医患纠纷上发挥了积极的作用,但也存在一些缺憾.对目前鉴定的公正性进行了分析,并提出相应的对策.     

论医务人员在医疗事故技术鉴定过程中的法律地位

目前,医疗事故技术鉴定过程中忽视了医务人员应有的地位。从法律规定和程序正义、当事人理论等方面明确了医务人员在鉴定中的法律地位。论述了医务人员应当是医疗事故技术鉴定的当事人,其在鉴定中享有当事人的权利和义务,这对保护医务人员的合法权益有着重要意义。     

对现行医疗损害鉴定方式进行改革的探讨

医惠纠纷要顺畅解决必须成立一个独立于卫生行政机关,能独立承担法律责任、能高速运转,医患双方均能认可、中立并且权威的医疗损害鉴定机构,用单一的医疗损害鉴定来取代现行的医疗事故技术鉴定和医疗过错司法鉴定.采用仲裁构架模式设立医疗损害鉴定委员会和成立中国医疗损害鉴定协会对医疗损害进行鉴定是一种可行的方法.     

《医疗事故处理条例》的法律缺陷与立法对策

《医疗事故处理条例》（以下简称《条例》）实施3年以来,其在医疗事故预防、医疗事故鉴定、医疗事故赔偿等方面发挥了积极的作用。随着我国相关立法的发展和完善,《条例》在医疗实践中的法律缺陷越来越明显。针对我国目前医疗侵权损害赔偿的现状,制定一部统一的关于医疗侵权损害赔偿的法律已是当务之急。     

The protection of patients’ rights in clinical trials

The Helsinki Declaration is a very important document regarding the protection of patients’ rights in clinical trials and one of the fundamental sources of operational principles for every ethics committee. Although they have been updated, the international guidelines for ethics committees continually fail to address certain issues pertaining to the protection of patients’ rights in clinical trials. These issues include, most significantly, the method of electing ethics committees (a free, secret ballot should be preferred to direct appointment), the avoidance of conflict of interest during the election of ethics committee members, and the necessary insurance coverage for the participants of clinical trials. Polish law should, on the other hand, be developed in such way as to not limit the effectiveness of ethics committees in protecting patients’ rights in clinical trials. The ideal solution would be to draft a uniform law concerning not only clinical trials, but all medical experiments. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. The author is Chairman, Bioethics Committee of the Warsaw Regional Chamber of Physicians and Dentists.     

Ethics education and value prioritization among members of U.S. hospital ethics committees

Calls for ethics education for members of hospital ethics committees presume that the effects and benefits of such education are well-established. This is not the case. A review of the literature reveals that studies consistently have failed to uncover any significant effect of ethics education on the moral reasoning, moral competency, and/or moral development of medical professionals. The present paper discuss this negative result and describes the author's national study of the value priorities of members of hospital ethics committees. This study discovered correlations between moral decision making and factors like age and type of institution where the committee operates. The results of this study also resemble those of previous studies in finding no correlation between ethics education and moral decision making. The author concludes that there is a need for more research on the effects of nonmoral personal, societal, and institutional factors on the moral reasoning of members of hospital ethics committees. Further, in the absence of any firm empirical basis, calls for ethics education for medical professionals and ethics committee members should be rethought.     

有关医疗事故认定问题的商榷

随着医疗法律制度的逐渐健全,人们法律意识不断提高,医疗纠纷逐渐成为热点问题,它的解决与医疗事故的认定密切相关.仅从认定的意义,包括赔偿责任承担、鉴定费用分配、行政和民事诉讼中的作用,以及认定书的效力方面作以商榷,旨在使该问题得以进一步明确.     

一起四级医疗事故引发的几点思考

目前,规范护士执业范围的法律、法规存在着盲区。作者通过对一起四级医疗事故的护理责任及护士执业范围的合法性进行分析探讨,认为应当尽快出台与《护士条例》配套的实施细则,以明确规范护士的执业范围及合法性,保障护士执业的安全。     

医疗过失的法律责任

引起医疗纠纷的事实可分为应由医方承担责任的事实和不应由医方承担责任的事实,只有医方符合法律责任的构成要件－即医疗行为的主体是医疗单位、主体有过失或违反义务的行为、有损害后果、而且主体的行为与损害后果之间有因果关系,才需承担法律责任,以消除只有损害后果医方就要承担法律责任和只有鉴定为医疗事故的才承担法律责任等方面的误区。     

2004–2009 : révision de la loi de bioéthique en France,quels enjeux,quels débats ? Assistance médicale à la procréation,gestation pour autrui,transplantation

The bioethics law, adopted for the first time in 1994 and revised in 2004, is under revision again. This process has raised numerous debates at various institutional, professional and social levels. The government also organised a unique type of citizens’ consultation: the General Estates in Bioethics (GEB). Several panels of citizens had the opportunity to express their informed opinion on a selected set of topics concerning the law revision, after having received a special training by an expert committee. We have analysed the contributions of six public bodies – the Parliament Office for Scientific and Technological Choices Evaluation (OPECST), the National Consultative Ethics Committee, (CCNE), the State Council, (CE), the Biomedical Agency, (ABM), the Senate and the Parliamentary Information Mission for this bioethics law revision – as well as the final GEB's report. In this article, we present and compare their proposals on three themes: Medically assisted procreation (MAP), surrogacy and transplantation. Whereas a consensus emerged from the debates on certain issues – apart from the Senate, all institutions seem to be in favour of maintaining the current banning of surrogacy – other points are still under debate – how to open the access to MAP technologies, under what conditions should we grant access to selected data concerning gamete donors, how is death defined in the difficult conditions of a potential non heart beating donor, should the presumed consent regime for post mortem donation be revised, and if so how, – The parliament should discuss the law during 2010's first semester, and will have the difficult responsibility to take measures on issues raising medical, scientific, social, philosophical and moral questions.     

麻醉告知与手术告知纠纷案问题探讨

麻醉告知和手术告知是两项独立的医疗活动,术后不良后果既可由手术引起,亦可由麻醉引起。术后不良后果发生原因的确定应作为医疗纠纷中责任划分的重要依据。案例表明,麻醉告知和手术告知在法律上没有单独存在的必要,依法完善手术风险的告知义务已成为医务工作者面临的新问题。     

医疗风险、责任与对策

医疗风险是医疗实践中客观存在的一种具有不确定性、损害性事件,对患者、医院和医学的发展有着不利的影响。医疗风险的存在有着复杂的原因,因此,对医疗风险管理与防范也应该采取包括提高医疗技术水平、加强风险教育、实行医疗责任保险等多种手段。     

The Emperor's clothes: Some serious problems in psychoanalytic training

The author discusses some of the key problems in psychoanalytic training, in particular those problems that stem from the power differential between training analysts and students in training. One effect of this differential can be that some students feel a pressure to comply with their teachers and supervisors, even their training analyst, in ways that can be seriously detrimental to their development. Further, when something goes wrong in a student's training, how is this to be viewed by those in charge of the training? Also, how are complaints dealt with? Is suffi cient weight given to external reality? Too often training analysts, and training committees, get into pathologising a student in a process that should be recognised as ‘wild analysis in committee’, rather than considering more carefully the external realities that may be affecting a student's progress in the training. This ‘analysis’ in committee should never be allowed. There is an urgency for immediate changes to be made in psychoanalytic training so that the problems discussed, with more care being taken, should be prevented from happening. Too often, however, an institutional resistance to change dominates discussions in committee, and in society meetings, with the result that little or no change takes place even after years of debate.     

Suicide and its ethical and legal evaluation

Suicide is--considering general principles to be judged both from ethical and legal viewpoints. Moreover special attentions has to be paid to the particularities of a single case and to the fact that these particularities do not recur. This is also true of the attempt to commit suicide. The "suicideprophylaxis" is of great social important. Attention has to be paid to the problems of a fellowman, who is possibly frightened of a think or who is ill and sees no wayout from his hopelessness. The author discusses regulations of the criminallaw such as indemniti in a case of suicide--if there was no "suicide and also a putting death against another person without there own consent" and the duty of help according to paragraph 119 StGB in an accident or represent a general danger. ("erweiterter Suicid")