论违反告知义务之医疗侵权形态的特殊性

Distinction of Medical Negligence Produced by Breach of the Doctrine of Informed Consent

违反告知义务("知情同意"法则)侵权形态是一种新近发展起来的侵权类型,它有自己独特的权利基础和法理基础。"知情同意"法则的独特性有二:(1)以保护患者的自我决定权或自主权为最高宗旨;(2)不需要很多的医学判断和专业知识的介入。医疗过失侵权法,作为一种专家责任法,具有一种潜在的保护医疗行业、尊重医学判断的本能和机制。它适用于主要依靠专业技能和专业判断的传统诊断治疗领域有道理,但在以尊重患者自我决定权为核心的知情同意领域有些勉强。知情同意法则以患者的需求和权利为依归,专业知识和技能不再具有强大的统治力。在需要医学专业判断的传统的诊断和治疗领域,法律可以表现对医学行业的极大尊重,因此在过失认定上,建立以医疗行业为依归的认定标准尚有道理,但是在知情同意领域,建立以患者为取向的注意标准更有说服力。在因果关系的认定上,法律也向患者权利保护作了倾斜,而对因果关系作了弹性适用。应当区分医师的疗法实施义务与说明义务。两种义务所服务的目的和所指向的对象范围并不一致。

Medical negligence produced by breach of the doctrine of informed consent is a newly developed type of tort.It has its own distinctive rights basis and rationale.Informed consent law has its distinctiveness. This distinctiveness mainly comes from two aspects:(1) respect for patient's right of self-determination or autonomy;(2) no much involvement of medical judgment and medical knowledge.Traditional medical negligence rules have a potential for protecting medical profession.It is most suitable to traditional diagnosis and treatment context;it is not a good fit for informed consent law.In the traditional realm of diagnosis and treatment involving medical judgment,the law can show weighty deference to the medical profession and can adopt profession-oriented standards in deciding negligence.However,in the realm of informed consent,a patient -oriented standard is more persuasive.In deciding the issue of causation, the law also gives patients' rights a special respect by relaxing traditional test of causation.It needs to be raised that the duty to select and perform particular treatment option is different from the duty to inform options.They serve different purposes and have different targets.