治疗行为正当化根据的解释论重构——基于允许风险理论的考察

Reconstruction of Interpretative Theory for the Justification of Treatment Behaviors:Based on the Permissible Risk Theory

治疗行为的正当化根据是医疗刑法的核心问题,而其中患者的知情同意原则居于判断的主导地位。但是知情同意原则实质上是被害人承诺法理的具体化,而且其过于夸大了患者的自我决定权,没有正确处理好与家长主义之间的关系,在某种程度上也忽视了患者的最佳利益,因此难以得到认同。从对专断治疗行为的处理中可知治疗行为的正当化应在于以事前的利益衡量为基础的允许风险理论。利益之间存在层次的不同,应区分治疗前的利益与治疗时的利益,前者包括病情的紧急程度、患者的同意以及治疗方案对患者有可能造成的影响,后者则包括治疗行为的目的性和手术的正当性这样两个要件。要想对治疗行为予以合法化,治疗时的利益要件必须同时具备,而治疗前的利益要件则至少满足其一。同时它们彼此之间也存在相互影响的关系,需要做综合判断。

The justification of treatment behavior is the core of medical criminal law and the principle of informed consent of patients is in the leading status of judgment.But such principle is essentially the concretion of the legal principle of the victim’s commitment and it overstates the self-determination right of patients,fails to properly handle the relationship with paternalism and,to some extent,overlooks the best interests of patients.Consequently,it is difficult to be accepted.It can be known from the handling of arbitrary treatment behaviors that the legitimacy of treatment behaviors lies in the permissible risk theory based on ex-ante measurement of interests.There are differences in interest levels.Hence,the interests prior to treatment and the interests during treatment should be distinguished.The former includes the urgency degree of patients’conditions,the consent of patients and the potential effects of treatment plan on patients.While the latter covers two essential elements:the finality of treatment behaviors and the legitimacy of surgical treatment.To legalize treatment behaviors,the essential parts of the interests during treatment must be in place at the same time.In terms of the essential parts of the interests prior to treatment,at least one of them should be satisfied.Meanwhile,they are also mutually influential,which necessitates a comprehensive judgment.