论生存机会丧失原理——以医疗损害责任中损害认定的例外为视角

On the Doctrine of Loss of a Chance to Survive——from the Perspective of Exceptional Definition of Damage in Medical Malpractice

在医疗损害责任中,对于生存率较低的疾病而言,不作为的诊疗行为与患者的人身伤亡后果的因果关系因为既定疾病的存在而不可能达到证明标准。通过转换损害的界定,承认生存机会丧失本身的价值,建立一种患者自决权的程序价值与生命权、健康权的实体价值有机统一的人格法益保护制度,对于填补侵权法保护的漏洞具有现实的必要性。生存机会丧失与原因力和过错程度不属于同一层面的问题,前者适用于责任成立的认定,是积极要件;后者适用于责任减轻或免除的认定,是消极要件。

In the case of a disease with very low rate of survival,it is impossible to prove the causation between the doctor’s omission and the patient’s physical harm or death up to the standard of proof due to the existing disease. For making up the loopholes in the tort law,it is of practical necessity to redefine the damage,recognize the value of loss of a change to survive itself and establish personality rights protection system organically combining the procedural value of the patient’s autonomy and the substantive value in the right to life and health. The loss of a chance to survive is different from the causative potency and the degree of fault,because the former is a positive element in determining the existence of liability;while the latter two are negative elements in alleviating or exempting the liability.