适应与调整:Tarasoff规则的演进逻辑及镜鉴

Adaptation and Adjustment:the Evolutionary Logic of Tarasoff Rule and Its Enlightenment to China

发轫于美国加州的Tarasoff规则旨在突破医生对患者所负之保密义务,从而就危险病人可能实施的侵权行为对第三人履行安全保障义务。该规则经由美国各州长期的立法、执法和司法实践,已成体系式发展趋势,相关判例既科学运用可预测性原则,又考虑特殊关系的认定依据,还凸显注意义务的衡量标准,后又扩张适用场域。Tarasoff规则之所以可以在美国及其他国家和地区大行其道,概因其背后蕴含的正当性基础,即隐私权之克减性、义务附加之周延性与必要性以及损益协调之均衡性。基于此,我国应于公法域和私法域分别采用强制型和豁免型两种立法模式引入Tarasoff规则,并明晰其与我国现行立法之间的衔接关系,实现立法取向由一味保护患者隐私向平衡他人合法权益及社会公益的转型。此外,还应出台相关行业操作指南,对于医生披露患者信息的行为流程加以引导,以此有效应对多样化的个案实践。

The Tarasoff Rule,which originated in California,is designed to break the confidentiality duty of doctors to their patients,and thus to fulfil the security obligation to third parties for possible torts committed by dangerous patients.The Tarasoff Rule has reflected the trend of systemic development through long-term legislation,law enforcement and judicial practice in the United States,and the relevant cases has not only scientifically applied the foreseeability principle,but also considered the basis for the determination of special relationship,and highlighted the measurement standard of duty of care,and then expanded the applicable field.The reason why Tarasoff Rule has prevailed in the United States and other countries and regions is the legitimacy behind it,that is,the derogation of the right to privacy,the distribution and necessity of additional obligations,and the balance of profit and loss coordination.Based on the foregoing,China should introduce the Tarasoff Rule in both public and private law by adopting two legislative models of mandatory duty and permissive duty respectively,and clarify the connecting point between the Tarasoff Rule and the existing legislation in China,so as to transform the legislative orientation from solely protecting patients’privacy to balancing the legitimate rights and interests of others and social welfare.In addition,relevant industry self-regulation should be issued to guide the behavior process of doctors in disclosing patient information,so as to effectively deal with diversified case practices.