基于理论梳理的“医疗过错”鉴定原则与思路

Identification Principle and Thought of“Medical Malpractice”Based on Theoreti⁃cal Analysis

目前,医疗纠纷仍然是社会焦点问题,有些甚至会演变为严峻的社会事件,在纠纷解决机制中,司法鉴定意见是重要的技术支撑。由于医学的高度专业性和复杂性,医疗过错的认定成为鉴定中的重点和难点问题。本文系统地梳理了医疗过错的概念、过错认定的5种法学理论学说,并指出我国现阶段的医疗损害司法鉴定应以“医疗水平”说为主导,以“谨慎的患者”标准说为补充,在形式上强化同行评议。同时,鉴定中需遵循7个主要原则:(1)以“诊疗义务”作为医疗过错判断的基本原则;(2)以是否尽到与当时的医疗水平相应的诊疗义务作为具体原则;(3)以诊疗常规、规范、指南为主要依据;(4)遵循“同行评议”原则;(5)“医疗紧急处置行为的宽泛性”原则;(6)“告知-知情-同意”原则;(7)“并发症的审查”原则。本文也针对上述原则提出了对应的鉴定思路,以期对医疗损害司法鉴定活动的规范化有所裨益。

At present,medical disputes are still widely-concerned social problems and occasionally evolve into severe social events.In the dispute settlement mechanism,forensic identification opinion is the important technical support.Due to the high professionalism and complexity of medicine,the identification of medical malpractice has become major and difficult problem in the identification.This paper systematically analyze the concept of medical malpractice and five legal theories of malpractice determination,pointing out that China’s forensic identification of medical damage should be led by the theory of“medical standards”,supplemented by“prudent patient”standard and strengthen“peer review”in form.At the same time,seven main identification principles should be followed in practice:(1)take“obligation of diagnosis and treatment”as the basic principle of medical malpractice identification;(2)take whether to fulfill the obligation of diagnosis and treatment corresponding to current medical level as the specific principle;(3)take diagnosis and treatment routine,norms and guidelines as the main basis;(4)the principle of“peer review”;(5)the principle of“the generality of medical emergency action”;(6)the principle of“notification-informed-consent”;(7)the principle of“review of complications”.This paper also puts forward the corresponding identification ideas in view of the above principles,hoping this helps standardize medical damage forensic identification activities.