医疗决定权与成年监护制度的衔接——医疗代诺权的制度建构

The Connection Between Medical Self-determination and the System of Adult Guardianship-The Institutional Construction of Medical Proxy

我国在《民法典》侵权责任编中通过第1219条和第1220条确立了医疗领域中的知情同意权的基本规则以解决医疗行为的合法性问题。因同意需以同意能力作为前提,当患者为完全行为能力人时,只要在医生有效的告知的基础上作出同意即可。但对无法作出有效同意的患者,尤其是成年的不完全行为能力人而言,医生的医疗行为导致对患者人身及健康的侵害,此时医生的医疗行为就存在解决合法性的问题。为了解决这一问题,在成年患者无法作出有效同意时必须有人替代患者作出同意。但告知后的同意这一医疗同意权的人身专属性,导致无法将其简单地委托给监护人等让他人代理行使。本文借用日本学者田山辉明教授提出的“医疗代诺权”的概念,立足于解释论的立场,第一次从成年监护角度,将两个制度进行衔接,在现行法中的成年监护制度的框架下探讨医疗代诺权的建构问题。

China has established the basic rules of informed consent in the medical field through Articles 1219 and 1220 of the Tort Liability Part of the Civil Code to address the legali⁃ty of medical conduct.Since patients'capacity to consent is the prerequisite,when the patient is a fully competent person,it is sufficient to give consent on the basis of valid notification by the doctor.However,for patients who are unable to give valid consent,especially adult patients with incomplete capacity,resolving the legality of the doctor's medical conduct remains an is⁃sue when it infringes on the patient's body and health.In order to solve this issue,someone must give consent in place of the patient when the adult patient is unable to give valid consent.However,the personal and exclusive nature of the right to medical consent,which is informed consent,makes it impossible to simply delegate it to a guardian or other person to ex⁃ercise it on behalf of the patient.In this paper,we borrow the concept of“medical proxy”proposed by Japanese scholar Teruaki Tayama,and for the first time,we discuss the construc⁃tion of medical proxy from the perspective of adult guardianship by connecting the two systems from the standpoint of interpretive theory.