论医疗侵权责任认定中“违法”与“过错推定”——兼谈《民法典》第一千二百二十二条第一项的适用

On"Illegality"and"Presumption of Fault"in the Determination of Medical Tort Liability--Also on the Application of Paragraph 1 Article 1,222 in the Civil Code

《民法典》第一千二百二十二条第一项所设定的“违法条款”在理论理解和实务适用中都引发了一些争议,特别是对“违法”之“法”理解得不清晰,对“违法”与“过错推定”之间的关系掌握得不准确,其突出表现为混同了“守法义务”与“注意义务”、“行政法律责任”与“民事法律责任”、“医疗机构过错”与“医务人员过错”,简化了医疗过错的判断标准,这导致在实务中医方的注意义务被过度强化、医方的法律责任被过度扩张。鉴此,在适用该条款时,应适度限缩“违法”之“法”的范围,建立“诊疗规范”在医疗过错证明中的使用规则,在违反许可类法律规定时适用“违法即过错”推定原则,在违反诊疗类法律规定时适用“近因”推定原则,以及在违反病历类法律规定时适用证据推定规则。

The"illegal clause"set out in the first paragraph of Article 1222 of the Civil Code has caused some disputes in both theoretical understanding and practical application,especially the unclear understanding of the"law"of"illegality"and the inaccurate grasp of the relationship between"illegality"and"presumption of fault",which mainly manifests the confusion between"law-abiding obligation"and"duty of care",between"administrative legal liability"and"civil legal liability",between"medical institution fault"and"medical personnel fault",and sim⁃plifying the judgment standard of medical fault.As a result,practitioners’duty of care is over-strengthened and their legal responsibility is over-extended.In view of this,when applying this provision,the scope of"law"of"ille⁃gality"should be appropriately limited,the rules for the use of"diagnosis and treatment norms"in medical fault proof should be established,the presumption principle of"illegality is wrong"should be applied when the provisions of licensing laws are violated,the presumption principle of"proximate cause"should be applied when the provisions of diagnosis and treatment laws are violated,and the evidence presumption rule should be applied when the legal provisions of medical records are violated.