实体法与程序法交互背景下医疗过错推定规制的分析及其完善  

Analysis and Enhancement of Medical Fault Presumption Regulation Under theInteraction of Substantive Law and Procedural Law

作　　者：李抒波 LI Shubo(College of Law,Shanxi University,Taiyuan,Shanxi,030006,China)

机构地区：[1]山西大学法学院,山西太原030006

出　　处：《医学与社会》2023年第10期138-144,共7页Medicine and Society

基　　金：国家社会科学基金资助项目,编号为18BGL25。

摘　　要：医疗损害过错推定规制兼具救济患者与规范医疗行为的双重功能。《中华人民共和国民法典》第一千二百二十二条第一项医方违反诊疗规范属于医疗过错对应的主要事实,并非法律推定;而第一千二百二十二条第二、三项作为法律推定,在患者依据基础事实主张医方过错时,明确医方提出相反证据以动摇法官心证的正当性。在法律适用上,首先应对第一项予以限缩解释以防止“过度医疗”现象的滋生;其次在肯定第二、三项是对证明妨碍规则突破的同时,需将审查医方恶意作为适用证明妨碍规则的前提。随着对域外法“表见证明”和“大致推定”认识的逐渐深入,建议在个案中增加举证责任缓和制度,尽可能弥合患者与医方间举证能力的客观差距,增加司法适用的操作性。The regulation of fault presumption in cases of medical injury serves a dual purpose of providing relief to patients and standardizing medical practices.According to Article 1222,paragraph 1 of the Civil Code of the People's Republic of China,a medical professional's violation of diagnosis and treatment norms constitutes a key factual element in establishing medical fault,rather than a legal presumption.However,Article 1222,paragraph 2 and paragraph 3 do establish legal presumptions,whereby if a patient asserts medical fault based on underlying facts,the medical professional must present contradictory evidence to challenge the validity of the patient's claim before the court.In terms of legal application,a narrow interpretation should be applied to the first provision to prevent the proliferation of"overtreatment"practices.Furthermore,while recognizing the second and third provisions as exceptions to the burden of proof,it is essential to consider the examination of medical professionals'malicious intent as a prerequisite for applying the burden of proof rules.As understanding of the extraterritorial legal doctrines of"prima facie proof"and"approximate presumption"deepens,it is recommended to introduce a system of mitigating the burden of proof in individual cases.This would help bridge the objective gap in evidentiary capabilities between patients and medical professionals and enhance the practicality of judicial application.

关 键 词：卫生法 医疗过错 法律推定 证明责任 

分 类 号：R19-019[医药卫生—卫生事业管理]