医疗告知义务的动态体系论  

On a Dynamic and Systematic Theory of the Obligation of Medical Notification

作　　者：王磊[1] Wang Lei

机构地区：[1]贵州大学法学院

出　　处：《东方法学》2025年第1期171-185,共15页Oriental Law

基　　金：国家社科基金青年项目“侵权损害的限制赔偿原理及规范技术研究”(项目批准号:21CFX036)的阶段性研究成果。

摘　　要：针对医疗告知义务的履行,既有方案在医师标准与病患标准之间游离不定,两者均是在预设医疗告知义务的某一价值立场后再实施法律评价的概念“推演”,难以调和医患利益冲突。为了消解医疗告知义务的解释难题,应该抛弃概念推演思维,站在功能性立场采取动态体系论的评价思路,根据个案情况浮动调整告知范围,从而避免医患利益孰高孰低的二律背反。法是多种要素相互作用的结果,当法律规则无法对现实社会发挥调整效益时,就需要回溯其背后的规范原理,医疗告知义务之下存在诊疗风险、诊疗紧迫性、病患对诊疗信息的知悉度、诊疗有效性四大规范要素,该等规范要素相互协动的结果映射出医疗告知的具体样态。其中,诊疗风险具有基础性的评价地位,是各规范要素发挥协动作用的支撑点,其他三个规范要素发挥辅助性的评价作用,根据诊疗风险确定医疗告知标准后进行再调节。医疗告知义务的履行标准在各个规范要素的协作与冲突之间得以形塑。Existing approaches to the fulfillment of the obligation of medical notification often vacillate between the physician's standard and the patient's standard, both of which are conceptual "deduction" that presupposes a predetermined value stance on medical notification obligations and then carries out a legal evaluation. This results in difficulties reconciling the conflicting interests between the physician and the patient. To address the interpretive challenges of the obligation of medical notification, the view of conceptual deduction should be abandoned. A functional perspective, using a dynamic system theory approach, should be adopted, adjusting the scope of notification based on the circumstances of cases. This method avoids the binary opposition of prioritizing either physician's or patient's interests. Law is the result of the interaction of multiple elements. When the legal rules can't play the adjusting effect on the real society, it is necessary to retrace the normative principle behind it. Under the obligation of medical notification, there are four normative factors, i.e. the risk of diagnosis and treatment, the urgency of diagnosis and treatment, patient's understanding of diagnostic and treatment information, and effectiveness of diagnostic and treatment. The result of the mutual interaction of the normative elements is mapped out in the form of a specific pattern of medical notification. Among them, the risk of diagnosis and treatment takes a fundamental evaluative position, supporting the coordination of the other three factors. The other three normative elements play a complementary evaluative role, moderating the standard of medical information according to the risk of treatment. The other three normative elements play a complementary evaluative role. After determining the medical notification standard based on treatment risks, further adjustments can be made. The standards for fulfilling the obligation of medical notification are determined by the collaboration and conflict between these vario

关 键 词：医疗告知义务 病患自决权 医师标准 病患标准 诊疗风险 动态体系论 

分 类 号：DF51[政治法律—民商法学]