违反医疗告知同意损害归责的反思与建构  

Reflection and Construction on the Liability for Damages Resulting from the Violation of Medical Informed Consent

作　　者：尹志强[1] 冯超 YIN Zhi-qiang;FENG Chao(Civil,Commercial and Economic Law School,China University of Political Science and Law,Beijing 100088,China)

机构地区：[1]中国政法大学民商经济法学院,北京100088

出　　处：《内蒙古社会科学》2025年第3期139-148,F0003,共11页Inner Mongolia Social Sciences

摘　　要：违反医疗告知同意规则的损害归责始终存在内涵不明、性质不清等问题。从适用范围与法益保护性上看,告知同意规则是指《民法典》第1219条第1款中后一句规定的内容,属于独立的损害赔偿请求权的基础。由于第1219条规范的保护目的具有特殊性,传统损害理论与违反告知同意的损害归责并不兼容,无论单一损害说还是双重损害说都无法有效地保护患者的自主权。基于患者同意本质上是违法性阻却事由,违反告知同意规则的侵入性诊疗行为应等效为人身伤害行为。然而,违反告知同意规则的行为并非一律等于同意无效,宜根据医务人员的专断程度,区分同意无效与告知不充分两种情形,分别构造损害归责原理。当认定患者同意无效时,应以故意伤害进行损害归责,而认定告知不充分时,则以过失致害进行损害归责。The liability for damages resulting from the violation of medical informed consent has always presented issues such as unclear connotation and ambiguous nature.From the perspective of the scope of application and the protection of legal interests,the informed consent rule refers to the second sentence of Paragraph 1 of Article 1219 of the Civil Code and constitutes an independent basis for claims for damages.Due to the particularity of the protective purpose of the norms in Article 1219,traditional damage theories are incompatible with the liability for damages from the violation of informed consent.Neither the single damage theory nor the dual damage theory can effectively protect patients'autonomy.Based on the essence of patients'consent being a matter of precluding illegality,invasive medical treatments that violate informed consent should be equivalent to personal injury acts.However,the violation of the informed consent rule does not always equal the invalidity of consent.It is appropriate to distinguish between the invalidity of consent and insufficient notification according to the degree of arbitrariness of medical staff,and respectively construct the principles of liability for damages.When it is determined that the patient's consent is invalid,liability for damages is determined based on intentional injury,and when it is determined that the notification is insufficient,liability for damages is determined based on negligent injury.

关 键 词：告知同意规则 自主权 行为等效 故意伤害 过失致害 

分 类 号：D923[政治法律—民商法学]