病人自主权的概念:从民法的宝库看

A. Lytvynenko
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摘要

在过去四五十年之前,病人权利的概念本身是相当为人所知的,各种医疗事故使受害方向法院寻求赔偿;但是,在20世纪后期之前,除了极少数例外情况外,还没有专门的立法来保障病人的权利。在20世纪,特别是前几十年的民法传统中,医生可能对各种各样的渎职行为承担刑事或民事责任,包括未经授权的医疗干预或泄露病人信息,尽管这些规定没有规定实际的权利,性质相当笼统,并由法院在每个案件中单独评估。在医疗法律理论的逐渐变化中,"自主权"一词,即病人决定对其身体进行何种医疗干预的权利,介入了现有的法律学术研究,后来又增加了各种问题,如查阅病人的医疗记录、拒绝输血、参加医学实验、决定生命终结的情况或与各种生殖法有关的考虑,并不总是被国家法律允许。这些权利中有许多比病人自主的概念本身要古老得多,并且是在判例法中发展起来的,判例法本身起源于对医生和医院的行为的诉讼,这些行为在现有的法律理论中几乎是模糊的,例如未经授权的医学实验。本文旨在探讨患者自主权的学术发展和总体要点,以及其在民法学说中的一些早期解释。关键词:患者权利,医疗事故,法学理论,医学法,患者自治,民法
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The Concept of the Patient’s Autonomy: From the Vaults of Civil Law
The concept of patient’s rights itself was fairly known before the last four or five decades, and medical malpractice of all kinds made the aggrieved party to seek redress at a court; but no special legislation, apart from rare exceptions, has ever existed to anchor the patient’s rights before the late 20th century. In the civil law tradition of the 20th century, especially its earlier decades, doctors could be held criminally or civilly liable for a wide variety of malpractice, including unauthorised medical intervention or divulgation of patient’s information, though such provisions did not develop actual rights, were quite general in their nature, and were individually assessed by the courts in each case. Within in the gradual change in the doctrines of medical law, the term “autonomy”, shaping the patient’s right to decide what medical interventions could or could not be performed upon his body, intervened into the existing legal scholarship, which was later augmented with various issues, such as access to medical records of the patient, refusal of blood transfusion, participation in medical experiments, deciding upon end-of-life situations or relating to various reproductive law considerations, not always permitted by national law. Many of these rights are much older than the concept of patient’s autonomy themselves, and have developed in the case law which itself has originated from lawsuits against doctors and hospitals for acts, being nearly obscure in the existing legal doctrine, such as unauthorised medical experiments. The given paper is aimed to discuss the academic development and overall gist of the patient’s right to autonomy, as well as some of its early interpretations in civil law doctrine. Keywords: patient’s rights, medical malpractice, theory of law, medical law, patient autonomy, civil law.
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