病案中存在举证不利的若干问题

由于我院医师对在患者住院治疗中具有高度的责任心和满腔热情,多年来尚未发生过严重的医疗纠纷事件。在2002年9月1日开始实施的《医疗事故处理条例》后,医师面临新的“举证责任倒置”问题,很多医师思想准备不足,少数医师缺乏对“举证责任倒置”的认识,可能使我们在发生医疗纠纷事件后处于“举证不利”的境地。回顾近几年病历中存在种种问题,在“举证责任倒置”的情况下,令人堪忧,现就病历中存在的举证不利若干问题评析如下。     

"举证责任倒置"对手术室护理工作的潜在影响及对策

本文，就“举证责任倒置”对手术室护理工作的潜在影响作简要分析，使我们正确认识“举证责任倒置”，加强防范，对日后护患纠纷的举证责任，提出改进护理工作的具体措施。     

预防急诊护理纠纷之我见

在医疗纠纷实行“举证责任倒置”的今天,为减少急诊护理人员的护患纠纷,本文对容易引发的急诊护理纠纷进行分析,并提出应对的策略。2002年4月1日最高人民法院《关于民事诉讼证据的若干规定》明确规定了医疗纠纷的处理实行“举证责任倒置”,即“因医疗行为引起的侵权诉讼,由医疗     

医院应如何正确理解和贯彻医疗纠纷中的"举证责任倒置"

为了贯彻实施好 2 0 0 2年国务院颁布的《医疗事故处理条件》〔1〕,依法做好医疗事故的防范、技术鉴定和处理 ,维护医患双方合法权益 ,促进医学科学发展 ,保障医疗安全 ,维护社会稳定 ,本文试就医院在新的法制环境里 ,应如何正确理解和贯彻医疗纠纷中的“举证责任倒置”问题进行初步探讨。1　医院应如何正确认识和理解“举证责任倒置”医疗侵权诉讼中的“举证责任倒置” ,源于最高人民法院 2 0 0 1年 1 2月 1日出台的《关于民事诉讼证据的若干规定》的司法解释。这则司法解释第四条第一款第八项规定 :“因医疗行为引起的侵权诉讼 ,由医疗机…     

浅析医疗纠纷案件中的举证责任倒置

2002年4月1日起,我国对于因医疗行为引起的侵权诉讼确立了“举证责任倒置”的原则。本文讨论医疗事故、医患纠纷的定义、举证责任的分配、举证责任“倒置”在医疗侵权纠纷中的适用等。     

谈举证责任倒置与护理文件书写

2002年9月1日，《医疗事故处理条例》已开始实施。最令医护人员难以转变观念的焦点问题是“举证责任倒置”。     

手术室护士如何做好“举证责任倒置”

目的 :为减少手术室护理工作所存在的医疗纠纷 ,从“举证责任倒置”的法律角度探讨手术室的护理工作。方法 :采取加强手术室护士的自我保护意识 ;作好灭菌监测和数据资料保存 ;做好术中护理记录 ;作好手术物品的查对工作等。结果 :手术室护士必须加强“举证责任倒置”的法律意识 ,减少医疗纠纷发生。结论 :为提高手术室护士的“举证责任倒置”意识 ,提出针对性对策。     

“举证倒置”实施后基层医院护理安全存在的问题和对策

医疗事故差错诉讼的“举证责任倒置”,对基层医院医疗、护理安全管理提出了更新、更高层次的要求。对“举证责任倒置”实施后基层医院护理安全存在的问题进行分析,并提出应对的措施和对策。     

举证责任倒置与医疗费用增长

在今年的全国政协会议上，政协医卫组委员呼吁，最高人民法院应对医疗领域中“举证责任倒置”的司法解释重新考虑，并对医疗纠纷中医院赔偿数额不断增大的判决倾向加以正确引导。委员们认为“举证责任倒置”，不仅可导致不必要的医疗费用，增加医患双方的负担，也给医生带来了巨大的心理压力。那么，举证责任倒置增加了哪些方面的医疗费用呢？     

在新的医疗卫生政策下，疾病分类编码员应该做什么？

新的《医疗事故处理条例》“举证责任倒置”,颁发实施,医院和广大医务工作者在医疗纠纷中处于不利的地位明显的凸现出来,医生书写的病历质量都将直接影响到医疗纠纷的最后结果。作为疾病分类编码员,怎样主动、积极的预防编码的错误和对病案首页填写的质量进行监督,加强自身的责任感,完善内部管理制度和增强个人专业知识、法律意识,搞好病案管理工作为“举证责任倒置”提供强     

医务人员需重视病案的法律证据作用

法律规定医疗诉讼实施举证责任倒置的原则,病案就成为非常重要的一种书面证据。而不少医务人员对病案的证据作用不重视,缺乏自我保护意识,甚至认为即使病历有问题也不会对病人带来直接的损害,为此造成法律鉴定不能举证,医院败诉、赔偿事件屡见不鲜。医师规范的书写病历对自身和患者都是负责的表现,全面、准确、真实的病历才能真正体现证据的作用,医务人员才能在举证责任倒置中立于不败之地,维护合法权益。     

医疗损害责任司法实践的调查分析

笔者设计了医疗损害责任司法实践的调查问卷,针对北京、上海、深圳、福州四城市的医院、患者、律师和法官进行了问卷调查,并对问卷调查结果进行了汇总分析,探讨了关于最高人民法院"损害后果出现在侵权责任法实施之后"的理解、举证责任、医疗损害责任鉴定、告知义务、不必要检查、医疗产品责任、医疗损害赔偿以及病历等问题。     

Duty to disclose what? Querying the putative obligation to return research results to participants

Many research ethics guidelines now oblige researchers to offer research participants the results of research in which they participated. This practice is intended to uphold respect for persons and ensure that participants are not treated as mere means to an end. Yet some scholars have begun to question a generalised duty to disclose research results, highlighting the potential harms arising from disclosure and questioning the ethical justification for a duty to disclose, especially with respect to individual results. In support of this view, we argue that current rationales for a duty of disclosure do not form an adequate basis for an ethical imperative. We review policy guidance and scholarly commentary regarding the duty to communicate the results of biomedical, epidemiological and genetic research to research participants and show that there is wide variation in opinion regarding what should be disclosed and under what circumstance. Moreover, we argue that there is fundamental confusion about the notion of "research results," specifically regarding three core concepts: the distinction between aggregate and individual results, amongst different types of research, and across different degrees of result veracity. Even where policy guidance and scholarly commentary have been most forceful in support of an ethical imperative to disclose research results, ambiguity regarding what is to be disclosed confounds ethical action.     

我国人类辅助生殖技术机构伦理委员会操作规程(建议稿)

目的:为规范我国ART医疗机构伦理委员会的伦理监督行为,建立我国ART伦理委员会操作规程或指南提供参考;方法:条文归纳法.按科学实施的要求将委员会职责行为规范以条文依次归纳概括;结论:该建议(稿)以伦理委员会实践探索为基础,适当接轨国际惯例和借鉴国外经验,具有较强操作性和借鉴意义.     

Should doctors intentionally do less than the best?

The papers of Burley and Harris, and Draper and Chadwick, in this issue, raise a problem: what should doctors do when patients request an option which is not the best available? This commentary argues that doctors have a duty to offer that option which will result in the individual affected by that choice enjoying the highest level of wellbeing. Doctors can deviate from this duty and submaximise--bring about an outcome that is less than the best--only if there are good reasons to do so. The desire to have a child which is genetically related provides little, if any, reason to submaximise. The implication for cloning, preimplantation diagnosis and embryo transfer is that doctors should only produce a clone or transfer embryos expected to enjoy a level of wellbeing which is less than that enjoyed by other children the couple could have, if there is a good reason to employ that technology. This paper sketches what might constitute a good reason to submaximise.     

由鲍光蛇事件引发对医院不作为的思考

作为国家向社会提供公共卫生产品的公立医院,大部分在政策上享有免税和财政补贴,这些医院有责任和义务为一切病人,尤其向危急病人提供及时合理的救治.但现实中,部分医院在面对危急病人时常因“一手交钱一手看病的明制度和潜规则”而表现出种种不作为,导致病人病情恶化,严重的致使病人死亡.所以,在理论上确定不作为的特征及构成要件,有利于在实践中认定医院的责任和患者的权利,以便更好地理清医院和患者之间的法律关系及相应责任.     

The ethics of anonymised HIV testing of pregnant women: a reappraisal

Seroprevalence monitoring of HIV in pregnant women by anonymised unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymised testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymisation is explained.

Key Words: Anonymisation • HIV • antenatal testing • informed consent • duty of care

     

The ethics of anonymized HIV testing of pregnant women: a reappraisal

Seroprevalence monitoring of HIV in pregnant women by anonymized unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymized testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymization is explained.     

Intervening in clinical research to prevent the onset of psychoses: conflicts and obligations

A prevailing issue in clinical research is the duty clinicians have to treat or prevent the progression of disease during a study that they are conducting. While all clinical researchers have a duty of care for the patients who participate in clinical research, intervening at the onset or progression of disease may skew results and have a negative impact on the scientific validity of a study. Extreme examples of failures to intervene can be found in the Tuskegee syphilis study and in an attempt to determine if cervical smears were an accurate predictor of cancer, which was uncovered by the Cartwright Inquiry. However, the issue arises in all research where delay in intervention can cause harm. A current study in Singapore is investigating the significance of an 'ultra-high risk' state that may constitute the prodromal phase of psychosis. This project called 'The Longitudinal Youth at Risk Study' is potentially contentious because it is recruiting young people who are identified as being 'at risk' of developing psychosis. In this paper, the decision to offer treatment to all participants as well as a fast track for those who are assessed to have developed serious mental illness into treatment is discussed. It is argued that this approach is ethically justified because of the duty of care that is owed to research participants, and suggests that the principle of equipoise may be used to guide intervention decisions in other clinical research protocols.     

微创PCNL治疗输尿管上段结石

目的：探讨微创PCNL治疗输尿管上段结石的可行性和临床经验。方法：2002年1月-2002年12月，利用微创PCNL技术治疗辅尿管上段结石进行回顾性分析。结果：运用本法治疗67例，结石一期取净率100％，无输尿管穿孔、术后出血及尿瘘。结论：微创PCNL治疗输原管上段结石具有创伤小、出血少，操作安全可靠、结石取净率高等优点，治疗效果良好，值得推广应用。