对构建和谐医患关系的制度思考

医疗纠纷是世界各国普遍存在的现象，也是当前社会的一个热点问题。医疗纠纷的产生有经济、法律、道德、思想意识等多方面的原因，因此建立医疗法律健全、经济有保障、质量有监管、道德有约束的医疗卫生工作各项规章制度，将有助于预防和减少医患纠纷，建设和谐的医患关系。     

依法维护医疗机构权益的思考

<正> 随着社会的发展和公民法律意识的不断增强,医患关系调节方式上的法制化趋势日益明显。相形之下,医疗卫生单位则缺乏应有的法律敏感性,对自身的合法权益维护的力度不够,在医疗纠纷处理及法律诉讼中往往处于被动。如何面对挑战,转变观念,在充分尊重病人的生命健康权利的同时,依法加强自身权益维护,是当前医疗卫生单位亟待重视的课题。 1.卫生单位主体意识淡薄     

医患关系的现状、成因及对策

目的 分析医患关系紧张的原因,并提出相应对策.方法 用文献综述方式,参考我国近期发表的22篇相关文献,就医患关系的现状及成因进行分析.结果 目前,医患关系紧张是不争的事实.成因既有医院外部因素,也有医院内部因素.外部因素与政府对医疗卫生事业投入不足;相关法律、法规建设滞后;患者医疗费用负担过重,医疗保障制度建设滞后;卫生资源分配不公;医患关系调控主体不到位;在医疗服务中引入市场机制;医患双方对医疗服务结果认识和要求存在差异;医疗行为的双刃效应;医患之间的非对称关系;部分新闻媒体不实报道加剧医患双方紧张关系等有关.医院内部因素有:医院内部改革滞后;医疗风险管理不到位;医患沟通尚未规范化、制度化;医务人员的职业道德和法律意识尚待提高;医院扩张的负面影响;医院重程序服务、轻人文关怀等.针对以上成因,提出保证卫生事业的公益性,增加对医疗卫生事业的投入;完善医疗服务法律、法规建设;医疗卫生行政主管部门应转变角色;加大卫生科普知识宣传力度,逐步缩小医患双方对医疗服务结果的认识差异;加大对新闻媒体的监督力度,使媒体理性传播;加强医院管理,建立健全并严格执行各项规章制度;建立规范化、人文化的医患沟通机制;加强医务人员的职业道德教育,全面提升医护人员的文化素养和道德水准;重建医患之间的诚信关系;理性发展医院,避免盲目扩张导致患者经济负担加重等对策.结论 医患关系的改善有赖于国家加大卫生行政管理力度,加快医疗改革,合理对医疗机构进行财政补偿;有赖于法律、法规的完善,教育的普及与提高,媒体的理性传播,公众道德水平的提升以及医疗机构主体自身的完善等.     

特区预防保健所和谐医患关系刍议

医疗卫生部门是精神文明建设的一个重要窗口,医患关系又是体现医疗卫生单位精神文明建设的一个重要指标.医患关系既是一种相互依存的共生体,又是一种存在利益冲突的矛盾体.     

伦理扩展与协调医患关系

医患关系是医学道德关系中的核心关系.当前,我国医疗卫生体制正处于深化改革的历史过程中,医患关系紧张是全社会所关注的一个焦点问题.解决医患矛盾不仅需要实践探索,同时需要理论扩展,通过推进医学伦理学的发展,为协调医患关系提供道德保证.     

关于“医患关系”的议论

作为一个医疗机构就必然存在着医患关系。医患关系分为良好的医患关系和不好的医患关系，后者即人们说的医患矛盾或医患纠纷。所谓“医患关系”，简单地说，就是在医疗活动中，医务人员与患者之间心理与行为的关系。它是医疗活动中最重要，而且是最基本的人际关系。它涉及到医务人员、病人及家属、医疗单位和社会之间，文化的、道德的、历史的、法律的等方面。     

和谐医患关系的经济伦理基础

医患关系紧张是在市场经济和高科技背景下，价值选择和制度安排失当造成的。实现医患和谐，需要政府、医院、医务人员和患者多方共同努力，在价值选择和制度安排上促进医患和谐。市场经济条件下的医疗卫生服务具有无私利他的道德责任和追求利益的需求，为病人最大利益着想是医护专业最根本的道德责任。     

美德建设与制度完善的互补与共进——对医闹、暴力伤医等事件的再思考

改善医患关系,在制定、完善法律制度之外,还需医患双方的美德建设.这就需要：减少医患之间的利益冲突,重建亲密的信任与合作关系;加强医患沟通交流,减少医患认知差异和冲突;培育和提升医护人员的美德和职业精神;提高公民文化与道德素养,提高患者就医道德.     

公立医疗机构的医事侵权损害赔偿应适用国家赔偿法

在我国目前的司法实践中，是不把国家生体医疗卫生事业中的医疗机构的医疗事故侵权损害赔偿纳入国家赔偿范畴的。笔者认为，这是对国家主体医疗卫生事业中的医患关系的法律属性错误判断的结果，严重侵害了医、患双方的合法权益。国家主体医疗卫生事业中的医患关系的法律属性，可以精确定位为“行政法律关系类权力关系型特别权力关系属的公法上的营造物利用关系”。无论是大陆法系国家，还是英美法系国家，均把国家主体医疗卫生事业中的医疗机构的医疗事故侵权损害赔偿纳入国家赔偿范畴。我国的国家赔偿法律法规并没有明确排斥“公立医院”由于侵权给公     

乡村两级卫生人才的道德关系比较研究——基于对B市五区县的调查分析

乡村卫生人才包括乡镇卫生院的医务人员和村卫生室的村医,他们作为农村基层医疗卫生事业的一线工作人员,其道德关系直接影响到医疗卫生服务的内容与效果、服务模式与医患关系.随着医疗卫生改革不断的深入农村基层,乡村两级卫生人才之间及其在村落社会所处的道德关系也在不断地发生着变化,具体表现在三个方面：一是乡村两级卫生人才之间体制内外的差异;二是乡村两级卫生人才与患者之间的医患关系和服务水平的差异;三是乡村两级卫生人才与村落社会之间,后者对前者医疗品行的养成与监督的差异.     

医患关系紧张的法律成因与对策

当前，我国的医患关系尚未实现全面的、真正的和谐，其原因是多元的。就法律层面而言，主要有医患关系重大涉法问题研究薄弱，调整、规制医患关系的法律法规滞后甚至缺失，医疗纠纷处理机制不健全、不完备以及医患双方法律意识失衡与法律知识不健全等。为此，应从这四个角度入手探讨构建和谐医患关系的法律对策，以期有助于医疗服务领域的和谐建设。     

明晰医学试验研究与医学临床治疗之间界限的意义

在医学生命科学领域中,存在着医学试验研究和医学临床治疗两种不同性质的行为,这两种行为形成两对对应关系,即试验者和受试者、医生和患者,明晰这两对关系的界限,方可进一步研究这两对关系中双方应该遵循的规律,以便制定法律法规指导、规范医学试验研究和医学临床治疗行为,保障各自的权益。     

Compensation for subjects of medical research: the moral rights of patients and the power of research ethics committees.

Awareness of the morally significant distinction between research and innovative therapy reveals serious gaps in the legal provision for compensation in the UK for injured subjects of medical research. Major problems are limitations inherent in negligence actions and a culture that emphasises indemnifying researchers before compensating victims. Medical research morally requires compensation on a no-fault basis even where there is proper consent on the part of the research subject. In particular, for drug research, there is insufficient provision in the current patient guidelines of the Association of the British Pharmaceutical Industry, since they make "no legal commitment" to paying compensation for injury to patient subjects. There is a need for the provision of both adequate insurance and contractual arrangements for making payments. The solution is for Local Research Ethics Committees (LRECs) to make use of their power to withhold approval of medical research where compensation is not legally enforceable.     

医疗纠纷案件中行业规范与法律规范之冲突

在医疗纠纷案件中，医疗行业规范和法律规范，无论在观念及思维方式上，还是在对医疗责任的认定和理解上，都存在着冲突和差异，增加了案件审理的难度。文章分析了医疗行业规范和法律规范两者间的冲突表现，并究其原因，提出解决这种冲突的方法，最大限度地平衡医患双方的利益。     

Readiness for legally literate medical practice? Student perceptions of their undergraduate medico-legal education

Medical councils increasingly require graduates to understand law and to practise medicine mindful of the legal rules. In the UK a revised curriculum for medical law and ethics has been published. However, coverage of law in medical education remains variable and doubts exist about how far students acquire legal knowledge and skills in its implementation. This survey of students in two UK medical schools measured their law learning and their confidence in using this knowledge. Concept maps and a self-audit questionnaire were used to capture students' understanding and perceptions of this knowledge domain and self-assessments of their legal knowledge and skills. A large sample was achieved across first, second and final year students. Students agree that a sound understanding of law is essential to being a good doctor. Their perceptions of law are generally positive but the interface between the legal rules and codes of medical ethics creates difficulty. In some areas students offer relatively confident self-assessments of their legal knowledge and skills for practising law. However, levels of confidence in other areas of their law learning raise doubts about the degree to which they can advocate for and protect their patients. Conclusions are drawn about the effectiveness of students' law learning and recommendations made for further research.     

医学实习生病程记录书写的教学探讨

探讨如何对医学实习生病程记录书写进行教学,提出应通过选优评差、举办专业和法律讲座等方式提高带教老师的综合素质和教学责任感,加强实习教学管理,妥善处理好实习、就业和考研之间的矛盾,利用教学查房等多种途径增强实习生临床技能和法律意识,争取患者对实习教学的配合,严格执行《病历书写基本规范》,提高实习生病程记录书写能力,出色完成临床实习任务。     

Fatal distraction: a case series of fatal fall-asleep road accidents and their medicolegal outcomes

Obstructive sleep apnoea is associated with an increased risk of sleep-related motor vehicle accidents. Seven recent legal cases of fatal motor vehicle accidents on NSW roads are presented, where the driver who caused the accident was suffering from an unrecognised or under-treated sleep disorder. The legal outcomes in these cases were variable: some of the drivers have been acquitted and others have been jailed. All remained licensed to drive immediately after their accidents. In some of the cases, the driver was cleared of any culpable driving offence because of a defence of sleepiness or a sleep attack without warning ("Jiminez defence"). This appears at odds with current medical research and legal opinion in other countries. More research is needed to understand the relation between sleep disorders and awareness of sleepiness. Medical practitioners need to be aware of current advice and guidelines with respect to obstructive sleep apnoea and driving.     

美国、德国医疗保险服务协议相关法律问题及对中国的启示

重点对美国医疗保险经办机构和医疗机构的关系、医疗保险申请、医疗服务协议的协商谈判机制、工作程序、医疗保险的支付方式,经费报销结算计算及医保纠纷解决五步上诉机制等相关法律问题,以及德国的医疗保险模式和医疗服务协议相关情况进行了综述介绍,在此基础上论述了美、德医疗保险服务协议相关法律问题对我国的启示。     

强化法律意识提高电子病案质量

探讨电子病案的法律与病案质量的关系，论述了电子病案的重要性；电子病案的法律效力；电子病案书写中的法律观念；电子病案的修改；病人知情权等有关问题。提出加强医院系统电子病历的管理，完善电子病历的调用机制，协调各部门在电子病历管理方面的职能等行之有效的电子病案管理办法。     

Research, ethics and conflicts of interest.

In this paper, I have tried to develop a critique of committee procedures and conflict of interest within research advisory committees and ethical review committees (ERCs). There are specific features of conflict of interest in medical research. Scientists, communities and the subjects of research all have legitimate stakeholdings. The interests of medical scientists are particularly complex, since they are justified by the moral and physical welfare of their research subjects, while the reputations and incomes of scientists depend on the success of their science. Tensions of this kind must at times produce conflict of interest. It is important to recognise that conflicts of interest may unwittingly lead to manipulation of research subjects and their lay representatives on research committees. It is equally important to recognise distinctions between the legal and moral aspects of conflict of interest. Some practical suggestions are made which may go some way towards resolving these difficulties. They indicate what might be needed to ensure the validity of ethical discourse, and to reduce the risks associated with conflict of interest.