建议我国设立无过错责任赔偿制度处理医疗纠纷

北京中济律师所医药法律专业主任律师：李洪奇
010－88083116；88083118

【内容提要】

适用过错责任原则处理医疗纠纷民事案件产生了很多问题，各国都在积极探索更有效的法律制度和解决方法。一些国家采用无过错责任原则解决医疗纠纷取得了成功经验。与过错责任原则相比，无过错责任赔偿制度具有相对明显的优势。

本文作者建议我国权衡两种法律原则的利弊，借鉴国外成功经验，尽快建立和完善无过错责任赔偿制度，解决医疗纠纷引发的各种社会问题。

【ABSTRACT】

The no-fault liability compensation system has advantages over the fault liability doctrine in dealing with medical disputes. What other countries have experienced in employing no-fault liability models offers lessons for policymakers here in China.

This article will examine the pros and cons of the no-fault liability compensation system and explore the possibilities for China of adopting such a scheme.

【关键词】

过错责任；无过错责任赔偿制度；医疗事故；社会保险；医疗保险；可快速赔偿医疗事件；指定可赔偿医疗事件；试验计划

【KEY WORDS】

fault liability; no-fault liability compensation system; medical mishap; social security; medical insurance; accelerated compensable events; designated compensable events; pilot project;

长期以来，世界上多数国家在处理医疗纠纷民事案件时都适用过错责任原则，无论这些国家是属于英美法系还是大陆法系，也无论它们的具体法律制度有何差异，在医疗侵权的归责原则上表现的相当一致。

但由于医疗纠纷涉及医学专业知识，侵权方式和原因不同于其他一般侵权行为，其侵权构成要素常常难以认定，因此依据过错责任原则追究医方法律责任时出现的问题越来越多，各国的情况不尽相同。

一，过错责任赔偿原则遇到的问题

一般侵权行为包括违法行为、损害后果、因果关系和主观过错四个构成要素；而认定某一侵权行为是否承担赔偿责任的原则通常有三种，即过错责任、无过错责任和公平责任；区别过错责任原则和无过错责任原则的主要标志则是侵权人的主观过错。

过错责任原则把侵权人主观过错作为赔偿责任的必要构成要素，所以采用过错责任原则处理医疗纠纷民事案件，实际是把医务人员的主观过错作为医方承担赔偿责任的前提条件，所谓“有过错就有责任，没过错就没责任”，因此医患双方在医疗纠纷解决过程中特别是诉讼过程中争议的焦点问题必然是“过错”。

然而，“过错”对于诉辩双方的意义完全不同：对患方而言，证明医方存在“过错”是其获得司法救济的唯一方法；而对于医方而言，存在“过错”就意味着承担民事赔偿责任、行政责任甚至是刑事责任，威胁到医务人员的职业生涯。因此追究医务人员的“过错”势必把医患双方的根本利益上对立起来，形成了一对不可调和的社会矛盾：

1，患者期望得到最好的诊疗服务，早日康复；而医务人员为避免“过错”，诊疗活动日趋保守，缺乏创新意识，不敢或不愿应用最新诊疗技术，妨碍了医学科学的进步和发展；最终损害的是广大患者的利益。
2，发生纠纷后，如果医患双方不能和解或调解，诉讼将是双方最终选择。但法院认定“过错”大多需要医疗鉴定，所以围绕“过错”的消耗战艰苦反复，诉讼难度和强度很大，诉讼成本很高。
3，因为医方要竭尽全力抗辩其医疗“过错”，所以人为掩盖医疗“过错”和损害原因的情况时有发生，不利于提高医务人员的业务水平。
4，各国的实践经验都表明，在过错责任原则下的医疗诉讼中，医方疲于诉讼，荒于医疗，患方也很难得到司法救济。
5，当大多数遭受医疗损害的患方得不到合法救济的时候，医患矛盾就可能演变成社会矛盾，不利于社会稳定和发展。

从上世纪70年代初开始，一些国家设立无过错责任赔偿制度处理医疗纠纷，积累了许多成功经验，值得我们学习和借鉴。虽然制度运行中也存在一些问题，但与过错责任赔偿原则相比，其优势还是比较明显。

二，无过错责任赔偿制度历史回顾

无过错责任原则就是不把侵权人主观过错作为承担赔偿责任的构成要素，侵权行为发生后，受害人只须证明自己遭受损害，且损害后果与侵权人的行为有关系，即可得到经济赔偿，受害人和侵权人都不需要证明有无过错存在。

1972年新西兰率先建立了无过错责任赔偿体系，赔偿范围覆盖了包括医疗损害在内所有突发事件造成的人身损害。运行费用主要取自用人单位、劳动者本人、车辆所有人和政府税收。
Hong Kong


BILLS OF EXCHANGE ORDINANCE
　(CHAPTER 19)
　ARRANGEMENT OF SECTIONS
　　
　　ion
　　I　　　　PRELIMINARY PROVISIONS
　　hort title
　　nterpretation
　　II　　　 BILLS OF EXCHANGE
　　and Interpretation
　　efinition of bill of exchange
　　nland and foreign bills
　　ffect where different parties to bill are the same person
　　ddress to drawee
　　ertainty required as to payee
　　hat bills are negotiable
　　um payable
　　Bill payable on demand
　　Bill payable at future time
　　Omission of date in bill payable after date
　　Ante-dating and post-dating
　　Computation of time of payment
　　Referee in case of need
　　Optional stipulations by drawer or indorser
　　Definition and requisites of acceptance
　　Time for acceptance
　　General and qualified acceptance
　　Inchoate instruments
　　Delivery
　　city and authority of parties
　　Capacity of parties
　　Signature essential to liability
　　Forged or unauthorized signature
　　Procuration signature
　　Person signing as agent or in representative capacity
　　Corporate signatures
　　ideration for bill
　　Value and holder for value
　　Accommodation party
　　Holder in due course
　　Presumption of value and good faith
　　
　　tiation of bill
　　Negotiation of bill
　　Requisites of valid indorsement
　　Conditional indorsement
　　Indorsement in blank and special indorsement
　　Restrictive indorsement
　　Negotiation of overdue or dishonoured bill
　　Negotiation of bill to party already liable thereon
　　Rights and powers of holder
　　ral duties of the holder
　　When presentment for acceptance is necessary
　　Time for presenting bill payable after sight
　　Rules as to presentment for acceptance, and excuses for non-
　　entment
　　Non-acceptance
　　Dishonour by non-acceptance and its consequences
　　Duties as to qualified acceptances
　　Rules as to presentment for payment
　　Excuses for delay or non-presentment for payment
　　Dishonour by non-payment
　　Notice of dishonour and effect of non-notice
　　Rules as to notice of dishonour
　　Excuses for non-notice and delay
　　Noting or protest of bill
　　Duties of holder as regards drawee or acceptor
　　ilities of parties
　　Funds in hands of drawee
　　Liability of acceptor
　　Liability of drawer or indorser
　　Stranger signing bill liable as indorser
　　Measure of damages against parties to dishonoured bill
　　Transferor by delivery and transferee
　　harge of bill
　　Payment in due course
　　Banker paying demand draft whereon indorsement is forged
　　Acceptor the holder at maturity
　　Express waiver
　　Cancellation
　　Alteration of bill
　　ptance and payment for honour
　　Acceptance for honour supra protest
　　Liability of acceptor for honour
　　Presentment to acceptor for honour
　　Payment for honour supra protest Lost instrument
　　Holder's right to duplicate of lost bill
　　Action on lost bill
　　in a set
　　Rules as to bill in set
　　lict of laws
　　Rules where laws conflict
　　
　　III　　　CHEQUES ON A BANKER
　　Definition of cheque
　　Presentment of cheque for payment
　　Revocation of banker's authority Crossed cheques
　　Definition of general and special crossings
　　Crossing by drawer or after issue
　　Crossing a material part of cheque
　　Duties of banker as to crossed cheque
　　Protection to banker and drawer where cheque is crossed
　　Effect of crossing on holder
　　Drafts on bankers payable to order on demand sufficient authority
for
　　ent without proof of indorsement
　　Protection of bankers paying unindorsed or irregularly indorsed
　　ues, etc.
　　Rights of bankers collecting cheques not indorsed by
　　ers
　　Unindorsed cheques as evidence of payment
　　Protection of bankers collecting payment of cheques, etc.
　　Application of provisions of this part to instruments not being
bills
　　xchange
　　Saving
　　IV　　　 PROMISSORY NOTES
　　Definition of promissory note
　　Delivery necessary
　　Joint and several notes
　　Note payable on demand
　　Presentment for payment
　　Liability of maker
　　Application of Part II to notes
　　V　　　　SUPPLEMENTARY
　　Good faith
　　Signature
　　Computation of time
　　When noting equivalent to protest
　　Protest when notary not accessible
　　Crossing of dividend warrant
　　Saving
　　dule. Form of protest, without notary
　　odify the law relating to bills of exchange, cheques and
promissory
　　s.　[4 May 1885]
　PART I PRELIMINARY PROVISIONS
　　
　　ed 51 of 1911; 63 of 1911 Schedule)
　　hort title
　　Ordinance may be cited as the Bills of Exchange Ordinance.
　　nded 5 of 1924 s. 6)
　　1882 c. 61 s. 1U. K.]
　　nterpretation
　　his Ordinance, unless the context otherwise requires--
　　eptance" means an acceptance completed by delivery or
notification;
　　ion" means action or suit and includes counterclaim and set-off;
　　ker" includes a body of persons,　whether　incorporated　or　
not,　who
　　y on the business of banking;
　　krupt" includes any person whose estate is　vested　in　a　
trustee　or
　　gnee under the law relating to bankruptcy; (Amended 50 of 1911;
62　of
　　Schedule)
　　rer" means the person in possession of a bill or note
　　h is payable to bearer;
　　l" means bill of exchange, and "note"
　　s promissory note;
　　ivery" means transfer of possession, actual or
　　tructive, from one person to another;
　　eral holiday" has the same meaning as in the Holidays Ordinance　
(Cap.
　　; (Added 5 of 1912 s. 8)
　　der" means the payee　or　indorsee　of　a　bill　or　note　who　
is　in
　　ession of it, or the bearer thereof;
　　orsement" means an indorsement completed by delivery;
　　ue" means the first delivery of a bill or note, complete in form,
to a
　　on who takes it as a holder;
　　son" includes a body of persons, whether incorporated or not;
　　ue" means valuable consideration.
　　nded 43 of 1912 Schedule)
　　1882 c. 61 s. 2 U. K.]
　PART II BILLS OF EXCHANGE
　　
　　nded 51 of 1911; 63 of 1911 Schedule)
　　and Interpretation
　　efinition of bill of exchange
　　A bill of exchange is an unconditional order in writing, addressed　
by
　　person to another, signed by　the　person　giving　it,　
requiring　the
　　on to whom it is　addressed　to　pay　on　demand　or　at　a　
fixed　or
　　rminable future time a sum certain in money to, or to the order
of,　a
　　ified person or to bearer.
　　An instrument which does not comply with these　conditions,　or　
which
　　rs any act to be done in addition to the payment of money,　is　
not　a
　　of exchange.
　　An order to pay out of a particular fund is not
　　nditional within the meaning of this section; but an unqualified
order
　　ay, coupled with--
　　an indication of a particular fund out　of　which　the　drawee　
is　to
　　burse himself or a particular account to be debited with　the　
amount;
　　
　　a statement of the transaction　which　gives　rise　to　the　
bill,　is
　　nditional.
　　A bill is not invalid by reason--
　　that it is not dated;
　　that it does not specify the value given or that any　value　has　
been
　　n therefor;
　　that it does not specify the place where it is drawn
　　he place where it is payable.
　　1882 c. 61 s. 3 U. K.]
　　nland and foreign bills
　　An inland bill is a bill which is or on the face of it purports
to be-
　　
　　both drawn and payable within the Colony; or
　　drawn within the Colony, upon some person resident therein.
　　Any other bill is a foreign bill.
　　Unless the contrary appears on the face of the bill,　the　holder　
may
　　t it as an inland bill.
　　1882 c. 61 s. 4 U. K.]
　　ffect where different parties to bill are the same person
　　A bill may be drawn payable to, or to the order of, the drawer;
or　it
　　be drawn payable to, or to the order of, the drawee.
　　Where, in a bill, drawer and drawee are the same person, or where　
the
　　ee is a fictitious person or a person not having capacity to
contract,
　　holder may treat the instrument, at his option, either as　a　
bill　of
　　ange or as a promissory note.　[cf. 1882 c. 61 s. 5 U. K.]
　　ddress to drawee
　　The drawee must be　named　or　otherwise　indicated　in　a　
bill　with
　　onable certainty.
　　A bill may be addressed to two or more drawees,
　　her they are partners or not, but an order addressed to two drawees
in
　　alternative, or to two or more drawees in succession, is not a
bill of
　　ange.
　　1882 c. 61 s. 6 U. K.]
　　
　　ertainty required as to payee
　　Where a bill is not payable to bearer, the　payee　must　be　
named　or
　　rwise indicated therein with reasonable certainty.
　　A bill may be made payable to two or more payees jointly, or it
may be
　　payable in the alternative to one of two or one or　some　of　
several
　　es. A bill may also be made payable to the bolder of an office
for the
　　being.
　　Where the payee is a fictitious or non-existing person, the　bill　
may
　　reated as payable to bearer.
　　1882 c. 61 s. 7 U. K.]
　　hat bills are negotiable
　　Where a bill contains words prohibiting　transfer,　or　
indicating　an
　　ntion that it should not be transferable, it is valid as　between　
the
　　ies thereto, but is not negotiable.
　　A negotiable bill may be payable either to order or to bearer.
　　A bill is payable to bearer which is expressed to be so payable,
or on
　　h the only or last indorsement is an indorsement in blank.
　　A bill is payable to order which is expressed to　be　so　payable,　
or
　　h is expressed to be payable to a　particular　person,　and　
does　not
　　ain words prohibiting transfer or　indicating　an　intention　
that　it
　　ld not be transferable.
　　Where a bill, either originally or by
　　rsement, is expressed to be　payable　to　the　order　of　a　
specified
　　on, and not to him or his order, it is nevertheless payable to
him　or
　　order at his option.
　　1882 c. 61 s. 8 U. K.]
　　um payable
　　The sum payable by a bill is a sum certain within the meaning of　
this
　　nance, although it is required to be paid--
　　with interest;
　　by stated instalments;
　　by stated instalments, with a provision that, upon default in　
payment
　　ny instalment, the whole shall become due;
　　according to an indicated rate of exchange or according to a　rate　
of
　　ange to be ascertained as directed by the bill.
　　Where the sum payable is expressed in words and also in　figures,　
and
　　e is a discrepancy between the two, the sum denoted by　the　words　
is
　　amount payable.
　　Where a bill is expressed to be payable with
　　rest, unless the instrument otherwise provides, interest runs
from the
　　of the bill, and, if the bill is undated, from the issue thereof.
　　1882 c. 61 s. 9 U. K.]
　　Bill payable on demand
　　A bill is payable on demand--
　　which is expressed to be　payable　on　demand,　or　at　sight,　
or　on
　　entation; or
　　in which no time for payment is expressed.
　　Where a bill is accepted or indorsed when it is overdue, it shall,　
as
　　rds the acceptor who so accepts or any indorser who so indorses
it, be
　　ed a bill payable on demand.
　　1882 c. 61 s. 10 U. K.]
　　
　　Bill payable at future time
　　A bill is payable at a determinable future time within the meaning　
of
　　Ordinance which is expressed to be payable--
　　at a fixed period after date or sight;
　　on or at a fixed period after the　occurrence　of　a　specified　
event
　　h is certain to happen, though the time of happening may be
uncertain.
　　An instrument expressed to be payable on a contingency is not a　
bill,
　　the happening of the event does not cure the defect.
　　1882 c. 61 s. 11 U. K.]
　　Omission of date in bill payable after date
　　e a bill expressed to be payable at　a　fixed　period　after　
date　is
　　ed undated, or where the acceptance of　a　bill　payable　at　a　
fixed
　　od after sight is undated, any holder may insert therein the true
date
　　ssue or　acceptance,　and　the　bill　shall　be　payable　
accordingly:
　　ided that--
　　where the holder in good faith and by mistake inserts　a　wrong　
date;
　　
　　n every case where a wrong date is inserted, if the bill
　　equently comes into the hands of a holder　in　due　course,　the　
bill
　　l not be avoided thereby, but shall operate and be payable as　if　
the
　　so inserted had been the true date.　[cf. 1882 c. 61 s. 12 U. K.]
　　Ante-dating and post-dating
　　Where a bill or an acceptance or any indorsement on a bill　is　
dated,
　　date shall, unless the contrary is proved, be deemed to　be　the　
true
　　of the drawing, acceptance, or indorsement, as the case may be.
　　A bill is not invalid by reason only that it is　ante-dated　or　
post-
　　d, or that it bears date on a Sunday or any other general holiday.
　　nded 5 of 1912 s. 8) [cf. 1882 c. 61 s. 13 U. K.]
　　Computation of time of payment
　　e a bill is not payable on demand, the day on which it　falls　due　
is
　　rmined as follows--
　　the bill is due and payable in all cases on the last day of　the　
time
　　ayment as fixed by the bill or, if that is a general holiday,　on　
the
　　eeding business day; (Replaced 67 of 1972 s. 2) [cf. 1971 c. 80
s. 3
　　U. K.]
　　where a bill is payable at a fixed period after date, after sight,　
or
　　r the　happening　of　a　specified　event,　the　time　of　
payment　is
　　rmined by excluding the day from which the time is to begin to
run and
　　ncluding the day of payment;
　　where a bill is payable at a fixed
　　od after sight, the time begins to run form the date of the
acceptance
　　he bill is accepted, and from the date of noting　or　protest　if　
the
　　is noted or protested for non-acceptance or for non-delivery;
　　the
　　"month" in a bill means calendar month.
　　1882 c. 61 s. 14 U. K.]
　　Referee in case of need
　　drawer of a bill and any indorser may insert therein　the　name　
of　a
　　on to whom the holder may resort in case of need, that is to　say,　
in
　　the bill is dishonoured by non-acceptance or non-payment. Such
person
　　alled the referee in case of need. It is in the option of　the　
holder
　　esort to the referee in case of need or not, as he may think fit.
　　1882 c. 61 s. 15 U. K.]
　　
　　Optional stipulations by drawer or indorser
　　drawer of a bill and　any　indorser　may　insert　therein　an　
express
　　ulation--
　　negativing or limiting his own liability to the holder;
　　waiving, as regards himself, some or all of the holder's duties.　
[cf.
　　c. 61 s. 16 U. K.]
　　Definition and requisites of acceptance
　　The acceptance of a bill is the signification by　the　drawee　of　
his
　　nt to the order of the drawer.
　　An acceptance　is　invalid　unless　it　complies　with　the　
following
　　itions, namely--
　　it must be written on the bill and be signed by
　　drawee. The mere signature of the drawee, without additional
words, is
　　icient;
　　it must not express that the drawee will perform his　promise　by　
any
　　r means than the payment of money.
　　1882 c. 61 s. 17 U. K.]
　　Time for acceptance
　　A bill may be accepted--
　　before　it　has　been　signed　by　the　drawer,　or　while　
otherwise
　　mplete;
　　when it is overdue, or after it has been dishonoured by a
　　ious refusal to accept or by non-payment.
　　When a bill payable after sight is dishonoured by non-acceptance,　
and
　　drawee subsequently accepts it, the holder,　in　the　absence　
of　any
　　erent agreement, is entitled to have the bill accepted as of the　
date
　　irst presentment of the drawee for acceptance.
　　nded 51 of 1911; 63 of 1911 Schedule)
　　1882 c. 61 s. 18 U. K.]
　　General and qualified acceptance
　　An acceptance is either (a) general; or (b) qualified.
　　A general acceptance assents without qualification to the order
of the
　　er. A qualified acceptance in express terms varies the effect　of　
the
　　as drawn.
　　In particular, an acceptance is qualified which is--
　　conditional, that is to say,　which　makes　payment　by　the　
acceptor
　　ndent on the fulfilment of a condition therein stated,
　　partial, that is to say, an acceptance to pay part only of the　
amount
　　which the bill is drawn;
　　local, that is to say, an acceptance　to　pay　only　at　a　
particular
　　ified place; an acceptance to pay at a particular place is　a　
general
　　ptance, unless it expressly states that the bill is to be　paid　
there
　　and not elsewhere;
　　qualified as to time;
　　the acceptance of some one or more of the drawees, but not of all.
　　1882 c. 61 s. 19 U. K.]
　　
　　Inchoate instruments
　　Where a simple signature on a blank paper is delivered by　the　
signer
　　rder that it may be converted into a bill,　it　operates　as　a　
prima
　　e authority to fill it up as a complete bill for any amount, using
the
　　ature for that of the drawer, or the acceptor, or an indorser;
and, in
　　manner, when a bill is wanting in any material particular, the
person
　　ossession of it has a prima facie authority to fill up the omission
in
　　way he thinks fit. (Amended 31 of 1981 s. 65)
　　In order that any such instrument, when completed, may be　
enforceable
　　nst any person who became a party thereto prior to its completion,　
it
　　be filled up within a reasonable time and strictly in accordance
with
　　authority given. Reasonable time for this purpose　is　a　
question　of
　　: Provided that if any such instrument after completion is　
negotiated
　　holder in due course,　it　shall　be　valid　and　effectual　
for　all
　　oses in his hands, and he may enforce it as if it had been　filled　
up
　　in a reasonable time and strictly in　accordance　with　the　
authority
　　n.　[cf. 1882 c. 61 s. 20 U. K.]
　　Delivery

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