—以三部门颁发文件的问题为视角

肖柳珍^1，2

（1.南方医科大学卫生管理学院，广东广州，510515 ；2.广东省高校哲学社会科学公共卫生政策研究与评价重点实验室，广东广州，510515）

【摘 要】医疗损害鉴定制度正面临着统一的转折点。三部门的文件对医疗损害鉴定都进行了不同程 度的规范，但异地鉴定制度不清晰、保障患者话语权制度不给力、重要程序制度缺失或瑕疵明显以及过 错与原因力认定亟待进一步规范。重构医疗损害鉴定制度应达成一些基本共识，包括保障患者话语权是 提升鉴定意见可信度的程序保障、鉴定专家库管理与使用的中立性是防止司法鉴定机构边缘化并可能引 发新一轮医患矛盾的关键、异地鉴定制度是保障同行评议制度相对公正的必要措施以及过错与原因力认 定的相对客观化是医疗损害鉴定的核心与困境，当前，应当统一医疗损害异地鉴定制度，建议设立患者 决定权优先的听证制度并在鉴定过程中增设患方专家辅助人制度、厘清鉴定机构、鉴定人、鉴定专家在 医疗损害鉴定中的定位，进一步规范医疗过错与原因力的判定规则与体系，实现医疗损害鉴定的科学性、 专业性与公正性，并提升其保障患者医疗安全的延展作用。

【关键词】医疗损害鉴定；异地鉴定；听证制度；同行评议

【中图分类号】D915.13

【文献标识码】A

【文章编号】1674-1226（2018）04-0441-12

Consensus and countermeasures of standardizing medical impairment appraisal: an analysis based on regulation documents issued by three departments. Xiao Liuzhen, School of Humanity and Management, Southern Medical University, Guangzhou, Guangdong, 510515.

【Abstract】Medical impairment appraisal system is facing a turn point to standardization. The regulation documents issued by three departments have established certain standards to regulate how to carry out the medical damage appraisal. However, some problems are left unresolved, such as, the validity of non-local appraisal is not specified, the patient right to participation in appraisal is poorly protected, some important procedure rules are missing or flawed, and the test of medical malpractice liability and causation needs to be further standardized. Reconstructing medical impairment appraisal system should be based on certain basic consensus. For example, the patient right to participation in appraisal is the procedural guarantee to enhance the credibility of appraisal opinion; the neutrality of maintaining and using the expert pool database is key to prevent judicial appraisal institution being marginalized and new round of doctor-patient conflicts occurring;non-local appraisal is necessary to ensure relative fairness of peer review; and objectification of determining the medical malpractice liability and causation is the core and predicament to medical impairment appraisal.In order to carry out scientific, professional and fair medical impairment appraisal and to enhance its further impact on medical treatment safety, this paper puts forward several proposals as follows, establishing unified non-local appraisal system, prioritizing patients' right in appraisal review hearing, permitting an assistant expert for the patient to participate in the process of medical impairment appraisal, clarifying the role of appraisal institution, appraiser and appraisal expert in the medical impairment appraisal, and standardizing the test of medical malpractice liability and causation.

【Key Words】 Medical impairment appraisal, Non-local appraisal, Hearing system, Peer review