刘 鑫

【摘 要】 因果关系既是一个哲学问题，更是一个实践运用问题。 在医疗损害侵权责任认定中，被告医疗行为与原告损害后果之间必须具有相应的因果关系，侵权责任才能成立。 侵权诉讼实践中必须先认定是否存在事实因果关系， 进而判断是否存在法律因果关系。 法律因果关系由法官在事实因果关系的基础上作出认定，而事实因果关系由于其专业性往往由司法鉴定来判断。医疗损害鉴定之因果关系判断，首先应当依据事故归因理论来分析造成患者损害的所有致害因素，进而依据相关理论检索、专家咨询、因素分析、实案验证来精确判断医疗损害事件中的因果关系，并做定量判断，作出参与度结论。医疗损害鉴定之因果关系分为主要因果关系、临界因果关系、次要因果关系、机会丧失因果关系。 医疗损害鉴定之因果关系鉴定实务中还会涉及到一系列特殊的鉴定情形，如医疗不当因素难以排除、医疗机构未尽告知义务的因果关系、误诊的因果关系， 各情形在鉴定中都有各自具体的操作要点。

【关键词】 医疗损害；侵权责任法；司法鉴定；因果关系；机会丧失

【中图分类号】 D918.9

【文献标识码】 A

【文章编号】 1674-1226（2013）03-0334-20

Study on Medical Harm Assessment of the Causation. Liu Xin. Key Laboratory for Evidence Science (China University of Political Science and Law), Ministry of Education, Beijing,100088

【Abstract】 Causality is more a problem of practical application than philosophical issue. To establish the tortious liability in medical malpractice cases, an appropriate causal relationship between the harm and the medical error must be met. In practice, tortious liability can be first determined on the factual causal relationship, and then on the existence of the legal causation. A judge will decide the legal causation on the basis of the factual causation that is decided by forensic expertise. To assess the causal relationship, first of all, based on the attribution theory of accidents, all factors that result in the harm to the patient will be analyzed before the determination of the casual relationships and the conclusion of quantitative judgment of participation based on the theory retrieval, expert advice, factor analysis, real case verification. The establishment of the causal relationship in medical cases includes the major causality, the critical causality, secondary causality, loss of chance causality. Medical impairment assessment of the causal relationship, in practice, also involves a series of special scenarios, such as elements involving malpractice that cannot be ruled out, failure to inform, a duty medical institutions should perform and also misdiagnosis, which, in the assessment, all require special operation approach.

【Key Words】 Medical Harm, Tort Liability Act, Forensic Assessment, Causality, Loss of Chance