赵西巨

（新西兰 奥塔哥大学法学院）

【摘 要】 在传统的医疗过失侵权诉讼中，为了体现行外人士对医疗这一专家型行业的尊重，医疗专家证言在诉讼中发挥着重要的甚至决定性的作用。知情同意诉讼，虽被归入医疗过失侵权诉讼，却提供了一个不同于传统的医疗领域———诊断治疗———的情景。知情同意的独特性改变了专家证言在诉讼中的格局。在知情同意诉讼中，医疗专家证言的参与度和重要性遭到削弱。以患者为取向的信息披露标准的建立意味着法律的关注点已从“专家”整体转移到“患者”；对“医学判断”所管辖领域的精细分割也说明，医疗专家证言只应在证明医疗信息的感知和启用“医疗特权”上有应用价值，医疗信息的实质性判断已让位于一般人知识，而且对“医疗特权”的严格控制会缩减医疗专家证言的适用空间；因果关系的认定和选择影响到医疗专家证言和患者证言的地位变化，尽管存在“事后诸葛”效应，为了与知情同意法则之主旨相匹配，主观化的因果关系应是前进方向。

【关键词】 知情同意；医疗专家证言；过失；因果关系

【中图分类号】 D923.8

【文献标识码】 A

【文章编号】 1674-1226（2008）05-0598-09

Evidential Aspect of Informed Consent Lawsuit: Perspectives of Common Law. Zhao Xiju. Faculty of Law,University of Otago,New Zealand.

【Abstracts】 Under the conventional medical negligence framework, as an indication of extraprofessional’s respect for medical profession, expert medical testimony has played an important, even decisive, role in the lawsuit. Informed consent law provides a distinctive context, different from that of diagnosis and treatment. In informed consent lawsuits, the role of expert medical testimony is limited. The patient-oriented standard of disclosure suggests that the focus of law has shifted from experts to patients. An analysis of medical judgment also indicates that expert medical testimony only has value in the context of appreciating medical information and invoking “therapeutic privilege”, the materiality of risk information is for layperson knowledge and human judgment. Careful definition of “therapeutic privilege” will inevitably further diminish the role of medical experts. The choice between subjective and objective causations will also influence the relevance and importance of expert testimony and patient’s evidence. Although suffering from hindsight, a more subjective causation should be applauded because it is more in harmony with the spirit of informed consent.

【Key words】 Informed consent, Expert medical testimony, Negligence, Causation