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医闹不是你想拒 想拒就能拒?

2017-09-13 贾朝娟 环球医学

从本质上讲,医患关系是基于一定的法律事实产生的一种特殊的契约关系。按理说,在某种条件下,医患双方都有权力解除这种契约关系,例如医生拒绝“医闹”或者有暴力倾向的患者。但现实中,美国医生想要拒诊一位患者绝非易事,不能说声拒绝就可以将患者拒之门外。

从本质上讲,医患关系是基于一定的法律事实产生的一种特殊的契约关系。按理说,在某种条件下,医患双方都有权力解除这种契约关系,例如医生拒绝“医闹”或者有暴力倾向的患者。但现实中,美国医生想要拒诊一位患者绝非易事,不能说声拒绝就可以将患者拒之门外。

在美国,虽然医生拒诊是合法的,但需要提前30天通知患者,并以书面形式阐述原因,比如“对医生、护士、其他病人进行暴力威胁或攻击”、“对医护人员展示明显的、足以妨害执业的敌意”。而且,解除医患关系还不只是发张通知函就结束了,还要确保患者能继续接受治疗、医疗记录顺利转达才算彻底完成。如果没事前通知的缓冲期、不能确保患者疗程继续而中止诊治,或者径自拒诊“医闹”者,吃官司是板上钉钉的事。

如果医生没有提前三十天书面通知、不理会疗程能继续,就自顾自地决定拒绝治疗患者,不论出于何种理由,这种单方面解除医患关系的行为被各州法院判例认定为“抛弃病患”。1962年的德州判例认为这种行为可按“医疗过失”提起诉讼。2007年的加州“科尔诉马歇尔医疗中心”案判决称这种行为是渎职,并且患者可以提出补偿损害的要求。

而对于急诊患者,即使其有暴力倾向,医疗机构也不能拒绝接诊。按照美国的相关规定,在指征明确的情况下,医疗机构必须为他们提供服务,以挽救病人的生命。针对有暴力倾向的急诊患者,美国各州医学会给会员的法律建议是:即使是因暴力袭击原因终止契约,医生应该立马报警或者向法院申请人身禁制令。但在报警、通知和患者接受下一任医生治疗的间隙,医生必须做出安排,将病人安置在能确保双方安全的区域继续提供治疗。

对于处于急性诊疗阶段患者,医患关系的终止必须推迟到患者疾病的急性期过后。对于那些手术后不久、或为了确诊正接受各种检查的患者,医师也不应当终结医患关系。如果医师是患者所需特种医疗的唯一提供者,那么,医师有义务继续提供这种医疗服务,直到患者可以被安全地转给另外一位能够确保准确治疗和跟踪诊察的医师。如果在数英里直径范围内没有别的医师可以选择,也不宜终止医患关系。

因此,医患关系虽属于一种契约关系,但属于一种特殊的契约系,患者享有较多的权力,医生负有较多的义务,这也是由医患关系的特点所决定的。患者要约的内容往往不够明确、具体,形式也多种多样。患者向医方提出自己的主要症状并要求医方给予诊治即视为已经提出了明确的要约,通过电话、网络也构成有效要约。而医护方作出了引导安排的建议,即可宣告医患关系成立。

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    2017-09-19 1e17414fm02(暂无匿称)

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    2017-09-16 189****7206

    学习了受益匪浅

    0

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    2017-09-16 1e17414fm02(暂无匿称)

    学习

    0

  5. 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    2017-09-16 1e17414fm02(暂无匿称)

    学习

    0

  6. 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content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Sep 14 13:52:09 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243909, encodeId=9c5f243909d6, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Thu Sep 14 11:41:45 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243862, encodeId=cb822438627c, content=同样的苦难, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Sep 14 09:35:26 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-15 1e17414fm02(暂无匿称)

    学习

    0

  7. 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content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Sep 14 13:52:09 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243909, encodeId=9c5f243909d6, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Thu Sep 14 11:41:45 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243862, encodeId=cb822438627c, content=同样的苦难, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Sep 14 09:35:26 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 哈哈869

    学习

    0

  8. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243862, encodeId=cb822438627c, content=同样的苦难, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Sep 14 09:35:26 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 惠映实验室

    学习了.谢谢.

    0

  9. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Fri Sep 15 09:40:10 CST 2017, time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244009, encodeId=eca02440096b, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Sep 14 19:43:39 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243950, encodeId=8bda24395039, content=学习了.谢谢., beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Thu Sep 14 13:52:09 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243909, encodeId=9c5f243909d6, content=学习一下谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzaiabIFicf63hKvVMjL6aJlx4yX4UcXmzX9DyibCRcicq0QtCRWMaQKh8MYjE1D3EKUBopgiaGWYuqbeR/0, createdBy=0c2b1999806, createdName=三生有幸9135, createdTime=Thu Sep 14 11:41:45 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243862, encodeId=cb822438627c, content=同样的苦难, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Sep 14 09:35:26 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 三生有幸9135

    学习一下谢谢分享

    0

  10. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Fri Sep 15 09:40:10 CST 2017, time=2017-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244009, encodeId=eca02440096b, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Thu Sep 14 19:43:39 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243950, encodeId=8bda24395039, 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243862, encodeId=cb822438627c, content=同样的苦难, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋,懒,贪, createdTime=Thu Sep 14 09:35:26 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 戒馋,懒,贪

    同样的苦难

    0

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