Di Landro Andrea R
University of Macerata.
Med Law. 2012 Jun;31(2):221-63.
The paper is divided into three parts. The first part sets out the comparative differences between the tort of malpractice in common law and the criminal negligence in civil law: while the common law takes for mens rea only the "gross" negligence, and rarely medical negligence, other law systems instead (and particularly Italian law) criminalize also ordinary negligence, frequently in medical malpractice cases. The second part of the paper addresses the pluses of using criminal law as response to medical malpractice: inadequate medical self-policing and "repeat offenders" problems are analysed, in the perspective of the patient, of the doctor, of the insurance company, and of the community. The third part addresses the minuses of the criminal law as response: medical "shame and blame" mentality, criminal stigma and culture of fear are disincentives to incident reporting and to system analysis (the most important means of prevention); "defensive medicine" and "courts-abiding medicine" are managed not yet in the patient's exclusive interest, but in the egoistic/utilitarian aim to avoid denunciations; finally, the uncertainty of the medicine, the accusatory system and the proof "beyond a reasonable doubt" seem hardly compatible with each other.
本文分为三个部分。第一部分阐述了普通法中的医疗过失侵权行为与民法中的刑事过失之间的比较差异：普通法仅将“重大”过失视为犯罪意图，很少涉及医疗过失，而其他法律体系（尤其是意大利法律）则将普通过失也认定为犯罪，在医疗过失案件中屡见不鲜。本文第二部分论述了将刑法作为应对医疗过失的手段的优点：从患者、医生、保险公司和社会的角度分析了医疗行业自我监管不足和“惯犯”问题。第三部分论述了将刑法作为应对手段的缺点：医疗行业的“羞辱与指责”心态、刑事污名和恐惧文化不利于事件报告和系统分析（预防的最重要手段）；“防御性医疗”和“循规蹈矩医疗”的实施并非完全出于患者的利益，而是出于避免被指控的利己/功利目的；最后，医学的不确定性、指控体系以及“排除合理怀疑”的证明标准似乎很难相互兼容。
