Yeung Karen, Horder Jeremy
The Dickson Poon School of Law, King's College London, London, UK.
Department of Law, London School of Economics, London, UK.
BMJ Qual Saf. 2014 Jun;23(6):519-24. doi: 10.1136/bmjqs-2013-002688. Epub 2014 Mar 5.
The egregious failings in patient safety at Mid Staffordshire NHS Foundation Trust between 2005 and 2009 identified by Sir Robert Francis QC in his public inquiry prompted him to recommend the introduction of a new criminal offence into English law in circumstances where a patient dies or is seriously harmed by a breach of fundamental standards. The authors evaluate whether, from the perspective of fairness and justice, a new criminal offence in this context is necessary and desirable.
The authors considered the basic principles and functions of the criminal law and compared them with the principles and functions of the civil law. They then identify two primary tasks for the criminal law to perform in healthcare settings: (a) to establish primary duties to patients consisting of appropriately graded offences targeted at conduct that harms patients or unjustifiably poses risks to patients, and (b) to establish secondary duties to patients, consisting of offences aimed at punishing and deterring instances in which healthcare management and workers undermine the goals of regulation by lying or giving misleading information to regulatory officials or by obstructing their work. The authors focus on the first of these functions, identifying the scope of existing regulatory schemes that may give rise to criminal liability in English law when applied to healthcare contexts to identify whether a new criminal offence is needed.
A gap in the existing regime of criminal liability is identified, and it is this gap which a new criminal offence seeks to fill. The authors suggest how such an offence should be structured, drawing primarily upon foundational principles of criminal liability. It is suggested that a new general offence of wilfully neglecting or ill-treating a patient that can be committed by any healthcare organisation or worker (appropriately defined) is warranted.
The criminal law has an important role to play in the healthcare context. Its central function is not primarily to deter and coerce people into complying with standards of behaviour deemed desirable. Rather, its central function lies in its symbolic and expressive significance, publicly proclaiming that the highly culpable mistreatment of others is wrongful and worthy of public censure and sanction.
罗伯特·弗朗西斯爵士在其公开调查中发现，2005年至2009年间，米德斯塔福德郡国民保健服务基金会信托机构在患者安全方面存在严重失误，这促使他建议在英国法律中引入一项新的刑事犯罪，即在患者因违反基本标准而死亡或受到严重伤害的情况下适用。作者从公平和正义的角度评估了在这种情况下设立一项新的刑事犯罪是否必要和可取。
作者考虑了刑法的基本原则和功能，并将其与民法的原则和功能进行了比较。然后，他们确定了刑法在医疗环境中要履行的两项主要任务：(a) 确立对患者的主要义务，包括针对伤害患者或无故给患者带来风险的行为设定适当分级的犯罪；(b) 确立对患者的次要义务，包括旨在惩罚和威慑医疗管理部门和工作人员通过向监管官员说谎或提供误导性信息或阻碍其工作来破坏监管目标的犯罪行为。作者专注于这些功能中的第一项，确定现有监管计划在应用于医疗环境时可能导致英国法律中刑事责任的范围，以确定是否需要一项新的刑事犯罪。
确定了现有刑事责任制度中的一个漏洞，而一项新的刑事犯罪正是试图填补这一漏洞。作者主要借鉴刑事责任的基本原则，提出了这种犯罪应如何构建的建议。建议设立一项新的一般犯罪，即任何医疗保健组织或工作者（适当定义）故意疏忽或虐待患者的犯罪。
刑法在医疗保健环境中可发挥重要作用。其核心功能并非主要是威慑和强制人们遵守被认为理想的行为标准。相反，其核心功能在于其象征和表达意义，公开宣称对他人的高度应受谴责的虐待是错误的，值得公众谴责和制裁。
