Kazarian MéLinée
School of Law, Faculty of Social Sciences, University of Southampton, Southampton, UK.
Med Law Rev. 2019 Aug 1;27(3):390-405. doi: 10.1093/medlaw/fwz004.
Many well-known cases of 'medical manslaughter' have shown that systemic issues play a significant role in contributing to fatal errors in healthcare institutions. The most prominent NHS scandal, Mid Staffordshire, demonstrated that wrongful prioritization of resources and staff shortages had contributed to the deaths of between 400 and 1200 patients due to appalling care by nursing staff and doctors between 2005 and 2009. Following the scandal, the Trust was prosecuted and convicted of a criminal offence under the Health and Safety at Work Act 1974 in 2014 and 2015. In contrast, in a scandal of comparable scale across the Channel, 'the HIV-contaminated blood scandal', individual decision-makers were subject to criminal convictions. Learning from features of the French criminal process, and the aftermath of the 1980s French tainted blood scandal, this article argues that the criminal process can only be a useful response to healthcare systemic failings if higher-level decision-makers are also included in the scope of criminal liability when they have recklessly endangered patients. When no individual reckless fault is found on the part of decision-makers, corporate criminal liability is a suitable alternative to individual criminal liability, if it is focused on ensuring safety and offering justice to patients who have been harmed as a result of healthcare systemic failings.
许多著名的“医疗过失杀人”案例表明，系统性问题在医疗机构致命错误的发生中起到了重要作用。英国国民医疗服务体系（NHS）最突出的丑闻——米德斯塔福郡丑闻——表明，2005年至2009年间，资源错误配置和人员短缺导致护理人员和医生护理不当，致使400至1200名患者死亡。丑闻发生后，该信托机构于2014年和2015年根据1974年《工作场所健康与安全法》被起诉并被判有罪。相比之下，在英吉利海峡对岸一起规模相当的丑闻——“受艾滋病毒污染血液丑闻”中，个别决策者被定罪。借鉴法国刑事程序的特点以及20世纪80年代法国受污染血液丑闻的后果，本文认为，只有当高层决策者鲁莽地危及患者时也被纳入刑事责任范围，刑事程序才能成为应对医疗系统失灵的有效手段。当决策者不存在个人鲁莽过错时，如果企业刑事责任侧重于确保安全并为因医疗系统失灵而受到伤害的患者伸张正义，那么企业刑事责任是个人刑事责任的合适替代方案。
