At present, the conclusion of technical appraisal of medical malpractice is the key to decide and deal with medical malpractice. The initiation mode of technical appraisal may be entrusted by both parties involved, handed over by the healthy administration department, or designated by the People＇s Court. Because it exerts a direct impact on the result of medical dispute, the conclusion of technical appraisal must undergo examination by the medical association, the health administration department, and the court. The conclusion plays different roles in cases of compensation for medical personal injury and of medical service contract disputes. To interpret and apply the technical appraisal and its conclusion correctly, we have to understand clearly the nature of technical appraisal of medical malpractice, recognize and handle skillfully the relation among identification-related issues such as the judge＇ s personal discretion, signature of the appraiser, the appraiser＇ s being present at the hearing and questioned, and the expert witness.
As a new discipline, the cardiac surgery has a great development in the modern age, but still faces many problems and disputes. The emergence of the evidence-based medicine (EBM), which emphasizes the best evidence, and combines the doctor’s clinical experience to make the best judgment, gives the development of the cardiac surgery a new thinking. Four systematic reviews published in The Cochrane Library (Issue 3, 2004) have interprated the importance of EBM on how to resolve the actual problems in different field of the cardiac surgery.
The conclusion of technical appraisal for medical accidents is closely related to both the outcome of the medical cases and medical advances. However, there have been some potential risks both in substance and form during the review process of the appraisal conclusion. In order to appraise the conclusion rigorously, some measures should be taken such as emphasizing the role of medical academic associations, seeking help from auxiliary expertsystem and exercising judge’s power of discretion.
It is essential to improve the practice of community healthcare service for the resolution of the problem of inadequate and overly expensive medical services, to promote the harmonization of doctor-patient relationship. From the aspects of the introduction of community healthcare service and the necessity of its standard management, the civil legal relation of community healthcare and its major problems, as well as the rights and duties of community doctors, the authors discussed the importance and necessity of scientific management, right protection by law as well as sound and orderly development of community healthcare service.
As more and more issues have emerged in organ transplantion cases, there is an increasing dispute about the definition of death: whether the criteria of cardiopulmonary death or brain death should be applied. The conflict between rights and obligations in brain death and organ transplantion is becoming ever evident, and there is a need for clarity on the issue of death and organ transplantion. This needs to come through legislation, which would be the most economical and effective intervention to provide this clarity. The authors believe that the National People’s Congress of China (NPC), the Standing Committee of NPC, the State Council of China and the Supreme People’s Court of China may get involved in the legislation for issues related to brain death and organ transplantion. As for the selection of decrees related to brain death and organ transplantion, all provinces, autonomous regions and centrally-governed municipalities can not exercise corresponding local legislative power except for special economic zones. After brain death and organ transplant related laws, administrative regulations, local decrees, autonomous decrees and special decrees have been settled, relevant executive legislation may be enacted. During such a legislative procedure, pilot programs can be adopted so as to enhance the applicability and success rate of the legislation of brain death and organ transplant.
Objective We aimed to investigate the attitude and suggestion from doctors, pharmacists and civil servants concerning brain death and organ transplantation and the legislation. Methods A questionnaire with 10 sections and 44 questions was designed and distributed. The effective questionnaire data was then recorded and checked for descriptive analysis. Results In 1 400 questionnaires distributed, 1 063 were responded and 969 of them were valid and analyzed. The respondents showed an incomplete understanding of brain death and organ transplantation laws. Seventy-four percent of the respondents recognized and accepted the standard of brain death. They agreed that legislation should be involved in the removal of organs for transplantation, the future use of the organs, and insurance and compensation for the donor for possible health risks induced by organ removal. Of the 969 respondents, 92% considered it necessary to have legislation in brain death and organ transplantation, and 61% thought that it is time to legislate. Conclusion Legislation for brain death and organ transplantation is urgent and timely in China. The laws must include the respective rights and obligations of patients, close relatives, and medical institutions. Educating the public about brain death and organ transplantation should also be encouraged in a variety of ways.
Objective To seek the best evidence on communication between physicians and patients so as to improve the physician-patient relationship in China. Methods We used the key words ‘physician-patient relationship’ and ‘communication’ to identify related systematic reviews and meta-analyses, and then evaluated them with the Overview Quality Assessment Questionnaire (OQAQ) checklist. Results Seventeen studies were included for final evaluation. According to the OQAQ checklist, the score range of the study quality was 3 to 9. 41.29% (7/17) of the included studies scored 7 to 9, 23.5% (4/17) scored 6, and 35.3% (6/17) scored 3 to 5. Factors influencing physician-patient communication primarily included communication targets, time, contents, and approaches. Conclusion There are not enough studies on physician-patient communication in China. We need to identify the problems affecting communication behavior, encourage patients to express their preferences, choose appropriate training strategies, and make timely evaluation so as to better satisfy the needs of patients and physicians.
Background and Objective Organ transplantation has become an essential and irreplaceable treatment for patients with organ failure. Although organ transplantation was introduced to China in the 1960s, it has witnessed rapid development in recent years. However, problems have been identified in the course of its development. We aim to present both medical and legal points of view on organ transplantation, to compare the current status of organ transplantation in China with that in developed countries, and discuss the challenges China faces in developing its own legislation for organ transplantation. Methods We searched the websites of WHO, NIH, AST, UNOS, and governments, as well as relevant conference proceedings and expert consensus documents. Articles or documents involving organ transplantation legislation were identified. Results We included 10 legal documents, 1 regulation, 9 government documents, and 4 expert consensus documents. Organ transplantation legislation started in the 1960s in the United Kingdom, and was soon followed by New Zealand and the United States. The first law on brain death was enacted in the United States in 1978. Since 1991, the World Health Assembly (WHA) and other non-governmental organizations have issued 7 consensus documents in order to regulate behaviors related to organ transplantation. China including Hong Kong, Macau and Chinese Taipei has not yet formulated any law on organ transplantation. Conclusion At least six challenges about organ transplantation and brain death legislation in China are identified: ① death definition and source of organ donors; ② prevention of organ transplant tourism; ③ risk assessment and insurance for living donors; ④ defining who has the right to choose about potential organ donation for an individual: whether spouses, parents, or children; ⑤ whether an organ donor should receive compensation; ⑥ whether brain death and organ transplant laws should be formulated separately.
Objective We investigated the effectiveness of legislation in developed countries by analyzingtheir legislation, and produced ideas and strategies for organ transplantation and brain death legislation in China.Methods Official websites were searched as follows: UNOS, TCE, CLTR, ANZDATA, and SRTR through December6, 2008. We included statistical reports and data analysis of organ donations and transplants, and excluded literatureabout non-solid organs. The absolute transplantation numbers were standardized to per one million people. Results 1.The following data was retrieved: The number of eight kinds of organ transplants and organ donations in Britain, the United States, New Zealand, Spain, France, Italy, Germany, and Australia from 2003 to 2005; the number of deceased donors in the United States and Spain from 1988 to 2007; the total number of organ transplants in Australia from 2002 to 2006; the amount of organ transplants in the United States from 1993 to 2006; liver and kidney transplant totals in the United States from 1988 through March, 2008; liver transplants number of China from 1993 through March, 2008; and the number of kidney transplants in some provinces and cities in China. 2. Transplant totals were greatest in the United States; in Spain, after ONT was founded in 1990, the rate of donation from the deceased was the most in theworld. 3. Spain had the best rate of donation with 34.5 pmp, 10.9 pmp higher than in the United States with separate legislation from 2003 to 2005. There was a rate difference of 0.98 pmp between Germany and the United Kingdomwhich implemented separated legislation nine years earlier. 4. Southern Australia had a maximum rate of average kidneytransplant in the country from 2002 to 2006. 5. Live donor kidney transplants accounted for 31.2~44% compared to4.3% and 4.1% for liver transplants in 2006 and 2007 respectively in the United States. 6. The following have been appliedglobally to regulate organ transplantation and brain death: 1) International or multilateral treaties; 2) Regulation ofNGOs; 3) Self-discipline in the field of organ transplantation; 4) Expert consensus; 5) Establishment of patient’s alliance.Conclusion Countries that have implemented organ transplantation and brain death laws have developed successfulmeasures to improve and support insurance and follow-up information for donors and recipients, however, legislation isstill urgently needed in China. As long as brain death and organ transplant laws are reasonably developed and legislatorsresolve to deal with the difficult issues, then the legislation and its subsequent enforcement will reflect the interests of the people and improve health quality for all.