民事醫療責任之判定 — 法院判斷vs.專業意見

Abstract

我國對於醫療責任成立係採取過失責任主義，司法實務多以「醫療常規」作為認定過失存否之標準，但去年最高法院接連針對醫療過失之判定，認為應採「醫療水準」作為注意標準，過失之認定應考量所有因素來作判斷，「醫療常規」僅係諸多審酌因素之一。 因「醫療水準」注意標準係不易預見之規範性概念。本文欲藉由實證研究方式來探知實務所稱之「醫療水準」標準的概念內涵與解釋範圍，希冀透過實證研究獲得之經驗事實，可適度具體該注意標準以提昇其損害預防功能，並與「醫療常規」標準相較，「醫療水準」標準是否係能更公平合理分配醫療風險、調和醫病雙方利益之注意標準。 經實證研究發現，採擇「醫療水準」注意標準之法院，除審酌醫療人員行為是否符合醫療常規外，亦會考量醫方是否善盡說明義務、醫療機構制度是否有瑕疵以及醫師臨床裁量是否有瑕疵。在個人方面，法院會審視醫療人員是否善盡說明義務以及醫療行為是否符合醫療常規，而在特殊情況病人時，法院會審酌醫師臨床裁量是否有瑕疵；在組織方面，法院會檢視醫療機構制度是否存有瑕疵。是以，採取「醫療水準」注意標準較「醫療常規」注意標準，更能充分保障病人就醫之安全；惟在醫師臨床裁量瑕疵部分，法院未考慮損害結果發生是否係臨床上客觀所能預見而有過度苛責醫師之虞。 我國醫療法第82條於去年進行內容修正，從實證研究獲得之經驗事實去端詳新法民事責任內容，可發現新法係將實務多數見解成文法，民事過失責任的標準仍跟以前相同，並未因修法而有減輕。希冀經由實證研究獲得之經驗事實，除可補充「醫療水準」標準的概念內涵外，亦能提供新視角來一窺我國「醫療水準」標準之堂奧。

Medical negligence is the core concept to determine either civil or criminal liability for medical malpractice in Taiwan. In medical litigation, many courts in Taiwan usually adopt the“medical custom”as the standard of care to judge the presence of negligence. Recently, a landmark judgement of the Supreme Court in Taiwan reaffirmed that medical negligence should be determined according to the“medical level”rather than the“medical custom”,“medical custom” was only one of the factors to judge the presence of negligence. However, the standard of“medical level” is an unpredictable concept. What actually constitutes “medical level” ? In this article, we would explore the content of“medical level” by empirical legal studies in order to know if it is more fair than“medical custom” and improve its prophylactic function of Civil Code. The result shows that the civil courts under the standard of “medical level” consider not only medical custom but also other factors such as medical inform, organizational defect and clinical discretion. In medical personnel aspect, the civil courts determine medical negligence by medical custom, medical inform and clinical discretion; In hospital aspect, it determines medical negligence by organizational defect. It shows that the standard of“medical level” more guarantees patient safety than the standard of“medical custom”. However, the standard of care is too high in the doctor of clinical discretion. The Article 82 of the Medical Care Act was revised last year. Through the result of empirical legal studies, we find the newly revised regulation acknowledges judicial practice and proclaims precedents in writing, it still keeps the same standard in civil liability. Hopefully, this study can shows clearer concept of“medical level”.