美容醫學刑事過失責任之認定——以醫療法第82條修法為中心

Abstract

近年來，與美容醫學相關的修法為2017年12月29日修正之醫療法第82條以及2018年9月6日修正之特定醫療技術檢查檢驗醫療儀器施行或使用管理辦法（下稱特管辦法），這兩部規範牽動著我國美容醫學領域之醫病安全。 醫療法第82條為醫療行為民刑事過失責任之認定依據，美容醫學屬醫療行為，亦以醫療法第82條作為認定美容醫學刑事過失責任之依據。在一般醫療領域中，醫療法第82條新增醫事人員必須「逾越合理臨床專業裁量」始負刑事過失責任，修法有助於解決醫師面臨防禦性醫療之困境，同時成為醫師在合理範圍內具有療法選擇權之依據。惟因美容醫學不具備急迫性、必要性等特質，以醫療法第82條中「合理臨床專業裁量要件」認定美容醫學刑事過失責任，可能使醫師得以透過「行為滿足新興儀器的治療規則」來迴避對於病人的個案裁量義務，甚至加劇一般醫療領域人才流失之情形。 根據本文的觀察，民國101年至110年間地方法院之美容醫學刑事過失案件，在醫療法第82條修法後，平均每年經起訴之案件數量並沒有減少，而在這些案件中，第一審法院判決醫師有罪比率亦僅略微降低。此外，實務上仍是以醫師行為是否違反醫療上注意義務作為判斷標準，因此醫療法第82條修法後亦未實質改變法院對於美容醫學刑事過失責任之論證方式。儘管如此，考量到美容醫學的本質與醫療法第82條之修法目的格格不入，本文認為應目的性限縮醫療法第82條中「逾越合理臨床專業裁量」要件之適用範圍，僅醫師進行具有「治療目的」之裁量時，方能以「醫師裁量權」排除醫師醫療過失責任，以根本解決醫療法第82條適用於美容醫學領域所生之疑慮。 最後，在特管辦法方面，修法增設「特定美容醫學手術專節」而就「美容光電治療」及「美容針劑注射」則不再設有相關規範。換言之，特管辦法欲加強的安全規範如麻醉規範、操作醫師之資格限制等，全然繫於是否達到「特定美容醫學手術」之門檻。對此，本文認為應將麻醉安全列為獨立規範項目，或針對列管美容醫學項目做更為細緻地區分，方能確實加強美容醫學領域之安全性。

In recent years, there are two major amendments related to Aesthetic Medicine, Article 82 of the Medical Care Act amended in 2017, and Regulations Governing the Application or Use of Specific Medical Techniques, Examinations, or Medical Devices (hereinafter referred to as the "Regulations of Special Medical Techniques") amended in 2018. The above regulations will affect the safety of both doctors and patients in the field of Aesthetic Medicine. The amendment of Article 82 of the Medical Care Act redefined the liability for medical negligence. However, since there are no characteristics of urgency and necessity in Aesthetic Medicine, it may cause concerns while using the same standard as the general medical behavior to determine negligence. According to this research, the judgment standard of criminal negligence in aesthetic medicine is still based on the “medical duty of care” in the actual practice. In other words, the amendment does not change how the court determines criminal negligence for aesthetic medicine. Nevertheless, it is crucial to not ignore the conflict between aesthetic medicine and the purpose of the amendment. Current medical discretion is only appropriate when judging general medical behavior. In terms of the Regulations of Special Medical Techniques, the newly added medical safety norms such as anesthesia safety and the qualification requirements are only taking effect when reaching the threshold of the “Specific Aesthetic Medicine Procedures”. It is likely that making anesthesia safety an individual regulation or defining distinct types of aesthetic medicine would help strengthen safety in the aesthetic medical field.