台灣醫療刑事追訴之現狀與政策走向

Abstract

醫療糾紛是否要以刑罰來追訴，一直是醫界與法界學者和實務家爭執的焦點。對於醫師而言，會認為無端的刑事追訴會造成其執行業務上之困擾，造成醫療環境之惡化。但在台灣以往法律文獻多注重質性分析，欠缺整體性的量化統計，造成在討論刑事追訴是否就是造成醫療環境問題因素時無法有力地說服各界人士，繼而在形成政策上，不容易聚焦形成共識。因此本文希望同時透過質性與量化之分析，來探討目前醫療糾紛之相關刑事政策上應該採取何種走向。 在探討醫療糾紛之前，本文於第二章中先自法律相關文獻，將本文所欲探討之「醫療糾紛」限縮在「病方所受到醫療行為之不良結果（如傷害或死亡）應否歸責於醫事人員或醫療機構」上，同時將醫療糾紛受刑事追訴之主體亦限縮在主導醫療行為的醫師身上。 其次，本文在第三章中探討醫療糾紛在台灣現行刑事實體與程序法上所適用之規定，並單就醫師所為之醫療行為與台灣其他業務行為相較是否具有其特殊性，討論有無針對醫療糾紛在刑事政策上為特別待遇之必要，並對照歷年來所提出關於醫療刑事政策上之立法意見所立論之依據，是否有其可採之處，但在此本文認為單以理論上而言，並無法得出有因為醫療行為之特殊性而特別修正刑事政策之必要。 而由於許多文獻均會提到比較法或實證數據上，台灣較容易以刑事追訴醫師為醫療行為之業務過失責任，本文第四章與第五章則分別從比較法與實證分析之研究方法來探討這樣之立論。在比較法上，各國刑事法均沒有對於醫師為特別之規定，縱使在中國有所謂「醫療事故罪」之特殊規定，但其實舉凡交通、鐵路、生產設施、教育設施相關人員之業務行為在中國刑法上也有特殊規定，並沒有只對於醫師另眼相看。 在第五章之實證分析上，在台灣之部分，在近三十年來，醫師受刑事追訴之比例並沒有明顯上升。並且，無論是法務部之法務或檢察年報或司法院之司法年報，都並未顯示出醫師為醫療行為相對於其他業務行為，有較容易受刑事追訴或量刑較重之情形，甚或與其他業務之人相比，醫師還比較不容易受刑事追訴。與法律體系較接近之日本或德國，經國民人口數、醫師人口數、偵查案件數進行背景修正後，台灣雖然在醫師為醫療行為受偵查之案件數量上均高於日本，但仍略低於德國。反之，在起訴率和有罪率上，台灣則高於德國但低於日本，無法得出台灣刑事政策上對於醫師較法律體系相近之他國較為苛刻之結論。 因此，本文結論上認為無論從醫師為醫療行為本身是否具有之特殊性、比較法、各類實證分析，均無法得出在刑事政策上只為此為特別待遇之正當性，縱或修正也無法解決醫療環境惡化之問題，反而會掩蓋真正為其主因之醫療政策問題。至於關於醫療政策與醫療環境惡化之關係，筆者限於能力與時間，無法於本文中詳細探討，僅認為此與台灣醫療勞動政策、全民健康保險政策有密切之關係，並建議醫界以此著手，才是改善台灣醫療環境之正確走向。

It has been a debate both in the medical and legal community whether medical disputes should be charged under criminal law. Generally, doctors contend that criminal prosecution intimidates medical practices and hurts the whole medical environment. However, legal literatures in Taiwan focuses primarily on qualitative research. The lack of a comprehensive quantitative research results in unpersuasive arguments on whether criminal charge is the problem to the medical community, and leads to the failure to reach consensus on policy. Hence this Paper aims to, through both quantitative and qualitative approaches, explore the future of criminal policy on medical disputes. Before proceeding to discuss medical disputes, in Chapter Two, this Paper starts from relevant legal literatures and narrows down the definition of “medical disputes” as the disputes of whether “the patients’ injury and death resulting from the medical treatments should be blamed on medical personnel and institutions involved,” and confines the subjects of criminal charge in medical disputes to doctors who had commanded the disputed medical treatments. Next, in Chapter Three, this Paper reviews the current state of criminal substantial and procedural law in Taiwan. By comparing medical treatments performed by doctors with professional techniques in other walks of life, this Paper discusses whether it is necessary to offer special treatment for medical disputes, and evaluates all the arguments offered as legislative opinions for medical criminal policy up to date. Here, this Paper argues that, in theory, the purported particularity of medical treatment is groundless, and that as a result the need to adjust criminal policy for this sake cannot be justified. Since many literatures point to the evidence in comparative law and empirical data arguing that in Taiwan criminal charge is more likely to be relied upon to prosecute doctors for negligent responsibility in professions, this Paper, in Chapter Four and Five, examines such arguments from the perspectives of comparative law and empirical analysis. In comparative law, this Paper finds that criminal laws in other jurisdictions stipulate no special treatment for doctors; even in China, where the “crime of medical negligence” is written into law, criminal law of China in fact punishes comprehensive professions including transportation, railway, productive facilities, educational institutions and personnel. In other words, the medical community receives no special treatment here. In Chapter Five, this Paper conducts empirical analysis and demonstrate that, in Taiwan, the past thirty years did not see apparent increase on the rate of doctors charged under criminal law. Both the yearbooks of the Department of Justice and the Judicial Yuan do not show any evidence that doctors are more likely to be charged under criminal law or receive longer sentence for performing medical treatment. Instead, these data shows that, compared with other professions, doctors are even under less chance for criminal charge. Compared with Japan and Germany, both sharing similar legal system with Taiwan, after background modification on population, number of doctors, and number of charged cases, though the number of charged cases of doctors performing medical treatment in Taiwan is higher than that of Japan, it is lower than Germany. Besides, on prosecution rate and conviction rate, Taiwan is higher than Germany but lower than Japan. These facts still cannot support the argument that criminal policy in Taiwan is more harsh to doctors than in any other country of similar legal system. Therefore, in conclusion, this Paper points out that, from the perspectives of the particularity of doctors and medical treatments, comparative law, and all kinds of empirical analysis, no ground of legitimacy exists for special treatment in criminal policy concerning medical disputes. To adjust criminal policy cannot save the worsening medical environment; much worse, it obscures the true culprit: medical policy. As for the relevance between medical policy and the worsening medical environment, due to limited capability and time, this Paper does not offer a more detailed discussion. However, this Paper points out medical labor policy and national health insurance policy as the key, and suggests that reviewing these policy is the right way to improve the medical environment in Taiwan.