論醫療告知說明義務

Abstract

醫療告知說明義務之確實履行，對於建立良好醫病關係至關重要。關於此議題，我國向來研究成果與實務案例頗豐，本文將之分為「義務發生」、「保護法益」、「義務人與相對人」與「義務履行」四部分進行討論，以期建立完整體系，並回應醫療告知說明義務於我國本土實踐中發生之問題。 本文指出，醫療告知說明義務源自於醫病間因專業知識地位、資訊落差而形成之特殊信賴關係，無論醫病間有無契約，此義務均得發生，且在契約責任與侵權責任中，義務範圍與違反義務之法律效果原則上應相同。此義務旨在透過資訊之提供，協助病人自主做成醫療決定，包含選擇是否治療、接受何種治療，以及是否承擔治療風險，具有保護病人自主決定權與病人之生命、身體及健康權之重要功能。 醫療告知說明義務之義務人，應包括收治病人之醫療機構，以及在醫療團隊中具有主導地位且和病人接觸密切之醫師。其中，醫療機構雖無法與病人進行言語溝通，但其仍可透過完善制度與妥善安排人事以對病人履行此義務。而在病人具意思能力時，病人本人應為唯一之相對人，僅在病人無意思能力時，與病人具一定密切關係、瞭解病人意願之關係人方成為相對人。 關於義務之履行，應以病人能實質理解之方式為之，原則上須由醫師親自以口頭方式對病人實質說明、釋疑。義務之內容、範圍則應以理性病人做成醫療決定所必須之充分資訊為準，惟亦應兼顧醫療機構與醫師之預見可能性。最後，關於義務之免除，僅可承認為確保病人能即時得到救治之「緊急情況」與展現病人自主決定權之「病人放棄」兩種事由，不應承認醫師為保護病人身心健康而得對其隱瞞資訊之「治療上特權」，以免重回醫師為病人過濾資訊之醫療父權模式。

Properly performing the duty of disclosure of medical information is crucial for establishing a good relationship between medical institutions, doctors, and patients. There have been numerous research outcomes and practical cases in our country regarding this issue. This thesis divides the discussion into four parts: "Occurrence of Duty," "Protected Interests," "Obligor and Obligee," and "Performance of Duty," aiming to establish a comprehensive system and address the problems encountered in the practical implementation of the duty of disclosure of medical information in our country. This thesis points out that the duty of disclosure of medical information arises from the fiduciary relationship between healthcare providers and patients, which is formed due to the professional knowledge status and information asymmetry. This duty exists regardless of whether there is a contract between the healthcare provider and the patient. In both contractual and tort liability, the scope of the duty and the legal consequences of breaching the duty should be identical. The purpose of this duty is to provide information to assist the patient in making autonomous medical decisions, including whether to accept treatment, what type of treatment to take, and whether to assume the risks of treatment. It serves the important functions of protecting the patient's right to self-determination and the patient's rights to life, body, and health. The obligors of the duty of disclosure of medical information should include the medical institutions treating the patients, as well as the doctors who hold leading positions in the medical team and have close contact with the patients. Although medical institutions cannot communicate verbally with patients, they can still perform this duty through a comprehensive system and proper personnel arrangements. When the patient has mental capacity, the patient should be the sole obligee. Only when the patient lacks mental capacity should a person with a certain close relationship and understanding of the patient's wishes become the obligee. The duty should be performed so that the patient can substantially understand. In principle, the doctor should provide substantial explanations and clarifications to the patient orally, and personally. The content and scope of the duty should be based on the sufficient information necessary for a reasonable patient to make a medical decision, while also considering the foreseeability of the medical institution and doctor. Lastly, regarding the exemption from the duty, only two grounds should be recognized: "Emergency," to ensure the patient receives timely treatment, and "Patient Waiver," to respect the patient's autonomy. The "Therapeutic Privilege," where the doctor withholds information to protect the patient's physical and mental health, should not be recognized to avoid reverting to a paternalistic model where healthcare providers filter information for patients.