初探系統化風險在刑法歸責理論的適用：以醫療過失案件為例

Abstract

本文認為，在過失案件中，即使行為人非第一線人員，如管理者、監督者，乃至制度與文化層面的決策者，只要風險實現結果能具體指向個人，皆有可能以刑法歸責系統評價其行為。 系統性風險在刑法過失歸責評價中，可透過「違反客觀注意義務所創造的法不容許風險」與「是否具有結果迴避可能性」兩個層次加以分析，並可區分為四類：一為傳統意義下的過失；二為現行實體法不處罰之過失未遂；三為不符規範保護目的之無過失，四為不可歸責給任何體制參與者的系統性風險。 在體制角色分類上，本文認為眾多的體制角色中，具刑法規範意義的分類可分為決策者與糾錯者，兩者的差異在創造法不容許風險後，是直接或是間接造成法益侵害。 實務中亦可看見檢察官與法院將系統性風險歸責於個人之嘗試，例如心肌梗塞案中，院長因聘任資格不符之醫師而被檢察官起訴以及榮總瘧疾感染案中放射科主任因未禁止放射科內針頭重複使用而遭法院判刑。在邱小妹人球案中，檢察官也起訴了兩位建議轉診的醫師。而在這些案例中，本文認為檢察官或法院對於刑事責任的歸責操作可能還可以有更完整之處，大部分系統性的風險，仍然是可能可以找到具體之個人負責。 因此，本文認為，即使是表面上看起來不可歸責於任何人之系統性風險，若能深入分析系統中法不容許風險的創造與風險實現，仍有機會找到可能需要負責的具體個人，並進行刑法歸責。但刑法過失歸責系統中，邏輯上仍然不排除存在無法歸責給體制中的任何個人之系統性風險，即本文定義的系統性風險。

The article asserts that in cases of negligence, even individuals who are not frontline personnel—such as management, supervisors, or decision-makers at the institutional or cultural level—may be subject to criminal attribution under the criminal law accountability system, provided that the realization of risk can be concretely traced to a specific individual. Systemic risk, in the assessment of negligence under criminal law, can be analyzed through two levels: (1) whether an objectively unreasonable risk was created by violating a duty of care, and (2) whether the harm could have been averted (potentials of avoidable results; avoidability). Such systemic risk may be categorized into three types: (a) traditional negligence, (b) attempted negligence, and (c) narrowly defined systemic risk that cannot be attributed to any individual participant within the system. Regarding institutional roles, the article posits that among the various roles within a system, those possessing normative significance in criminal law can be categorized as "decision-makers" and "correctors." Both of whom, after generating an objectively unacceptable risk, may directly or indirectly inflict harm on legally protected interests. Practical jurisprudence offers examples of courts applying systemic-risk principles to individuals. In the myocardial infarction case, a hospital director was held responsible for hiring an underqualified physician; in the Veterans General malaria infection case, the radiology department chief was convicted; and in the the Case of Little Girl Chiou—originally considered a classic example of narrowly defined systemic risk—subsequent review revealed grounds for holding specific individuals accountable. Thus, the article argues, even when a risk initially appears to be purely systemic and not attributable to any individual, upon closer analysis of how the objectively unacceptable risk was created and realized within the system may still identify specific individuals who should bear criminal responsibility under the attribution principle of criminal law.