長期照顧服務之爭議處理與服務提供者之刑法上注意義務

Abstract

隨著我國邁入超高齡社會，長期照顧服務之需求日益增加，如何吸引與留任長期照顧服務人才，已成為長期照顧政策中亟需回應的重要課題。然而，我國目前對於長期照顧服務衍生的爭議事件，仍欠缺合適的訴訟外處理機制與明確合理的服務提供者刑法上注意義務判斷標準，致使服務提供者面臨高度訴訟風險與責任不確定性，進而不利於長期照顧服務體系之人才吸納與留任。相較之下，醫療服務領域對於類似議題，已累積相當之學者與實務討論，並有相關之立法與修法，其相關經驗或可作為長期照顧服務爭議處理與責任判斷之重要參考。 本文透過文獻分析、法規整理與判決評釋，先聚焦於長期照顧服務所生爭議事件之處理，檢視現行長期照顧服務爭議處理機制之現況與不足，並分析《醫療事故預防及爭議處理法》所建構之訴訟外紛爭解決制度，探討其作為長期照顧服務爭議處理參考對象之必要性與可能性。接著，依循訴訟外爭議處理機制未能化解爭議而進入訴訟程序之脈絡，進一步就長期照顧服務傷害事件中服務提供者之刑法上注意義務進行分析，並自刑法過失概念出發，探討《醫療法》第82條所揭示之醫療過失認定標準，嘗試具體化長期照顧服務提供者注意義務之內涵與判斷標準。 本文認為，在爭議處理上，立法者應修法為長期照顧服務建構與《醫療事故預防及爭議處理法》同等有效的爭議處理機制；在刑事過失責任的判斷上，則可參考《醫療法》第82條以為判斷，綜合考量護理與照顧常規、機構規模、設備、人力配置及服務能力等因素，並避免將非屬護理或照顧本質之事項納入注意義務範圍，以防止對服務提供者之不當苛責。期望透過本研究所提之建議，藉由程序面建構合宜的爭議處理機制，以及實體面確立明確且合理之注意義務判準，改善長期照顧服務體系之勞動環境，並促進其健全與永續發展。

As Taiwan enters a super-aged society, the growing demand for long-term care services has made the recruitment and retention of care personnel an increasingly urgent policy concern. However, Taiwan’s current framework lacks both effective alternative dispute resolution mechanisms for disputes arising from long-term care services and clear, reasonable standards for determining the criminal duty of care of workers. This legal uncertainty exposes providers to heightened litigation risks and undermines workforce stability within the long-term care system. In contrast, the medical sector has addressed comparable issues through sustained academic debate, judicial practice, and legislative reform, offering a useful reference for long-term care regulation. This thesis employs literature review, statutory analysis, and case law analysis to examine disputes arising from long-term care services. It first evaluates the structure and limitations of existing dispute resolution mechanisms and then analyzes the alternative dispute resolution system established under the Medical Accident Prevention and Dispute Resolution Act, assessing its relevance and applicability to long-term care disputes. The study further addresses criminal duty of care in long-term care-related injury cases by examining standards of criminal negligence. In particular, it analyzes Article 82 of the Medical Care Act, which articulates the standard for determining medical malpractice, and explores how its reasoning may inform the assessment of the duty of care for long-term care workers. This thesis argues that the legislature should establish a dispute resolution mechanism for long-term care services comparable in effectiveness to that of the medical sector. In determining criminal negligence, adjudicators should adopt a contextual approach that considers caregiving norms, institutional scale, facilities, staffing, and service capacity, while excluding obligations unrelated to the essential nature of caregiving. Such reforms may promote legal clarity, reduce undue liability burdens, and support the sustainable development of the long-term care system.