論醫師違反告知義務之刑事責任

Abstract

近十年關於刑事醫療之告知義務，從原先過失犯注意義務之一環，變成與醫療行為無涉之前階段歷程，不難看出最高法院在病人自主權及醫師專業性天秤兩側的掙扎。 現行實務判決深受最高法院101年度台上字第2637號判決之影響，截然劃分刑法注意義務與告知義務，以兩大理由排除兩者連結的非難可能，因此，本文首要將試圖從刑法過失犯架構中，建構告知義務違反之意義。此部分涉及刑法傷害罪的保護法益、自主在醫療行為的意義與刑法注意義務的本質，從三者的串連，勾勒出醫師告知義務成為刑法注意義務的路徑。 其次，本文將接續討論，究竟醫師未說明什麼樣的副作用、併發症，會被評價為製造法所不容許的風險？此部分囿於我國缺少可參照之實務判決，因此，將從美國法院與德國法院判決中，尋找兩國法院所審酌之個案要素，加以歸納、分析。另外，亦會從應然面探討歸納與分析所得出的結論，在法理上是否有待調整之處。 最後，在醫病關係的互動中，雖已從過去的醫療父權逐漸走向平等對話，但某些情況下，仍有賴醫師的專業裁量，決定告知與否以及內容上之取捨。在違法性中，如何一方面維護醫師的專業性與醫療行為之本質，另一方面彌補病人流失的自主，以及有無必要援引德國法之假設同意概念，成為本文第三個欲討論之重點。

The role of informed consent in the clinical context, as be regarded as the duty of care, has transformed into pre-medical procedure which is not relevant to medical practice in recent ten years. It is not difficult to find out struggle of the Supreme Court between patient autonomy and medical professionals’ own judgments. Nowadays, the courts follow the decision made by Supreme Court 101 Tai-Shang-Tzu 2637 and demonstrate that duty of care and informed consent are distinctly separate based on two reasons. Therefore, this article will attempt to establish the meaning of violating informed consent from the framework of negligence in criminal law. This article will show the relationship between duty of care and informed consent by connecting the legal interest of offences of causing bodily harm, the meaning of autonomy in the medical field and the essence of duty of care. What’s more, this article will discuss that what kind of side effects or complications that doctors don’t inform patients will be assessed of generating risks which are not allowed. Due to lack of relevant judgments in Taiwan, therefore, this article will analyze the court’s opinions of United States and Germany. Besides, this article will also examine the factors adopted by courts of United States and Germany from perspectives of the legal principle. At last, the doctor-patient relationship has been gradually turned into an equal partnership. However, whether to inform the patient and how to inform are at the discretion of the doctor in specific situations. Hence, how to balance discretion of the doctor and autonomy of the patient becomes an important problem. In addition, in order to achieve perfect balance, is it necessary to apply hypothetical consent originated from German Civil Code? This article will illustrate the difficulty of using such concept.