論醫療過失的判斷基準-以106年修正醫療法第82條為中心

醫療法第82條於106年再次修法，將臨床專業裁量的要件明訂於法條中，並增列第4項多元審酌要件，希望可以使醫療過失的判斷標準明確化，並減輕醫事人員的責任。然而，將臨床專業裁量入法，實際上僅是重複審查注意義務，並將實務行之有年的見解明文化，實質上並未變動醫事人員的注意義務程度，反而限縮了本條的適用範圍。率然增訂多元審酌要件，亦未使過失判斷更加明確，反增添實務運作的困擾。民事實務於修法後，仍然偏好以民法第184條而非本條作判斷，即為顯例。刑事責任中，最高法院106年度台上字第4587號判決雖肯認本條修正乃有利行為人的責任減輕，然一個符合臨床專業裁量的醫療行為，不論是在修法前後，本即皆不會被認定違反注意義務，則本條的修正方式是否真有減輕醫事人員刑事責任，亦值存疑。又本條第5項作為醫療機構組織責任的宣示，不但可彌補病人因系統性錯誤受有損害時之侵權保護漏洞，亦可使醫療契約給付義務的內容更加完整。然本項之實際適用上，仍有諸多障礙存在，是否能真正發揮功能，值得觀察。本文認為，本次修正除有法條文字與結構不當之失外，其立法目的過度偏向減輕醫療提供者責任，未妥善考量對病人的保護，並不妥當。醫療責任之規範設計，不應單向、直觀的僅從醫療提供者角度，只考慮如何限縮病人求償，而應落實履行告知說明義務、適當揭露病歷與資訊，以強化醫病互相溝通、理解的管道，並在訴訟上減輕或轉換病人的舉證責任，適度調整武器不平等的狀態，才能有效解決醫療糾紛，真正減低醫病的對立。

關鍵字

醫療法第82條；醫療行為；醫療過失；注意義務；臨床裁量；組織責任

並列摘要

To clarify the standard of medical negligence and to reduce liability of healthcare workers are the purpose of amendment to Article 82 of the Medical Care Act in 2017. However, according to the conclusion of this thesis, whether in the region of criminal liability or civil liability, the standard of medical negligence has not been clarified and liability of healthcare workers has not been reduced due to the amendment. Although organizational liability of medical institution established by Clause 5 of Article 82 can improve protection of patients' rights, there are still many obstacles on it which shall be overcome, and may weaken the effectiveness of it. This amendment has strong intention to reducing liability of healthcare workers. However, legislation on medical liability shall not only consider reducing liability of healthcare workers, but shall also consider protection of patients' rights as well. Ensuring the performance of the obligation to disclose, intensifying communication and consensus between patients and healthcare workers, adjusting or even shifting burden of proof which the plaintiff bears, and balancing equality of arms between patients and healthcare workers are the more effective ways to resolve medical dispute, rather than only putting obstacles on patients’ right to compensation.