告知說明義務之重新審思：以法國法上醫療責任之「機會喪失」理論為中心

本文藉由探討法國法上醫療事故案件中，機會喪失理論於實務上及學說上之發展脈絡，進而重新思考在醫師違反告知義務的案例裡，是否真的適合運用機會喪失理論。至少，是否適合以生存或治癒機會喪失理論，來和緩因果關係及評估損害賠償範圍。特別是我國法院實務在許多案件中採取存活機會喪失理論，並且不同於多數美國法院判決，在既存病症之案例，無論是否發生死亡結果，均承認得以存活機會喪失提起損害賠償，此項見解和法國法早期較為類似。但機會喪失理論有其限制，實際上是否真的能對妥適保護病患權益，似有值得再思考之空間。本文認為根據法國2004年3月4日通過之病患權利及醫療體系品質法，及法國法院近年豐富的討論，不論是利用非財產上損害賠償的方式彌補機會喪失之突襲損害，或轉而針對「避免風險發生機會喪失」之獨立損害賠償，都是在尋找醫師告知說明義務與病人自主權間的重新平衡。過度強調醫師告知義務而使醫病關係更加緊張，並非病人之福。而如何從醫療父權走向病人之合理期待，則是醫師告知義務中最核心的議題。

關鍵字

告知說明義務；機會喪失理論；損害賠償；法國醫療責任

並列摘要

The loss of chance doctrine in medical malpractice cases holds that when a physician is responsible for the destruction or reduction of prospects for achieving a more favorable outcome, the patient should be compensated by the doctor for that percentage loss. However, the application of loss of chance doctrine in the informed consent cases could be very problematic: It seems difficult to link a mere failure to inform with the loss caused by a non-negligent medical act or treatment. The concept of loss of chance developed by the Cour de cessation and Conseil d'Etat in France deals with this problem and amends the usual causal link theory. The victim does not need to show that the breach caused him to suffer loss or die, but only needs to show that such a breach prevented him from benefiting from a chance of cure, or a chance to avoid certain damages. At the same time, French Law of March 4 2002 concerning patients' rights and the quality of the health care marks also an evolution of the rights recognized to the patient. Yet, the expansion of physician liability can really contribute to the rights of patients' autonomy? The author argued that the loss-of-chance doctrine should be given a more balancing approach in the informed consent cases, and regarded as a distinct compensable injury to the ultimate harm.