醫療糾紛的倫理反思

Ethical Reflection on Medical Malpractice

徐金雲

《台灣醫學人文學刊》 15&16卷 (2015/09) Pp. 161-181

摘要

醫療糾紛訴訟就其法律層面而言，所涉及的是「違反契約」、「侵權」，以及「注意義務」責任的輕忽（negligence）。就其實質層面而言，則主要起因於病人的健康、身體以至生命權因醫療行為而受到侵害，治療過程中病情的發展或結果出乎意料，以及醫病關係不佳所導致。近幾年，台灣地區地方法院每年醫療糾紛案件的收件總數約達三至四百件，其中，原告勝訴率在民事部分，平均不到兩成，至於刑事案件的勝訴率更低。這種未能實質補償原告對權益主張的訴訟結果，背後所反映的是醫療技術低落的問題還是相關訴訟體制的不健全？亦或是相關聯人士在倫理觀念上的待釐清？這篇文章將嘗試透過倫理的角度，在觀念上分析並探討醫療糾紛的倫理層面的問題。期望透過西方傳統的規範理論，思考並反省醫療糾紛的相關當事人在思維上以至行動上應面對的倫理責任與義務。

關鍵字

醫療糾紛 ； 效益主義 ； 道義論 ； 美德理論 ； 分配正義

並列摘要

On the legal perspective, medical malpractice comes from doctor's ＂breaching of contract＂, ＂infringement of patient right＂, or ＂the negligence of duty of care＂. However, on the material perspective, three things are called for considering: first, the disputes are due to patients' rights to health, body and life are infringed by doctor's medical behaviors; second, the developments and results of the course of diseases are unexpectedly; and third, the discordance of doctor-patient relationships. According to the statistics made by High Court, three to four hundreds of medical malpractice cases were moved to local courts each year, whereas only less than 20 percent civil cases were recovered, and the recovered ratio of criminal cases were even lower. Regarding the low rate of compensation in respect of giving plaintiffs' revenge, three dimensions can be deliberated: either the medical techniques need to be improved; or the litigation structure with respect to medical dispute should be reformed, or else the ethical attitudes and reflections on medical malpractice resided in agents involved should be elucidated. This article aims to analysis and discuss the ethical perspective of medical malpractice with the hope that we can give some clues about how to think righteously and taking appropriate reactions for those who involved in medical dispute.

並列關鍵字

medical malpractice ； utilitarianism ； deontology ； virtue ethics ； distributive justice