醫師及醫療機構就債務不履行責任之法律關係－兼評最高法院99年度台上字第1055號民事判決、臺灣高等法院99年度醫上更（一）字第3號民事判決

Legal Relations among the Physician, the Hospital and the Patient Regarding Non-Performance of Medical Contracts-Comment on the Judgments of the Supreme Court and the Taiwan High Court

吳振吉(Chen-Chi Wu) ； 姜世明(Shyh-Ming Chiang)

《臺北大學法學論叢》 86期 (2013/06) Pp. 1-50

摘要

關於醫療契約責任之歸屬主體，本案臺灣高等法院99年度醫上更（一）字第3號民事判決及其他多數實務見解以為，僅醫院為醫療契約之當事人，醫師除可能之侵權責任外，對於病人毋庸負契約責任。因我國多數醫院屬於「閉鎖性」醫療組織，而由醫院所聘用之專任醫師從事醫療工作，以醫師為醫療契約之履行輔助人，而以醫院為醫療契約之當事人，原則上應值贊同。惟本文以為，於特定之例外情形，醫師亦須負契約責任。其一，於「開放性醫院」及「半開放性醫院」由院外醫師提供醫療給付之部分，應以院外醫師為契約之當事人，醫院僅就病人住宿、膳食與其他護理照護等事項負契約責任；惟若病人之損害係同時起因於院外醫師及醫院之給付領域，則宜參考德國實務操作，由院外醫師及醫院負連帶賠償責任。其二，於「指定醫師費制度」就病人支付「指定醫師費」選擇特定之醫療給付部分，醫院及被指定醫師均為契約之當事人，應由醫院及被指定醫師負連帶賠償責任，至於住宿、膳食及其他非特定醫療處置，則由醫院單獨負責。

關鍵字

醫療契約 ； 契約當事人 ； 連帶債務 ； 開放性醫院 ； 指定醫師費

並列摘要

In the Taiwanese courts, a consensus has almost been reached that in the context of medical contracts, the hospital is the obligor, whereas the physician is a third party of the contract whom the hospital uses to perform the obligations. In other words, the physician is exculpated from contractual liability, although he or she may still be liable for torts. This consensus is essentially valid, as the great majority of hospitals in Taiwan are ”closed” hospitals, in which only physicians employed by the institution may admit and treat patients. In the present article, we propose that the physician is liable on medical contracts together with the hospital under two circumstances. First, in ”open” or ”semi-open” hospitals, to which physicians who are not staff members may send their own patients and supervise their treatment, the medical contract is divided into two parts: the physician is obliged to provide medical care, whereas the hospital is obliged to provide accommodation, catering service, as well as other non-medical care. Second, if the patient selects a specific physician for special medical service by paying an additional fee, both the selected physician and the hospital are the obligors, constituting a joint-obligation with regards to the selected special medical service. Otherwise, obligations for the accommodation, catering service and non-selected medical care are confined to the hospital.

並列關鍵字

medical contract ； obligor ； joint-obligation ； open hospital ； physician selection fee

參考文獻

王澤鑑(2004)。民法概要。自版=self publication。

王澤鑑(2009)。債法原理。自版=self publication。

史尚寬(1986)。債法各論。自版=self publication。

朱秀鳳(2008)。從組織圖探討醫院管理部門之位階演變型態。國立中山大學人力資源管理研究所=Institute of Human Resource Management, National Sun-Yat-San University=Guo li zhong shan da xue ren li zi yuan guan li yan jiu suo shuo。

吳志正(2006)。解讀醫病關係。元照出版有限公司=Angle Publishing Co., Ltd.=yuan zhao chu ban you xian gong si。