德國醫事民法中病人與有過失之探討

Research on Comparative Negligence of Patients in German Medical Malpractice

侯英泠(Ing-Ling Hou)

《臺北大學法學論叢》 86期 (2013/06) Pp. 125-183

摘要

由於病人對醫學知的不足，一般傾向否定病人與有過失之成立，但隨著病人權益與醫師告知義務之重視，逐漸肯認病人在醫療過程中，共同參與角色及其配合義務。基於危險損害公平分配，德國文獻逐漸有肯定病人與有過失之聲，德國實務雖然也肯認病人與有過失成立之可能性，但以醫療提供方已確實盡到告知義務為前提，病人在可以認識到自己應有的配合義務與意義下，始可成立與有過失。德國實務在醫療意外風險分配上，非常小心謹慎地肯認病人與有過失成立之可能性，在此吾人可以發現透過加害人主張被害人與有過失，實務逐漸周延加害者（醫療提供方）之說明義務，因此，雖然病人之與有過失可能被肯認，但基本上病人權益並未被忽視，反而是更周延，因此，本文希望透過德國實務病人與有過失類型之介紹，提供國內對於醫療意外損害合理分配之另一思考方向。依據德國實務之見解，病人與有過失成立之要件有三：一、醫療提供方己盡說明義務；二、病人有真正義務或非真正義務違反之情形；三、違反自己之過失；四、病人義務之違反，與損害之產生或擴大有因果關係。至於病人對於其義務違反有違反自己之過失，其過失判斷，依德國民法第276條第1項規定，而未成年病人對於自己之行為是否有與有過失之適用，則依德國民法第276條第3項規定，準用德國民法第827、828條規定。病人是否應承擔第三人之過失與參與損害之行為，則依德國民法第254條第2項第2句對於使用人（第三人），也須負同一過失責任，且德國民法第278條對於使用人之過失有適用。但是究竟是要件準用還是效果準用，則有爭議。德國實務基於對未成年人之特別保護，以有契約或類似契約關係存在為前提，始對法定代理人之過失負同一責任，畢竟未成年人無法選擇父母親，不宜讓其負擔過重責任。而病人體質特殊，非病人所能控制，故無過失。

關鍵字

遵循醫囑 ； 病人與有過失 ； 外籍病人 ； 醫師說明義務 ； 藥品仿單 ； 錯誤醫囑 ； 非真正義務 ； 病人協力義務 ； 病人恣意出院 ； 第三人過失 ； 拒絕治療 ； 損害擴張義務 ； 損害賠償責任

並列摘要

In Relation to lack of medical knowledge of patient would generally hardly recognize their negative in medical malpractice. But with the gradual respected patients' rights would observe the informed consent. The Judgment expects participatory role and its cooperation obligations from patients in medical process. The Patient must correctly follows medical advice, such as medication or drug compliance, chronic wound care, self-directed physiotherapy exercises. And medical compliance is often an important factor in healing process. Both the patient and the health-care provider affect a positive medical opportunity. Non compliance thwarts a medical Treatment. On the basis of equitable distribution of risk damage Germany literature gradually recognizes the obligation of patient in medical Treatment. The German judgment stipulates enough of Information about medical Treatment form medical provider beforehand acceptance of the obligation of patient to compliance in medical process. The German judgment very care to ken acknowledged of patient in medical accident. The German judgment sets us a good example. There are 3 reconditions in recognition of cooperation obligation patients in Germany. 1. health care providers have made obligation of explanation; 2. patients have hurt their cooperation duty or obligation to compliance; 3. culpable negligence against themselves. As the patient negligence violate his obligation against himself, on the basis of German civil law article No. 254 the patient contributes his damage with the health care provider together. The criterion for a decision of their negligence is Germany civil law article No. 276. The underage patient is liable for his own negligence in case of his compensation under German Civil law article No. 827, 828 in connection with German Civil law article No. 276. The underage patient should be responsible for negligence of his helper in case of his own compensation under German Civil law article No. 254, 2^(nd). But Germany practice based on the special protection of underages, to have a contractual or similar relationship to conditions of contract, began the same responsibility for negligence of legal representatives (their parents).

並列關鍵字

Assumption of risk ； Compliance obligation ； Handeln auf eigenene Gefahr ； Grundsatz von Treu und Glauben ； comparative negligence ； Mitverschulden des Patienten ； Nichtbefolgung von ärztlichen Anweisungen ； non-compliance, Prescription ； patient-centred care ； Drug labeling ； Prescription ； Rezeption ； Patient's Obligation to cooperate ； Obligation to reduce damage ； Schadensminerungspflicht ； therapeutic partnership

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