專科護理師輔助醫療行為適法性之探討

The Legality of Medial Assisted Activities by Nurse Practitioners

邱慧洳(Hui-Ju, Chiu)

《中正大學法學集刊》 53期 (2016/10) Pp. 231-276

摘要

關於專科護理師（下稱「專師」）之執業範圍，「專科護理師於醫師監督下執行醫療業務辦法」於2016年1月1日施行前，衛生福利部（下稱「衛福部」）僅以行政函釋說明專師於醫師指示下可執行醫療輔助行為、解釋病情、提供醫學諮詢、開立檢驗單、檢查單與領藥單以及書寫病程紀錄單，上述函釋未予規定之項目，專師得否執行，遂產生模糊空間，再加上衛福部以函釋對醫療輔助行為所為之解釋，語意不清或相互衝突，亦使專師執業範圍更加模糊。執業範圍若模糊不清，專師執業極易遊走於密醫罪之法律邊緣，因專師執業範圍模糊不清，曾有專師於2010年為病人執行氣管插管、動脈血抽取與X光檢查，遭病人提告密醫罪，所幸檢察官對此不予起訴，法院亦駁回聲請人所為交付審判之聲請，本文欲評析檢察官與法官之法律檢解是否妥適，並一併評析衛福部對醫療輔助行為所為之函釋是否妥適。「專科護理師於醫師監督下執行醫療業務辦法」施行後，專師執業範圍更趨明確，若將上開專師遭提告密醫罪之案例以新法觀點審視，專師執業範圍能否因新法之規定而告別模糊不清之窘境，本文將一併評析之。期待本文之淺見可拋磚引玉，引發醫護界與法界對專師執業範圍之關注，進而集思廣益探究之，以期專師執業範圍之界定可更趨合理。

關鍵字

專科護理師 ； 執業範圍 ； 醫療行為 ； 醫療輔助行為 ； 護理人員法 ； 密醫罪 ； 立法 ； 法律 ； 法規命令 ； 行政函釋

並列摘要

Regarding the scope of practice of nurse practitioners (NPs), before Jan 1, 2016, the promulgation of the Regulation of Nurse Practitioners Practicing Medicine Intervention under the Supervision of Physician, the only document to define the scope of practice is an administrative directives from Ministry of Health and Welfare (MHW) that notes NPs can assist physicians to provide the following services: explain patient's condition, prescribe lab works, order medicines, composes progress notes, and assist in medical procedure. Besides these items mentioned above, whether the NPs can practice some other items or not is questioned. In addition, the way that the administrative directives adopted to define the assisting medicine practice is vague, this makes the scope of practice of nurse practitioners more vague. If the scope of practice is vague, the NPs might easily commit the ＂Physician without License Crime＂. In year 2000, a NP was claimed for the ＂Physician without License Crime＂, because he did endotracheal intubation, withdrew arterial blood, and implemented electrocardiogram. Fortunately, this NP was not prosecuted by the prosecutor, and judge also overruled this case. This paper intends to analyze whether the opinions of prosecutors and judges and the content of administrative directives were appropriate. After the promulgation of the Regulation of Nurse Practitioners Practicing Medicine Intervention under the Supervision of Physician, the scope of practice of nurse practitioners become more clear. This paper intends to analyze the case mentioned above by the application of the new regulation and to discuss whether scope of practice of nurse practitioners become not vague due to the promulgation of the new regulation. Hopefully, this article can inspire health professionals to discuss the issues regarding the scope of practice of nurse practitioners, and make that the scope of practice of nurse practitioners could be defied more reasonably.

並列關鍵字

Nurse Practitioners ； Scope of Practice ； Medical Practice ； Assisting Medical Practice ； Nurses Act ； Physician without License Crime ； Legislation ； Law ； Regulation ； Administrative irectives

參考文獻

姚念慈(2015)。專科護理師─護理人員法第24條問題與研究。元照。

曾育裕(2007)。醫護法規。五南。

黃丁全(1999)。護理事故的理論與實例。永然。

黃丁全(2000)。醫事法。元照。

蔡墩銘(2005)。醫事刑法要論。翰蘆。