探討醫療行爲之客觀注意義務－以最高法院九七年臺上字第三四二八號判決爲例

Comment on Objective Duty of Care in Medical Practice: Supreme Court Verdict No. 3428 in 2008 as an Instance

陳英淙(Ying-Chung Chen)

《長庚人文社會學報》 3卷1期 (2010/04) Pp. 147-169

https://doi.org/10.30114/CGJHSS.201004.0006

摘要

醫療行爲所引發的法律問題，如同交通、環保一樣，均可能涉及行政懲處、民事賠償與刑事責任，其中以刑事制裁最爲嚴厲，亦最爲當事人所畏懼，此由2008年12月於馬偕醫院所舉行的「過失醫療行爲應否負刑事責任之探討」學術研討會即可知悉，而刑事責任以醫療行爲具有社會損害性爲前提，一個失敗的醫療行爲在刑法上可能成立業務過失傷害罪或業務過失致死罪，過失犯非難的重點是行爲人違反注意義務，醫師違反注意義務最常見的類型是疾病處理瑕疵。
本文以最高法院九七年台上字第三四二八號判決爲例，探討醫療行爲之客觀注意義務，先就醫療過失犯之刑事意義加以說明，次就系爭核心概念－消極不作爲與積極作爲之區別加以探討，並指明本案的重點在於不作爲，且深究不作爲在醫療上的特別意義；再者，一併指出違反醫療注意義務的認定標準，宜有一套客觀的指導原則及作業標準，不但能保障病人亦可保護醫師，以減少醫病糾紛；最後，針對本判決評析之。

關鍵字

不作爲 ； 客觀歸責 ； 保證人地位 ； 客觀注意義務 ； 醫療準則

並列摘要

Legal issues caused by medical treatment involve administrative punishment, civil compensation and criminal liability. Among them, criminal liability is the most severe and most feared by the litigant, which can be known in the seminar on ”Should Medical Malpractice Attract Criminal Liability?” held by Mackay Memorial Hospital on December, 2008. The premise of criminal liability here is that medical treatment may lead to social damage. According to criminal law, a doctor who commits malpractice will be found guilty of ”occupational negligent bodily harm” or ”occupational negligent killing.” The point of negligent crime is that the perpetrator breaches the duty of care. As for the doctor's situation, the most common type of breach of duty of care is flawed medical treatment.
In order to discuss the objective duty of care in medical practice, Supreme Court verdict no. 3428 on 2008 will be taken as an example in this paper. Firstly, criminal meaning of medical malpractice will be illustrated. Secondly, the differentiation between positive commission and negative forbearance of an act also will be analyzed. It is indicated that the focus of this case is forbearance, whose special meaning in medical treatment will be then interpreted. Moreover, it will be pointed out that breach of duty of care in medical practice should be based on an objective guideline and standard operating procedures, which are beneficial for both the patient and the doctor, and are able to reduce cases of medical dispute. Finally, comment on this verdict will be made.

並列關鍵字

Forbearance ； Objective Imputation ； Status of Guarantor ； Objective Duty of Care ； Clinical Practice Guideline

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