論醫師告知義務之範圍

A Study of the Scope of the Physician's Duty to Inform

劉南英(Nan-Inn Liu)

《致理法學》 11期 (2012/03) Pp. 103-147

摘要

在醫病關係中，學說理論上有所謂「告知後同意法則」（the Doctrine of Informed Consent），包括醫師的告知與病人的同意二部分，主要目的在保障病人的自主權（night to autonomy）或自我決定權（right to self-determination）。我國醫師法第12條之1規定醫師診治病人時，應向病人或家屬告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應。另外在醫療法第81條規定醫療機構診治病人時，應向病人告知其病情、治療方針、處置、用藥、預後情形及可能之不良反應，均為針對告知義務（duty to disclosure）的範圍所作的規定。只是，此等內容似乎過於簡略，以致學說與法院實務看法，都認為告知義務的範圍不應僅侷限於此，而應有所擴張，至少也要包括其他可代替的醫療行為建議、拒絕治療的後果或醫院的設備、醫師的專業能力等在內，以期更加周延。然而此等內容是否可以無限上綱而漫無限制？其間究應如何取捨？如何可以兼顧醫師的專業裁量權與病人的自主決定權？進而減緩醫病關係的緊張與衝突，似乎仍有很多值得討論的地方。醫師在診治病人時，到底什麼該說？什麼不必說？要說到什麼程度？其範圍與界限如何？凡此等等，都是告知義務範圍所可能牽涉到的議題。本文目的，希望在學說理論的綜整與法院實務的見解評析中，能夠找到一些共識，進而提供我國現行醫師法或醫療法相關規定在立法修正時的參考。

關鍵字

告知義務 ； 告知後同意 ； 醫病關係 ； 醫師專業裁量權 ； 病人自主決定權

並列摘要

In the physician-patient relationship, the ＂Informed Consent Doctrine＂ consists of two parts--physician's informing and patient's consent, which mainly aims to protect the patient's right to self-determination. Article 12-1 of our Physicians Act provides that when diagnosing and treating patients, a physician shall inform the patient or the patients' family of the status of the disease, treatment principles, treatment medication, prognosis and possible unfavorable reactions ＂. Also article 81 of our Medical Care Act provides that when treating the patient, the medical care institution shall inform the patient of his/her condition, course of treatment, disposition, medication, expected condition, and possible ill effects. The two articles mentioned above are all about the scope of the physician's duty to inform, however, they are not detailed enough. The scholars and the courts all think the scope of the physician's duty to inform should be expanded to the suggestion of other alternative medical act, the result of not accepting the treatment or the facility of the hospital and the expertise of the physician. There are still a lot worth of being discussed in how to decide the scope of the physician duty to inform to balance the physician's therapeutic discretion and the patient's right to self-determination. When diagnosing and treating patients, what should and shouldn't a physician say? what's its scope and limitation? All of the above are the issues concerning with the scope of a physician's duty to inform. This thesis aims to find out the consensus between the scholars and the courts, and further to offer some suggestions to the revision of the current Physicians Act and the Medical Care Act.

並列關鍵字

Duty to Inform ； Informed Consent ； Physician-patient Relationship ； Physician's Therapeutic Discretion ； Patient's Right to Self-determination