刑法政策上醫療說明義務發展趨勢之研究

醫師為病人採取醫療行為前，必須踐行說明義務，如此病人方有可能對此醫療行為，完成具有效力之承諾。當醫師違反醫療上說明後承諾之法理，是否成立犯罪行為而負擔刑事責任，學說上則有極大之爭論。主張上開醫師行為應成立犯罪與負擔刑責之見解，對於成立犯罪為何與負擔刑責為何，亦有不同之處。本文建議，醫師故意或過失違反醫療說明義務之行為，採取醫療傷害行為阻卻違法事由判斷模式，審查者對行為人所為係醫療行為判斷完成後，則依序審查是否具備任何阻卻違法事由，以確認是否得以阻卻違法。經由上開之模式判斷，若醫療行為無阻卻違法事由，亦無阻卻罪責事由，即表示此醫療行為係犯罪行為。醫師故意違反醫療說明義務，若無阻卻違法事由與阻卻罪責事由，即成立普通傷害罪。醫療說明義務是否屬於過失注意義務之內容，係取決於踐行醫療說明，能否減低醫療行為之風險，因而避免導致侵害法益之後果。醫師因過失違反此項義務而侵害病人之身體法益，若無阻卻違法事由與阻卻罪責事由，即成立過失傷害罪。亦即醫師未踐行說明義務，有可能係故意行為，亦有可能係過失行為，不宜一概而論，應視醫師行為之主觀構成要件係故意或過失，以決定醫師未踐行說明義務成立之罪名。上開違反醫療說明義務行為之判斷模式，若能結合法律政策與司法實踐，不僅符合醫療說明制度之發展趨勢，亦將有效維護病人自主決定之權利。

關鍵字

醫療說明義務；醫療注意義務；業務上正當行為；病人知情權利；病人承諾

並列摘要

Physicians must fulfill their explanation obligation before taking medical behaviors for patients, so that patients may fulfill effective promises to this medical behavior. When a physician violates the legal principle of promise after medical explanation, whether to constitute a criminal behavior and bear criminal responsibility, there is a great controversy in the doctrine. There are also differences in the opinion that the behavior of physicians should constitute a crime and bear criminal responsibility, but there are also differences in why it is a crime and how to bear criminal responsibility. This article suggests that when a physician intentionally or negligently violates the of medical explanation obligation, the judgment model of preventing the violation of the law from the medical injury behavior shall be adopted. After the reviewer has judged that the behavior committed by the behavioral people is a medical behavior, the reviewer will examine whether there are any cause of preventing the violation of the law to confirm whether the violation can be prevented. The above model shows that if the medical behavior does not have any cause of preventing the violation of law and cause of preventing the liability, it means that the medical behavior is a criminal behavior. If a physician intentionally violates the medical explanation obligation, if there is no cause of preventing the violation of the l aw and no cause to prevent the liability, he or she is guilty of ordinary injury. Whether or not the medical explanation obligation is a negligent care obligation depends on whether the practice of medical explanation can reduce the risk of the medical behavior and thus avoid the consequences of infringement of physical legal interests. If a physician negligently violates this obligation and infringes on the patient's physical legal interests of patients, the crime of negligent injury will be established if there is no cause of preventing the violation of law and cause of preventing the liability. In other words, the physician did not fulfill the explanation obligation, there may be intentional behavior, there may be negligent behavior, it is not appropriate to generalize , depending on the subjective elements of the behavior of physician is intentional or negligent, in order to determine the crime of physician's failure to fulfill the explanation obligation. The above-mentioned judgment model of the violation of the medical explanation obligation, if combined with the legal policy and judicial practice, not only conforms to the development trend of the medical explanation system, but also effectively protects the right of patients to make their own decisions.

並列關鍵字

medical explanation obligation ； medical care obligation ； conduct of due business ； patient's right to know ； patient's promise

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