我國醫療調解制度之功能﹣以紛爭解決為中心

醫療與科技的日新月異，伴隨而來的是層出不窮的醫療糾紛，且於資訊的快速流通及教育的普及下，人民對於權利的意識逐漸高漲，致使醫病關係從早期的醫療父權關係轉變成對等的夥伴關係。然而，隨著時代的更迭，亦發展出更多的醫療紛爭解決機制，如訴訟、調解等。惟若以訴訟之方式解決紛爭，所耗費時間與資源耗費較大，等待判決結果的過程對於當事人雙方皆是身心煎熬，且判決結果並非均能滿足醫病雙方當事人之要求甚至可能造成「內、外、婦、兒」專科四大皆空的狀況，導致醫療品質下降「防衛性醫療」的情形產生。為避免訴訟資源的耗費及上述所提及之情形產生，各國開始採用訴訟外解決機制，期盼透過訴訟外解決機制，以避免訴訟資源的浪費，故如何革新醫療糾紛訴訟外解決制度的發展，實為重要的課題。本研究以醫療糾紛訴訟外解決制度中關於司法調解部分作為研究重點，利用文獻分析法、比較分析法與深度訪談法所獲得的資料，從學理與實務之角度檢視現行醫療調解於制度層面可能存在之問題。將資料彙整並分析整理後，獲得「醫療調解模式應視調解程序之進行為調整」、「醫療及法律雙調解委員制有助於調解程序之進行」、「調解委員性別與調解品質無涉；人格特質對於調解品質有影響」、「調解場域對於調解品質有影響」、「道歉法則之效益有待改善」、「提供相關誘因有助於調解程序之進行與成立」、「針對濫用調解程序之行為予以懲罰有助於調解程序之進行」、「醫療仲裁制度有其限制性」、「醫療事故關懷小組成員宜具有中立性」與「醫療事故關懷小組結合告知後同意之實行可能性低」等十個主要的研究發現。並於研究最後提出三大建議，期許能作為有效健全及革新我國醫療調解制度之參考：一、醫療調解程序正式化與普及化二、醫療調解程序細緻化三、紛爭解決早期化

關鍵字

醫療糾紛；訴訟外紛爭解決機制；調解模式；調解制度；調解委員；法院調解

並列摘要

The rapid development of medical treatment and technology is accompanied by an endless stream of medical disputes. With the rapid circulation of information and the popularization of education, people's awareness of rights has gradually increased, resulting in the transformation of doctor–patient relationship (DPR) from early medical paternalistic model to peer-to-peer partner relationships. However, as time goes by, more medical dispute resolution mechanisms have also been developed, such as litigation and mediation. Nevertheless, if the dispute is resolved through litigation, the time and resources consumed are relatively large. The process of waiting for the judgment is both physically and mentally painful for both parties and not all the judgment results can meet the requirements of both parties. It may even cause a shortage of physicians in "Internal Medicine, Surgery, Gynecology and Obstetrics, and Pediatrics", leading to a decline in medical quality and "Defensive Medicine". In order to avoid the waste of judicial resources and the situations mentioned above, countries began to adopt the alternative dispute resolution (ADR), hoping to avoid the waste of judicial resources through the alternative dispute resolution. Therefore, how to reform the development of the medical dispute resolution system is really a crucial issue. This research focuses on judicial mediation of the alternative dispute resolution aiming to deal with medical disputes. Use the data obtained through the literature review, comparative analysis approach and in-depth interview to examine the possible problems of the current medical mediation in terms of an academic and practical perspective. After collecting and analyzing the data, obtain the following ten major consequence： 1.Medical mediation type should be adjusted according to the process of mediation. 2.The mediation process attended by medical personnel and legalist as mediators will help the process go smoothly. 3.The gender of the mediator does not affect the quality of the mediation; the personality traits of the mediator will effect the quality of the mediation. 4.The mediation field has an influence on the quality of mediation. 5.The effectiveness of apology law needs to be improved. 6.Providing relevant incentives is helpful for mediation proceeded and established. 7.Punishing the misuse of mediation helps mediation proceed. 8.The medical arbitration is limited. 9.The members of the care group should be neutral. 10.Caring group combined with the doctrine of informed consent has a low possibility of implementing. and provided three suggestions hoping to provide effective references improving and strengthening medical mediation: 1.Formalization and popularization of medical mediation. 2.Elaboration of medical mediation procedures. 3.Resolve dispute early.