醫療過失之犯罪與醫療傷害補償制度之研究

A Study on Criminal Negligence in Medical Cases and Medical Injury Compensation

劉　綺(Chi Liu)

指導教授 ： 葛祥林

國立臺灣大學/社會科學院/國家發展研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.01959

摘要

為了妥善解決療糾紛，本論文一方面必須建構問題意識，即觀察相關之社會現象後，指出醫療糾紛未能和平解決此一現實問題；另一方面基於此問題意識指出，相關之各個制度（如：民法、刑法、行政法，以及相關立法草案等）雖然皆具有實質的或潛在的有效性，但仍然缺乏實效性或可行性。由此可以探討各個制度的問題何在，並且進而指出合理的制度修改或建設之方向。
論文第一章為緒論，首先說明本研究之動機與目的，即交待本研究之問題意識為何。第二章係以理論之檢討為重心，即針對本論文之核心概念，作概念之界定及說明。在第三章中以醫療糾紛迅速、和平且合理解決之觀點出發，分別評析國內現行醫療過失之民事、刑事及行政法律責任，並從實效性之角度探討國內相關法律對於醫療過失的責任分配是否合理，有無輕重失衡的矛盾現象產生，以及此種責任分配對於醫療糾紛之解決有無助益。
在論文的第四章中，以第二章中介紹之理論為基礎並以第三章中由演繹法及歸納法分析制度所得之結果，針對我國現有之相關立法草案及法律修正草案進行檢討。為促使刑事醫療過失能迅速且合理的解決，並調整相關法律責任之分配，針對刑事實體法及程序法之修正草案分別提出相關之修法建議。檢討「醫療糾紛處理及補償條例」草案及「醫療糾紛處理法」草案，能否達成迅速且妥善解決醫療糾紛之目的。另外，於醫療強制責任保險之規劃方面，針對「強制醫療責任保險法」草案進行簡介與評析，並探究此一強制責任保險之組成、財務等方面，應如何規劃才能在台灣社會中具有可行性，且能達成迅速且和平的解決醫療糾紛，促進醫病關係和諧之目的。
論文第五章則針對其他輔助系統及其功效作檢討。以建全台灣醫療糾紛處理機制之分析並強化醫療過失之預防為目的，探究現行醫療糾紛鑑定制度、病歷之相關制度、醫療品質監督機制，以及醫師繼續教育等輔助系統，並提出改進之建議。最後，在第六章的結論中，總結上述各章之分析，就國內醫療糾紛相關制度規劃之走向，提出建立或改革的建議。

關鍵字

醫療糾紛 ； 醫療過失犯罪 ； 除罪化 ； 加害人．被害人調解制度 ； 醫療過失之法律責任 ； 醫療準則 ； 醫師懲戒制度 ； 醫療糾紛處理程序 ； 醫療傷害補償制度 ； 強制醫師責任保險 ； 醫療鑑定 ； 專家諮詢 ； 專家證人 ； 電子病歷 ； 多元醫療品質管制 ； 全民健康保險 ； 醫院評鑑 ； 醫師繼續教育

並列摘要

In order to deal with medical disputes properly, we have to observe relevant social phenomena. Based on this base, we can point out that medical disputes have not been resolved in a situation of mutual consent. Current legal systems reveal deficiencies as to their actual effect or practicability, this although related norms are in no lack of substance or potential effectiveness. As a consequence, we find the problem being entangled in the legal system. After analyzing and discussing these problems, the thesis suggests ways to revise or establish a more reasonable legal system about medical dispute resolving.
In more detail, the first chapter, points out motive and purpose of the study. In the following, we review some important theories, and give definitions or explanations to some major concepts in the second chapter, i.e. implications from the principle that medical disputes shall be solved rapidly, peaceably, and reasonably are explored. Based on this view, in the third chapter, we comment the legal responsibilities of medical malpractice cases in the civil, criminal, and administrative legal systems in Taiwan. Moreover, we review legislation of related systems via their actual effect, to find out whether the distribution of legal responsibilities is reasonable, and helpful to resolve medical disputes or not. In the forth chapter, we take the theories reviewed in chapter 2 as basis to draw out conclusions that are on one hand deduced from the principles in chapter 2 and on the other hand induced from the positive results in chapter 3, using both of these to comment on relevant legal drafts.
For the sake of resolving the criminal negligence in medical cases rapidly and reasonably, and adjusting the distribution of relevant legal responsibility, we should propose our suggestions about how to adjust the drafts of criminal code in crime and procedure. We also review the legal draft of “Resolving and Compensation of Medical Dispute Act” and “Resolving of Medical Dispute Code”, to find out whether they are likely to achieve the purpose of resolving medical disputes rapidly and appropriately. Furthermore, in respect of the medical-injury compensation system, we comment on the legal draft of “Mandatory Medical Liability Insurance”. Then we ponder how to build a medical-injury compensation system that is feasible in Taiwan, and help to resolve medical disputes rapidly and peaceably.
In the fifth chapter, for completing the analysis of medical dispute resolving systems in Taiwan, we must probe into assistant systems, like medical expert examination, medical record, regulation of the quality of health, and continuous medical education, deploring their shortcomings and give our proposals for improving them. The last chapter is our conclusion. We summarize the analysis of the previous chapters, and put forward our suggestions about relevant systems of medical dispute resolving.

並列關鍵字

Medical Dispute ； Criminal Negligence in Medical Cases ； Decriminalization ； T&auml ； ter- Opfer- Ausgleich (offender-victim-mediation in criminal cases) ； legal responsibility in case of negligence in medical cases ； guidelines for medical treatment ； Disciplinary System of Physicians ； system for resolving of medical disputes ； system for compensation of medical injures ； Mandatory Liability Insurance for Physicians ； Medical Expert Examination ； Expert Consolation ； Expert Witness ； Electronic Medical Record ； pluralistic regulatory system for guaranteeing quality standards in medical treatment ； Hospital Accreditation ； National Health Insurance ； Continuing Medical Education

參考文獻

王俊文與葉德豐，〈台灣地區醫師繼續教育實施之探討〉，《台灣衛誌》，2007，Vol.26，No.2，頁140- 148。

王俊文、葉德豐與曾坤儀，〈台灣醫院評鑑制度趨勢之探討〉，《中山醫學雜誌》，No.14，2003，頁513-522。

徐偉群〔撰〕，〈論妨害名譽罪的除罪化〉，國立台灣大學法律學研究所博士論文，2005。

陳端容、鍾國彪、吳麗竹、曾靜瑤、張金堅，〈同儕資訊回饋與內科醫師開立TG檢驗次數之關係：一個探索性研究〉，《台灣衛誌》，2006，Vol.25，No.1，頁26-36。

楊哲彥、楊秀儀，〈台灣地區中醫與西醫醫療糾紛的差異〉，《中醫藥雜誌》，15：1，2004，頁1-15。