醫師法第二十八條密醫罪之探討──以實習醫學生與實習醫師為核心

A Study on the Article 28 of the Physicians Act:Focused on Clerk and Intern

葉晨暘(Chen-Yang Yeh)

指導教授 ： 王皇玉

國立臺灣大學/法律學院/法律學研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.02743

摘要

我國憲法雖保障人民的工作基本權，但國家仍可基於一定目的而對特定職業設定執業資格。由於我國將醫療業務視為是專門職業的一類，因此除行政上已有嚴格的證照制度外，這些無醫師資格、卻仍施作醫療業務之人，尚會受到醫師法第28條密醫罪的刑事制裁。
本文首先回顧醫師法第28條密醫罪的歷史沿革、立法紀錄，輔加參考他國相似的立法例，認定密醫罪實屬保護國民健康法益之罪。該罪固有其良善之保護目的，但也間接造成我國醫療市場中，唯有現代醫療實屬合法的醫療模式，於法制層面上，將有透過刑法父權主義不當限縮病患自主權之弊病，並使密醫罪之立法正當性受到質疑。
再來，我國醫學教育近年來雖有變革，但由於畢業前，醫學生仍須接受一定的臨床教育，畢業後，醫學畢業生也有一段身分轉換的銜接期，導致具醫學學歷、卻未正式取得證照之人，仍有因無照行醫而觸犯密醫罪的風險。考量多數醫療業務技術，都需透過親身施作來學習，因此如何於培育醫事人力的過程中，顧及病患的安全，即屬衡量密醫罪要件解釋是否適切的重要基準。
最後，本文認為密醫罪的要件解釋，不宜納入行政機關自行發展的「醫師親為行為」概念，否則將使實習者的業務施作權限受到箝制、臨床學習目的無能達成。另外，指導醫師只要在能就其授權事項，負擔刑法上的監督責任，應該就具有全面性的教學自由，司法機關也不應越俎代庖地限定有照醫師的指導方式。

關鍵字

密醫罪 ； 密醫 ； 醫師法第28條 ； 法律父權主義 ； 實習醫學生 ； 實習醫師 ； 醫學訓練 ； 醫學實習

並列摘要

The right to work is enshrined in the Constitution, however, such a right for specific vocations can be subjected to limitation and restriction from laws. In the Republic of China(R.O.C.), due to the fact that medical practice is categorized as one of the professions, physician’s practice with no license will violate the criminal law (The Article 28 of the Physicians Act) in addition to the administrative law.
This thesis reviews the historical context and legislative record of the Article 28 of the Physicians Act and analyzes similar regulations from other nations, and comes to acknowledge the Article 28’s legal interest, the public health. But the study also reveals problematic issues of the Article 28:
First, the Article 28 excludes all the other practices that do not belong to the system of modern medicine. Consequently, patients’ self-decision right is inappropriately limited by the legal paternalism and that the legitimacy of the offence of the Article 28 is shaky.
Second, the fact that clinical medicine education is required for medical students, and that there is a gap of time between their graduation and the acquisition of the license, leads to the risk of offending the Article 28. How to take the training and cultivating aspect of medical manpower into account and to protect the safety of patients at the same time should be considered in the explanation of the Article 28.
Last, medical interns should have the right to practice medical treatment under the supervision of physicians. If the Article 28 adopted the concept of “the reservation of physician ” developed from the administration, the interns’ right of learning, the supervisors’ right and freedom of teaching and direction within their authority, and the goal of medical training, would have been damaged. The judiciary should not go beyond is duties and restrict the ways of medical teaching.

並列關鍵字

the crime of fake physician ； quack ； the Article 28 of the Physicians Act ； legal paternalism ； clerk ； intern ； medical training ； medical practice

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