我國對遠距醫療之規範及其合理性探討

Study on the reasons for regulations and responsibility of telemedicine in Taiwan

張玉純(Yu-Chun Jhang)

指導教授 ： 李崇僖

中原大學/商學院/財經法律研究所/碩士(2013年)

https://doi.org/10.6840/cycu201300809

摘要

遠距醫療等以資訊科技導入醫療照護領域之新興醫療科技的發展，對於增加醫療可近性以促進醫療資源分配之公平、提升醫療品質與效率、發展個人化醫療、降低醫療成本等有相當之效益，且為國際之間用以改善醫療環境之相當重要之方式之一。遠距醫療的應用雖然做為一個新的醫療照護途徑，擴大醫療照護服務提供的範圍，然而，由於遠距醫療本身具有與一般醫療行為不同之特性，其中不以醫師與病患之間面對面接觸為必要，且倚賴遠距設備的設置，而使應用遠距醫療時將產生新的疑慮。

關於我國遠距醫療之發展與我國醫師法第11條之規範息息相關，從醫師法第11條之修正過程與實務上針對該條文所做出之解釋，在我國遠距醫療由於對醫師法第11條醫師親自診察義務之文義解釋與實務上通常對醫師親自診察義務採取嚴格解釋之情形下，進而形成遠距醫療與遠距照護之發展落差。本文認為，醫師法第11條之規範模式與實務之解釋，使醫師親自診察義務成為以法律將醫療常規之內容明文化之情形，為忽略醫療常規本質上充滿變動、醫療行為因病患個體差異性之不確定性以及醫學之進步空間，退一步言，醫師法第11條本身之規範內容限制醫師進行診察必須親自為之，則親自是否代表醫師必須到場當面進行診察，又例外得進行通訊醫療之情形以地理區域做標準，如此僵化的認定與區分法使真正需要進行通訊醫療、遠距醫療之病患無法獲得適切的醫療照護，亦嚴重阻礙我國遠距醫療之發展。因此，為兼顧平衡、發展我國遠距醫療與遠距照護，應修正醫師法第11條之內容，刪除以偏遠地區做為例外得進行通訊醫療之情形。另外，本文提出我國發展遠距醫療時應參考之因素，包括遠距醫療的醫療品質確保的問題以及遠距醫療產業之發展可能會對過去以一般醫療行為為主之醫療場域產生之衝擊，說明我國應如何一方面促進發展遠距醫療時，並控制這些可能產生之流弊。並以我國對於一般醫療行為之管制與責任為基礎，討論如何因應遠距醫療之特性及其所衍生之特殊問題作出調整，以創造有利於我國之遠距醫療照護等新興醫療科技在醫療領域之應用之環境，使我國國民能夠享有更高品質、更多元之醫療選擇，並得促進相關醫療照護相關產業之發展，減少可能產生之流弊。

關鍵字

醫療過失 ； 遠距照護 ； 遠距醫療

並列摘要

New development of medical science and technology of field with information technology from telemedicine, etc., for increasing medical assess in order to promote the justice of medical resource allocation, raising medical quality and efficiency, developing individualized medicine, reducing the medical cost has suitable benefits, and improve the medical environment in the world. The application of telemedicine expands medical treatment, look after range offered to serve, but because characteristic of telemedicine is different from general medical behavior itself, among them not keep in touch for being essential face-to-face with doctor and patient, and rely on arrangement of the tele-apparatus, will produce new doubt at the telemedicine.

Telemedicine in Taiwan is closely bound up from section 11 of Physician Act, it usually takes strictly attitude in the explanation and practice of this clause and makes different development standard in telemedicine and telecare. This text think strictly explanation of section 11 in Physician Act and make a clinical guideline which ask doctors examine by themselves to become law, come from the neglect of full of changes in clinical guideline，patient's individual difference，and the progressive spaces of medical science. On the other hand, the regulation that ask physicians to examine and treat by themselves and set the exception according to different geographical areas, lead to patients who need telemedicine cannot take appropriate care and hinder the development of telemedicine in Taiwan. Therefore, for balance and development of telemedicine and telecare, it should delete the geographical limitation in section 11 of Physician Act. In addition, this text also provides some considerations for development of telemedicine and telecare about how to resolve the problems of telemedicine , including to maintenance of medical quality in telemedicine and impact on development of medical industry. And is based on control and responsibility of general medicine process in Taiwan, discuss how to adjust from characteristic and special problems of telemedicine, in order to create the environment to make new developing medical science and technology in medical environment, and make people of our country enjoy high quality, more plural medical choice, and must promote relevant medicine development of the relevant industry and reduce the negative effects that may be produced.

並列關鍵字

telemedicine ； telecare ； medical malpractice

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