醫療法第82條之探討－以醫療糾紛民事責任為中心

有關醫療法第82條修正，醫界歷經約20年之努力，於2018年初正式公告施行，此次修正更加明確有關醫療糾紛之刑事責任、民事責任之認定及合理化，亦即從以往實務上之認定基礎予以法律明文定之。法院於審理有關醫事人員之醫療糾紛，之前有關刑事責任與民事責任認定理由依據相異，此次醫療法第82條之修正，將刑事責任與民事責任認定原則明列並相同，本文以醫療糾紛民事責任為探討範圍，醫療糾紛責任認定初步可以先借由「醫療常規」來加以判定醫事人員執行醫療專業之業務過程中，是否符合該醫療機構之臨床準則，次以「醫療水準、醫療設施、工作條件及緊急迫切等客觀情」作為輔助判定標準，另有關是否逾越臨床合理專業裁量，可以經由醫療鑑定協助加以判斷，故法院審理醫事人員是否有過失，納入醫師是否有注意義務之違反及臨床專業裁量之範圍，需要視當時個案之病情變化及醫師所處之境，醫師所採取之醫療行為是否洽當涉及過失問題，法院應綜合各方面之原因後作出判決。至於醫療機構方面，則以故意或過失為注意義務之判定準則。法院面對醫療糾紛案件在審理特殊專業領域案件時，需要藉助助於專業之鑑定報告，以補足專業性不足之困境，另醫療糾紛民事案件進入法院審理前，需要強制調解，法有明文規定，依據歷年醫療糾紛案件，需要花費長時間才能結案，造成醫療品質受此因素影響，故此次修法之目的為加速醫療爭議案件之處理效率，以及提昇醫療品質。為明瞭醫療糾紛實際現況，本文經由蒐集彙整相關文獻，以系統性方式呈現及探討有關醫療糾紛民事責任，提供醫事人員及病人雙方相涉醫療紛爭之法律知識，增進醫病關係及互信。此次醫療法第82條之修正大幅增加構成要件之修定，將以往實務上之認定原則化為法條文字，故實質上並無變化，各界仍認為有不確定及模糊地帶，個人提出針對醫療法第82條之淺見，希望能提供日後修法之參酌，達到提高醫療品質，保障病人權益，增進國民健康之目標。

關鍵字

醫療法；醫療法第82條；醫療糾紛民事責任

並列摘要

The amendment to Article 82 of the Medical Care Act, which came into effect in early 2018 after 20 years of efforts by the medical profession, clarifies the identification and rationalization of criminal and civil liability for medical disputes, namely, it is made explicit in the law based on the previous practice. Court on hearing about the medical staff of medical disputes, reassured about criminal responsibility and civil liability reason according to the dissimilarity, Article 82 of the Medical Care Act of the correction, the criminal responsibility and civil responsibility cognizance principles listed and the same, this article discusses the medical dispute civil liability scope, liability in medical disputes as a preliminary to borrow to decide by "medical" conventional medical personnel in the process of carrying out medical professional services, conform to the medical institutions of clinical guidelines, time to "medical level, medical facilities, working conditions and urgent urgent objective conditions" as auxiliary decision criteria, the other about whether beyond reasonable clinical professional discretion, Medical appraisal can help to judge, the court if there is a fault, medical personnel into the physician if there is a breach of a duty of care and clinical professional discretion, the scope of the need to change depending on the case of illness and physicians are in, the doctor takes medical behavior whether contact problem when it comes to negligence, the court should be integrated in all aspects of reasons after the decision. As for medical institutions, willfulness or negligence is the criterion for the duty of care. Court in the face of medical disputes in special field courts need help from professional appraisal report, to make up professional shortage of trouble, the other before entering the court, the medical dispute civil cases need compulsory mediation, are prescribed method, based on medical dispute cases, the calendar year will take a long time to resolve, medical quality caused by the factors, so the purpose of repair method for speed up the processing efficiency of medical disputes, and to improve the quality of medical treatment. In order to understand the actual situation of medical disputes, this paper presents and discusses the medical disputes related to civil liability in a systematic way by collecting and summarizing relevant literature, so as to provide medical staff and patients with legal knowledge related to medical disputes, and enhance the relationship and mutual trust between doctors and patients. Article 82 of the Medical Care Act of the revised sharply increase the constitutive requirements of the revised, determination of principles into law text on previous practice, therefore, in essence, there is no change, still think there are uncertain and fuzzy zone from all walks of life, personal is put forward in view of Article 82 of the Medical Care Act, hope to provide repair method of post in the future, to improve medical quality, safeguard the rights and interests of patients, the improvement of national health goals.