論組織醫療與刑事過失責任-以藥事行為為中心

Legal Study On Criminal Liability In Medical Teamwork-Focus On Pharmaceutical Malpractice

許育瑋(HSU YU WEI)

指導教授 ： 盧映潔

國立中正大學/法學院/法律學系/碩士(2013年)

摘要

在目前醫療專業日趨多元之發展與結構下，團隊分工成為現代醫療行為中最重要的特徵之一，而所謂「組織醫療」，即是指在高度專業化與複雜化的現代醫療組織中，各醫療職系之人員或團隊，於相同或不同醫療進程裡，依其個別專業提供水平或垂直型態的醫療行為與服務，彼此分工與合作，以提供更專業與更安全之醫療品質。「藥事行為」在組織醫療中，可說是與醫療核心最直接也最相關的醫療行為，在醫療進程的各個時點皆有藥事行為參與的可能及必要，因而當醫療行為發生疏失且該傷害係由藥物疏失所造成時，與藥物事件最密切與相關的藥事人員，與醫師一同成為刑事責任可能的究責對象，是藥事人員在組織醫療角色的使然與必然。

另由於近年來，醫療糾紛及醫療訴訟的新聞在媒體的報導下，逐漸引起民眾高度的關注與廣泛之討論，姑且不論造成這些疏失背後的原因是什麼，這些一再發生的醫療疏失及糾紛事件，除了造成醫病關係的緊張與不信任外，對臨床的醫療人員與藥師無形中也產生莫大的壓力與包袱。而由於目前絕大多數的醫療行為皆以治癒或緩解疾病為目的及出發，絕大多數醫療人員也不會希望或故意使患者受到傷害，因此在發生醫療糾紛時，亦顯少有醫療人員會因「故意」而需負刑事責任，多數刑事上之責任仍以「業務過失傷害」或「業務過失致死」罪居多。而與醫療核心最密切的藥事行為亦不例外，但因藥事行為的特殊性及多樣性，多數之藥事疏失往往不是因為單一原因所引起，常見是數個環節中的複數個過失所造成。如何確立藥事行為刑事過失之概念與責任，同時釐清藥事過失之注意義務範圍與標準，以及當藥事過失發生時，各過失人員的過失責任分配及責任歸屬為何，乃至有無共同正犯、信賴原則之適用餘地等問題，都是在面對未來組織醫療蓬勃發展、藥事行為極為多元且複雜的現代醫療環境下，值得深究與釐清之議題。

本文以筆者之藥事執業經驗為基礎，藉由對組織醫療中之藥事行為類別與態樣重新回顧，期待能確立藥事行為過失之概念與責任，同時釐清藥事過失之注意義務範圍與標準，使藥師彼此間或與其他醫事人員間之責任分配與歸屬更加明確與清晰，提供藥師與其他醫療人員於執業或組織調整上之法學準則與參考。另亦期盼本文成為藥界之引石，吸引更多之藥學前輩與後進投入藥事法學之穹蒼，為台灣之醫療法律領域提供更為精闢的見解與參考，創造醫療、法律與患者三贏的醫療環境。

關鍵字

信賴原則 ； 藥事行為 ； 刑事過失責任 ； 組織醫療 ； 過失共同正犯

並列摘要

Under the diverse development of medical practice, division labor for teams has become one of the most important characteristics of modern conducts of medical practice. The medical personnel or teams under “Medical Teamwork” provide horizontal or vertical services according to their specialties in the identical or different medical process. They divide labor and cooperate with each other to provide more professional and safer medical quality. “Pharmaceutical practices” in medical teamwork is known as the most direct and relevant medical behavior to the core of medical practice. There are possibilities and necessities for participation of pharmaceutical practices at any phases during the medical process. However, in the event of medical malpractice while the damage is the result of pharmaceutical negligence, the pharmacist with closest relation and most relevance to pharmaceutical malpractice will collectively become the possible objects of criminal prosecution, which is inevitable result for pharmacist in the role of medical teamwork.

Additionally, news on medical disputes and medical malpractice litigations has gradually drawn intense attention and extensive discussions from the public under the reporting of media coverage. Regardless of the reasons behind such malpractice, the repeated medical negligence and dispute incidents not only result in the tense and distrust between the hospital-patient relationship, but also produce extensive pressure and burden on the medical staffs and the pharmacists. The majority of medical practice is started out with remission or curing disease, while most medical staff would not wish or intentionally injure the patients, therefore in the event of medical disputes, it is rare to see medical staff taking criminal liabilities for “Intentionally.” “Negligently Causing Injury” or “Negligently Causing Death” still account for the majority of criminal liabilities, which is no exception for the pharmacist. Nonetheless, due to the diversity and distinctively in pharmaceutical practice, most pharmaceutical malpractice is caused by multiple negligence in different phases. Therefore, how to validate the concepts and liabilities in criminal negligence for pharmaceutical practice, identify the scope and standards for the obligations in pharmaceutical negligence, and the liability attribution for negligence in personnel during the incident of pharmaceutical negligence, in addition to whether if there is “Joint Principal Offender”, and “Principle of Reliance”, are all issues merit further study and clarification when confront with complex modern medical environment.

With basis on the experience of pharmaceutical practice, the author intends to validate the concept and liability of criminal negligence in pharmaceutical practice while identifying the scope and standards of obligations in pharmaceutical negligence through a review on the categories and patterns of pharmaceutical practice in the medical teamwork. Consequently, the pharmacists or other medical staff can identify the liability allocation and attribution more clearly, to provide legal guidelines and reference for medical practice. Additionally, the author expects to draw attention from the medical field through this paper by attracting more people to commit in the study of laws related to pharmacy, thereby to provide more incisive interpretation and reference for the legal field of medical treatment in Taiwan, creating a triple-win environment for the medical field, laws and patients.

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