實證醫學數據於醫療事故損害賠償上之意義

The Evidence-Based Medicine Statistics in Medical Malpractice Liability

吳志正(Chih-Cheng Wu)

《臺大法學論叢》 40卷1期 (2011/03) Pp. 139-207

https://doi.org/10.6199/NTULJ.2011.40.01.03

摘要

實證醫學係以流行病學或統計學方法所得之數據為基礎，不僅提供醫療照護決策之參考，更成為司法實務相當重要的證據資料，惟此等實證醫學數據畢竟係以流行病學與統計學方法所得，如何賦予該數值於醫療事故損害賠償上適當之意義，遂有探討之必要性。
按損害賠償之債，以有損害之發生及有責任原因之事實，並二者之間，有相當因果關係為成立要件，此損害賠償法基本理論的每個環節，均可能與實證醫學數據相牽連。本文認為，就醫療事故中醫方責任原因之判定而言，不宜將實證醫學數據本身從基於該數據所發展出之臨床指引或醫療常規中抽離出來，單獨作為過失判斷之基礎，毋寧綜合考量臨床指引或醫療常規制定之合理性與目的性、以及病患受損權益之重要性等因素而為判斷。再者，以實證醫學數據作為「抽象因果關係」並藉以判定「個案因果關係」時，應力求二者間情節變數之一致，方能獲致正確之論證結果。就論斷責任成立上損害而言，與其將存活率或治癒率等數據之減損本身視為新興人格權之損害，毋寧正視該數值之減損其實只是反映出病患身體權與健康權受損害程度之參考，於責任範圍上損害之數額算定時再予以參酌；而於算定責任範圍上損害時，無論是客觀賠償範圍與單位期間賠償數額、總期間、或是履行利益賠償數額之估算上，均應參酌實證醫學數據為之。

關鍵字

實證醫學 ； 數據 ； 臨床指引 ； 存活率 ； 治癒率 ； 機會喪失理論 ； 醫療失當 ； 損害 ； 因果關係 ； 損害賠償責任

並列摘要

Evidence-Based Medicine (EBM) has been interpreted as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients; moreover, the clinical practice guidelines, which were developed through EBM, are becoming one of the popular judicial evidences in medical malpractice litigation. Besides, the medical statistics which constitute the main portion of EBM evidence have also promisingly gained their judicial significance.
The complication rate of the treatment and the ratio of side effects of medication are such kind of EBM Statistics, which were themselves collected by scientific methods and were objective figures in nature. Accordingly, these figures in some degree, correlated to the ”foreseeability” concept judicially; however, in inquiring the liability of physicians, these figures should not be apply totally independent from the statistics-related clinical practice guidelines.
Meanwhile, the survival rate or cure rate of the patients with certain disease with or without treatment implies some evidence of causal relation. These kinds of EBM Statistics indicate the so-called ”abstract causation”, which by way of deduction could infer the conclusion of ”personal causation”. However, the parameters between these two sets of causation should be as similar as possible to draw an accurate conclusion.
There was a famous ”Loss-of-Chance Doctrine”, which allows plaintiffs to recover money without having to show that it was more likely than not that the charged medical negligence made the difference in their recovery or survival, by way of regarding the reduction in patient's survival rates itself (i.e. the EBM Statistics) as the suffered injury caused by medical malpractice. Nevertheless, this doctrine actually could never at all alleviate patient's duty of proof in causation between the malpractice and the injury suffered especially herein in patients whose survival or cure rate happens to be lower than 50%. We would rather recognize the cellular level injuries of ”health rights” in these patients and recovered as such by applying these EBM Statistics to determine the compensation extent.
Hopefully this article will help in utilizing EBM Statistics as the judicial evidence and the fairness and justice of jurisdiction can finally be realized in medical malpractice litigations.

並列關鍵字

evidence-based medicine ； statistics ； clinical practice guideline ； survival rate ； cure rate ； loss-of-chance doctrine ； medical malpractice ； injury ； causation ； liability

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