醫療分工與信賴原則－我國與德國法之比較研究

Medical Teamwork and The Principle of Reliance-A Comparative Study of the Law in Taiwan and in Germany

卓育璇(Yu-Hsuan CHO)

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(2008年)

https://doi.org/10.6342/NTU.2008.00327

摘要

鑒於醫學科技之日新月異，複雜龐大的醫療團隊工作已成為醫療中常見之型態。在醫療團隊中，每個分工者的責任範圍有多大，此涉及分工者之刑事過失責任認定，是十分重要的課題。團隊中的每個分工者若皆須對整個團隊醫療行為的所有環節負責，客觀上是對分工者過高的要求，如此不但使醫療行為之目的難以實現，亦會使人對於需要多人合作的工作卻步，對人類社會生活之發展將產生阻力。
若不欲使每個分工者負擔過重之責任，必須找出責任劃分的方法。「信賴原則」之適用，可使醫療行為分工者在盡其應盡之義務後，可以信賴其他分工者將做好他們被分配到的任務，且具有達成該任務所應具備的專業知識與經驗。因此，信賴原則可使醫療分工者的責任合理化，不至成為過重之負荷。然而，於醫療領域中，信賴原則若被不恰當的主張，將無法保障病人之權益，因此肯定信賴原則於醫療領域之適用的同時，必須使得主張信賴的條件明確化，以免信賴原則之適用反而減損了病人的權益。
本文從信賴原則之由來、定義，以及其於過失理論之地位談起，論述其於醫療領域之適用，並將醫療分工之類型分為典型分工與非典型分工，於典型分工之下又分為水平分工與垂直分工。藉由觀察德國與我國司法實務見解，對於高度專業且多樣化的醫療團隊工作得有具體的認識。本文歸納了這些實務見解，並做出比較、評論。尤其是近來因民眾較容易取得醫療資源而日益增加的非典型醫療分工（各醫護人員彼此間並沒有分工合作的認知，也不需要倚賴彼此的專業才能完成診斷或治療，只是因為偶然的因素，導致客觀上有分工合作之事實），到底可否適用信賴原則？如果可以適用，應如何適用？這是應受到重視的課題，亦是個不容易回答的問題。病人的保障、醫療人員責任的合理化，都很重要，信賴原則於醫療領域的適用規則，需要法界與醫界共同努力使其明確與細緻化。

關鍵字

醫療團隊 ； 分工 ； 信賴原則 ； 典型醫療分工 ； 非典型醫療分工 ； 水平分工 ； 垂直分工

並列摘要

In light of the ever changing medical technics, complicated medical teamwork is a type of medical practice that occurs more and more in the medical scene. When malpractice responsibility arises from the teamwork, how to distribute the responsibility? Is everyone responsible for every part of the teamwork? How far is the range of each teamworker’s responsibility? Those are questions to which we must attach importance. If every teamworker is held responsible for every part of the teamwork, it would not be reasonable, because a man’s ability is not unlimited. Asking teamworkers to take too much responsibility would make people avoid work that needs cooperation to accomplish. This is no good for the advancement of human society.
We have to find a way to define the boundary of every teamworker’s responsibility, so that they won’t shoulder too much burden. If we apply the principle of reliance (der Vertrauensgrundsatz) to medical practice, it would turn out that when a participant has done what he should do, then he can hold the belief that others will get their assignment done with due diligence. Therefore, the principle of reliance can lead to the reasonable range of responsibility. However, if this principle is misused, patients’ rights and interests will be affected. To avoid the misuse of the principle of reliance, we must find out a set of precise and concrete rules when we apply this principle.
This thesis starts from the history and definition of the principle of reliance. From its origin and its role in the criminal system to its application in the medical practice. Then follows the exposition of how we apply the principle of reliance in different kinds of medical teamwork—typical cooperation, untypical cooperation, horizontal cooperation, and vertical cooperation. Through the observation on the judicial rulings in Germany and Taiwan, we can have a rather concrete understanding of the highly professional and varied medical teamwork and the judicial notions within. The author induces these notions, compares them and gives commentary. Among the different kinds of medical cooperations, untypical cooperation (the doctors don’t have the cooperant understanding with each other and they don’t have to depend on each other’s specialty to give diagnoses and treatments. However, casual events e.g. the patient freely shifts to another doctor make the situation virtually cooperant.) is an important topic worthy of more study, yet hasn’t got much attention. Is the principle of reliance applicable in this area? If it’s applicable, how to apply it? Both the protection of patient’s interests and the reasonable definition of medical teamworker’s responsibility are important. The application rules of the principle of reliance in the medical arena must be made clear and precise through the effort of judicial and medical professionals.

並列關鍵字

medical teamwork ； boundary of responsibility ； the principle of reliance ； typical cooperation ； untypical cooperation ； horizontal cooperation ； vertical cooperation

參考文獻

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