論醫療說明義務--以契約責任與侵權責任之區別實益為中心

Duty of Disclosure of Medical Information-- On the Distinction of Contractual Liabilities and Tortious Liabilities

黃瀞儀(Ching-Yi Huang)

指導教授 ： 陳忠五

國立臺灣大學/法律學院/法律學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.00922

摘要

觀察我國醫療相關的實務判決，可發現兩個值得注意的趨勢：其一為醫療說明義務的重要性逐漸增加，姑且不論其是否對訴訟結果造成決定性的影響，至少原告方在陳述時，或多或少都會提到「醫師未為完善的說明」作為其主張權利的論點之一；其二則是，儘管大部分醫療案件在我國民事法體系下存在契約責任與侵權責任競合的關係，多數當事人卻是捨棄契約責任，選擇侵權責任作為其權利主張的依據，為什麼會有這樣的現象出現呢？是因為二者的權利義務內容、範圍有所差距嗎？抑或是因為法律效果，如保護客體、損害賠償範圍之計算、舉證責任負擔或消滅時效期間等有差距呢？

結合這兩個趨勢後，其所呈現出來的問題點在【輔大新生健康檢查案】與【奇美醫院未告知手術外病況案】中表現得尤為明顯：在這兩個案件中，原告皆因醫師未告知於檢查時已知的病徵致錯失治療良機，而發生侵害原告生命、身體、健康利益的情形；巧合的是，在這兩個案件中，醫師方皆提出「告知異常症狀並非醫療契約的給付內容」作為抗辯理由，然而，非得是白紙黑字明示的義務，醫師才有履行的必要嗎？醫師是否可能基於契約法理，在雙方未為約定的情況下，仍然負有告知病患資訊的義務呢？又，倘若雙方間不存在契約，那是否仍然存在醫師說明義務呢？可以從侵權責任觀點推導出來嗎？

本文的推論過程是從契約責任與侵權責任義務之起源談起，進而自侵權責任與契約責任之義務本質—醫病之間的信賴關係及歷史源流來探討其個別發展出的「說明義務」在內容與範圍上是否有所差異，以解決「醫師發現未屬於醫療契約之給付義務中的重要事項（如所選之＜輔大新生健康檢查案＞與＜奇美醫院未告知手術外病況案＞中的肺癌），是否有告知病患的說明義務」此一問題。此外，相較於醫師之手術行為責任，醫療說明義務乃為一較新、定義較模糊且適用上也相對爭議的責任型態，故本文也欲藉此機會，試圖為說明義務的範圍劃定一個較清楚的界線，以期對醫病雙方間的責任進行更合理的分配。其三，乃從說明義務之法律效果入手，探討其法律性質，及契約責任與侵權責任下的法律性質在訴訟上可能造成的差異。

總之，本文欲藉由如此的討論順序為醫療說明義務劃定明確的適用範圍及法律效果，除了探討醫療說明義務在契約責任與侵權責任間之區別實益外，也希望透過理論與實務的對話，更合理地分配醫病雙方間的責任分擔。此外，也希望透過醫療說明義務之法律性質的釐清，幫助法院在遭遇相關案件時更容易釐清爭點，減少訴訟資源的浪費。

關鍵字

醫療說明義務 ； 告知後同意 ； 信賴關係 ； 醫病關係中的契約義務 ； 醫病關係中的侵權義務 ； 病患自主權

並列摘要

In most medical cases, two trends have been observed: on one hand, “duty of disclosure of medical information” plays a more significant role; on the other hand, most people turn to tort liability rather than contract liability when claiming their rights despite the fact that in Taiwan contract liability and tort liability are collateral in most medical cases. What makes such a difference? Is it because the content and scope of the liabilities are different from each other? Or is it because the legal effects, such as the rights protected, the measurement of injury compensation, burden of the proof, and extinctive prescription, are different?

The issues show evidently in the selected two cases. In both cases, the defendants stressed that “ as a debtor, it is not their duty to inform patients about some major symptoms which are not included in the contracts.” However, is it really fair that doctors could pay no attention to some major symptoms only because it is not written in the contract? Is the duty of disclosure of medical information an implied obligation in medical contracts? If no medical contract exits, is there still room for us to recognize the duty of disclosure of medical information, maybe induced from tort liability?

This thesis starts with the origin of contract liability and tort liability, and by discussing the nature of this two kind of civil liability, which is “reliance relationship”, as far as I am concerned, to further explore and define the content and scope of the duty of disclosure in medical information in doctor-patient relationship. In this way, I will have a better chance to deal with questions mentioned above. In addition, since the duty of disclosure of medical information is a relatively new obligation, it is also a good opportunity for me to try to draw a fine line between patients’ right and doctors’ responsibility. Finally, I will also keep an eye on the procedural effects, such as the rights protected, the measurement of injury compensation, burden of proof and extinctive prescription, to figure out if there is any significant distinction between contract liability and tort liability as far as the duty of disclosure of medical information is concerned.

In a word, through this thesis, I would like to make a more relatively accurate definition and a clearer scope for the duty of disclosure of medical information, and to figure out whether there should be a stark distinction between contract liability and tort liability. Hope it will help all people to access the courts more easily, and help the courts to better apply the law, and distribute the responsibilities between doctors and patients more properly in the same time.

並列關鍵字

the duty of disclosure of medical information ； informed consent ； reliance relationship ； contractual liabilities in doctor-patient relationship ； tort liabilities in doctor-patient relationship ； patient’s autonomy

參考文獻

19.陳聰富（2008）。＜誠信原則的理論與實踐＞，《政大法學評論》，第一０四期。

6.王千維（2008）。＜侵權行為損害賠償責任法上之允諾＞，《政大法學評論》，第一０二期。

17.陳聰富（2007）。＜美國醫療過失舉證責任之研究＞，《政大法學評論》，第九十八期。

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