醫療民事責任因果關係之研究

Causation in Medical Liability

李小芬(Siao-Fen Li)

指導教授 ： 陳聰富

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.2008.01251

摘要

因果關係向來為侵權行為法上最令人困擾的問題之一，我國法院係以相當因果關係理論作為判斷之依據。惟於醫療過失案件中，由於醫療行為之特殊性，相當因果關係理論有時無法正確地發揮判斷因果關係存否之功能，此時是否有以其他方法取代或補充之必要，值得討論。
本文先以實務判決為例，說明醫療民事責任關於因果關係判斷之種種問題，並接續該問題點，分別介紹實體法上疫學因果關係理論、比例因果關係理論及機會喪失理論，探索其理論之實質為何？對於前揭問題是否能妥善解決？於我國法應如何解釋適用？
接著以訴訟法關於舉證責任之理論為核心，先析述舉證責任之基本原則，再說明醫療事件中原告對於因果關係存在有何舉證困難，故於符合某些要件時，應採取減輕或轉換舉證責任之方法，以謀求雙方當事人訴訟上之實質公平。
最後將簡單歸納重要之論點，希望能作為我國審判實務之參考。

關鍵字

醫療民事責任 ； 因果關係 ； 疫學 ； 比例因果關係 ； 機會喪失 ； 舉證責任

並列摘要

Causation is one of the most troublesome questions in tort law. The theory of adequate causation is adopted by our courts to judge whether there is a connection between the act of defendant and the damage caused therefrom. But in medical malpractice cases, sometimes the theory of adequate causation can not function correctly due to the specific characteristics of medical practice. Therefore, it is worthwhile to make a further research in order to help us to determine whether or not the causation between defendant’s act and damage does exist by applying other theories in causation.
The author firstly illustrates the problems while determining the existence of causation in medical liability by referring to some precedent cases of Taiwan courts. And then the author will make a research on the “causation in epidemiology”、 “proportional causation” as well as “loss of chance theory”. The main concerns of such research includes to elaborate the nature of these theories, to clarify which problems are these theories proposed to solve, and to realize how our courts explain and apply these theories.
After that, theories about burden of proof will be discussed. Because it is apparent that plaintiffs always have difficulty in proving the existence of causation in medical malpractice cases, the courts tend to ease off or switch their burden of proof. The author will discuss the problems regarding the balance between the plaintiff and the defendant by the application of some evidentiary rules.
At last, the author will try to propose her views and suggestions for legal practitioners’ reference.

並列關鍵字

medical liability ； causation ； Epidemiology ； proportional causation ； loss of chance ； burden of proof

參考文獻

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呂綺珍，「論民事證據法上之事實認定與證明責任」，國立台灣大學法律學研究所碩士論文，2005年。

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陳聰富，〈美國醫療過失舉證責任之研究〉，政大法學評論第98期，2007年8月。

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