臺灣地區外科手術醫療糾紛之研究--以醫病關係為例

A Study of Taiwan's Medical Malpractice of Surgical Operation Focusing on Physician-Patient Relationship

林明泉(Ming-Chuan LIN)

指導教授 ： 黃人傑

國立臺灣師範大學/教育學院/三民主義研究所/碩士(2001年)

摘要

在醫學各專科分類中的外科手術（surgical operation）是一項具有高度專業技術的醫學領域。 由於健保對於外科手術給付偏低、外科手術醫療風險高、外科醫師值班待命時間長、工作繁多、醫療糾紛多。…..這些現象是造成外科手術的醫療糾紛層出不窮，令人不勝枚舉。 根據以往外科手術醫療糾紛求償案，常因病人與家屬缺乏醫學專業能力，不瞭解醫療的程序而無力舉證。 如今舉證責任改由醫方負責，會使得醫師會採用防禦性醫療（defensive medicine）－亦即做更多的檢體及血液檢查，以防止一旦發生醫療糾紛時吃上官司。
所以長久以來，外科手術所衍生出來的醫療糾紛當中，反映出醫病之間不對等的關係－使得醫病（physician－patient）之間在處理醫療糾紛時，病人無法獲得公平待遇與補償時，往往採取變相的非理性抗爭手段。 如今立法院尚在審查行政院衛生署版的「醫療糾紛處理法草案」該草案是採「調解強制、仲裁任意」原則，因此以後病人未經過調解程序將不可直接向法院提出告訴。
以效益論的觀點用在醫病關係中，比較符合傳統臺灣的醫病模式：醫師採取「父權威權式的醫療」；羅爾斯正義論的觀點對於政府制定醫療政策時，必須要照顧到每一個階層的族群；醫師不僅是必須具有崇高的道德標準的要求，同時也要有較高的IQ、EQ與第二個EQ，也就是醫師必須要懂得跟病人建立起良好的醫病溝通，達到和諧的醫病關係。
從希波克拉底誓言（Hippocrates Oath）、「紐倫堡法典」（the Nuremberg Code）到美國Beauchamp 與 Childress（2001）生命倫理四原則：（一）行善原則（The principle of beneficence）（二）不傷害原則（The principle of nonmaleficence）（三）正義原則（The principle of justice）（四）尊重自主原則（The principle of respect for autonomy）。正是現代醫病之間醫學倫理互動所產生的新思維，同時也提供給我們另一種思考醫病關係的價值判斷。
筆者擬從人文醫學的角度出發，去探究人文醫學對於實際上促進良好的醫病關係的可行性。特別是身為醫師在替病人動外科手術時，應該具有人本主義（humanism）的精神與信念。
臺灣的醫學教育所欠缺的是人文醫學方面的教育，如果我們的醫學教育能夠有足夠的人文課程來濡化醫師對於人性的瞭解，培養察顏觀色，善解人意的能力。體認關懷「人」的重要性，並且增強他們對「人」的興趣。而不是像現在年輕一輩的醫生只對看「病」有興趣，卻忽略了病人心理的感受，如此一來才是增進和諧醫病關係的不二法門。

關鍵字

外科手術 ； 醫療糾紛 ； 全民健保 ； 防禦性醫療 ； 醫病關係 ； 父權主義 ； 醫學倫理商數 ； 人文主義

並列摘要

Surgical operation plays a very critcal role in surgery .
However , in Taiwan , more and more cases of medical malpractice happen nowadays , except for the dispute between the surgeon and the patient .
For this , the purpose of this study is to find out the reasons why the interns prefer to be a pediatricians , a otologist,or a dermatologist , rather than be a gynecologist , or a general surgery and how the surgeon and the patient are deal with medical dispute .
According to some researches in Taiwan, the reasons are followed ：
1. The National Health Insurance leads to the shortage of the
manpower in surgery .
2. Surgeons have to stay at hospitals or clinics longer than
any other specialties .
3. Surgical operation is easy to make medical claims break
out , because it is relative with aggressive medical
cure on the physical treatment .
4. Defensive medicine is taken by the sorgen in taiwan , based
on the civil law of the Republic of China said that the
surgeon must be responsible for being certified for
himselfthat there is no any wrong while medical
malpractice comes about .
5. According to the suggestion of the medical society ,
physicians should not be relieved from the Criminal
Law ofthe Republic of China , once the medical
malpractice take place . That is , as far as the
physicians in Taiwan are concerned , medicial
malpractice should not be accused by the Criminal Law
of the Republic of China.
6. In the physician’s point of view in Taiwan , medicial
treatment should not be responsible for "Non-fault
Liability".
Based on “the Draft of the law dealing with medical malpractice” made by the Department of Health of the Exeutive Yuan , it is not allowed to take any treasures by laws in the beginning of medical malpractice . On the contrary , mediation should be done at first.
In the future , mediation is forced to be held when the medical malpractice begins to neogotiation. However , arbitration is not necessary .
Traditionally , there is unfair status in Taiwan’s society between physicians and patients. Physicians always take it for granted that the patients must obey what the physicians say and the paternalism should not be challenged and doubted . In fact , the myth which the physicians are the most outstanding roles must be gotten rid of . In order to get along well with the patients , the physicians must be characterized by the higer medical ethics equotient.
The medical ethics resulted from Hippocrates Oath . In the past two decades , the four principles of biomedical ethics founded by Beauchamp and Childress in U.S.A. become the mainstream in the medical society .
Finally , humanism should be established when the physicians face hundreds of patients . It is necessary for the physicians to think of the patients first no matter what happens .
Physicians should not only be concerned about the patients’ suffering , but also be care about their humans’ right .
“All men are created equal.” Each should be treated respectfully .

並列關鍵字

sugical operation ； medical malpractice ； Ntional Health Insurance ； defensive medicine ； physician-patient relationship ； paternalism ； Utilitarianism ； deontology