論醫療上告知後同意法則及刑事實務上相關判決之研究

An analysis on the Informed Consent Doctrine and Its Relevant Criminal Judgements

張百欣(Pai-Hsin Chang)

指導教授 ： 甘添貴

國立臺北大學/法律學院/法律學系/碩士(2008年)

摘要

隨著社會之進步，人民自我意識之提高，在醫療方面，病患自我決定權亦日漸受到重視，但另一方面，近年來我國之醫病關係亦日趨惡化，醫療訴訟與日俱增，其中亦包括病患主張醫師違反「告知後同意法則」而產生之醫療訴訟類型，究其原因，應與醫病間之溝通不良有關。為能使醫師與病患間建立良好之信賴關係，並使刑事實務上面對與「告知後同意法則」有關之醫療訴訟時能作出正確之判斷，則有必要就「告知後同意法則」之相關議題加以研究介紹。
本文於第二章即先就「告知後同意法則」之發展歷程加以介紹，首先介紹醫學倫理思維之演變，由醫師本位演進至尊重「病患自我決定權」病患自我決定權之嶄新醫學倫理思維。之後再介紹「病患自我決定權」為憲法所保護之基本權，並透過「告知後同意法則」之確立而獲得具體之保障。
第三章即開始就「告知後同意法則」之內涵加以介紹，首先就醫師說明義務之內容加以分析，將說明之主體、說明之對象、說明之時點、說明程度之標準、說明義務之類型，以及說明義務例外可免除之情況均加以介紹；之後再分析「病患之同意」，就同意能力之判斷標準、同意之方式、同意之代理、同意之內容及時點，以及例外可以不用取得病患同意之情況分別加以說明。
第四章則係討論醫療行為之意義，並就醫療行為於刑法上是否應評價為傷害行為加以分析，之後再討論醫療行為與刑法上阻卻違法事由之關係，最後再介紹違反「告知後同意法則」之醫療行為於刑法上評價，本文主要將之區分為違反說明義務與未取得病患之同意兩種情形分別討論，並就違反「告知後同意法則」之醫療行為本身及另外衍生之死亡或傷害結果於討論上亦加以區分。
於第五章，本文則將與「告知後同意法則」相關之刑事實務判決加以介紹分析，並提出本文判斷「告知後同意法則」於醫療刑事實務上應該如何運用之判斷流程，以期能使日後刑事實務面對與「告知後同意法則」相關之案件時，能作為判案之參考，最後本文則於第六章總結上述各章之內容作成結論。

關鍵字

告知後同意法則 ； 醫師之說明義務 ； 病患之同意

並列摘要

With the progress of our society, people have higher self-awareness. In medicine, patients’ self-decision right is getting more respect. However, doctor/patient relation in Taiwan has been getting worse in recent years. The number of medical lawsuits is increasing, including patients accusing doctors in violation of informed consent rule. All these might result from poor communication between doctors and patients. To build good trust between doctors and patients and enable correct judgments related to informed consent rule in criminal cases, I thereby do a research on issues of informed consent rule.
Chapter II of this thesis introduces the development of informed consent rule, starting with changes of medicine ethics thoughts from doctor egoism to respect of patients’ self-decision right. Furthermore, this chapter discusses that patients’ self-decision right is a constitutional right, which obtains substantial protection through the establishment of informed consent rule.
Chapter III illustrates informed consent rule by analyzing the details of doctor’s obligation to explain—subject and object of explanation, explanation timing, standard of explanation level, types of explanation obligations and exceptions. Afterwards, it discusses some issues related to consent of patients such as the judgment standard of consent ability, consent methods, consent agency, consent content, consent timing, as well as exceptional conditions where patients’ consent is not required.
Chapter IV explores the meaning of medical behaviors and analyzes whether medical behaviors shall be deemed as injury behaviors in criminal law. Relation between medical behaviors and defences based on justifications in criminal law is discussed. Evaluation of medical behaviors in violation of informed consent rule in criminal law is introduced. This chapter mainly discusses two conditions respectively—violation of obligation of explanation and not having patients’ consent. Besides, it also divides behaviors of violation of informed consent rule and the resulted deaths or injuries in discussions.
In Chapter V, criminal sentences related to informed consent rule are introduced and analyzed. And then I figure out a judgment process to be applied in medical crime practice related to informed consent rule cases as future sentence reference. Chapter VI is the conclusion of the preceding chapters.

並列關鍵字

Informed Consent Doctrine

參考文獻

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