證明妨礙法理在醫療民事責任訴訟之適用

The Application of Spoliation Evidence Principle in the Medical Malpractice Claim

沈冠伶(Kuan-Ling Shen)

《臺大法學論叢》 38卷1期 (2009/03) Pp. 163-216

https://doi.org/10.6199/NTULJ.2009.38.01.04

摘要

在醫療訴訟，證明妨礙法理之適用，可適當調整當事人間舉證責任。妨礙舉證之當事人一造係因故意或過失而違背證據法上義務，造成他造陷入不能或難以舉證之困境時，基於誠信原則、公正程序及武器平等原則之要求，應減輕舉證人之證明責任，在證據法上課他造以不利益之認定，或為事實之推定或轉換舉證責任。
尤其是在醫師違背病歷記載義務或檢查結果確保義務，造成病歷不完整、闕漏或不存在之情形，上開義務雖本於醫療關係而生，且發生在訴訟繫屬以前，但由於病歷在醫療訴訟上屬於重要之證據，宜承認病歷記載兼具有證明目的，而具有程序法（證據法）上義務之性質。醫師違反上開義務，造成病人一造難以本於病歷以回溯醫療過程，而生證明上困難時，由於醫師對於病歷記載、保存處於完全可支配之領域，因此，其如具有可歸責性，得適用證明妨礙法理及相關規定，減輕病患之舉證責任。至於在法律效果上，得視違背病歷記載義務之方式、態樣，為事實上推定、降低證明度或轉換舉證責任之方式為之，以減輕病患之舉證責任。

關鍵字

醫療訴訟 ； 證明妨礙 ； 病歷記載義務 ； 武器平等原則 ； 舉證責任轉換

並列摘要

Although it's most advantageous to patients that shift the burden of proof of negligence and causation to doctor's side in the medical malpractice claim, it may easily in doctor-patient-relationship cause defensive medicine, which is not really favorable to patients. But when a party has acted so as to frustrate the other's ability to satisfy its burden of proof, it can lead to relaxation or even schift in the burden of proof.
Before a medical malpractice claim is filed, doctors hold the duty to make medical records and to keep the results of examination on the basis of medical relationship. Because in malpractice claim medical records are important evidence, it's suitable to regard its catalogue as serving also the evidential end. Thus the duty mentioned above contains a procedural (evidential) nature. If a doctor disobeys this duty and procure a hardship, under which a patient could not use the anamnesis to reconstruct the medical course, and to him this is to be attributed, the judge then should draw on the theory of spoliation evidence and relating rules to mitigate patient's burden of proof. With regard to the legal effect, methods such as assuming the truth, reducing the degrade of proof or shifting the burden of proof are to be chosen in accordance with how the doctor breaches his duty.

並列關鍵字

medical malpractice claim ； spoliation of evidence ； relaxation or shift in the burden of proof ； equally-armed-principle ； duty of making medical records anamnesis ； presumption

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