論美國訴訟外醫療紛爭處理之歷史發展經驗：兼評我國現狀之反省與展望

本文探討美國訴訟外醫療紛爭處理之比較經驗，首節為研究背景與問題，第貳節介紹美國醫療糾紛危機之歷史背景，及其衍生之兩類改革方案，第參節討論審判前篩選、仲裁、調解與溝通解決等醫糾ADR選項之發展經驗，本文發現追求修補醫病關係與提升病人安全之利益導向式調解，和強調資訊透明、誠實檢討、坦承道歉與早期和解的溝通解決，已成為美國近年最受期待之ADR選項。第肆節進而以上述比較觀察為基礎，檢視我國醫糾ADR發展現狀，特別點出我國醫療體系普遍抱持最小化訴訟曝險之風險管理觀，此文化特性也構成我國本土發展溝通解決機制的主要挑戰。

關鍵字

訴訟外醫療紛爭處理；審判前篩選；仲裁；調解／調處；溝通解決機制

並列摘要

This paper explores the experience of medical alternative dispute resolution in the US. Part I lays out the background and research question. Part II introduces the historical background of medical malpractice crisis and the two generations of policy responses to the crisis. Part III further examines the development and evolution of four of the most widely used medical ADR options, including pre-trial screening panels, arbitration, mediation, and communication-and-resolution programs. The paper discovers some of the most promising and anticipated medical ADR options and policy proposals, including interest-based mediation and communication-and-resolution programs, which emphasize such ideas as repairing patient-physician relationships, promoting patient safety, ensuring full disclosure, expressing timely sympathy and apology, committing to prevention efforts, and making early offer of compensation. Based on these observations, Part IV reflects on the current status of medical alternative dispute resolution in Taiwan, and points out that limiting litigation exposure remains the dominant risk management philosophy of Taiwan's healthcare organizations, which constitutes a significant barrier to the local development of communication-and-resolution type of reforms.

並列關鍵字

medical alternative dispute resolution ； pre-trial screening panels ； arbitration ； mediation ； communication-and-resolution programs (CRPs)

參考文獻

黃鈺媖、楊秀儀 (2015)。〈病人為何要告醫生？以糾紛發動者為中心之法實證研究〉，《國立臺灣大學法學論叢》，44, 4: 1845-1885。(Huang, Y.-Y., & Yang, H.-I. [2015]. Why do people sue doctors? An empirical legal study from the perspectives of patients and their families. National Taiwan University Law Journal, 44, 4: 1845-1885.) https://doi.org/10.6199/NTULJ.2015.44.04.04

丁予安、黃珮清 (2012)。〈號角響起，推動醫療疏失除罪化之進程〉，《臺灣醫界》，55, 12: 50-55。(Ting, Y.-A., & Huang, P.-C. [2012]. Sound the trumpet! Progression on the legislative effort to decriminalize medical errors. Taiwan Medical Journal, 55, 12: 50-55.) https://doi.org/10.30044/TMJ.201212.0005

王志嘉 (2021)。〈建構醫療爭議預防的三段五級模式及多元處理機制〉，《月旦醫事法報告》，51: 107-114。(Wang, C.-C. [2021]. Constructing the prevention of medical disputes with the module of three-section and five-levels and multi-mechanism. Angle Health Law Review, 51: 107-114.) https://doi.org/10.3966/241553062021010051008

林義龍 (2017)。〈醫療糾紛關懷與調解之臺中經驗〉，《月旦醫事法報告》，3: 27-43。(Lin, Y.-L. [2017]. The care of medical malpractices and its mediation in Taichung. Angle Health Law Review, 3: 27-43.) https://doi.org/10.3966/241553062017010003002

陳永綺、李詩應 (2017)。〈論醫療糾紛調解的中立性〉，《月旦法學雜誌》，260: 126-136。(Chen, Y.-C., & Lee, S.-Y. [2017]. On the neutrality of medical dispute mediation. The Taiwan Law Review, 260: 126-136.) https://doi.org/10.3966/102559312017010260008

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