從醫師通報制度論公共衛生與病患資訊隱私權之平衡

台灣談傳染病議題是獨具意義的。台灣自古就面對傳染病的威脅，在現代更因都市化與外向型經濟兩個因素而越發嚴重。SARS經驗我們仍驚魂未定，新型流感(H1N1)又已撼動全球。管控傳染病，需要蒐集、傳遞與利用病患資訊，因此傳染病防治法定有醫師通報制度，然而，醫師通報制度存在著公共衛生與病患資訊隱私權之價值衝突。過當之國家行為會導致病患遁逃於管制網絡之外，致國家掌握疫病資訊失真，反而造成公共衛生危機。本文在橫向以美國為參照對象，參考法院判決，及1966年「資訊自由法」(FOIA)、1974年「隱私法」、1996年「健康保險可攜性及責任法」隱私準則(HIPAA Privacy Rule)， 1999年「各州模範公共衛生隱私法」(MSPHPL)。在縱向以國際衛生條約(IHR(2005))、1980年OECD八大準則、1995年歐盟指令為研究對象，尋求國內制度與國際規範的銜接。經分析整理現行醫師通報制度之規範後，本文指出現行制度的困境：資訊隱私權與公共健康的價值衝突，並展現在違憲疑慮、分配不正義、偏重公益、及破壞醫病信賴等方面。本文由抽象到具體的提出建議：重新分配風險，重視人權價值，維護醫病信賴關係，並以正當法律程序與健全資訊法制作為調和資訊隱私權與公共健康價值衝突的方法。本文的核心觀點是病人資訊隱私權保障在防疫政策上極具重要性，二者之關係是相互加成—保障病人資訊隱私權有助於促進防疫效果。施政者應體認到病患不是犯罪人，而是受害人，甚至是科技文明發展下不幸的犧牲者，「治病」是為「救人」，除了對病的治療(cure)，還有對人的照料(care)，政策制定應該多一點「同情」，少幾分「制裁」。

關鍵字

醫師通報制度；公共衛生；病患資訊隱私權；醫病信賴關係；違憲審查

並列摘要

It is especially meaningful to discuss and debate infectious diseases in Taiwan. From a historical standpoint, Taiwan has never been able to escape from the threat of infectious diseases. Globalization and an internationally-oriented economic market have taken the situation from bad to worse. We still haven’t fully recovered from the SARS experience, and now the current H1N1 epidemic is ravaging the world. It is essential to collect, process, and disseminate medical information of patients in order to control infectious diseases. It is for these exact reasons that we built up the clinical reporting system in the Communicable Disease Control Act. Infectious disease regulation and information privacy of patients are however, inherently conflicting in this system. Inappropriate government actions will lead most patients to become reluctant to access medical systems. It will, additionally, affect the accuracy of information that the government collects. In the long run, it will have destructive impacts on public health. Horizontally, this article used the United States as a comparative target to benchmark its judicial decisions, the Freedom of Information Act in 1966, Privacy Act in 1974, Health Insurance Portability and Accountability Act in 1996, and Model State Public Health Privacy Act in 1999. Vertically, in order to harmonize the domestic and international legal standards, this article also takes International Health Regulation 2005, OECD guidelines in 1980, and EU Directive in 1995 into consideration. After analyzing the current clinical reporting system, this article points out the dilemmas of this system: namely the value conflicts between public health and information privacy. It emerges from several aspects: unconstitutional anxiety, distributional injustice, over-focus on public interest, and breach of confidentiality between the physician and the patient. From abstract ideas to pragmatic methods, this article suggests that we should re-distribute risks, put more attention on human right values, protect physician and patient relationships, harmonize the conflict between public health and information privacy by implementing due process of law, and building information security measures. The core idea of this article is that patients’ information privacy protection plays a significant role in infectious disease control policy. They are in a mutually reinforcing relationship which means that patients’ information privacy protection will facilitate the result of infectious disease control. The administrator should recognize that patients are victims rather than criminals. In many ways, they can even be considered as casualties in the development of technology and its affect on civilization. The main purpose for curing is to save people from suffering. Besides “curing” diseases, “care” towards fellow man is just as important. Policy-makers should make decisions based more on compassion than punishment.

並列關鍵字

CLINICAL REPORTING REQUIREMENTS ； PUBLIC HEALTH ； CONFIDENTIALITY BETWEEN THE PHYSICIAN AND THE PATIENT ； JUDICIAL REVIEW

參考文獻

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王開弘，〈台灣防疫政策的歷史制度分析〉，《臺灣大學/政治學研究所/碩士論文孫煒教授指導》，2005

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從醫師通報制度論公共衛生與病患資訊隱私權之平衡

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