醫療事件慰撫金之研究

Compensation for Non-pecuniary Loss in Medical Liability

吳依蓉(Yi-Jung Wu)

指導教授 ： 陳忠五

國立臺灣大學/法律學院/法律學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.02507

摘要

本論文從醫療責任的非財產上損害賠償範圍開展討論，探討在醫療事件中，實務上關於慰撫金的參酌因素及量定數額如何具體運用，以及醫療事件與交通事件在慰撫金之量定數額究竟有無不同，據以論證此種差異是否有區別之實益。

研究方法方面，本論文以醫療慰撫金的參酌因素與量定數額分別探討，先討論實務在具體個案中，究竟參酌何等因素以決定最終之判決數額，並提出學說上關於此些參酌因素之建議;再討論醫療事件慰撫金之量定數額明顯偏低的理由，並思考慰撫金量定結果是否朝向客觀化、表格化，以節省司法訴訟資源、賦予兩造評估是否尋求訴訟之依據。

本論文提出疑問，實務上關於醫療事件慰撫金向來參酌「兩造身分地位、經濟狀況及傷害程度」，是否所有參酌因素與慰撫金量定數額及慰撫金功能相關，並且此些參酌因素須耗費裁判者與兩造當事人的勞力、時間、費用進行審理及辯論。另外，實務上針對醫療事件之個案進一步參酌之「病患特殊體質、被害人與有過失、加害人可歸責事由及醫療行為特性」，是否在每個個案中均予納入?納入此等參酌因素之基礎理由為何?此等因素與慰撫金量定是否密切相關?此等因素於特定具體個案援用、於其他個案不予援用之理由為何?

本論文認為，目前實務現狀在醫療事件慰撫金之操作主要有兩個問題:一為參酌因素虛假不實;二為量定數額明顯偏低，此二問題雖然分別討論，但亦息息相關、難以截然二分，簡言之，為找出量定數額明顯偏低之根源，仍須回歸參酌因素的問題點。因此解決之道，實務上向來既有的參酌因素應簡化為「兩造家庭狀況、被害人年齡及傷害程度」、向來所無的參酌因素得依個案具體納入考量，惟是否參酌以及如何參酌應詳附判決理由。主要思考為:

一、從「複數賠償權利人」間觀察，複數之請求權人經濟狀況、教育程度、職業狀況迥異，獲判慰撫金數額相同之情形在醫療判決中佔居多數，事實審法院形式上調閱兩造之詳細資料，並以此作為判決依據，實質上從判決結果觀察，兩造身分地位之不同，似無影響慰撫金數額。除此之外，從「不同事件類型」觀察，醫療事件之賠償義務人多居於財力雄厚之地位，與賠償權利人之經濟狀況相比，賠償義務人之財產資力顯然高於賠償權利人。與交通事件相較，多數醫療事件之賠償義務人經濟狀況顯然較佳，不論在侵害他人生命法益或身體健康法益，從實證結果而論，法院判決並未因此酌定較高之金額。最後從「複數賠償義務人」觀察，似乎不因賠償義務人究為大型醫院或小型診所或個人執業醫師而有所區別，無法從判決結果解讀出賠償義務人之資力高低會影響賠償權利人獲償之慰撫金數額。

二、目前實務關於醫療案件之慰撫金數額，與其他民事事件類型及德、日等相關國家之實務案例相較，賠償權利人獲判之金額明顯偏低，主要原因為，法院判決參酌「加害人過失」因素為量定慰撫金數額之基礎，判決數量並非少數，換言之，法院以「加害人非故意所為」為由酌減慰撫金數額;另外法院基於醫療風險性較高，當醫療損害發生時，歸責醫療人員之理由較低，不宜課予其過高之義務為由，減輕賠償義務人之責任;最後法院參酌被害人方面與有過失或病患特殊體質之因素而減輕加害人責任，此類加重被害人責任之因素，實務上亦非少數。

未來是否朝向慰撫金數額表格化的目標，本文採取保守之見，由於建立客觀標準的目的在於避免裁判者的主觀恣意，並藉以輔助參與訴訟者評估訴訟成本及訴訟結果。然而，關於醫療事件之慰撫金量定，在區分「最高法院判例既有的參酌因素」及「最高法院判例所無的參酌因素」下，前者僅需考量被害人之「傷害程度」、「家庭狀況」及「年齡多寡」，借由參酌因素之精簡化，亦可達到節省訴訟資源之目標，且既有參酌因素無涉及裁判者之價值取捨，具有客觀化、外部性之特質，即毋庸擔憂是否有裁判者主觀恣意的問題。反之，後者之參酌因素涉及價值取捨之評價，理論上應嚴謹運用，在實務操作上宜詳附擇取與否之具體理由，在判決理由中公開心證，以尋求慰撫金客觀量化及裁判者主觀恣意之平衡點。

關鍵字

醫療責任 ； 慰撫金 ； 非財產上損害賠償 ； 身分地位 ； 因果關係 ； 特殊體質 ； 與有過失

並列摘要

The damages discussed start from compensation for non-pecuniary loss in medical liability. In the medical incident, the deliberate practice apply on considering factors and the amount of gold given how the amount of the specific application. Besides, there is any difference between on the amount of gold given in medical events and in traffic incident or not.

In research methods, considering factors and the amount of gold given were discussed in this thesis. At beginning, discuss practices in specific cases about what considering factors to determine the final amount of the judgment and make recommendations on this some scholars about the considering factors. Secondly, Discuss reasons for the amount of medical events consolation given is significantly lower, and we have to think whether the results towards the objective, tabular in order to save judicial proceedings resources, giving the parties in assessing whether to seek the basis litigation. One factor is deliberate false. Second is the amount of fixed amount is significantly lower. Although these two issues were discussed separately, but there were also closely. In short, in order to find out the root causes, we still return to considering factors problems.

The thesis put forward questions that medical practice has always been deliberate event consolation payments "personal status, economic status and degree of injury both sides" whether all considering factors and the amount of gold are related or not. Besides, judges and the parties need so spend much time and cost to debate. In addition, to further deliberate on the practice of medical events for cases of "special physical victim, the contributory negligence, the offender’s negligence and medical characteristics of the ", whether are all in cases considered?

Why do we need to consider factors such reasons deliberate? Whether these factors and consolation given the amount of gold is closely related? Why such deliberate references to specific factors specific cases, but not cited in other cases?

The paper believes that there are two main problems in the medical event gold operation consolation in the current practice. Therefore, judges should simplify as "the parties in family status, age and degree of injury victims," other factors are considered in accordance into consideration case by case, but whether and how deliberate judgment should be attached detailed reasons. The main reasons are as follows.

Firstly, from among "the plural right person," observed the complex economic situation, education, occupational status is different. However, people get the same amount of gold in the medical judgment. Access to detailed information on the parties in the court of the form, and as a basis for judgment, in essence, the verdict seems to be no impact on the amount of consolation in the different position of the parties in status. Besides, from the "different types of events," observed the medical events obligor's financial position is strong, compared with the right people in the economic conditions, the obligor's financial viability property is clearly higher than the rights holders. Compared with the traffic incident, the obligor's economic situation is clearly better in most medical events, regardless of the legal interest in the infringement life or physical health of legal interest from the terms of the verdict, and the verdict was not therefore a higher amount of discretion. Finally, from the "plural obligor" observation, it does not seem differ among the obligor large hospitals, small clinics or individual practitioner. We cannot interpret the funding of the obligor level would affect the rights of the person to whom compensation amount from the verdict.

Secondly, compared practical cases with other civil event types Germany and Japan, people get the right amount is significantly lower. The main reason is that the court deliberate "defendant’s fault", and the number of judgments are not a minority. In other words, the court held that "the defendant was unintentional" as the reason for the amount of gold consolation reduce it. In addition, the court found due to higher medical risk when the damage occurred to blame the medical staff. We should reduce the responsibility of defendants. Finally, the judges think negligence in patients with special physical causes to lessen the responsibility of defendants. These aggravating factors are not a minority practice.

This article takes a conservative view. Whether the amount of the form is to be established in the future, the purpose is to avoid the subjective arbitrary and to assist the parties in assessing the results of litigation and litigation costs. However, about the decision of the amount of gold in medical liability, in distinguishing "the Supreme Court established deliberate Factors" and "Supreme Court of deliberate non-factors", we only consider the "family status", "the degree of injury," and "age" by streamlining the considering factors in the former, by the way we also can achieve the target of saving resources. Besides, judges’ subjective choice and considering factors are unrelated, with objective, external attributes, namely, needless to worry the judge’s arbitrary. On the contrary, considering factors in the latter relate to the value of the judge. Judges should theoretically rigorous use, attaching the specific details of the reasons for taking or not. Therefore, we could seek the equilibrium point between consolation gold objectively and judges of arbitrary.

並列關鍵字

medical liability ； pain and suffering ； non-pecuniary loss ； spiritual damages compensation ； causation ； Egg-shell skull rule ； comparative negligence

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