從醫療法及民事法律論我國美容醫療之管制與歸責理論

Reviewing the Medical Cosmetology Regulation and Liability Theory From Medical Care Act and Civil Law in Taiwan

謝易澄(Charles Hsieh)

指導教授 ： 李崇僖

中原大學/商學院/財經法律研究所/碩士(2011年)

https://doi.org/10.6840/cycu201100189

摘要

本論文主要討論於我國美容醫療於法律上定位、而法律上之定位又從事前及事中的病人側的保護及醫療側的規範著手，而事後之保護則必須仰賴民事訴訟程序及實體法中請求權基礎關係，病人側的保護由於有風險分配及醫療技術使用知情權，故於此本文於該章節中有目的性的加強論述。全文共分六章，除第一章緒論討論全文架構及文獻回顧外及第六章結論提出各種建議外，第二章至第四章分別以一般性醫療之觀點及美容醫療特有之特殊性來討論美容醫療的各種問題於現行法制度下之不足與改進之方向，蓋環顧現有之法規多以一般性醫療為基礎而制定，如何使美容醫療於此法規範制度下亦受其規範而不相衝突，以下從本論文第二章述其摘要至第五章：
在第二章美容醫療本質論的第一個重點為探討醫療法中之醫療行為是否包括美容醫療，而在本章的第一節之反覆辯證下，本文肯認美容醫療是醫療法中之醫療行為。而於本章第二節之一般醫療與美容醫療之行為主體及義務，除將美容醫療與一般性醫療之醫療側共通之義務加以敘述外，另更以美容醫療之特性闡述醫療院所提供美容醫療服務應整合美容醫療各跨科別之特性而組成一整合各專長之團隊以合乎美容醫療之跨科別性之特徵。本章第三節則分成三個面向討論一般醫療行為之性質與美容醫療之特性，第一個面向是醫療行為之裁量空間及界線，於此，本文從外國法及本國法做一般醫療行為之界限只須合乎當地當時之醫療水準即可，但美容醫療則必須與患者進行極詳細之溝通始完足之，而其與患者溝通之結果即醫師裁量權之界線。本章節第二面向乃討論美容醫療服務之特殊性質，從經濟學的觀點為比較，而得出美容醫療服務需求的被動性不成立、美容醫療需求的不確定不存在及美容醫療服務價格之彈性不若一般醫療之價格彈性小之特性，以此特性建構出第三個面向，即醫療契約與美容醫療契約之定性不同處。
第三章之美容醫療之行政管制乃分第一節、美容醫療機構設立之管理，本節認為必須依美容醫療之特色而增加管理項目。第二節美容醫療機構廣告之管理則認為因其求診患者情報權遠較一般醫療需求較高，可學習日本國平成十三年、十四年之醫療廣告管制之改正案，再以消保法第二十二條管控其內容。第三節美容醫療人員之管制，本文主張應將專科醫師之認可權回歸中央，以合乎重大事項保留原則。第四節則論充分告知義務於醫療法中已成一公法上之給付義務，為一種倫理法制化之立法。
第四章美容醫療之失敗醫療論之第一節主要論述因過失所致之失敗醫療側主因、醫療注意義務及說明義務在侵權行為法中之地位及美容醫療有危險責任之民法第一百九十一條之一之適用。第二節則闡述非因過失之失敗醫療之補償機制。第三節美容醫療過失之因果關係則於辯證後主張續採相當因果關係說。
第五章之美容醫療之舉證責任之第一節則先敘述民事舉證責任概論；第二節則論述醫療行為及美容醫療行為之舉證責任，本文辯證後主張於契約責任方面依民法第二百三十條由醫師就無債務不履行事由舉證，於侵權行為部分於一般醫療由患者舉證，於美容醫療部分由醫師就危險責任之推定舉本證證明不可歸責，並且依本節所述之日、美法中之事實推定原則為其參考，而第三節醫療及美容醫療之證據協力則討論德派之當事人真誠原則及證明妨礙、文書交付義務等證據法上之規定和英美法體系之事證開示制度，二者間之異同。第四節美容醫療之鑑定則討論美國聯邦證據法及Daubert理論之優點及值得我國參考之處；本章節另一重點在討論心證度之形成，本文主張契約責任面於美容醫療事件及一般醫療事件，醫師皆應依民法第二百三十條負舉證責任，且應採高度概然性之心證程度，但若是一般醫療事件，心證強度本於平等分配錯判風險，應採優勢概然度心證即可。在侵權行為上，於美容醫學中，因危險責任之推定，舉證責任分配於醫師側，其心證強度採高度概然性理論，而若是一般醫療事件，由於係由病患側舉證，其於證據資源上屬資源上之弱者，且為民訴法第二百七十七條但書明文降低心證程度之事項，故採優勢概然性心證即可。

關鍵字

心證強度 ； 證據法 ； 民事訴訟程序 ； 法規範 ； 醫師裁量權 ； 經濟學 ； 價格彈性 ； 行政管制 ； 美國聯邦證據法 ； 美容醫療

並列摘要

Reviewing the Medical Cosmetology Regulation and Liability theory From Medical Care Act and Civil Law in Taiwan ,in other word, means that analysis on Taiwan cosmetic surgery regulations and relevant responsibility theory in terms of Medical Care Act and Civil Law , the major goal of this research is to explore the legal orientation of cosmetic surgery in Taiwan. The legal orientation shall be implemented by enacting feasible and comprehensive regulations for patients’ pre-case and case-in-progress protection and for governing medical institutes. Post-case protection shall resort to civil procedures and basis of claim right defined in Substantial Laws. As the patient protection involves risk allocation and the right for obtaining true information of medical technique, this dissertation offers more comprehensive logical conclusion in the relevant chapters to address the aforesaid purposes. This dissertation is constituted of 6 Chapters. The Chapter 1 is composed of summarized discussion and overall dissertation structure. The Chapter 6 “Conclusion” provides various feasible suggestions. Each of Chapter 2, Chapter 3 and Chapter 4 expatiates individually the current enactment of regulations are not sufficient and comprehensive for administering various problems of cosmetic surgery nowadays and the proposals for making enactment improvement by means of the asserting that regular medical affair treatment principles are incompetent of handling the special characters of cosmetic surgery. As nearly all the current relevant governing acts and regulations are enacted in perspective of regular medical therapy, how can cosmetic surgery be governed by such enactment system without raising any discrepancy are expatiated by the digest of from Chapter 2 to Chapter 5 stated as below:

In Chapter 2 concerning the essentialism of cosmetic surgery, the 1st key issue is whether the analysis of the cosmetic surgery should be included into domain of medical therapy of the current Medical Care Act. From the repetitive dialectical in the Section 1 of Chapter 2, it can thus be concluded that cosmetic surgery shall be categorized into the domain of medical therapy of the Medical Care Act. In the Section 2 of Chapter 2 whose title is “The behavior actant and obligations of regular medical therapy and medical cosmetology, in addition to expatiation of mutually common obligations of medical institutes concerning medical cosmetology and regular medical therapy, it has also detailed medical cosmetology shall be conducted by a team composed of and meeting the requirement of integrating characters of each individual medical departments of medical cosmetology, due to the unique characters of medical cosmetology.
The contents of Section 3 of Chapter 2 include analysis of the characters of regular medical therapy and medical cosmetology in perspective of 3 directions. The 1st direction involves the autonomy judgment range and limits of regular medical therapy. It has been discovered in this research that both the foreign and domestic acts regulate that the limits of regular medical therapy shall only in compliance with current local medical standards. However, in sharp contrast, The implementation of medical cosmetology shall require comprehensive and detailed physician-patient communication in which the finalized decision-making of such communication results from physician-autonomy-judgment limits. The 2nd direction of this Chapter describes the unique characters of medical cosmetology services. By means of making comparison in perspective of economics theories, it thus concludes that the passivism of medical cosmetology can’t be justified, the uncertainty of medical cosmetology demands can’t be validated and medical cosmetology characterizes price flexibility more significant than that of the regular medical therapy. The aforesaid characters concluded can thus be used for constituting the 3rd direction that there exist certain difference between contract characterization of both regular medical therapy and medical cosmetology and it can be thus deduced that medical cosmetology features contracting agreements for some terms and conditions and ensuing obligations.
Section 1 of Chapter 3 introduces the administration regulations of medical cosmetology and the establishment of medical cosmetology institutes. It is proposed in this Section that additional enactment of regulated issues shall be required for meeting the unique characters of medical cosmetology. It is asserted in Section 2 that as the patient-information-identifying of medical cosmetology demonstrates a higher level than others, the enactment of regulations of advertisement of medical cosmetology institutes shall factor in the amendatory acts of Japan Medical Therapy Advertisement Regulations enacted in Heisei 13th and 14th years respectively with assortment of usage of Article 22 of Consumer Right Protection Act for regulating such advertisement contents. Section 3 states the regulations of medical practitioners of medical cosmetology. It is asserted in this Section that the vocational practice governing authority of specialty physicians shall be returned to the central government as to comply with the Principle of Reservation of Law in consideration of significant issues. Section 4 states the obligation of comprehensive informing has already been regarded the Leistungspflicht of the Public Law, constituting the legalization trend of ethics norm.
Chapter 4 states the medical cosmetology therapy failure. Section 1 introduces the major causes of medical failure attributable to the medical institute, the legal status of On-Duty care in medical treatment and information-disclosure information in the Torts Law and that the Article 191-1 of Civil Law shall apply on that medical cosmetology involves liability of dangerous activities. It is asserted in Section 3 that the casual relationship of medical cosmetology treatment failure shall still be subject to the correspondence of casual relationship theory after conducting dialectical.
Chapter introduces burden of proof of medical cosmetology. It is depicted in Section 1 the summarization theories of burden of proof in Civil litigations. It is then explained In Section 2, the burden of proof for both medical treatment and medical cosmetology treatment. It is asserted in this writing that in perspective of contracting responsibilities shall be subject to Article 230 of Civil Law concerning physician-exemption of burden of proof in consideration of nonexistence of Nonfulfillment of Contract Debts. The torts shall be subject to burden of proof by patient in case of regular medical treatment and to that the burden of proof by the physician for claiming the dangerous responsibilities not attributable to the physician. The fact presumption principle of Japan and the U. S. stated in this Section are cited for reference. In Section 3 concerning the evidence of third party for medical treatment and medical cosmetology, describes the similarity and difference between the principle of impartiality, proof of prejudice, instrument delivery obligations which are the regulations of Evidence Law in Germany Law system and Evidence Discovery Mechanism of Common Law System. In Section 4, titling medical cosmetology treatment authentication, it is discussed the advantages of Federal Evidence Law of the U. S. and Daubert theory that shall be adopted into the enactment for our country. The other key issue of this Section is discussing the development of free evaluation of evidence through inner conviction. It is asserted in this Section that the contracting responsibilities for both the medical cosmetology and regular medical treatment shall be subject to the Article 230 of Civil Law demanding the burden of proof by the physician and the adoption of requirement of free evaluation of evidence through inner conviction by means of significant probative principle. However, the regular medical failure cases characterizing that the significance level of free evaluation of evidence through inner conviction shall apply on equal sharing of risk of misjudgment shall adopt preponderance of evidence. For evaluating the torts of medical cosmetology, the burden of proof shall be assumed by the physician and the high level of preponderance of evidence shall apply on free evaluation of evidence through inner conviction. In case of regular medical treatment failure, the preponderance of evidence shall apply in consideration that the burden of proof shall be assumed by the patient, who are disadvantaged in evidence collection and such a fact meets the definition of the proviso of Article 277 of Law of Civil Procedures.

並列關鍵字

informed consent ； malpractice ； tort ； Cosmetology ； legalization ； Article 277 of Law of Civil Procedures ； evidence ； duty of care ； Daubert ； Medical Care Act ； Civil Law ； surgery

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