病患自主權與醫師說明義務之研究─以倫理學與法學觀點探討

Patients' Autonomy and Doctors' Duty of Disclosure - From the Viewpoint of Ethic and Law

蔡智勛(Chih-Hsun Tsai)

指導教授 ： 劉幸義

國立臺北大學/法律學院/法律學系/碩士(2008年)

摘要

從傳統醫病關係模式之醫學倫理思維來看，醫師對於病患並沒有所謂說明之義務。因為在當時傳統的醫療倫理中，醫師具有倫理上之權威性，以及專業知識之權威性，使病患淪為醫療行為客體，完全沒有要求醫師詳細說明病情之權利，因而呈現父權主義式的醫師本位醫療模式。

而歷經近代社會對於人性尊嚴之重視、醫療人權運動之興起以及醫學科技之進步，造成傳統醫學倫理不僅受到前所未有之挑戰，也逐漸開始邁向變革之方向。從新醫學倫理四大原則之提出，尤其是尊重病患自主原則之概念，使得病患自主之理念在醫學倫理上逐漸覺醒與受到重視。而為了使尊重自主原則徹底落實，以保障病患自主權之實現，尊重自主原則逐漸發展出醫師應遵守之各種具體之道德義務，其中又以「告知後同意」原則最為重要。「告知後同意」原則之精神後來不但逐漸發展成為我國醫師倫理規範，並逐漸強化成為我國在相關醫療法規上，醫師對於病患所應負擔之說明義務。

為了貫徹落實病患自主權的目標，醫師具體道德義務中的告知後同意原則，強化成為法律上之醫師說明義務。而司法實務藉目前對於病患自主權與醫師說明義務最重要之判決，就是最高法院94年度台上字第2676號判決，判決中確定了醫師說明義務範圍以及例外規定，堪稱我國醫病關係中往前邁步之重要判決。

而從近幾年醫療糾紛之案例，我們可以發現台灣的醫病關係不良，原因之ㄧ就在於醫師沒有徹底落實說明義務，才會導致許多應可避免之醫療糾紛，雖然醫師說明義務理論目前正在逐漸發展形成，但是也面臨許多理論上之難題。以致於病患自主權理論與現實仍有差距。尤其目前科層化之醫療機構體制，帶給病患不溫暖且非人性化之感受，也使得醫學倫理所強調的病患自主理念淪為空談，而我國目前病患自主權與醫師說明義務之法制不完備，也正是全體民眾需要共同研究與努力之課題。

關鍵字

病患自主權 ； 告知後同意 ； 醫師說明義務

並列摘要

Viewing from medical morality of the traditional medicine mold, doctors do not have what so-called the“Explanation Duty”to patients. For the conventional medical morality at that time, doctors had authoritativeness either in morality or in expertise that made patients descend to objects of the medical behavior. There was entirely no right for the patient to request doctors to expound his condition, thus, the patriarchal medical mode based on doctors’ base emerged.
The traditional medical morality is not only challenged, but also gradually turning to reformations after going through the value of modern society to human dignity, the rise of the movement of medical human rights, and the advance of medical science. The presentation of four major principles of the new medical morality, especially the conception to respect patients’ autonomic principle, makes the medical morality become more and more awakening and highly regarded. To implement thoroughly the principle of respect and autonomy, to fulfill and protect patients'autonomy, and to respect the autonomic principle, various specific moralities and obligations are gradually involved into a norm for doctors to comply with; among which, the most important thing is the principle of “Consent is succeeded by advice”, which is not only involving into doctors’moral standard here in Taiwan, but also enhancing, step by step, the interpreted duty that doctors shall be responsible to patients in accordance with the provision of our medical statute.
To implement the target of patients’autonomy, the principle of “Consent is succeeded by advice”in doctors'concrete moral duty is intensified as a legal obligation for doctor to illustrate patients’conditions. In currently judicial practices, the most important judgment given by the Supreme Court (No.94-Shang-Tsi-Di -2676) in respect of the patient autonomy and doctor’s explanatory duty is definitely ensuring the scope of doctors’explanatory duty and the exceptional stipulation, the sentence of which may be ranked as the significant step to walk forward in terms of medical relationship in our country.
From the cases of medical dispute in recent years, we may find the poor medical relation here in Taiwan is caused by doctors having no duty to explain patient's condition. Although it is one of the reasons, it still leads to a lot of medical disputes that originally can be avoided. Regardless of the theory of doctor's explanatory duty being evolving, we are still facing so many difficulties in respect of the theory that makes patient's autonomic theory having a distance from the reality. The current bureaucratization of medical mechanism brings neither warm nor humanized perception to patients that make patient’s autonomic philosophy which emphasized by medical morality become hollow words. The incomplete legal institution of patient’s autonomy and doctor's explanatory duty is also subjects that all of us have to jointly research and work out.

並列關鍵字

informed consent

參考文獻

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