醫療民事責任體系再建構－以契約責任法理為中心－

Reconstruction of Civil Liability System for Medical Malpractice-A Focus on Contract Liability-

莊錦秀(Ching-Hsiu Chuang)

指導教授 ： 陳自強教授

國立臺灣大學/法律學院/法律學研究所/博士(2011年)

https://doi.org/10.6342/NTU.2011.00233

摘要

本文從向來不為人重視的醫療契約責任法理出發，嘗試重新建構醫療民事
責任體系，藉以調整醫療民事訴訟結果失衡現況。有鑑於本論文定位在以台灣本土醫療民事法律問題提出解決方法，從而，以醫療訴訟民事責任法實證分析為開端，整理歸納出目前醫療訴訟民事責任法實務運作上問題，再從目前民事責任法規範面探討「契約責任體系」與「侵權責任體系」二者，對醫療民事案件何者較利於患者權益保護，在這裡同時援引英德國比較法及目前台灣實務見解觀察，導出採契約責任體系較有利於患者權益保護。
接續著本文嘗試著重構醫療契約責任體系，從三方面著手，首先透過契約解釋原則將向來契約責任要件「故意或過失、可歸責」二元論調整為「契約義務違反為契約責任歸責事由的一元論」，降低「責任成立要件越多舉證風險愈高」；其次，將向來契約責任成立要件「因果關係去要件化」；再引入日本「契約拘束力」及法國「手段債務與結果債務類型區分理論」，拉出「私法自治契約自由原則=契約當事人意思原則=當事人契約拘束力=歸責事由內涵=當歸責事由具備時=契約義務違反=契約責任成立」思想軸心的適用空間，然而，這樣的適用空間，本文認為能適用在非強制醫療場域裡。
最後，本文所建構醫療契約責任體系異於傳統民事契約責任的特色有下列幾點：一，向來我國在民事責任成立要件，無論契約責任或侵權責任均採二元論，本文則認為至少在現行法規範下契約責任成立要件上，似乎是有解釋一元論空間。二，在引入法國手段債務與結果債務理論來處理醫療民事訴訟事件時，歸類為結果債務類型醫療契約義務群，在責任成立要件上是對原告較有利的。三，歸類某種系爭醫療契約義務性質究屬手段或結果債務類型，需回歸私法自治契約自由原則，探究當事人契約拘束力所及範圍，當契約當事人意思有對結果實現為承諾時，歸責事由嚴格化程度高，則解釋上會認定為結果債務類型，從而，手段債務與結果債務是相對性概念。四，在契約責任運用上，透過當事人契約拘束力，將契約利益（給付利益）放大，將損害賠償範圍放大。不過，如此思維，實踐面在結果債務類型似乎較為可行。

關鍵字

醫療民事責任 ； 契約拘束力 ； 契約責任 ； 手段債務 ； 結果債務 ； 因果關係 ； 舉證責任

並列摘要

This study is based on medical contract liability that has long been ignored in an attempt to build a new civil liability system and correct civil litigation results in medical malpractice. In light of the fact that this study sets its tone to provide Taiwan with a solution to its local civil actions for medical malpractice, it begins with empirical analysis of civil liability in medical malpractice lawsuits and identifies problems with the present system in the handling of medical malpractice cases. Then, this study explores whether the contract liability or the tort liability can help better protect the rights of patients in civil cases of medical malpractice from the perspective of today’s civil liability. Meanwhile, English and German comparative law is quoted in this study, along with practical insights and observation of contemporary practices in Taiwan. The conclusion is that contract liability works better in the protection of patient rights.
Continuing the attempt to reconstruct the medical contract liability, this study focuses on three aspects. First, it adjusts the dualism of “intended acts or negligence are attributable” which has always been an important element in contract liability to the monism that “breach of contract obligations comprises contract liability” through interpretation of the contract, and this reduces the risk in burden of proof associated with a large number of elements required for contract liability to sustain. Another long-standing prerequisite for contract liability to sustain is the element of causation which this study has removed. Finally, it introduces Japan’s contract binding force and the theory differentiating obligation of means and obligation of result from France, producing the scope of application with the central train of thought being “self-government contract freedom in private law = the doctrine of party autonomy = contract binding force on the parties = imputation of causes = imputation of causes established = breach of contract obligations = contract liability sustained.” However, this study holds that such scope of application can only be applied in non-mandatory medical settings.
Last but not least, the contract liability for medical malpractice constructed in the present study differs from the conventional civil contract liability in that: 1. In Taiwan, the prerequisites for civil liability to sustain have always been based on dualism for both contract liability and tort liability; however, this study finds that there may be room for monism under the existing regulations. 2. In the handling of civil litigations in the case of medical malpractice, obligation of result-oriented medical contract obligations are in favor of plaintiffs for prerequisites of liability to sustain compared to the obligation of means-oriented ones. 3. It requires reviewing the self-government contract freedom principle of the private law and the scope of contract binding force on the parties before determining whether a medical contract falls in the category of obligation of means or obligation of result. If the parties has committed to fulfillment of the results, imputation of causes is strict and hence the interpretation favors obligation of result. Therefore, obligation of means and obligation of result are relative concepts. 4. Contract binding force on the parties expands contract interests (payable ones) and the scope of compensation. Nevertheless, obligation of result seems more feasible in actual practice.

並列關鍵字

medical civil liability ； contract binding force ； contract liability ； obligation of means ； obligation of result ； causation ； burden of proof

參考文獻

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