民刑事因果關係於訴訟證明之科學依據研究——以醫療事故案件為核心

A Study on the Legal Causation in the Contemporary Scientific World: Focusing on Medical Malpractices

關正闓(Cheng-Kai Kuan)

指導教授 ： 陳聰富

共同指導教授 ： 陳志龍

國立臺灣大學/法律學院/法律學研究所/碩士(2012年)

https://doi.org/10.6342/NTU.2012.01762

摘要

因果關係，素為法學中最難以理解掌握的概念之一。在醫療事故、公害、藥害、食品安全等牽涉「科學不確定性」與「複雜因果關係型態」的新型態案件中，因果關係之存否，常成為事實認定上最棘手的難題，民刑事訴訟皆然。本文認為，這種難題須透過兩種途徑解決，一是傳統上因果關係概念的重新理清，一是因應新型態案件而就法學因果關係的概念與證明活動，運用某些調整與修正的策略。論述的同時，亦須時時觀照民事法系統和刑事法系統的差異，始能讓因果難題的妥善解決成為可能。

本文擬先分析科學發展所帶出的獨特因果難題，以實務之醫療事故判決為核心，考察這些因果難題的具體面貌，並交待「不確定性」和「複雜因果關係型態」二要素對處理因果問題時有何影響，以及因果要件在訴訟證明上之現有缺陷。其次，本文將從哲學、科學和法學的觀點，重新分析過往關於因果關係之概念、理論與實務判決，分別就「事實經驗的因果關係概念」和「法律責任的因果關係概念」，選擇出最優越與最適切的理解方式。

其次，本文將從「民事法系統」與「刑事法系統」角度，分別探討關於因果關係的修正策略或限制這些調整的既有誡命。於民事，本文將論述「存活機會喪失理論」、「比例責任理論」和「概然性因果關係理論」等三種基進程度由低至高的觀點，以及當代物理科學發展對法學因果關係概念的衝擊，並主張應仍採取決定論式的因果觀點。於刑事，本文則論述「無罪推定原則」、「罪疑唯有利被告原則」於因果關係要件判斷上扮演何種角色，「流行病學因果關係」的可行與否，以及相當程度主宰我國法院認定的「醫療糾紛鑑定制度」之影響與缺陷。

最後將歸納簡單的重點，希冀作為我國實務判決或學界先進之參考。

關鍵字

因果關係 ； 醫療事故 ； 科學不確定性 ； 複雜因果關係型態 ； 抽象因果關係 ； 個案因果關係 ； ＮＥＳＳ理論 ； 存活機會喪失理論 ； 比例責任理論 ； 概然性因果關係理論 ； 罪疑唯有利被告原則 ； 流行病學因果關係 ； 醫療鑑定制度

並列摘要

Legal causation has always been one of the most difficult parts of the law. In a specific case whether there is a causal connection between two events is often hard to decide for the fact finder, especially in cases involving scientific uncertainty and complicated forms of causation it would become an extraordinary challenge. This thesis is meant to find solutions for the causal problems our courts met in those modern-typed cases, which could be represented by medical malpractices. The causal problems should be solved by two approaches, one is to clarify the traditional concepts of legal causation, and the other is to adjust those concepts properly to better fit into the hard cases. While considering new strategies to solve causal problems, we could see more vividly the differences between civil and criminal law system and how such differences influence the understanding of legal causation.

At first, this thesis is going to look at the unique problems brought by development of modern technology, and illustrate the influences of scientific uncertainty and several complicated forms of causation by showing a series of medical cases. After that there is a thorough analysis of concept of causation per se from philosophical, scientific and legal aspects, introducing and comparing the causal theories and judgments which played significant roles within the development of legal systems. To be able to make a more accurate analysis, this thesis differentiates three issues about causation in the law: the actual (empirical) causation, the responsible causation and the proof of causation. At the end of this part, the author would suggest which of these causal theories could best serve our purpose as the best understanding of causation in the law.

In chapter 4 and 5, the thesis discusses different adjustments of the element of causation in civil and criminal law systems. In civil law systems, the thesis mainly focuses on three relatively new causal theories: the loss-of-chance theory, the proportional liability theory and the claim of probabilistic theory. In addition, the thesis would introduce a famous debate between Determinism and Indeterminism in modern physics as well as its impact on the legal area. In criminal law systems, the author studies “Unschuldsvermutung” principle and “Der Grundsatz in dubio pro reo” principle underlying our whole criminal justice system, and how the two imperatives set a limit on any modifications or adjustments that might be disadvantageous for defendants. Then the thesis is going to examine the claim of Epidemioloic causation, and the current medical identification system, which often dominates the medical malpractices cases regardless of civil or criminal one.

The last chapter is the conclusion.

並列關鍵字

causation ； medical malpractices ； scientific uncertainty ； complicated forms of causation ； abstract causation ； personal causation ； NESS theory ； Loss-of-chance theory ； proportional liability theory ； probabilistic causation ； Der Grundsatz in dubio pro reo ； Epidemiologic causation ； medical identification system

參考文獻

李小芬，「醫療民事責任因果關係之研究」，國立台灣大學法律研究所碩士論文，２００８年。

陳琬渝，「論強制醫療責任保險—從立法的觀點評析強制醫療責任保險法草案」

顏厥安，〈道德、政治與法律—由對現代性法學之觀察反思緊急命令體制〉，臺大法學論叢，第３０卷第６期，２００１年１１月。

陳聰富，〈消保法有關服務責任之規定在實務上之適用與評析〉，台大法學論叢，第３１卷第１期，２００１年１月。

林萍章，〈海峽兩岸醫療訴訟實證研究：從最高法院刑事判決九十九年度台上字第二四八號與民事判決九十八年度台上字第六五六號出發〉，發表於「臺北醫法論壇（IV）實務判決與實證研究」研討會，２０１０年１１月２０日。