醫療機構之民事責任

林幸怡

doi:10.6342/NTU.2010.03507

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醫療機構之民事責任

Civil Liability of Medical Institution

林幸怡 , Masters　　Advisor：陳聰富　　

繁體中文 DOI： 10.6342/NTU.2010.03507

醫療機構；僱用人責任；組織責任；法人侵權；民法第二十八條；民法第一八八條；民法第二二四條； Medical institution ； Corporate liability ； Vicarious liability ； Civil Code Article 188 ； Civil Code Article 28 ； Civil Code Article 224

Abstract │ Reference (135) │ Times Cited (7) │ Altmetrics

Abstract 〈TOP〉

隨著社會的變遷，近年來，醫療糾紛成為我國醫、法二界共同關注的焦點。觀察目前醫療糾紛之發展，可以發現各界多將爭論重點集中於第一線醫療人員，扮演醫療服務提供核心角色的醫療機構卻在眾多案件中隱而未現。但在許多情況，問題的根源毋寧在於醫療機構之本身，因此實有對醫療機構民事責任加以深入探討之必要。

本文從英美法之比較發覺，不論在僱用人之代負責任亦或組織責任上，其實務與學說見解都深受法政策之影響，意即其乃受到醫療機構地位轉變之影響應運而生的責任體系。在代負責任之部分，醫療機構的責任係從無到有，從嚴格到寬泛之進程，然而因為代負責任有受僱人成立侵權行為之前提要件，因此無法全盤解決醫療實務上所面臨的問題，司法實務遂以醫療機構為主體，課與其組織責任，以填補其法體系之不足，並藉此而力求達成正確填補損害以及預防未來損害、創建安全醫療系統之目標。

而後本文回到我國司法體系，觀察醫療機構責任架構，並分就僱用人責任、組織責任、契約責任以及消費者保護法責任進行探討。本文認為，於我國民事法體系下，無論是僱用人責任、依民法第二十八條成立之法人侵權責任亦或依民法第二二四條成立之契約責任，皆須以自然人之故意過失為前提始能要求醫療機構負責，然而觀察目前之醫療糾紛，許多醫療事故之產生實係出自於系統性之錯誤而非個人性之錯誤，此時若係因原告無法找到故意過失之自然人，即將不幸之苦果交由被害人承擔，毋寧是一種不當的責任分配方式。再者，由於民事責任成立之前提係自然人之故意過失，因此有時法院在別無選擇的狀態下，為轉移被害人之損害，亦會不當的課與不應承擔責任之醫療機構人員或代表人民事責任，藉此與醫療機構責任勾稽，此種作法實為飲鴆止渴，不得其利反生其害。

為解決醫療糾紛在現今民事法體系下之困境，本文參酌外國立法例及學說認為，僅管法人在真實世界中僅管無法實際「自為行為」，然而外國立法例與學說毋寧是將法人機構上所呈現出來之「組織狀態」擬制為法人之行為，就此，關於目前學說實務認為法人無法直接該當侵權行為之疑慮即可解決。蓋法人本來即為法律之創造物，與一般民事法體系本有扞格，因此重點並非法人可否為自為行為，而是如何找出一套可行之責任歸屬理論以解決民事責任法之需求。本文認為，在吾人肯認醫療機構組織責任建立之必要時，本文所提出之責任歸屬模式應可作為解釋適用之依據，而此種責任係因法人之組織狀態而來，因此稱之為組織責任。在確認醫療機構可以自為行為而直接成立侵權責任後，本文分就提供安全設備場所之義務、檢驗結果通知義務、應召會診之義務、完善人力配置之義務、管控院內感染之義務以及建立整體安全系統之義務等面向加以說明，批判我國目前司法實務見解之不足，並以醫療機構組織責任之觀點出發來建構不同的論理方式。而就契約責任之部分，本文認為法人侵權責任之突破亦同樣可運用於契約責任上，意即穿透以自然人故意過失為歸責前提之窠臼，直接以醫療機構為主體來論斷契約責任。而後本文特別以組織管理之概念來探討醫療機構之主給付義務、從給付義務及附隨義務之義務內容。

此外，本文認為消保法之無過失責任並不可採，而藉由組織責任之提出，可以達成提倡消保責任者所欲達成之目的，亦不會使醫療機構背負過重之責任，應係一種務實之責任類型。

本篇論文之提出，最主要係要解決目前醫療糾紛實務上所遇到的困境，而藉由僱用人責任之重新梳理、組織責任之之全面建立與契約責任之再構築，相信將可解決目前醫療實務許多問題。最後，本論文由衷希望，經由本篇論文所提出來的觀點，能適度緩解目前過度緊繃的醫病關係，創立更為安全之醫療環境。

Parallel Abstract 〈TOP〉

With the rapid change of social development, the role of medical institutions as health-care providers has evolved significantly over the past decades. Many studies found that today’s medical institutions are directly implicating in most of harmful medical errors; however, medical malpractice litigations and its doctrinal substructure are still heavily oriented toward holding individuals liable for medical injuries, and doctrines that contemplate the role of organizations still gain little attention. In order to conform the increased role of medical institutions, Taiwan’s legal system needs to figure out civil liability of theabovementioned as central providers of health care.
　In American and British laws, hospital can be held liable under either of two theories, vicarious liability and corporate liability, which were both heavily affected by the changing status of hospitals. Vicarious liability is based on Respondeat Superior whereby the hospital’s liability is answerable for those torts committed by its employees; therefore, it cannot solve the disputes creating from the fault of organization. Thus, there is no negligence of individual members. Anglo-American law creates “corporate liability” to deal with organizational or system failures, thus improving patient safety to fill this gap in medical malpractice,
　Taiwan’s legal system lacks similar concepts to solve the same problems. No matter Civil Code Article 188, Article 28 or Article 244, they all focus on negligence of nature person, and ignore the importance of medical institutions. 
　To deal with medical malpractice, the author believes that the most important question is what kind of view better serves justice. The doctrine of corporate liability imposes upon medical institution an independent, affirmative, and non-delegable duty to provide quality medical care. Therefore, an injured party does not have to rely on and establish the negligence of a third party. Thus, the plaintiffs do not need to find out the wrongdoers except the medical institution itself; namely, the imposition of corporate liability provides an easier source of compensation for the injured compliant. Furthermore, the threat of corporate liability is a useful and positive tool that gives medical institutions great incentives for self-monitoring and diligent, careful operation. After embracing the doctrine of corporate liability, the author discusses different duties of medical institution and breach of these duties. In addition,, the author also borrows this tort concept to apply to contract liability of medical institutions, thus establishing comprehensive protection of patient safety. 
　The current conflicts between patients and doctors have led to a rethinking of the relations between Taiwan’s health care and civil justice systems. This is the time to renovate our system of liability to design it better suit a new world dominated by medical institutions. The “corporate liability” model the author has introduced and developed is precisely constructed for this purpose.

Reference ( 135 ) 〈TOP〉

2.朱柏松（1986），＜民法第二十八條法人賠償責任之探討＞，《臺大法學論叢特刊－七十四年度民商事裁判研究專輯》，頁19-68。
連結：
3.朱柏松（1998），＜適用消保法論斷醫師之責任＞，《臺大法學論叢》，第27卷4期，頁3-72。
連結：
17.陳忠五（2005），＜產前遺傳診斷失誤的損害賠償責任＞，《台大法學論叢》，第34卷第6期，頁107-260。
連結：
25.黃立（1997），＜消費者保護法對醫療行為的適用＞，《律師雜誌》，第217期，頁70-84。
連結：
33.詹森林（2007），＜德國醫療過失舉證責任之研究＞，《台北大學法學論叢》，第63期，頁47-80。
連結：

Times Cited (7) 〈TOP〉

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