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  • 學位論文

刑事醫療過失客觀注意義務之標準與限縮——以病患自主權及醫師裁量權為核心

The Standard of Criminal Objective Duty of Care in Medical Practice and Its Appropriate Limitation: Focusing on Patient Autonomy and Medical Discretion

指導教授 : 甘添貴
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摘要


近年醫界出現四大皆空的現象,其原因之一係醫師為免訟累而出走至小科,各界逐漸出現檢討改革聲浪,於刑法界之討論核心即圍繞於「如何合理界定醫師之過失刑事責任」,此問題不僅涉及醫療行為之客觀注意義務標準,亦須討論在容許危險的理論下,應如何合理地限縮客觀注意義務。 本文先就「醫療行為之客觀注意義務標準」進行討論,首先對於醫療行為的定義,本文基於醫療行為傷害說而採廣義之見解──主觀或客觀要件成立其一者即為醫療行為;而在標準的討論上,則依現行實務、學說常採之三種標準──醫療常規、醫療準則、醫療水準,分別進行比較討論,並說明宜採醫療水準作為醫療行為之客觀注意義務標準之原因。 本文接下來係對醫療行為與容許危險之關係,區分病患自主權、醫師裁量權分別進行討論;在病患自主權的部分,強調告知說明義務為刑法上之義務,但於認定上應與醫療行為相為區分,並應留意該不當之告知說明行為是否確與病患所受之法益侵害間存有相當因果關係;其後則對於告知說明義務之內涵(如主體、客體、內容、方式、程度、例外)進行分析說明。 在醫師裁量權的部分,則分別探求美、日、德、中對於醫療過失以及醫師裁量權之態度,並列出我國學界對於醫師裁量權之意見,再從全國醫療刑事案件中選出我國較具代表性之五件案例,和前述資料進行比較法之分析討論,而發現我國實務對於醫師裁量權已有多則判決採取相當尊重之態度,最後則說明在醫師裁量權應採「值得尊重的少數原則」之理由。 希望藉由本文拋磚引玉,能對醫療刑事過失之討論有所助益,更希望在醫師裁量權此一議題能有更豐富之討論意見,因如能以正面確立方式,完整建立醫師裁量權之體系,即無須以負面排除之方式,將醫療行為限於重大過失或去刑化,對於刑法體系的衝擊應較低而便於推行,醫療行為亦會更有彈性而不會輕易入罪,醫師不會因害怕裁量而採防禦性醫療,對醫病雙方可為雙贏。

並列摘要


Because of increasing medical criminal lawsuits, Taiwan’s medical system is now facing the problem of manpower deficit. One of the major approaches to solve this problem is by defining doctors’ criminal negligence appropriately. To do so, it not only have to describe the standard of medical objective duty of care properly, but also have to set an appropriate limitation to the medical objective duty of care in the context of assumption risks. The first part of the thesis illustrates the standard of medical objective duty of care with the discussion of medical criminal act and the standard of duty of care in medical practice. Regarding the definition of medical criminal act, the author takes a more generalized stance. As for the standard of duty of care in medical practice, the “standard of care theory” is more applicable to current medical practice compared to medical customs and medical guidelines. Then this article probes into the connection of the assumption of risk and the medical act by exploring patient autonomy and medical discretion. From the patient’s aspect, patient autonomy emphasizes that informed consent should be regarded as one of the criminal obligation which must be distinguished from the duty of care in medical practices. The causality between informed consent and right infringement should be clarified, and the content of inform consent in criminal law would be further examined. From the health care provider’s aspect, “medical discretion” is a rather unclear concept. The perspective of comparative law offers valuable hints, and the discussions of medical discretion are presented with coverage of USA, Japan, Germany, China and Taiwan. Then by referring to five representative precedent cases in Taiwan, we can find that Taiwan’s court system has adopted the concept of medical discretion, and fairly respect doctor’s medical discretion. It is suggested that “respectable minority rule” be taken into criminal-law reasoning while examining whether a medical act falls within the range of medical discretion. The thesis further qualifies medical discretion in medical criminal negligence, and hopefully in the future there will be more discussions to replenish the concept of medical discretion. By affirming medical discretion in a positive way, there will be no longer need to restrict doctor’s liability by developing gross negligence or decriminalization. By warranting health care providers with medical discretion, they could focus more on individual patient’s well-being rather than on defensive medicine, and eventually it would bring win-win situation to heath care environment.

參考文獻


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