法學期刊.
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論著名稱: 醫療事故民事責任之過失判定(Determination of Negligence in Medical Malpractice Civil Litigation)
編著譯者: 陳聰富
出版日期: 2012.06
刊登出處: 台灣/政大法學評論第 127 期 /349-412 頁
頁  數: 42 點閱次數: 2377
下載點數: 168 點 銷售明細: 權利金查詢 變更售價
授 權 者: 陳聰富
關 鍵 詞: 醫療事故醫療常規醫療慣例醫療鑑定醫療準則理性醫師注意標準漢德公式專門職業人員侵權過失責任
中文摘要: 侵權行為法採取過失責任主義,必須加害人具有過失,始需負擔損害賠償責任。關於醫療事故,由於醫療行為涉及高度專業性、實驗性與不確定性,無論國內外之法院實務上,均發展出醫療常规的注意標準。然而,醫療常規係指普通一般醫師所依循的醫療行為模式,而非理性醫師應為之醫療行為。採取醫療常規之醫療標準,無疑降低醫師應有之注意義務。
日本法上所謂醫療水準之判斷標準,並非固定不變的一致標準,而應相應於個案,探討醫師之診療、檢查是否符合診療當時,可合理期待之醫療方法。在概念上,亦屬斟酌病患之風險與利益的衡量標準,與理性醫師之標準並無不同。
醫學界使用之醫療準則,僅為一般共同治療方式之規範,無法針對個別案件予以規定。醫療行為本身是一種技術,也是一種藝術,無法以抽象共通的醫療準則,作為唯一的判斷標準。
本文認為,關於醫師之醫療行為是否具有過失,應適用理性醫師的注意標準,由法院依據醫療慣例(醫療常規)、鑑定意見、醫療準則之规範等,考察個別病人之特殊情狀,斟酌系爭案件的病人病情、某項診斷治療行為之風險、對於病人未為診斷治療所生之損害大小、損害發生之機率、醫師為病人進行某項診斷治療可能花費之成本,及病人本身之經濟負擔,予以綜合判斷之。
英文關鍵詞: Medical MalpracticeMedical CustomsMedical Review OpinionMedical GuidelinesReasonable Physician’s Standard of CareLearned Hand FormulaProfessionalsNegligence in Torts
英文摘要: Defendants' negligence is required for tort liability under tort law. In medical malpractice suits, many courts around the world create medical customs to be the standard of care for physicians in a tort litigation instead of the reasonable person of the standard of care due to the high uncertainty of the outcome of medical treatments and their experimental nature. The standard of medical customs is lower than that of reasonable person since it endows physicians with more privileges than ordinary defendants.
The so-called "medical level" standard prevalent in Japanese medical law is not a concrete standard of care; it is nothing more than a standard of care that takes into account whether a physician's diagnosis and treatment meets the anticipated medical standard. In theory, this standard is similar to that of a reasonable person, considering the risk and benefits of the treatments offered to patients.
As far as the medical guidelines are concerned, although they are often followed by physicians in their practice, the guidelines are general rules, which are not specifically designed to be enforced in an individual patient's case. These medical guidelines may not be construed to be a unique standard of care since medical treatments are not only techniques but also arts.
This study argues that it should depend upon the standard of reasonable physician when determining the negligence of a doctor, while medical customs, medical review opinions, and medical guidelines are deemed relevant criteria only in so far as to determine the standard of reasonable physician. The standard of reasonable physician is equivalent to that of reasonable person with the specific taking into consideration of medical professionals. The standard of care under a reasonable physician should consider multiple factors such as an individual patient's special circumstances, the risks of treatments, the potential losses, the possibilities of occurrence of risks, the cost of treatments, and the patient's financial burdens.
目  次: 壹、序言
貳、兩則法院判決
一、臺灣板橋地方法院九十五年度醫字第二號民事判決(院內感染案)
二、最高法院九十七年度臺上字第一○○○號民事判決(骨質疏鬆案)
三、法律爭議
參、醫療慣例(醫療常規)與理性醫師的注意標準
一、英美法上醫療慣例或醫療常規之意涵
二、我國法院實務見解
三、對醫療慣例之質疑
(一)醫療慣例是否存在?
(二)醫療慣例是否符合病患利益?
四、外國法院實務發展
(一)美國法
(二)英國法
(三)日本法
五、小結
肆、醫療水準與理性醫師的注意標準
一、醫療水準說之源起
二、醫療水準與醫療慣例
伍、醫療準則與醫療鑑定意見
一、醫療準則與醫師注意義務
二、醫療鑑定意見與法院之判斷
三、小結
陸、醫療過失責任之判斷
一、專業人員之過失概念
二、理性醫師的標準
柒、結語
一、醫療過失之判定
二、本文前揭案例評述
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