| 關 鍵 詞: |
道歉法;醫療事故;醫療爭議;修復式正義;實證;心理社會;道德情緒;真相;品質;補償 |
| 中文摘要: |
主動揭露錯誤並道歉的修復式正義思維與實踐,於 1990 年開始出現在英美法系國家的醫療糾紛解決模式,在某些實踐此政策的醫療機構中,呈現出醫療傷害訴訟風險與賠償給付不升反降的正向效果。我國自 2000 年迄今,行政院共提出 6 個醫療事故處理相關草案,並於 2022 年 5 月 30 日通過、同年 6 月 22 日公布「醫療事故預防與爭議處理法」。歷次草案及本次通過的版本包含道歉法規範條文,保障醫事人員道歉相關的言語行動表達,免於成為不利於醫事人員的訴訟證據。本文回顧各國道歉法規定、分析道歉行為及道歉法制種類、範圍與相關倫理意涵相關文獻,綜合道歉的心理社會與道德情緒效果、法律與經濟效果的實證分析,認為從論理及實證的觀點,在道歉法制保障下的真摯完整道歉能夠符合病人、家屬,甚至醫事人員的心理社會與道德情感需求,可達到修復式正義、矯正正義及應報正義的法律政策目的。真摯完整的道歉是處理醫療事故「必要但非充分」的條件,在建置完善配套措施底下,幫助病人及家屬獲知醫療事故真相,進而透過透明化的處理機制,從系統性的角度提升整體醫療品質。即便道歉法制用以降低訴訟風險或賠償給付成本的效果仍待商榷,完善道歉法制仍具有撫慰人心與降低對立的正當性基礎,值得我國採用。
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| 英文關鍵詞: |
Apology Law;Medical Incident;Medical Dispute;Restorative Justice;Empirical;Psychosocial;Moral Emotion;Truth;Quality;Compensation |
| 英文摘要: |
In 1990s, restorative justice ideas and practices that emphasize proactive disclosure of error and apology began to emerge in the medical disputes resolution procedures in common law countries. Some empirical data have shown that in the medical facilities that adopted these policies, medical malpractice litigation risk and damage payment cost, instead of increased, actually decreased. In Taiwan, the Executive Yuan have drafted six versions of bill to deal with issues related to medical incidents’ dispute resolution, prevention and compensation. Based on the latest version, the current Medical Incident Prevention and Dispute Management Act was passed in May 2022 and was announced on June 22, 2022. All the six versions incorporated apology law provisions that protect medical personnel’s apology expressions from being admissible as legal evidence. This paper first shortly reviewed apology laws in different countries, and analyzed literature related to the kinds, scopes, and ethical implications of apology and apology laws. Then, it integrated empirical evidence related to apology’s impact on people’s psychosocial and moral emotion and the medical malpractice litigation risk and compensation damage payment cost. Based on the doctrinal reasoning and empirical findings, the paper argued that under the protection of apology law, medical personnel’s sincere complete apology could fulfill the psychosocial and emotional needs of the patients and family members. To a certain extent, apology could achieve the policy goal of restorative justice, corrective justice and retributive justice. Sincere complete apology is a necessary but insufficient condition for establishing a good enough institution of medical dispute resolution. It is important to combine apology law with mechanisms to help patients and their family members learn the truth about medical incidents, to enhance health care quality and avoid similar medical incidents in the future. Even if it is uncertain whether apology law could diminish the malpractice litigation risk or the compensation payment cost, a well-designed apology law is still worth adoption based on its benefit to soothe people’s minds and attenuate opposition between the medical party and the patient party.
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| 目 次: |
壹、前言 貳、道歉法之立法趨勢 一、美國 (一)俄亥俄州 (二)亞利桑那州 二、澳大利亞 三、加拿大 四、英國 (一)英格蘭與威爾斯 (二)蘇格蘭 五、愛爾蘭 六、香港 七、我國 八、小結 參、醫療傷害處理法制之正義論述 一、傳統醫療傷害處理法律政策之正義論述 二、醫療傷害處理法制、修復式正義與道歉 三、本文見解 肆、道歉之型態與心理社會效果 一、道歉的型態與成分 (一)心理學家 Alfred Allan 的觀點 (二)社會科學學者 Aaron Lazare 的觀點 (三)哲學家 Nick Smith 的觀點 二、道歉的心理與社會效果 三、本文見解 伍、對道歉法制之正反意見:以美國為例 一、對於道歉法制的贊成意見 二、對於道歉法制的反對意見 三、本文見解 陸、道歉法的東亞文化考量及我國相關法制與實證資料 一、道歉法的東亞文化考量 (一)日本 (二)韓國 (三)中國 (四)我國 二、我國道歉相關法制 (一)事實發生到進入訴訟程序前 (二)訴訟程序進行中 (三)裁判做成後 三、我國社會大眾對於醫療傷害訴訟政策與道歉的態度 柒、我國道歉法制之省思 一、國外道歉法制與國內外實證研究帶給我們的省思 二、簡析現行醫療事故預防與爭議處理法之道歉法制 (一)道歉法制的規範主體 (二)道歉法制的規範客體 (三)道歉法制的情境限制 (四)道歉法制的法律效果 (五)道歉法制的配套措施 捌、結論
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