論「不證自明原則」暨「表見證明」於我國醫療民事訴訟之適用性

Presumptions in Medical Malpractice Law: Res Ipsa Loquitur and Anscheinsbeweis

醫療糾紛訴訟之本身型態別具一格，如何分配當事人之舉證責任以落實武器平等原則，迄今尚無清楚之操作指引可資依循。為此，本文借鑑外國實務之相關經驗，討論主軸置於英美法上之不證自明原則、德國法上之表見證明法則，從中解析各別之適用要件與法律效果，比較兩者在醫療訴訟上付諸實踐的可能性。經審視評估結果，文末思考擇以不證自明之三階理論作為基礎架構，並參酌本國醫療訴訟之運作特性，進一步建構出醫療過失舉證分配之操作模式，據以合理分派當事人舉證活動之危險負擔，設法解決民事訴訟法第277條但書規定之適用難題。依本文所見，醫療機構組織責任之涉訟案件較易通過三階檢驗，尤以排他性控制力、欠缺外在原因力兩者之表現最顯突出，堪稱為醫療訴訟上不證自明之適用典型。

Litigation for medical malpractice is a distinctive legal action. So far there has been no clear operation guidelines on how to distribute litigants’ burden of proof so as to carry out the principle of equality of arms. With reference to actual practices in other countries, this article discusses the main ideas of ＂Res Ipsa Loquitur＂ and ＂Anscheinsbeweis＂, analyzes the elements and legal effects of the two principles, and compares the possibility of putting them into practice on medical malpractice cases. After the review and assessment of the results, three-stratum theory of Res Ipsa Loquitur is applied as the fundamental structure. Then referring to the characteristics of conducting domestic medical malpractice lawsuits, we further construct the model of distributing the burden of proof in medical malpractice in order to reasonably allocate the risks born by litigants when providing evidences. It is aimed to solve the difficulties in application of the proviso of Article 277 of Civil Procedure Code. This research found that the organizational liabilities of hospitals involved in lawsuits tend to pass the three-stratum test easily, especially the performances of exclusive control of instrumentality causing injury and absence of voluntary action on the part of plaintiff are the most outstanding. The finding of this article can serve as a paradigm of applying Res Ipsa Loquitur on medical malpractice cases.