論醫師保密義務之原則與例外－－一個擺盪於保障醫療人權與維護公共利益間的難題

Principles and Exceptions of Doctor-Patient Confidentiality - A Dilemma between the Human Right to Health Care and Protection of Public Interest

有鑒於醫病雙方於診療過程所產生之特殊信賴關係，早於古希臘醫者希波克拉底時代即已意識到：醫師有為其病患保密之必要；而此項傳承已久之醫學倫理原則，亦透過醫師法第23條、醫療法第72條，以及民、刑法上之相關規定，明確落實為一項醫師對病患所負擔之法律上義務。原則上，此項義務並非單純隨著病患死亡即告消滅；惟在某些例外情況下，醫師卻有揭露病患秘密資訊之必要，其中在我國現行之法令制度下，應特別進行探討者係：醫師若受到有關機關詢問或委託鑑定、抑或依法益權衡原則，是否即當然負有揭露病患秘密資訊之義務？此時往往涉及「醫師與病患」之內部信賴關係、以及「醫師與公共利益」之外部連動保護需求。如何在兩者間取得平衡，此乃本文所欲探討之焦點所在。

Given the special relationship that exists between doctors and patients in medical practice, Hippocrates, a physician of Ancient Greece, advocated doctors' obligations to protect patients' privacy from early on. This ethical principle is codified as the doctor's duty of confidentiality to his/her patients in Article 23 of the Physicians Act and Article 72 of the Medical Care Act, as well as in similar regulations in the Civil and Criminal Codes. In principle, the duty is owed even after a patient passes away. In certain exceptional cases, however, a doctor must violate the duty of confidentiality and disclose patients' privacy without their consent. There are controversial cases that need to be studied to inform our regulations. For example, when receiving an inquiry or being asked to disclose information by authorities, and when considering how such disclosure must be balanced with a patient's right to privacy, when does the doctor have the duty to disclose? On one hand, the relationship of trust between doctors and patients is essential to medical practice. On the other hand, a doctor's role in safeguarding the public interest involves a benefit to society as a whole. This paper addresses the question: How can a balance be achieved between doctors' professional relationship with patients and their broader relationship with society at large?