精神科護理人員保證人地位之個案研究

The Status of the Psychiatric Nurse as a Guarantor in Taiwan: A Case Study

背景：精神科護理人員對住院的精神病人具保證人地位，負有應注意防範危害病人結果發生之義務，但國內精神科護理人員醫療過失中保證人地位之議題缺乏研究探討。目的：（1）確認精神科護理人員的保證人地位；（2）了解精神科護理人員保證人地位與「不作為」犯罪之關係；（3）了解案例中精神科護理人員犯罪事實的認定及爭議；及（4）探討案例中精神科護理人員被判決業務過失致死之原因。方法：採文獻探討與個案研究法，解析臺灣高等法院94年度上更（一）字第122號刑事判決案例。結果：（1）精神科護理人員同時具有「保護型之保證人地位」及「監督之保證人地位」二種功能類型。（2）本案護理人員保證人地位之來源有因自願承擔保護義務者、醫療契約、及因看管義務者三種。（3）本案之精神科護理人員具保證人地位，因未履行保證人義務之「不作為」，導致精神病人發生自殺死亡之實害結果發生，被依業務上之過失致人於死論罪。結論：精神科護理人員在工作中應正確認知自身具保證人地位之實質意涵和保護病患之角色義務以避免觸犯刑法。研究結果可協助精神科護理人員明瞭自身的法律角色與責任。

Background: Psychiatric nurses have a special obligation and legal duty as guarantor against criminal negligence. The guarantor role and medical negligence in psychiatric nursing are topics that have been neglected in Taiwan.Purpose: (1) Identify the status of psychiatric nurses as guarantors; (2) Understand the causal relationship in a legal context between this status and Non-Genuine Omission in the current case; (3) Understand the facts and the dispute in the current case. (4) Explore the reasons why the psychiatric nurse was convicted for criminal negligence in the current case.Methods: A literature review and case study were used to analyze the high court criminal judgment and sentence reconsideration of the first instance No. 122 (2005).Results: (1) Psychiatric nurses hold two guarantor roles in Taiwan. One role is as legally protected interest guarantor and the other is as supervisors' dangerous source guarantor. (2) The three sources of guarantor status relevant to the current case are: nurses' voluntary commitments; medical contract; duty of care of supervisors. (3) In this case, the psychiatric nurse did not discharge her obligations as guarantor and failed to prevent the patient from committing suicide. Negligence resulted in patient death and the psychiatric nurse was found guilty.Conclusion: In order to prevent criminal acts, psychiatric nurses should gain a better understanding of their status as guarantor and the obligations entailed in this status. This article is intended to assist psychiatric nurses understand their responsibilities under current laws.