告知同意倫理及法律之反思

Introspection on Moral Correlation between Patients' Prior Consent and Law Aspect

告知同意，不僅係醫學倫理尊重自主原則之內涵，更係法律賦予醫師之義務。既為法律上義務，即須明確。然台灣告知同意之內容，係多元呈現在法規及司法審判見解上，造成實務上運用之困難。
本文將介紹告知義務發源地之美國，美國在告知同意之法制，係先有先有倫理上反思，後再形成法律規範。表現在司法實務上，美國係從侵權行為之角度出發；對於告知內容之認定標準，兼採理性醫師模式及理性病人模式；且將告知內容擴大並細緻化。反觀，台灣係因醫療糾紛及法律規定，開始繼受告知同意之法則，藉由法律義務推動倫理改革。表現在司法實務上，違反告知義務，構成侵權行為及債務不履行；對於告知內容之認定標準，採取理性病人模式；且將告知內容擴大並細緻化。
本文藉由介紹英美關於告知同意之倫理規定及美國之法制及司法實務見解，以期對台灣在告知同意之倫理、法律規範及實務，有所助益。

Informed consent is not only the connotation of the principle of respect for autonomy, but also the physician’s obligation in laws. Since legal obligation, it should be clear. However, informed consent appears diversely in laws and judicial trials in Taiwan ,it results in the difficulties of practical use.
This article will introduce the obligation birthplace—the United States of America. Informed consent in the USA first exists ethical reflection, then form legal norms. In judicial practice, it’s from tort, adopting both the rational physician mode and rational patient mode above the identified standards of informed consent. Besides, it expands and refines the informed content. On the other hand, due to medical malpractice and legal requirements, Taiwan follows the rules of informed consent, promotes ethics reform by legal obligation. In judicial practice, the breach oh informed obligation constitutes infringement and default. It takes rational patient mode above the identified standards of informed consent, and it expands and refines the informed content.
This paper will introduce the ethics of informed consent in the USA , UK and American legal system and judicial practice insights to help Taiwan’s ethics, legal norms and practice above informed consent.