台灣醫療糾紛20年的實證研究

Empirical Study of 20-Year Medical Malpractice in Taiwan

科學之所以能夠不斷進步，根植於提出實證資料加以驗證假說。反觀法律作 為一門社會科學，過去在學界卻偏向於學說與理論的引介，即使擴及實際案例的 討論，往往擇以單一或少數判決評析為主，甚少採用系統性的方式，進行大量案 例的實證研究。相形之下，其他類同之經濟、社會、政治等學科，則紛紛從事實 證調查而有為數可觀之研究成果。有感於此，苦心思索如何找出辦法迎頭趕上， 幸蒙衛生福利部、國家衛生研究院與科技部等單位鼎力相助，而今得以在醫療糾 紛開啟全方位之實證研究。 本研究團隊乃以定量研究作為實證法學的研究基礎，涵蓋內容跨越十多年的 全國性醫師問卷調查、二十年醫事審議委員會完整的醫療糾紛鑑定報告書，以及 近十年的全國各級法院醫療糾紛判決書。從中不乏累積了許多全國性、長時間的 珍貴資料，可供成為後續研究之重要素材。文末並從實證經驗提出反思，醫療行 為既屬國民健康賴以確保之重大公益，也兼具無法完全預測結果之特性，見諸醫 學本質的不確定性、生物體本身的多樣性、疾病的自然病史，以及醫療預後所不 可避免者，未符合病方期待的治療效果，評價上可解為法所容許之危險。反映在 醫療過失歸責之操作課題，醫療事故之因果流程錯綜複雜，事案解明本有其窒礙 之處，難由私人保險概括承擔危險責任。再加上舉證不易，訴訟過程必然費時曠 日，一端對原告病方之援助緩不濟急，另一端將對被訴醫方之聲譽影響甚鉅。遇 有針鋒相對、鑽牛角尖、充滿情緒的醫療爭議案件，則不妨採行「多元雙向解決 機制」，尋求更為多元的角度、寬廣的視野，乃至溫暖的心胸進行善後處置，互 勉彼此為維繫醫病關係而共同努力，以和為貴。

The reason why the science can keep developing is because the empirical data were purposed and the hypotheses were verified in the past. However, the law, considered as a social science, became the introduction of doctrines and theories in the academic circles for the past years. Even though the actual cases were widely discussed, decisions are always made on the basis of single or minority judgement. It is very rare that the systematic methods are used in a great number of cases in the empirical study. By contrast, other subjects, including economics, society, and politics, etc., conducted the empirical surveys, with a great amount of study results. For this reason, we’ve tried our best to find a way to catch up with them. Nowadays, thanks to the aid of Ministry of Health and Welfare, National Health Research Institutes, Ministry of Science and Technology and other organizations, we are able to conduct versatile empirical study in medical malpractice claim. The quantitative research method is used as the study basis of legal positivism in this study. The source of our study includes doctor’s questionnaires made for over 10 years in Taiwan, complete assessment reports of medical malpractice claim made by Medical Review Committee for 20 years, as well as the nationwide verdicts in the recent 10 years, including a great deal of nationwide long-term data that can be the important sources for future studies. In the end of study, the introspection is proposed on the basis of empirical experience. The medical treatment is a part of essential public interest of the health of people, and the result is completely unpredictable. Therefore, the treatment result doesn’t meet the expectations of patients and can be considered as the law-permitted danger. As for the medical malpractice, it is difficult to use private insurance for risk liability because the causation of medical accidents is extremely complicated, and the difficulties always happen when we try to make the case clearer. In addition, it is very hard to constitute proofs. For this reason, it is going to take more time for lawsuit, resulting in the aid for plaintiff failing to reflect the emergency and the worsened reputation of accused doctor. When having medical malpractice cases that are tit-for-tat, paranoid or appeal to emotion, you might as well use Diversified and Two-way Settlement Mechanism to include multiple perspectives, wider visions and kindness for the postarrangement. The last but not the least, we shall encourage each other to strive for the best doctor-patient relationship and the social harmony.