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篇名
鑑定於訴訟外醫療糾紛解決機制之必要性探討
並列篇名
An Exploratory Analysis on the Necessity of Expert Evidence in Alternative Dispute Resolution for Medical Disputes
作者 楊哲銘
中文摘要
醫療糾紛日益增加,在台灣由於醫療業務上的過失,同時會有刑事及民事上的責任,醫師因此選擇逃離高危險科別,也築起防禦醫療的高牆,因之社會各界一直努力希望建立醫療糾紛處理的特別法,加重訴訟外醫療糾紛解決機制的角色。衛生福利部自2012年開始「鼓勵醫療機構辦理生育事故爭議試辦計畫」,並於2014年擴大開辦「鼓勵醫療機構妥善處理手術及麻醉事故爭議事件試辦計畫」,以獎勵的方式鼓勵醫病雙方可以自行和解。試辦計畫強調審議過程不作有無過失之認定或鑑定,所以社會上浮現沒有真相何以補償的質疑。
現行試辦計畫形式上是就該醫療事故須機構與病人已經達成協議或和解,再由政府給予機構以一定經費之鼓勵,但須排除醫療事故明顯可完全歸責於機構或病方者,並把這樣的任務交由事故審議會審查,卻又強調審議過程不作有無過失之認定或鑑定。所以雖無鑑定之名,但有某種程度上的鑑定之實。
在醫療糾紛鑑定制度上,以行政機構參與的程度來說,有美國只是很低度的參與在調解或是仲裁上,有台灣的提供訴訟上的鑑定到訴訟外的准鑑定,到中國大陸不論在訴訟上或是訴訟外都提供鑑定。如果讓醫病雙方更容易使用具公信力的鑑定,是否會有利於訴訟外醫療糾紛解決機制的推廣,值得進一步的探討。
英文摘要
In Taiwan, physicians face with both civil and criminal liabilities for medical negligence. As medical disputes are increasing, physicians tend to practice defensive medicine and run away from high risk specialties. And Taiwanese society has tried to establish special laws for medical dispute resolution stressing the role of alternative dispute resolution. Taiwan’s Ministry of Health and Welfare (MOHW) started a pilot project encouraging the resolution of birth adverse events in health care institutions since 2012, and in 2014 expanded the scope to surgical and anesthetic adverse event disputes. MOHW offers incentives for both health care providers and patients and their families to reconcile by themselves. Due to the emphasis on not determining whether there is negligence by the pilot project, the general public has doubt about how we can compensate without truth.
The current pilot project in formality requires that the health care provider and the patient and his or her families have reached an agreement or settlement before the government can provide monetary awards. However, one of the exclusion criteria is that the adverse event is completely and obviously attributable to the health care provider’s or the patient’s fault. The task of determining eligibility is left with the adverse event review committee, but the project proclaims the review process does not assess whether there is negligence. It appears that there is no expert evidence in name but to some extent there is in reality.
In terms of the involvement of the administrative branch of government in medical dispute resolution, U.S. relevant authorities only have low degree participation in mediation and arbitration, Taiwanese government provides expert evidence in court proceedings and quasi expert evidence in miscellaneous administrative proceedings, and Mainland China provides expert evidence in all kinds of dispute resolution proceedings irrespective of public or private. Whether providing easily accessible and credible expert witnesses can promote the application of alternative dispute resolution to medical disputes is worth further exploration.
起訖頁 1-17
關鍵詞 醫療糾紛訴訟外糾紛解決機制醫療事故鑑定Medical DisputeAlternative Dispute ResolutionAdverse EventExpert Evidence
刊名 醫事法學  
期數 201506 (22:1期)
出版單位 中華民國醫事法律學會
DOI 10.3966/207976642015062201001  複製DOI
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