兩岸醫療糾紛侵權行為之法制比較研究

A Research of Legal System Comparison of Tort Regarding to Medical Malpractices in Mainland China and Taiwan

近年來，觀察中國大陸醫療糾紛之現況，包含法制化推動ADR，如：制定「人民調解法」、陸續推動強制醫療責任保險、開始實施公安機關民警即時介入、嘗試實施先住院後付費制度與廉潔文化進醫院活動等。本文認為由觀察中國大陸現行對醫療糾紛之因應舉措可作為臺灣之借鏡與參考。另外，針對舉證責任，考量醫療糾紛之專業性與證據可及性，由病人負擔有欠公允，而由醫療機構承擔亦恐面臨防禦性醫療與影響醫學發展，在兩難之下，中國大陸嘗試按不同情境加以類型化，區分為過錯責任原則、過錯推定原則、無過錯責任原則與醫療機構毋庸負責，此乃值得臺灣借鏡之重大嘗試。本文認為多元歸責體系未來有以下三點值得後續觀察：第一，過錯推定原則之範圍是否再擴張；第二，回歸過錯責任原則後，「侵權責任法」第61條所宣示之「……患者要求查閱、複製前款規定的病歷資料的，醫療機構應當提供。」是否有效落實而不被醫療機構規避責任，亦即病歷保全程度考驗過錯責任原則可否有效落實；第三，無過錯責任原則之解釋是否趨嚴，有待後續觀察司法實務見解。

Observing medical malpractices situation in mainland China recently, includes the following: applying a legalization way to promote ADR, such as the “People Mediation Law”, promoting compulsory medical liability insurance successively, implementing polices to intervene instantly, carrying out paying after to be hospitalized and probity culture in a hospital. Different ways how mainland China dealing with medical malpractices can be treated as lesson learning for Taiwan. Besides, in terms of burden of proof, considering medical malpractices’ high profession and evidence availability, it seems unfair to let patients carry the burden of proof. But, if medical institutions carry the burden of proof, defensive medicine might happen and influence medical development. Under this dilemma, mainland China tries to categorize burden of proof based on different situation. It’s differentiated into fault liability principle, the principle of presumption of fault, the principle of liability without fault, and medical institutions pay no responsibility and this major attempt deserves Taiwan to follow. This article attempts that there are three points regarding to multiple responsibility system deserves future observation. First, whether the scope of the principle of presumption of fault should be broaden or not. Second, according to article 61 of the “Tort Liability Law”, if patients require examining or copying medical records, medical institutions should provide. Whether the above is effectively implemented or not and medical institutions won’t evade responsibility. In other words, the level of medical records preservation tests whether fault liability principle can be effectively implemented. Third, whether explaining the principle of liability without fault will be harder or not, this relies on observing future judicial practices.