醫療風險理論概論

Introduction of the Medical Risk Theory

醫療風險理論的重點在於只有可避免性（Avoidability）的醫療結果才是醫療事故，如壽終正寢（Natural Death）或疾病使然（Natural Course）就不在討論範圍之內；其次，自結果預知可能性（Predicability）及結果迴避可能性（Preventability） ， 我們可以把醫療事故（ Medical Incident ） 區分為醫療過失（ MedicalNegligence）、醫療不幸（Medical Mishaps）或醫療意外（Medical Accident）三種，其中沒有結果迴避可能性的醫療意外及醫療不幸合稱為「醫療風險」。實務上自許多醫療爭議調解的案例可以發現，臨床上爭議最多的都是醫療風險的案件，醫師自認已盡全力診療，但礙於疾病本身的風險，病人發生傷亡後果或不良反應，根本不是醫師能力範圍所及，而病患人傷體亡，家屬亦無法接受這種後果，各說各話自然爭端迭起，紛爭不絕。結論一是醫療糾紛，醫師不一定有過失：一、廣義的醫療糾紛，醫師沒有過失。二、非醫療事故的醫療糾紛，醫師更沒有過失。三、誤診及手術失敗是醫療風險，即醫療不幸，醫師並沒有過失。四、醫療風險為可容許危險，醫師當然沒有過失。結論二是自醫療風險理論建立醫法民三方共同語言。目前的醫療爭議調解，其實爭議最多的是在於醫療風險的案件，醫師自認已盡全力，但礙於疾病本身的風險，病人發生傷亡後果或不良反應，根本不是醫師能力範圍所及，而病家人傷體亡，亦無法接受這種突如其來的悲痛後果，自然各說各話爭端迭起，糾紛當然就多了。醫療風險理論就是要讓醫界、法界以及民眾之間，一有醫療糾紛時，三方先心平氣和坐下談，而且有「醫療風險理論」的共識，三方使用共同語言討論，首先就是要先確定發生的醫療事故是屬於醫療過失、醫療不幸或醫療意外的哪一種？釐清法律責任，再決定要救濟？還是要賠償？醫師有過失，當然要賠償，傾家蕩產不足為惜，但醫療風險就要靠國家提出一套風險救濟的方式解決，而不是任由醫病雙方廝殺抗爭，造成社會動盪不安。總之，若能遵循「醫療風險理論」，碰到醫療糾紛，醫法民三方理性對話，相互諒解，用風險救濟消弭訴訟勞費，醫病關係才能維持和諧，醫療生態方能導入正途。

The main principle of medical risk theory is that only medical results with avoidability are medical incidents, so natural death and results due to natural course of diseases are excluded. Further, using the concepts of predictability and preventability, medical incidents can be divided into medical negligence, medical mishaps, and medical accidents, with the latter two, which are not preventable, categorized as medical risks. Examining cases of medical dispute mediation in practice reveals that medical risk cases generate the most number of disputes. While the harm or adverse effects due to risks of diseases suffered by patients are outside the physician’s control despite the physician’s best efforts, family members are still unable to accept the patient’s injury or death. This article shows that first, physicians are not necessarily negligent in medical disputes. In general, physicians are not negligent. In cases of non-medical incidents, physicians are not negligent. Misdiagnoses and surgery failures are medical risks and medical mishaps, so physicians are not negligent. Medical risks are acceptable dangers, so physicians are not negligent. Second, this article shows the need to create a common language based on medical risk theory to resolve medical disputes. Medical risk theory creates a common language that allows legal professionals, medical professionals, and the people to have productive discussions once medical disputes arise. This common language allows all interested parties to first determine whether the medical incident is medical negligence, medical mishap, or medical accident. This then allows for the determination of legal responsibility and either indemnity or relief for the patients or family members. If physicians are negligent, they are liable for indemnity, but cases categorized as medical risk are the responsibility of the state, which needs to implement a relief scheme to avoid hostility between physicians and patients leading to social instability. Following medical risk theory allows parties in medical disputes to have productive conversations that maintain harmonious doctor-patient relationships and a positive medical environment.