醫療糾紛中因果關係舉證責任之轉換──簡評最高法院106年度台上字第227號民事判決

Inversion of Burden of Proof on Causality in Medical Disputes: A Commentary of the Civil Judgment Appeal-227 by Taiwan’s Supreme Court in 2017

最高法院106年度台上字第227號民事判決指出：當醫師之醫療行為有可歸責之重大瑕疵，導致該醫療行為與病人所受損害間之因果關係不明，則應由醫師證明因果關係不存在。本件判決明確採用德國法上的重大醫療瑕疵理論，具有指標性，然本件判決對於個案中各項醫療疏失，如何具體運用到重大醫療瑕疵理論，而使因果關係之舉證責任轉換，容有再更為詳細闡述之空間。作者不揣淺陋，提出管見，期能拋磚引玉，就教於方家。

Taiwan’s Supreme Court’s Civil Judgment Appeal-227 in 2017 pinpoints as follows: Upon any severe fault attributable to the physician during the personal practice (i.e. any medical services/behaviors provided to a patient) leading to any unidentifiable causality between such practice and the damage/hazard borne by the patient, such physician shall be liable for proving inexistence of causality. Despite the indicative nature of the case apparently adopting the Severe Medical Fault Theory of German laws, the author identifies the need to state in details how the burden of proof on causality in medical disputes is inversed by materially employing the Severe Medical Fault Theory to respective medical malpractices in the case and therefore proposes some personal remarks as the references to future investigation.