人身傷害之微觀思維

The Cellular View of Personal Injury

長潛伏期的人身傷害，最初的損傷起始點，往往是從不知不覺的細胞層級破壞開始。倘若受害者未有定期健康檢查、癌症篩檢、患病有危機意識地注意細節，於臨床症狀出現之前，不能即時阻止有毒物質，而繼續危害身體細胞層級之健康，則將漸漸由細胞層級的損害，擴展到局部組織的破壞，再擴大到器官系統障礙，甚至突變細胞已轉移至其他器官，或引發全身性的敗血症而死亡。並且，此長潛伏期傷害有毒性劑量的累積作用，越到後期，臨床症狀越是嚴重，存活率也相對急速下降。有些因毒物致癌的患者，一旦有「巨觀」的臨床症狀發現，就已經是病入膏肓的癌症末期。因此，提早發現與早期治療，不僅治療的費用少，併發症少，預後亦較佳。
另一方面，如果法院可以接受在細胞篩檢或次細胞層級（DNA）階段，即診斷出疾病，作為受害者人身傷害的請求權構成要件，將傳統之人身損害的時間點提前，則有以下益處：1.能夠「早期發現、早期治療」，不致於衍生為「不治之症」，並且後續的醫療費用與併發症也較少。2.以醫學科學理論所劃定的界限較客觀，可廣泛為企業與民眾所接受。3.廠商可以提早得知損害原因，提前改善工廠之污染，不致持續讓其他無辜者受害。4.縱有受害者，其群眾數目比持續擴大，損傷的人數少，病情亦較輕，所需付出之人身傷害賠償金額也相對地可以減輕。5.避免大多數廠商極力撇清因果關係，千方百計纏訟，乃欲逃避長期損害所造成之巨額賠償金額、或面臨破產的惡運，讓受害者的訴訟，可能拖延至臨終前仍遲遲沒有定讞。6.倘若非得有肉眼可見的「巨觀」出現，使能說服法官相信有人身傷害，則有些疾病此時已經進入末期，壽命僅剩一年半載，縱使判決勝訴，可以獲得巨額賠款，但可以享用的日數不多，意義也不大。況且，越是末期疾病，越難醫治，醫療費用勢必高昂，亦可能耗盡所獲之求償；所剩餘命實難以巨額金錢來彌補。
又或許，在法院判決結果定讞之前，法人早已不復存在。因此，如何以醫學科學理論，如病理學報告等，從而確定人身的「微觀」損害，即時給予損賠，創造企業與民眾雙贏策略，乃當務之急。
美國法學界，對於長潛伏期的「微觀」人身傷害，因為無經驗法則或礙於現有的科技水準，無法有「直接證據」來確認損害之發生，於是在2017年提出「間接證據」，有兩種主要類型，亦即採用病因學和流行病學的證明。於2019年，再將有毒侵權訴訟的舉證，可以是充分的暴露證據、足夠的傷害證據、流行病學的研究、專家證詞、動物研究、案例報告等，從而建立因果關係。話說美國法律試圖解決從文化角度審視長潛伏期毒害的侵權案件中，醫療與法律脫節的因果難題，將吞噬流行病學家使用的常態分配所產生之長腿和長尾，一點也不為過。既然美國法學界與法院趨勢是企圖以醫學專業之病因學、細胞傷害之病理學、流行病學及暴露證據、藥理學之劑量反應，一併納入可以作為證據的考量。因此，試圖徹底明瞭上述跨醫學專業與法學領域之橋樑，以及其證據能力，已經刻不容緩。
本文除跨越醫學的病理學、運用生物統計學找出真正之危險因子、藥理學的安全劑量、以預防醫學的三段五級理論，從而提前確定人身傷害的微觀證據之外，亦佐以國內與美國之相關判決評析，做出最佳的策略，以期符合現今世界法律潮流趨勢。

The initial point of long-latency personal injury often begins at unconscious cellular level. If the victim does not have regular health checkup, cancer screening, and crisis-conscious attention in detail, it is not possible to stop toxic substances immediately before the onset of clinical symptoms. It will continue to harm the health of the body’s cellular level little by little. Gradually from cellular level damage extended to the destruction of local tissue until organ system disorders, even mutant cells have been transferred to other organs, or death due to systemic sepsis. Moreover, this long incubation period has a cumulative effect of toxic dosage, and the more later on, the clinical symptoms are more serious and the survival rate is also rapid declined relatively. Some patients who are carcinogenic due to toxic substances, once found the “Giant” clinical symptoms coming out, are already at the end stage of the cancer. Therefore, detection in advanc and early treatment, are not only less the cost of treatment but also the incidence of complications are few and the prognosis is better.
On the other hand, if the court can believe the disease is happened beginning at the cell screening or sub-cell level (DNA) stage and accept a request for the victim’s personal injury that make it advance than the time of the traditional personal injury, there are several benefits as below: 1. Enable to “early detection, early treatment” will not become “incurable disease” easily and subsequent medical spend or complications will be less. 2. The boundaries delineated by medical science theory are more objective and can be widely accepted by enterprises and the public. 3. The manufacturer can know the cause of the damage earlier to improve the pollution of the factory in advance and not continue to victimize the other innocent people. Even if there are the cases of victims, compare with who continue to exposure the toxic damage, the number of victims is less and the disease condition is also less severe. The amount of personal injury compensation required can be relatively reduced. 4. Most manufacturers try to clear out the causal relationship or avoid the huge amount of compensation caused by the long-term damage, even face the bankruptcy, make the victim’s lawsuit may be fixed delayed until the end of life. 5. If there is a “macro view” which is visible by naked eye then can start to convince the judge to believe a personal injury, the some diseases have already entered the final stage with the life expectancy may is remaining only one and a half years. Even though a lot of compensation can be rendered, there are not so many days to enjoy and not too much meaning for him. Moreover, the more near end-stage diseases, the more difficult to be cured and the more medical spend. It may be exhausted the all of compensative fee. The victim’s remaining short life is difficult made up by huge compensation. Perhaps, the juristic person had no longer existed before the court’s result was fixed. Consequently, it is a urgent priority that how to apply medical science theories, such as pathology reports, to determine the “microscopic” personal injury actually and give compensation immediately in order to create a win-win strategy between the enterprise and the people.
In the US jurisprudence, for the “micro” personal long latency injury, because there is no rule advance or the current level of technology, there is no “direct evidence” to confirm the occurrence of damage. Therefore, in the past 2017, the so-called “circumstantial evidence” was proposed. There are two main types of indirect evidences which are etiology and epidemiology. In 2019, the evidence of toxic tort can be proof by full exposure evidence, sufficient evidence of injury, epidemiological studies, expert testimony, animal studies, case reports, etc., to establish causal relationships. It is not an exaggeration to say that US law attempts to swallow the epidemiological grown long legs and a tail, in order to solve the causal relation problem of toxic tort about the disconnection between medical care and law from a cultural perspective. It is imperative to thoroughly understand the above-mentioned bridges in the field of interdisciplinary between medicine and law as well as its evidentiary ability since the trend of American jurisprudence and courts take the etiology of medical speciality, pathology of cell injury, epidemiology and exposure evidence, pharmacological dose response which are considered as evidences.
This paper is not only does a bridge make cross between the medical pathology, biostatistics to discover the real risk factors, pharmacological dosage respond, three-stage and five-level theory of preventive medicine to establishes micro-evidence determining personal injury in advance, but it also analyzes judgments’ opinions from national and USA relevantly. Try to make the best strategy in order to adaption to the current legal trends in the world.