論美國訴訟外醫療紛爭處理之歷史發展經驗：兼評我國現狀之反省與展望

On the Historical Development of Medical Alternative Dispute Resolution in the US: Lessons for Taiwan

本文探討美國訴訟外醫療紛爭處理之比較經驗，首節為研究背景與問題，第貳節介紹美國醫療糾紛危機之歷史背景，及其衍生之兩類改革方案，第參節討論審判前篩選、仲裁、調解與溝通解決等醫糾ADR選項之發展經驗，本文發現追求修補醫病關係與提升病人安全之利益導向式調解，和強調資訊透明、誠實檢討、坦承道歉與早期和解的溝通解決，已成為美國近年最受期待之ADR選項。第肆節進而以上述比較觀察為基礎，檢視我國醫糾ADR發展現狀，特別點出我國醫療體系普遍抱持最小化訴訟曝險之風險管理觀，此文化特性也構成我國本土發展溝通解決機制的主要挑戰。

This paper explores the experience of medical alternative dispute resolution in the US. Part I lays out the background and research question. Part II introduces the historical background of medical malpractice crisis and the two generations of policy responses to the crisis. Part III further examines the development and evolution of four of the most widely used medical ADR options, including pre-trial screening panels, arbitration, mediation, and communication-and-resolution programs. The paper discovers some of the most promising and anticipated medical ADR options and policy proposals, including interest-based mediation and communication-and-resolution programs, which emphasize such ideas as repairing patient-physician relationships, promoting patient safety, ensuring full disclosure, expressing timely sympathy and apology, committing to prevention efforts, and making early offer of compensation. Based on these observations, Part IV reflects on the current status of medical alternative dispute resolution in Taiwan, and points out that limiting litigation exposure remains the dominant risk management philosophy of Taiwan's healthcare organizations, which constitutes a significant barrier to the local development of communication-and-resolution type of reforms.