道歉法對醫療糾紛之影響：實證回顧與對台灣之啟示

Impact of apology laws on medical malpractice: an empirical review and implications for Taiwan

目標：過去二十年道歉法成為減少醫療糾紛的重要改革策略，但其對醫療傷害責任之實際影響尚不清楚。本文藉由回顧實證性文獻，分析道歉法之影響，以及對台灣醫療爭議預防及處理法之啟示。方法：於PubMed資料庫進行英文文獻搜尋，經排除重複、納入及排除條件篩選，再逐一查閱文末參考資料，納入符合篩選條件之文獻。結果：共納入14篇文獻，研究地區均為美國，全國性資料的研究顯示道歉法對降低整體醫療責任效果不明顯，但由道歉法帶動、在機構層次推行之溝通與紛爭解決計畫（Communication and Resolution Program, CRP），有較顯著減少訴訟、降低成本、縮短爭議解決時間之成效。有成功經驗的機構通常具備強有力領導者、責任保險人、醫師及品質與風險人員認同、專業經理負責執行以及主動提出補償等條件。結論：台灣目前欠缺揭露醫療錯誤之倫理共識，機構層次之政策及橫向組織連結不明確，亦無補償機制，道歉法在台灣之執行成效需要持續關注與分析。

Objectives: Over the last two decades, apology laws have emerged as a crucial strategy for reducing medical malpractice liabilities. However, the effectiveness of these laws is unclear. This study investigated the effect of apology laws on medical malpractice by conducting a systematic literature review, providing insights into Taiwan’s Medical Accident Prevention and Dispute Resolution Act. Methods: A search for relevant articles in the PubMed database was conducted. Articles lacking abstracts or not written in English were excluded. Eight studies that met the inclusion criteria were identified. The reference lists of these eight articles were checked, and six additional eligible studies were identified. Results: We included 14 studies in the analysis. All the studies were conducted in the United States. The studies revealed that apology laws have a negligible effect on reducing medical malpractice liabilities. However, communication and resolution programs implemented at institutional levels do effectively reduce litigation frequency and costs and expedite dispute resolution. Organizations with successful outcomes typically exhibit strong leadership, support from liability insurers, physicians, and quality and risk personnel, dedicated management by skilled professionals, and proactive reimbursement. Conclusions: Taiwan currently lacks an ethical consensus regarding the disclosure of medical errors. Institutional-level policies and horizontal organizational relationships are not well-defined, and a mechanism for compensation is absent. The effectiveness of apology laws necessitates continuous monitoring and discussion.