透過道歉法與強制調解緩和醫病關係──以新通過的醫預法為主軸

Improving Doctor-Patient Relationships Through Apology Laws and Mandatory Mediation: A Focus on the Medical Accident Prevention and Dispute Resolution Act

當醫療事件發生時，各國均高度關注如何緩和醫病關係，避免醫療訴訟並保障病患權益。2022年5月30日通過之《醫療事故預防及爭議處理法》（以下簡稱醫預法）納入道歉法與強制調解制度，象徵著臺灣在醫療爭議處理方面的重大突破，本文將探討其立法內容及對法制的影響。
道歉法制度起源於1986年麻州，目前已在美國39個州及其他地區實施，成為訴訟外紛爭解決機制（ADR）之一。該制度主要透過排除道歉於訴訟與行政處分中作為證據的可能性，鼓勵醫事人員表達善意並揭露醫療資訊。
美國聯邦層級以《替代性紛爭解決法》和《聯邦證據規則》為主要依據，州層級則多參考《統一調解法》，對調解特權及其例外情形作出規範。此外，美國道歉法的實施經驗顯示，無論部分道歉或完全道歉，均能有效降低醫療糾紛。
醫預法吸收上述經驗，首次在臺灣法律中明定道歉法制度，並進一步將強制調解納入民事程序，填補醫事審議委員會調處之不足。此制度設計在訴訟對峙尚未展開前促成和解，降低衝突並提升調解成功率。同時，道歉法不僅在訴訟中提供證據排除保護，也延伸至行政處分，鼓勵醫療機構以善意化解爭端。
於未來修法時，為充分發揮醫預法的功能，宜進一步明確道歉法中部分道歉與完全道歉的界定，並強化調解程序的彈性與執行力，以期提升醫病信任、減少訴訟，並促進醫療服務品質與病患滿意度之提升。

When medical incidents occur, countries worldwide place significant emphasis on mitigating tensions between healthcare providers and patients, preventing medical litigation, and safeguarding patient rights. Taiwan’s enactment of the Medical Accident Prevention and Dispute Resolution Act (hereafter referred to as MAPDRA) on May 30, 2022, which incorporates apology legislation and mandatory mediation systems, symbolizes a significant advancement in handling medical disputes. This paper explores the legislative content of MAPDRA and its implications for Taiwan’s legal framework.
The apology legislation originated in Massachusetts in 1986 and has since been adopted in 39 states within the United States and various other regions, becoming a prominent mechanism for Alternative Dispute Resolution (ADR). Its primary function is to encourage healthcare professionals to express goodwill and disclose medical information by excluding apologies from being used as evidence in litigation and administrative sanctions.
At the U.S. federal level, the Alternative Dispute Resolution Act and the Federal Rules of Evidence serve as the primary foundations. At the state level, reference is frequently made to the Uniform Mediation Act, which regulates mediation privileges and their exceptions. Moreover, empirical experience from implementing apology legislation in the U.S. indicates that both partial and full apologies can effectively reduce medical disputes.
MAPDRA has adopted these experiences and explicitly incorporated apology legislation into Taiwanese law for the first time, further integrating mandatory mediation into civil procedures, thereby compensating for the limitations inherent in the prior Medical Review Committee dispute-resolution mechanism. This legislative design facilitates reconciliation before litigation escalates, thereby minimizing conflict and improving mediation success rates. Furthermore, the apology legislation not only provides evidentiary protection in litigation but also extends to administrative actions, encouraging medical institutions to resolve disputes proactively.
In future legislative amendments, to fully realize the potential of MAPDRA, clarification of the definitions of partial and full apologies within the apology legislation is necessary. Additionally, enhancing the flexibility and enforceability of mediation processes is recommended to foster trust between healthcare providers and patients, reduce litigation occurrences, and improve the quality of medical services and patient satisfaction.