法院對醫務人員過失判斷依據之辨析－－以《侵權責任法》施行以來相關判決為主要考察對象

Determination of Negligence of Medic in Medical Malpractice Litigation : Observation of Major Judgments since the Enactment of Tort Law

法院在判斷醫務人員過失時對相關依據的適用多有偏差，實踐中的結果常常與理論中的預設相左。因此，應妥當適用相關依據：醫療常規和法律、行政法規、規章及其他有關診療規範，不得僅以是否與之相符為由全然判定過失，其通用性規定可推定過失，但如行為符合患者利益可予推翻。鑒定意見限於提供法官裁判素材，不能做出過失鑒定。關於醫療水平，應確定與當事醫方條件相符的參照對象，並以個案情況確定其行為模式，即斟酌患者情況、診療行為的風險、收益、成本、發病概率及損害後果。然後將當事醫方的行為與之相比以判定過失。總之，對過失的判斷不僅要依據醫療常規、法律規範等通用性規定，更要考察個案的具體情況，沒有統一內容的模式可循。

There are some mistakes about relative criteria during courts determining the negligence of medic, which results in the conflict between the theory and practice about negligence. Therefore, the criteria should be applied appropriately: medical customs, law and relative medical norms cannot determinate the negligence absolutely on the basis of accordance, the common norms can presume negligence. However, in the case that the treatment is in favor of the patients’ interests, the determination can be overthrown. Medical review opinions should be limited in providing the evidence to judge. They cannot determinate negligence. As to medical level, similar reference subject to the concerning medic should be determined, and then determining the act mode accord to the situation of individual cases, i. e. considering multiple factors such as patient’s special circumstances, the risk of treatment, the potential losses, the possibilities of occurrence of risks, the cost of treatments and the damage. In the end, the act of concerning medic shall be compared with the reference subject to determine the negligence. In conclusion, determination of negligence not only depends on the common norms from medical customs and relative law, but also the circumstance of individual cases.