違反醫療告知義務之法益侵害類型與民事責任——從實務裁判之猶疑談起

The Injury Pattern and Liability of Violating Informed Consent Doctrine: With Special Reference to Judicial Decisions

醫師未盡告知義務而實施後續醫療，咸被認為係侵害病患之自主決定權，惟倘醫療過程無其他專業疏失，卻因為醫療本身所伴隨之固有風險實現而造成病患傷害時，醫方是否應負責賠償，不無疑問。本文蒐集德、日、以及我國相關判決，可窺得各國法院間就此之態度其實均頗有猶疑，特別是我國最高法院與高等法院晚近之審查方式似有轉變，值得注意。筆者試從此類事件中病患受侵害法益之不同類型切入，觀察其相對應阻卻違法事由範圍之交錯，並斟酌告知後同意法則並非意在剝奪病患接受必要、相當且無疏失醫療機會之觀點，重新審視未取得病患有效同意而實施醫療行為時，對病患各類型法益侵害之歸責審查。於兼顧醫業執行不同於一般侵害行為之特殊性、對病患自主權之尊重、以及對其生命身體與健康權實質保障之前提下，並呼應我國實務晚近見解之發展，提出或可供參考之法理基礎。然而，法學論述與法律適用，不能悖離社會所形塑之當今法價值，實務見解之遞嬗與本文論點，其可接受性仍有待後續之觀察。 A difficult situation is facing us that if a physician antecedently violating the ?informed consent doctrine? and the patient according to the insufficient information consenting to take the following treatment course which is faultless, yet some complication develops. Should the physician be liable for it? This article collects and analyses the judicial decisions of such litigations in of German, Japan and Taiwan and finds that the majority hold that the physician who violates the doctrine is liable and should compensate the patient for the pecuniary loss and emotional distress even if the following treatment course is faultless, however some discrepancies still exist among them. Some of the minor opinions tends to restricted the liability or compensation amount through the strict examination of causation between the violation and injuries, some attempts to distinguish the behavior and liability of doctrine violation from the following treatment performance and accordingly implies that the violation of doctrine might not necessarily be liable for the complication caused by the following treatment. Regarding the unique nature of medical practice, which marks its segregation from ordinary personal injury behaviors, this article holds that even if the physician antecedently violates the ?informed consent doctrine?, the following faultless treatment should not be regarded as Illegal if the treatment is necessary and appropriate for improving or maintaining the patient's health. The reason is that such faultless medical practice will do good to patients and consequently will satisfy the need of our society and be permissible. On the contrary, if the following treatment fails to meet the above criteria, the physician will be liable for the complication caused by the faultless treatment behavior. Asides from the personal injury, the physician perform medical practice without abiding by the ?informed consent doctrine? will infringes the autonomy of patients, which might be regarded as the damage to personality in a severe way and should be liable and compensate the emotional distress.