醫療刑法中的假設同意──一個有意義的法制度？

The Hypothetical Consent in the Medical Criminal Law-A Meaningful Legal Figure?

在德國，醫療侵入行為通常是透過病人的同意來阻卻違法。最高法院的民事判例長期以來都承認所謂的假設同意，後來也有刑事判決接受這個概念。但學界對於這個法制度是否適用於刑事案件，則是有許多爭論。支持者大多是以排除（不法）歸責為其論點，認為此時存在一個所謂的（不法）抵銷模式，而醫師的結果不法就會被抵銷。不過，這個法制度一方面在調查虛構的病人意願時，會有難以克服的困難，甚至因此可能讓病人透過對醫師要求金錢以及勒索，來做出在訴訟上排除醫師可罰性的證詞；另一方面，其在釋義學上也充滿了許多的矛盾與困境。例如，假設同意無法既在構成要件階層判斷，又同時作為一個獨立的阻卻違法事由；此外，假設同意也會破壞推測同意所具有的補充性，而且最終也會掏空了病人的自主權；最後，從客觀歸責理論借用過來的欠缺義務違反關連性或合法替代行為的想法，並不能基於假設同意而排除歸責。由於假設同意顯現出太多在結構上及合法性上的困境，因此，不論是在醫療刑法或是其他犯罪領域，在結論上都應該要拒絕這個法制度。雖然民法原則上也承認假設同意，但就算刑法在這些情況中仍對醫師加以處罰，也不會自動地導致違反法秩序的一體性的後果。對於假設同意在刑事政策上所關注之事的解決之道，也就是對醫師的可罰性風險之限制，則必須從它的源頭──氾濫的醫師說明義務──中去尋找。

In Germany, the legal liability of medical interventions is always prevented by the patient's consent. The Supreme Court's judicial precedents in the civil law have recognized the so-called hypothetical consent for a long time. Later on, some criminal judgments also accepted this concept. However, it is disputed in the academic circle whether this legal figure also applies to criminal cases. However, on the one hand, this legal figure will have insurmountable difficulties in investigating the fictional willingness of the patients, and may even let the patient blackmail the physicians in consideration of testifying for the exclusion of punishments on the physicians during the litigation procedure. On the other hand, it is also full of contradictions and dilemmas in dogmatics. For example, the hypothetical consent cannot be evaluated in the level of the facts of case on the one hand and also as an independent justification on the other hand. Furthermore, the hypothetical consent may damage the subsidiarity included in the putative consent, and in the end hollow out the patient autonomy. Lastly, the context of obligation violation or legal alternative behaviors borrowed from the theory of the objective attribution can not justify the exclusion of liability attribution with the hypothetical consent. As the hypothetical consent is confronted with a lot of structural and legal dilemmas, this legal figure shall be denied both in the medical criminal law and other areas of the criminal law. Although the hypothetical consent is generally recognized in the civil law, any punishment on the doctors based on the criminal law will not automatically cause any consequences of violating the conformity of the legal order. Any solution to the questions, which are concerned with the hypothetical consent in the criminal policies, i.e. the risk limitation on the punishment of physicians, needs to be found in the source, namely the information obligation of the doctors.