臺灣疑似兒虐案件鑑定問題與對策

The pitfalls and problems and their countermeasures of forensic investigation of child abuse cases in Taiwan

臺灣目前疑似兒虐案件的司法調查面臨診斷、調查及鑑定的問題。在醫師方面對於搖晃嬰兒症候群（shaken baby syndrome, SBS）、非意外性頭部損傷（Non-accidental head injury, NAHI）或虐性頭部外傷（Abusive head trauma, AHT）定義不清，以致司法調查產生諸多問題。醫師的診斷方面須注意硬腦膜下腔出血、雙側視網膜出血、瘀傷或瘀斑及骨折診斷上的陷阱。檢察官司法偵查面臨臨床醫師診斷與調查結果不符的窘境。法醫解剖醫師面臨解剖採檢及檢驗的問題。解決之道在於建構跨部會機制，提供醫師建立鑑定醫師資格的認定標準與教育訓練，建構鑑定報告書的格式與內容及檢核表，強化法醫學診斷及鑑定的支援系統。檢察官方面應舉辦疑似兒虐案件調查教育訓練，強化專家諮詢系統。針對法醫解剖舉辦解剖技術及檢體採樣及檢驗教育訓練，建構疑似兒虐案件解剖檢核表，強化分子病理學診斷與應用。

There are pitfalls and problems in medical diagnosis, forensic investigation and forensic autopsy of child abuse cases in Taiwan. The definitions of shaken baby syndrome (SBS), non-accidental head injury (NAHI) and abusive head trauma (AHT) are not well known in clinicians. Diagnostic pitfalls in subdural hemorrhage, bilateral retinal hemorrhage, contusion or echymosis and bone fractures should be cared. Prosecutors face on the disagreement of medical diagnosis and legal investigation, or autopsy results. Forensic pathologist should enforce on the skills of autopsy, sampling and following studies. The solution method is to set up an integration system between ministries, to build up the qualification and certification system of experts, reporting and checklist system, diagnostic supporting system, consulting system, continuing forensic pathological education, and application of forensic molecular pathology.