論醫療行為與強制罪

The Study on Medical Practice and Coercion

系所名稱：法律學系碩士在職專班專業法律組 學位別：碩士 畢業學年：100年 指導教授：林東茂 台灣高等法院96年上易字第2020號刑事判決，為我國首宗因醫師積極搶救病患卻遭檢察官以強制罪起訴的案例。本文主要目的在研討醫療行為的意義與種類，而醫療行為的施行畢竟落在病患的身體，由此導出告知後同意（Informed Consent）的法理。告知後同意的瑕疵或違反要到何等的程度才達到強制罪的門檻，是本文最終想要解決的問題。本文認為現行醫療行為的定義單為行政管理的便利，僅於81年以行政函釋的方式處理並不足採，且經過將進20年醫療科技的進展，醫療行為漸趨複雜且多樣化，醫療行為的定義應明訂於醫療法中，並做適度的修正為「醫療行為應當是指對人體正遭受或可能遭受的疾病、傷害與殘缺，由醫師本於醫療常規以回復健康為目的，所施行對於人體具有一定侵襲性且本身具有風險性的診察、診斷、預防、治療與處置的行為總稱。」醫療行為的本質是促進保護病患的健康，因此在刑法上的評價應以醫療行為非傷害說較為可採。而告知後同意法理所欲保護的是病患的醫療自主決定權而非保護病患不受傷害，所以告知後同意應僅列為醫療常規的ㄧ環而不是獨立的阻卻違法事由，以免架空刑法22條對於業務上正當行為的規定。當醫療行為的施行因病患同意的瑕疵或違反而有強制之虞時，應仿德國法強制罪可非難性條款的規定，對強制手段與強制目的間的關聯性作進一步實質違法性的判斷，以排除構成要件該當卻不具違法性的醫療行為。

The Taiwan High Court’s criminal judgment No. 96-Shangyi-2020 is the first case where a doctor proactively rescued the patient but was prosecuted for coercion. The main objective of this paper is to discuss the definition and types of medical practice. After all, medical practice is performed on the bodies of the patients, from which the jurisprudence of informed consent is derived accordingly. This paper would like to answer what degree of informed consent fault or violation would be considered as committing the crime of coercion.This paper holds that the current definition of medical practice is defined only for administrative convenience, and the 1992 Administrative Interpretation is insufficient in this kind of cases. Moreover, with improvement in medical technology over the last two decades, medical practice has become more complicated and varied. The medical practice should be defined clearly in the Medical Care Act and modified appropriately as follows: “Medical practice shall be referred to the collective act of a doctor, based on medical guidelines, to perform invasive and inherently risky examination, diagnosis, prevention, treatment and management, with the goal of patient’s health recovery, on a patient who is suffering from disease, injury, or deformity.”Medical practice is to improve the health of the patients. It would be appropriate to adopt the theory of non-maleficence when assessing such conduct in the Criminal Code. The jurisprudence of informed consent is to protect patients’ autonomy, not to prevent the patients from being harmed. Therefore, informed consent shall be listed as one part of the medical guidelines but not an independent justification (Rechtfertigungsgrund) against offenses, so as to prevent any improper interpretation of the due course provided in Article 22 of the CriminalCode.When the performance of medical practice may possibly be considered as committing the crime of coercion due to the fault or violation of informed consent, we should use relevant provisions as the German law into consideration before making a determination on the illegality of the relationship between the mean and purpose, in order to exclude conducts which conform to the provision but having justification.