民事醫療糾紛舉證責任之研究

A Study on the Burden of Proof in Medical Malpractice Disputes

系所名稱：法律學系碩士班 學位別：碩士 畢業學年：96年 指導教授：陳啓垂 因醫療而不幸造成病患死、傷者，自古有之，每個國家都會發生，並不是現在才存在的問題。在我國近幾年新聞媒體所揭露的醫療糾紛案例來觀察，醫療發生糾紛的成因，大多是在治療的效果上不如病患本身或家屬所期待。也使得，處於資訊爆炸時代，電子媒體對於醫療糾紛事件的關注報導下，醫療糾紛常成為眾所矚目的社會焦點。對於傳統上「父權式權威」的醫父思想，受到法治思想及教育普及，使得「醫療人權」概念的興起，造成醫師與病患間關係的改變。導致，當人們碰上醫療糾紛時，會勇於對醫師提出救濟而非默默承受。醫療訴訟存有許多先天不平等的因素累積，使得醫生在訴訟上佔有較優於病患的相對優勢存在，形成目前緊張與懷疑的醫療關係。所幸學界對於醫療糾紛的相關問題討論，不斷透過引進國外學說或相關立法規範，努力嘗試緩和醫師與病患間長期不對等的地位與關係。綜上，基於醫療人權的興起與醫療父權概念的突破，在醫療糾紛的訴訟過程中應如何將醫療人權概念落實，避免病患在訴訟上因醫療關係上的不平等造成醫療父權的復萌，為研究此論題的重點所在。我國在民事訴訟舉證責任的分配上，有民訴法第二七七條的規定存在。但是，此一民事舉證責任的分配規則，是否能平衡醫師與病患在醫療訴訟的舉證責任分配，則還有疑問存在；依修正後新民訴法增加二七七條但書的規定，雖已考量到對於個案中舉證責任分配顯失公平的情形。只是，此一規定要如何操作，才能適當成為醫療訴訟上的舉證責任合理分配標準，是在醫療訴訟中值得觀察的重點所在。故藉由民事醫療糾紛訴訟事件觀察病患所主張，如醫療契約的債務不履行或醫療侵權行為等，進而分析在訴訟上因各種不同的請求基礎對於民事舉證責任的負擔是否不同，有何差別及影響，而應如何調整以尋求在醫療訴訟中保障病患權利及避免防禦性醫療產生的兩個極端間的平衡點。本論文的研究範圍共分為六章，在各章相關的討論內容上，依下列綱要次序進行，臚列說明如下。第一章 序言闡釋說明研究動機，並指明目前民事醫療糾紛事件的問題在於「醫療訴訟舉證責任分配上」。在研究過程中，則先藉由分析醫病間實體法律關係，進而觀察民事舉證責任的分配是否能合理分配。第二章 醫療行為與醫療糾紛就醫療行為的概念說明，確定醫療糾紛問題上所討論「醫療行為」的定位如何，其中並論及比較法上與我國相關立法及實務意見，對於醫療行為的定義比較說明。其次，討論醫療糾紛發生的原因以及對醫療過失、醫療傷害等概念釐清。第三章 醫療糾紛的民事責任此章討論範圍主要集中在醫病民事法律關係的責任上，說明醫方與病方間之民事實體法律關係。例如，「醫療契約」、「醫療無因管理行為」與「醫療侵權行為」，以利於之後對於民事舉證責任的分析論證。第四章 民事訴訟法舉證責任的分配規則醫療糾紛事件若選擇以民事訴訟方式主張損害賠償時，在訴訟的過程中最關鍵的問題為舉證責任的分配。舉證責任的分配，幾乎決定了訴訟當事人是否能勝訴，並鑑於我國民事訴訟法第二七七條規定，對於舉證責任的分配有明文的法規範。此一明文法規在相關學說意見或實務上的實際操作如何，在本章說明中將詳細說明，以作為觀察醫療糾紛事件的舉證責任分配基礎。第五章 醫療過失舉證責任的分配首先說明醫療糾紛事件與一般民事紛爭訴訟事件的差異性，其次分析醫療過失舉證責任的分配，並輔以我國實務上的案例分析，觀察在醫療過失民事舉證責任的分配上是否符合合理性的要求。此外，有關「防禦性醫療」、「告知同意法則」等概念在一定的程度上，也影響了醫療糾紛問題處理上的思考，並對於民事舉證責任亦有相當的影響，將一併探討。第六章結論將前述各章節的內容歸納出重點，其次扼要的歸納個人對於問題研究的看法並分析醫療糾紛舉證責任的宜有的合理分配模式。

Because of medical treatment to lead to the fact unfortunately that the patient dies, wounded, have it from ancient times, every country will happen, not just the existing problem now. The medical malpracticecase that reveals of the news media in recent years is observed in our country, the origin cause of formation of the dispute takes place in medical treatment, do not mostly look forward to as the patient or the relative on the result of treatment. Make too, in information explosion era, the electronic medium, to the concern report of the medical malpractice incident; the medical malpractice often becomes all social focuses attracted attention. As to the thing that patriarchy authority cure thought traditionally, is it popularize to educate governed by law thought, make medical human rights rise of concept, cause doctor and change of relation among the patient. Cause, when people run into the medical malpractice, will dare to propose relieving the doctor but bear quietly.The medical lawsuit has a lot of congenital and unequal factors to accumulate, make the doctor occupy the relative advantage relatively superior to the patient and exist on the lawsuit, form the tense and medical relation suspected at present. The relevant problem to the medical malpractice of educational circles is discussed fortunately, through introducing the foreign theory or relevant legislative norm constantly, make great efforts to try to relax the status and relation not for long time reciprocity among the doctor and patient. To sum up, on the basis of the rise of medical human rights and break-through of the medical patriarchy concept, how to implement the medical human rights concept in the course of lawsuit of the medical malpractice, prevent the patient from causing the replying and sprouting of medical patriarchy because of the inequality on the medical relation in the lawsuit, in order to study the key of this proposition. Our country is in the distribution of the burden of proof of the civil action, regulation that the civil procedure tell article 277 of the law exists. However, the distribution rule of this civil burden of proof, whether can balance the doctor and patient to assign in the burden of proof of the medical lawsuit, doubt exists; In accordance with new civil procedure tell law increase 277 regulation of proviso, is it get burden of proof assign apparent to lose the fair situation to case to consider already after revising. Only, regulation this want how operate it, could proper to become burden of proof of medical lawsuit distribute the standard rationally, it is the key that is worth observing in the medical lawsuit. So observe patients to advocate with the civil medical malpractice lawsuit incident, debt defaulting or medical tort of the for instance medical agreement ,etc., and then analyze because burdens to the civil burden of proof of all kinds of request foundations are different on the lawsuit, there are any differences and influence, and how to adjust the equalization point in order to seek to ensure patient's right in the medical lawsuit and prevent from between two extremes produced in defensive medical treatment.