道歉是否能夠了事？結合論理與實證觀點論臺灣醫療事故道歉法制之建置

Could Apology Resolve Medical Disputes? The Construction of Medical Incident Apology Law in Taiwan from Doctrinal and Empirical Perspectives

主動揭露錯誤並道歉的修復式正義思維與實踐，於1990年開始出現在英美法系國家的醫療糾紛解決模式，在某些實踐此政策的醫療機構中，呈現出醫療傷害訴訟風險與賠償給付不升反降的正向效果。我國自2000年迄今，行政院共提出6個醫療事故處理相關草案，並於2022年5月30日通過、同年6月22日公布「醫療事故預防與爭議處理法」。歷次草案及本次通過的版本包含道歉法規範條文，保障醫事人員道歉相關的言語行動表達，免於成為不利於醫事人員的訴訟證據。本文回顧各國道歉法規定、分析道歉行為及道歉法制種類、範圍與相關倫理意涵相關文獻，綜合道歉的心理社會與道德情緒效果、法律與經濟效果的實證分析，認為從論理及實證的觀點，在道歉法制保障下的真摯完整道歉能夠符合病人、家屬，甚至醫事人員的心理社會與道德情感需求，可達到修復式正義、矯正正義及應報正義的法律政策目的。真摯完整的道歉是處理醫療事故「必要但非充分」的條件，在建置完善配套措施底下，幫助病人及家屬獲知醫療事故真相，進而透過透明化的處理機制，從系統性的角度提升整體醫療品質。即便道歉法制用以降低訴訟風險或賠償給付成本的效果仍待商榷，完善道歉法制仍具有撫慰人心與降低對立的正當性基礎，值得我國採用。

In 1990s, restorative justice ideas and practices that emphasize proactive disclosure of error and apology began to emerge in the medical disputes resolution procedures in common law countries. Some empirical data have shown that in the medical facilities that adopted these policies, medical malpractice litigation risk and damage payment cost, instead of increased, actually decreased. In Taiwan, the Executive Yuan have drafted six versions of bill to deal with issues related to medical incidents’ dispute resolution, prevention and compensation. Based on the latest version, the current Medical Incident Prevention and Dispute Management Act was passed in May 2022 and was announced on June 22, 2022. All the six versions incorporated apology law provisions that protect medical personnel’s apology expressions from being admissible as legal evidence. This paper first shortly reviewed apology laws in different countries, and analyzed literature related to the kinds, scopes, and ethical implications of apology and apology laws. Then, it integrated empirical evidence related to apology’s impact on people’s psychosocial and moral emotion and the medical malpractice litigation risk and compensation damage payment cost. Based on the doctrinal reasoning and empirical findings, the paper argued that under the protection of apology law, medical personnel’s sincere complete apology could fulfill the psychosocial and emotional needs of the patients and family members. To a certain extent, apology could achieve the policy goal of restorative justice, corrective justice and retributive justice. Sincere complete apology is a necessary but insufficient condition for establishing a good enough institution of medical dispute resolution. It is important to combine apology law with mechanisms to help patients and their family members learn the truth about medical incidents, to enhance health care quality and avoid similar medical incidents in the future. Even if it is uncertain whether apology law could diminish the malpractice litigation risk or the compensation payment cost, a well-designed apology law is still worth adoption based on its benefit to soothe people’s minds and attenuate opposition between the medical party and the patient party.