醫療瑕疵舉證責任分配與舉證減輕之研究——以病歷記載與保存義務為中心

A Study on the Distribution of Burden of Proof and the Facilitated Standard of Proof in Medical Malpractice — Focusing on the Obligation of Recording and Preserving Medical Records

於民事訴訟程序上，基於武器平等原則，應保障兩造享有地位、機會、風險平等之權利。然於醫療訴訟中，病人方對於醫療事故之發生，具事實上不知、專業上不知、證據偏在等困難；醫療方則對於醫療行為基於活體組織之不可預測性，亦無法保證其結果成功，因此醫療訴訟舉證責任之分配與舉證減輕，實為一價值判斷與利益衡量上之難題。
於醫療訴訟中，須醫療機構或醫師先具備醫療瑕疵存在，始得為醫療民事責任之探討，因此醫療瑕疵可謂醫療訴訟之核心。本論文於架構編排上，首先於實體法上，將探討醫療瑕疵之定義，以及其於契約責任與侵權責任中之請求權基礎要件事實。其次，因醫療瑕疵之成立與否，常須以病歷資料作為醫療鑑定報告之基礎而為判斷，是以本論文亦將就病歷記載義務、保存義務、提出義務及其違反之效果分別為探討。再者，於訴訟法上，將先鳥瞰民事訴訟舉證責任分配與舉證減輕之三階層體系，進而聚焦醫療瑕疵要件事實之舉證責任分配與舉證減輕之探討，及可完全控制風險原則於醫療瑕疵舉證減輕之適用。
最後將回歸本論文之核心，分析病歷記載、保存、提出義務之違反，對於醫療瑕疵主要事實舉證責任轉換之舉證減輕是否產生影響，以及上開三者義務之違反，對於證明妨礙、文書與準文書提出義務、間接事實舉證責任轉換，此等醫療瑕疵主要事實舉證責任未轉換之舉證減輕手段，其適用要件以及法律效果影響為何。並於現行法解釋論以及未來立法論層面，基於適當補償原則，提出病歷記載義務、保存義務、提出義務違反效果固定化與明確化之見解，以期未來於司法實務操作上，達到法律安定性、法律明確性、預見可能性及裁判之一致性，並適當分配醫療訴訟之風險，以避免產生過度補償或不足補償之危險。

In civil litigation, both parties should be guaranteed equal status, opportunities, and risks based on the principle of equality of arms. However, in medical malpractice lawsuits, patients face difficulties such as lack of knowledge of the facts, lack of professional knowledge, and evidence bias. On the other hand, medical practitioners cannot guarantee the success of their treatments due to the unpredictability of living tissues. Therefore, the distribution of the burden of proof and the facilitated standard of proof in medical litigation is a complex issue of value judgment and balancing of interests.
In medical litigation, it must first be established that there is medical malpractice by the medical institution or physician before discussing civil liability. Thus, medical malpractice is the core of such cases. This study first discusses the definition of medical malpractice in substantive law and its requirements for claims under contractual and tort liability. Then, given that the establishment of medical malpractice often relies on medical records as the basis for medical assessment reports, this thesis also investigates the obligations of recording, preserving, and providing medical records and the consequences of their violation. As for the procedural law, this study first provides an overview of the three-tier system of the distribution of the burden of proof and the facilitated standard of proof in civil litigation, then focuses on the distribution of the burden of proof and facilitated standard of proof for medical malpractice and the application of the principle of complete risk control in facilitating the standard of proof for medical malpractice.
Finally, this study returns to its core by analyzing whether the violation of the obligations of recording, preserving, and providing medical records affects the facilitated standard of proof for the key facts of medical malpractice when the burden of proof is shifted. It also examines the effects of such violations on the spoliation of evidence, the obligation of providing documents and quasi-documents, and the shift of burden of proof for indirect facts, including the application criteria and legal effects. In the context of current legal interpretation and future legislation, this thesis puts forward recommendations on the effects of violations of the obligations to record, preserve, and provide medical records based on the principle of appropriate compensation, hoping to ensure legal stability, clarity, foreseeability, and judgment consistency in future judicial practice, and to appropriately distribute risks in medical litigation, thereby avoiding both overcompensation and undercompensation.