醫療民事訴訟鑑定之實證研究——著重於法院對鑑定證據之評價

An Empirical Study on Medical Expert Testimonies in Civil Litigation: with Special Reference to the Evaluation of Evidence

隨著科學技術發展，知識與資訊在流通上變得更為容易及迅速，醫病關係從以往尊重醫師權威，逐漸轉變為尊重病人自主，病人不再是醫療行為之客體，而係享有決定權之主體。伴隨而來的影響是，當發生不良或非預期之醫療結果時，容易產生負面評價及紛爭，訴諸法院作為紛爭解決方法之比例亦隨之增加。
醫療訴訟涉及醫療事實認定與醫療責任判斷，本質上具高度專業性，作為審判者之法院因受限於對醫學知識之不熟悉，實難以其既有經驗法則為正確且妥適之判斷。為解決上開困境，有必要尋求各專業意見從旁協助，即透過鑑定制度以補強法院對於醫療案件審理能力之不足。目前醫事鑑定被廣泛使用於醫療民事訴訟當中，並以衛生福利部醫事審議委員會為最主要受託鑑定單位。
而我國民事訴訟法將「鑑定」置放證據章節中，定位為一種證據方法，作為法院裁判基礎資料之一，故法院對於是否採用鑑定意見應踐行調查證據程序，且鑑定意見並不當然拘束法院，法院亦未必須全盤採納，只不過應將其取捨理由於判決中揭露，方為適法。有鑑於此，本論文擬以法院判決作為研究對象，嘗試回答以下問題：一，醫療民事訴訟中，有多少比例會使用鑑定？二，而法院於決定是否採納鑑定意見時，是否確實遵照民事訴訟法之規定於判決中表示取捨理由？三，其理由類型為何？並附帶探討：醫事鑑定多由何機關作成、鑑定詢問事項又以何類型居多。
此外，現行醫事鑑定意見因制度設計及運作方式飽受客觀性及公正性批評，已有諸多改革上之建議被提倡，惟非一時半刻能完成，從而本論文企圖建構使用醫事鑑定操作流程及證據調查與證據評價上可審酌事項，使法院循之調查鑑定證據後，能確保鑑定意見具備最低程度之專業性、客觀性及公正性，期望能在不改變現行醫事鑑定制度運作方式下，使當事人之權益受到最大之保障、降低對醫事鑑定之質疑。

As technology advances, the transmission of knowledge and information became easy and rapid. Doctor-Patient relationship gradually moves from the traditional“respect the doctor’s authority”to“respect the patient’s right to autonomy”. Patients are no longer the“object”of a medical conduct but rather the“subject”with the right to make decisions. Accompanying this is the easy generation of negative reviews and disputes when facing unfavorable or unexpected outcomes. Consequently, the amount of medical litigation rises.
Medical litigation involves the identification of medical facts and medical liability, both of which are highly professional. The court, as an adjudicator, is limited to the unfamiliarity to medical knowledges, therefore is unable to make the appropriate judgement using its existing rules of experience. To resolve the aforementioned difficulty, it is necessary to seek professional advice, i.e., the use of“expert testimony”to fortify the court’s lack of ability to try medical cases. Nowadays, Medical Expert Testimony is widely adopted in medical litigations with the Medical Review Committee under the Ministry of Health and Welfare as the main entrusted institution.
The Code of Civil Procedure puts expert testimony under the chapter of evidence, positioning it as a method of evidence. Therefore, the court has to conduct an evidence investigation when considering whether or not the expert testimony will be adopted and is obligated to disclose the reasoning behind why the testimony is adopted or not. Given that, this thesis intends to choose the court’s judgments as the object of study and attempt to answer the following questions: 1. What is the proportion of the usage of expert testimony in medical litigations? 2. Does a court abide the Code of Civil Procedure by disclose the reasoning behind the adoption or rejection of an expert testimony in the judgement? 3. What are the categories of reasons? 4. What institutions are expert testimonies mainly conducted by and what types of inquiries are made during expert testimonies?
Furthermore, the design and operation of the existing Medical Expert Testimony system has been criticized for its objectivity and fairness. Many suggestions regarding the reformation of the system have been advocated but are not accomplishable in a short duration of time. Therefore, this thesis attempts to construct a procedure of operation and standards of review for investigation and evaluation of a Medical Expert Testimony, allowing the court to verify the professionality, objectivity, and fairness of the testimony, expecting to assure the rights and interest of the litigant and lower the doubt about medical expert testimony without major reform of the existing system.