美國醫療過失舉證責任之研究

Abstract

美國法上關於醫療責任採取過失責任主義，必須醫療人員未盡注意義務，致被害人發生損害，始負損害賠償責任。依據民事法上一般舉證責任之分配，原告對於被告之過失，負擔舉證責任。若無法舉證成功，則無法請求損害賠償。然而醫療事故，經常涉及複雜之醫師診療、判斷、醫治等行為，非一般人所能瞭解。 且在許多手術過程中，病患經常因麻醉而處於無知覺狀態，因而在法律上要求病患對於被告醫療行為之過失負舉證責任，顯屬過苛。因而在美國法上，越來越多的法院，適用「事實說明自己」法則（res ipsa loquitur），在原告無法提出直接證據，而以情況證據足以推論被告具有過失及因果關係存在時，改由被告舉證該過失及因果關係之推定並非確實，否則即應負擔損害賠償責任。 本文說明美國法關於「事實說明自己」法則的歷史發展，法學上對於該法則適用於醫療事故案例的理論爭辯，以及美國實務上在醫療案件適用「事實說明自己」的要件。最後，本文以我國法院之判決，與美國法作比較，以觀察我國法院在醫療案件，適用舉證責任倒置之情形。\\r 本文指出，「事實說明自己」法則起源於英國法，為美國法所繼受，對於一般民事事件，在符合相關要件時，均得適用，以推論被告之過失行為與因果關係，減緩原告之舉證責任。在醫療事故，美國早期法院基於醫療行為的特殊性，拒絕適用本法則。其後限於被告顯然具有過失之醫療案件，始適用本法則。惟目前多數法院均認為，醫療專業人員相對於病患，更有能力提出證據說明事件發生之原因，因而在醫療事故，肯認有本法則之適用，以平衡醫病關係雙方當事人之利益。 我國台北地方法院明白適用美國法上之「事實說明自己」法則，強調該案之醫療事故，若非因醫事人員欠缺注意，於通常情形不會發生。且被告對於事故之發生，具有完全掌控能力。而被告對於醫療事件之舉證，較諸原告，更為容易。因而認為該件醫療事故應由被告醫院及醫師負擔舉證責任，否則即應負損害賠償責任。

The tort liability of medical malpractice is based on negligence under American law. It requires that the medical professionals be breach of duty of care and incur damage and that a causal connection exists between the breach of duty and the damage. The burden of proof is imposed on the plaintiff in order to gain damages from defendant. This burden of proof is harmful for the injured to win their cases. In particular, in the case of medical malpractice, it is almost impossible for laypersons to understand what happens during a surgery and how a medical treatment is under way. In order to relieve the plaintiff’s burden of proof, the American courts adopt the rule of “res ipsa loquitur” in dealing with medical malpractice cases. Under this rule, it is for the plaintiff merely to provide circumstantial evidence, which would enable the jury to infer the defendant’s negligence and subject him to civil liability. This article introduces the legal development of res ipsa loquitur under American law. It explores the requirements for applying res ipsa loquitur to medical malpractice cases. It also discusses the fierce debate over whether it is appropriate to apply res ipsa loquitur to medical malpractice cases, especially concerning about the use of expert witnesses for the application of res ipsa loquitur. Finally, it examines Taiwanese court decisions using res ipsa loquitur in medical malpractice cases. This article confirms that res ipsa loquitur is a useful way to alleviate the plaintiff’s burden of proof. Due to the inequality between the patients and the physicians in terms of their access to medical knowledge, I argue that Taiwanese courts have to apply res ipsa loquitur in medical malpractice cases.