民事醫療訴訟舉證責任問題之研究─以我國近十年確定判決為中心

Abstract

本文藉由民事醫療糾紛訴訟事件觀察我國各級法院於司法實務中，關於舉證責任分配考量之相關因素：自病患或病患家屬一方觀察，於醫療爭議事件發生時，關於判斷醫事人員及醫療機構應否負責，涉及醫學、法學等領域之專業知識，具有高度技術性，僅由治療結果通常無法遽以論斷；病患及其家屬常因缺乏相關專業知識，處於資訊不對等之地位，是以於訴訟上舉證處於不利之地位。從而，為衡平雙方之舉證能力，而有舉證責任減輕或轉換之考量。自提供醫療服務之醫療機構或醫療人員而言，恐懼憂慮病患動輒興訟的壓力，其醫療行為與態度勢必受大重大的影響，不利於醫療服務之提供。一般民眾對於提供醫療服務者產生不信任，而提供醫療服務者採取防衛性醫療行為，導致提供醫療服務者與病患間之關係，日益趨於緊張與對立，同時也造成醫療生態改變，亦不利於醫藥的發展與進步。因此，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，為目前司法實務應當重視的問題。\r\n\r\n 本文認為，民事醫療糾紛訴訟的進行，長久以來，由於考量專業知識之不平，對於一般人而言，無法確實主張其請求或充分防禦，均可能導致訴訟程序的冗長與不易。於事實真偽不明時，關於舉證責任之分配，如未能依據武器平等諸項法理，就個案之實際情況予以彈性適用，仍僵硬地依照傳統規範理論所主張之舉證責任分配，將導致當事人往往因舉證困難而承受敗訴之不利益。因此，應適當衡平當事人之舉證能力。惟舉證責任轉換制度係舉證責任減輕制度之一環，其作用較諸證明度降低、具體化義務強化或表見證明等制度，顯然較為強烈。因此，此一制度之承認與採用與否，對於當事人在訴訟上之影響甚鉅，更足以左右當事人之訴訟勝敗。對於此一制度之研究，固有其必要性，司法實務上，更需戒慎考量，以求得真正之平等。倘若未能考量個案之差異性，詳查當事人之舉證能力，以及影響舉證不能之相關因素，率爾採取舉證責任轉換之強烈作法，其極致難免有要求醫療人員舉證證明其無故意或過失及無可歸責性之虞。如此一來，不啻要求被告醫療人員負擔無過失責任。則醫療行為不適用消費者保護法之法律規範，其立法意旨將蕩然無存。對於醫療人員執行業務之特殊考慮將不復存在，學說及實務所憂慮之防禦性醫療等等，將成為醫療人員從事醫療行為時之手段，對於醫病關係之緩和毫無助益，且無益於民眾就醫之權利保障。因此，判斷個案狀況，在公平誠信之原則下對於個案中之與醫療訴訟相關之關鍵因素如:過失行為之認定及因果關係之判斷，均個別適當的進行舉證責任之調整，方能體現我國對於民事醫療訴訟舉證責任例外明文化之立法善意。同時藉由制度之調整與改善，亦有助於民眾了解醫療糾紛之難題並增加對法院判決之信賴度。

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.According to recent 154 cases about court decisions, the study try to find a better way improving the problems between the doctors and the patients.\r\n\r\nThe study firstly illuminates the civil code requirement basis of the medical lawsuits, and then treats the reversal issue of legislative burden of proof. It further discusses about the theory of burden of proof as well as the explanation and application of the article 277 of Taiwan Code of Civil Procedure. Afterwards, it establishes the general guideline of the allocation of burden of proof.\r\n\r\nThe medical lawsuits are very unique compared with lawsuits of other kinds. If the responsibility attribution of burden of proof, which comes out from the general guideline of the allocation of burden of proof, is not anticipated by one party, the court must make an adjustment. It 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 in Taiwan. However, it still exists doubt about 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.\r\n\r\nThe thesis claims that the adjustment of allocation of burden of proof should be regarded as lessening the burden of proof more than as transferring the burden of proof. The transfer of the burden of proof should not be applied unless there are any facts as significant medical defects, violation of duty of disclosure, destroying or hiding a piece of evidence. Transfer of the burden of proof will make a great impact and easily causes a doctor to take the duty of result for the medical action. It will make tense relation between the doctors and patients while practically changing the allocation of burden of proof of civil code.\r\n\r\nIt is indicated in the thesis that when considering lessening the burden of proof, the cases should apply to the doctrine of res ipsa loquitur, doctrine of appearance proof, destroying or hiding a piece of evidence or doctrine of informed consent by referring to legislative cases and court practice of other countries. It will make balance between the parties of medical lawsuits and resolve the conflict between doctors and patients.