University of Macau / Faculty of Law

University of Macau / Faculty of Law

University of Macau / Faculty of Law

本論文以台北地方法院、士林地方法院及板橋地方法院民事判決中之符合狹義醫療糾紛定義及其上訴三審共計247筆案件 之相關判決書內容進行研究。主要分析的對象包括判決理由記載內容中，法院對於系爭案件「請求權基礎」、「過失認定標準」、「因果關係」、「舉證責任」以及醫療糾紛案件類型中所特有的「告知義務」等影響判決結果的關鍵因素加以分析。再進一步與學說上針對各該「關鍵因素」在「醫療糾紛」的應用論點相互比較與驗證。並針對各關鍵因素，分別依實務觀點及適用結果加以類型化，或是由醫學觀點提出可能存在的問題及解決之建議。

本研究主要探討臺灣地方法院民事訴訟案件，透過會計鑑定之輔助，是否可以提升訴訟之經濟性。本研究將訴訟之經濟性分別以上訴與否、維持原判決與否、和解與否三項變數來加以衡量，採行法律實證分析。實證結果顯示執行會計鑑定不能夠降低兩造當事人上訴之比例，且達統計顯著水準、不能增加上級審法官維持下級審法官判決之比例，但未達統計顯著水準、不能增加兩造當事人和解之比例，但未達統計顯著水準。推論原因為有執行會計鑑定之案件其案件本身較為複雜且困難，而複雜案件本身上訴率即較高、維持原判決率即較低及和解率即較低。 / The purpose of this study is to investigate whether using forensic accounting litigation support service to assist civil litigation cases proceeded in Taiwan District Court enhances the economics of litigation. The study adopts empirical legal research approach to examine the impacts of forensic accounting litigation support on the the outcome of civil action. The study uses three indexes to measure. The indexes are appealing or not, affirming appeals or not and reaching a settlement or not. The results indicate that (1)if court used forensic accounting litigation support, the appeal rate will not be lower and it reach statistical significant level；(2) if court used forensic accounting litigation support, affirmed appeals rate will not be higher but it didn’t reach statistical significant level；(3) if court used forensic accounting litigation support, settlement rate will not be higher but it didn’t reach statistical significant level. According the analysis, the potential cause includes the civil action cases which use forensic accounting litigation support are more complicated than the civil action cases don’t use. There are the more complicated civil action cases having higher appeal rate, lower affirmed appeals rate and lower settlement rate.

本研究探討影響法官對於會計鑑定意見採納程度之因素。本文以2000年至2016年間有關會計鑑定之民事訴訟判決書為研究樣本，分別就鑑定人之身分(係機關或個人)、鑑定人是否具名及是否到庭陳述、鑑定人之選任方式等特性，探討其與法官對會計鑑定意見採納程度是否存在關聯性。實證結果顯示，鑑定人具有身分為機關、採具名方式提供意見，以及係由兩造合意選任等特性，與法官採納程度存在正向關聯性；鑑定人到庭陳述則與法官對鑑定意見的採納程度不存在顯著關聯性。 / This study examines the determinants of judges’ adoption of opinions provided by forensic accounting experts in civil litigation cases. Based on a sample of verdicts over the period of 2000 to 2016 issued by judges, this study empirically investigates the association between features of forensic accounting experts (whether the experts performing their services on behalf of their institutes, providing signed statements of opinion on forensic findings, being appointed on a consensus from plaintiffs and defendants, or making appearance in court) and the opinion adoption behavior of the judges (whether the forensic findings are fully adopted, partly adopted or completely refuted by the judge) resided in Taiwan district courts and high courts. The empirical results show that cases with forensic accounting experts performing their services on behalf of their institutes, providing singed opinion statements and appointed by both parties of the litigation are positively associated with the a more positive opinion adoption behavior of judges. However, this study fails to find a significant association between whether the forensic accounting experts would make their appearance in court and the opinion adoption behavior of the judges.

近代民事訴訟法史・オーストリア. 鈴木正裕著. -- 信山社, 2016. -- (学術選書 ; 134 . 民事訴訟法). / 京都大学 / 0048 / 新制・論文博士 / 博士(法学) / 乙第13123号 / 論法博第197号 / 新制||法||160(附属図書館) / 京都大学大学院法学研究科私法専攻 / (主査)教授 山本 克己, 教授 笠井 正俊, 教授 山田 文 / 学位規則第4条第2項該当 / Doctor of Laws / Kyoto University / DGAM

京都大学 / 新制・課程博士 / 博士(法学) / 甲第23653号 / 法博第273号 / 新制||法||174(附属図書館) / 京都大学大学院法学研究科法政理論専攻 / (主査)教授 笠井 正俊, 教授 山本 克己, 教授 山田 文 / 学位規則第4条第1項該当 / Doctor of Laws / Kyoto University / DGAM

University of Macau / Faculty of Law

隨著社會變遷，近一二十年來，我國醫療糾紛有大幅增加之現象，而經由媒體的報導，醫療糾紛在我國亦經常成為眾所矚目、備受爭議的社會焦點。由於醫療行為所導致的損害，直接侵害病人之身體權、健康權、甚至生命權，對於病人及其家屬生活所造成之影響，難謂非為鉅大，故醫療糾紛之妥善處理，實係吾人從事醫療法律之研究者，應予正視並深入探討之議題。 我國醫療糾紛之處理，向以刑事訴訟為主要之救濟途徑，惟晚近醫界、法界均已達成共識，認為醫療糾紛應回歸至以民事程序為主之處理模式。惟吾人若欲藉由民事法律關係妥善處理醫療糾紛，則須注意醫療民事訴訟之特殊性，亦即，因醫病雙方專業知識上之落差，導致雙方在民事程序上處於武器不平等之地位。為衡平此一武器不平等，我國實務上部分法官在審理醫療民事訴訟時，曾打破傳統民事過失歸責原則，將消費者保護法無過失責任與民法第191條之3一般危險責任之規定適用於醫療行為，惟自民國93年醫療法第82條第2項修正之後，該法既規定「醫療機構及其醫事人員因執行業務致生損害於病人，以故意或過失為限，負損害賠償責任。」邇近之實務判決遂多採醫療行為過失責任之見解，也多排除民法第191條之3之適用。我國醫療訴訟醫病爭執之重點，乃於近年由實體法之無過失責任之採擇與否，轉換至程序法之舉證責任分配。 於醫療訴訟等現代型訴訟事件中，被害人時常發生舉證上之困難，倘若依照僵化固定的舉證責任分配規則，則不免有失公平正義。因此，舉證責任分配於醫療訴訟上應如何操作方屬適當，實為醫療民事訴訟中值得觀察的重點所在。基於上述之問題意識，本論文的研究架構共分為七章，其內容綱要如下： 第一章 緒論：闡釋說明研究動機，並指明目前民事醫療糾紛事件之問題重心在於「程序法」，特別係在「舉證責任之分配」。進而說明本論文之研究動機、研究目的、研究範圍與研究方法。 第二章 醫療糾紛之發生及其處理：本章由醫療糾紛之發生談起，進而說明醫療糾紛之法律關係，探討不同法領域下醫療提供者違反義務時之法律責任，包括民事責任、刑事責任及行政責任等，並論證醫療糾紛實應回歸至以民事程序為主之處理模式。最後，介紹醫療糾紛發生後，國內外現今法制上之醫療糾紛處理機制，並分析其優缺點。 第三章 醫療糾紛之民事法律關係與醫療民事訴訟之特殊性：本章聚焦於醫療糾紛之民事法律關係，探討醫療提供者之契約責任、醫療無因管理與醫療提供者之侵權責任等。同時，討論醫療民事訴訟之特殊性，分析醫療民事訴訟被害人舉證困難之原因，並分析加重醫療提供者民事責任之法理基礎、以及過度加重醫療提供者民事責任所可能導致之反效果。 第四章 民事訴訟舉證責任分配之學說：按我國關於民事舉證責任之立法明文，係規定於民事訴訟法第277條：「當事人主張有利於己之事實者，就其事實有舉證之責任。但法律別有規定，或依其情形顯失公平者，不在此限。」學者乃認為，在我國法制下，所謂舉證責任分配法則係一總體概念，而可區分為「舉證責任分配一般原則」與「舉證責任分配減輕」二者，而以前者為原則，後者為例外。本章即由舉證責任之基礎觀念出發，藉由介紹國內外之學說，而分別處理「舉證責任分配之一般原則」與「舉證責任分配之減輕」等概念。 第五章 醫療民事訴訟舉證責任分配規則之具體適用：本章集中討論醫療民事訴訟之舉證責任。本章前半段介紹醫療民事訴訟舉證責任分配之一般規則、以及比較法上(包括德國、美國與日本)醫療糾紛舉證責任減輕之具體規則，後半段則分析我國實務操作醫療糾紛舉證責任分配之問題。本文一共歸納出實務判決於適用舉證責任分配時共六個問題，並分別找出判決加以闡釋。於本章末，則提出將醫療糾紛類型化，應有助於解決我國實務之問題。 第六章 醫療糾紛之類型化與舉證責任分配體系之建構：本章先試從「法學思維」、「醫學思維」、以及「綜合醫學思維與法學思維」出發，分別建立三套操作模組，以將醫療糾紛類型化，並建構其各別之舉證責任分配體系。關於純粹由「法學思維」或「醫學思維」所建立之操作模組，本文將分析其操作上之侷限，而針對本文所建議「綜合醫學思維與法學思維」之操作模組，亦將於各醫療糾紛分類，舉實務案例諸例實際操作之，以驗證本文所建議操作流程之可行性。章末則另提出法院於適用舉證責任分配規則時，其他與客觀舉證責任分配無直接相關，但應予考量之事項，以助於更正確地適用舉證責任分配規則。 第七章 結論、建議與展望：綜合前開章節討論，針對醫療民事爭訟程序中之舉證責任分類體系與操作模式，做出總結。並提出其他相關建議，以終極落實醫療需求者憲法上基本權之保障。 / The number of malpractice claims filed in Taiwan against physicians has increased significantly in the recent decades. Medical malpractice litigations are characterized by a huge gap in medical knowledge between physicians and patients, leading to an unequal status between both parties in the trials. To ensure that the principle of equality of arms is upheld in civil procedures, the courts applied the strict liability embodied in Article 7 of the Consumer Protection Law and Article 191-3 of the Civil Code to malpractice cases. However, since the amendment and promulgation of Article 82 of the Medical Care Act, there has been a consensus that strict liability is no longer applicable in medical litigations, and negligence becomes an essential element for establishing the liability of medical practitioners. In addition to modifying liability rules, an alternative for achieving equality of arms is to relieve the plaintiffs from the burden of proof. However, the burden of proof should be adjusted with precaution, because an excessive shift might contribute to defensive medicine. Accordingly, this study aims to standardize the algorithm for allocating the burden of proof by classifying medical malpractice disputes. The thesis is composed of the following seven chapters: Chapter 1 Introduction: This chapter outlines the background of the present study, with a special emphasis on the pivotal role of the burden of proof in medical litigations. Also delineated in this chapter are the objectives and methodology of the present study. Chapter 2 The occurrence and resolution of medical malpractice disputes: In this chapter, the incidence of medical injury and medical malpractice is discussed first, followed by an analysis of the civil, criminal, and administrative liabilities of medical professionals. The plethora of resolutions for settling medical malpractice disputes are summarized at the end of the chapter. Chapter 3 Civil liabilities of medical malpractice and characteristics of medical litigations: This chapter focuses on the civil liabilities of medical malpractice, which arise from failure to undertake contractual duties or tort liabilities. The characteristics of medical litigations, such as the unequal status in arms between plaintiffs and defendants and the difficulties in concluding negligence or deciphering causation, are discussed in the second half of the chapter. Chapter 4 Theories and rules in allocating the burden of proof: The allocation of the burden of proof is determined according to Article 277 of the Taiwan Code of Civil Procedure: A party bears the burden of proof with regard to the facts which he/she alleges in his/her favor, except either where the law provides otherwise or where the circumstances render it manifestly unfair. Consequently, in principle, the burden of proof is allocated according to the “Normentheorie,” with specific rules applied to ease the plaintiff’s burden of proof under exceptional and unfair circumstances. Chapter 5 Rules for allocating the burden of proof in medical litigations: German, American, and Japanese rules for allocating or relieving plaintiffs from the burden of proof in medical litigations are introduced. The current problems in applying these rules to medical litigations in Taiwan are inspected. The solution to these problems relies on a precise classification of medical malpractice disputes. Chapter 6 Establishing the algorithm for allocating the burden of proof by classifying medical malpractice disputes: Three models for allocating the burden of proof are created on the basis of three classification systems: classification from a legal perspective, classification from a medical perspective, and classification from a combined medical-and-legal perspective. A comparison of these three models reveals that the last might be the best algorithm. Specific tips for an accurate application of this algorithm are also provided. Chapter 7 Conclusions: This chapter highlights the importance of an appropriate allocation of the burden of proof in medical litigations, as well as the algorithm for allocating the burden of proof established in the present study. Also included are suggestions on how to ameliorate Taiwan’s medical litigation system in the future.