全民健保創下世界奇蹟，但台灣醫界卻是哀嚎遍野，糾紛不斷，同時要應付醫療，行政，民事和刑事司法問題。姑不論健保制度下，醫師的權利義務責任發生的巨大變化。由行政院醫事審議委員會手委託的鑑定案件逐漸年增高的事實來看，由民國79年的104件至民國98年的538件。如何有效的解決醫療糾紛已成為醫界和法界的熱門話題。 醫療糾紛似乎已成為醫師們執業時最大的隱憂，目前西醫方面地方法院民事判決賠償金額最高達3100萬。曾幾何時，一向重視醫病和諧關係的中醫界也發生民事判決賠償金額也達900多萬。此發展趨勢與過去社會認為中醫界較不易發生醫療糾紛的認知，大不相同。由民國88年和99年的統計資料中發現，雖然中醫醫療紛的發生率下降，由5.07%至4.3%，但發生醫療糾紛後進入司法訴訟的比率由5%增至17%，增加3.4倍之多。 筆者為臨床中西醫師，在診所同時執行兩種業務，常思考的問題是中醫師執行中醫業務同時，有無須盡西醫師的注意義務。因為中醫師由學歷、臨床訓練和應考背景可分成五種之多。例如單純的特考中醫師，西醫的基礎訓練不夠，完全沒有臨床見習和實習的訓練，這些中醫師有無需盡一般西醫師的注意義務，成為本篇研究的最早動機。於是筆者想透過整理台灣地方法院民事案例有關中醫師醫療訴訟的判決現況，以解決筆者的問題。 本篇研究方法分為文獻分析和內容分析法。 文獻分析包括: 一、 中國傳統醫療、歷代醫事制度和歷代醫療法律　 二、 中醫醫療行為、醫療事故和醫療糾紛 三、 中醫醫療過失之民事法律責任 四、 中醫醫療過失之判斷標準 五、 中醫醫療過失之鑑定 六、 中醫醫療糾紛研究之現況 　　內容分析方面: 是以全國21所地方法院民事訴訟一審判決案件線上電子檔知判決書為研究對象。擷取時間以民國88年1月1日至99年12月1日指，經由判決書進行內容分析。 研究結果方面，經由判決書共搜尋出12個案例符合狹義醫療糾紛之定義。人物部份之統計，非單一被告較多，含醫師為被告身分者較多，被告科別以傷科較多，被害者死亡所佔的比例8.3%；訟訴時間方面，平均訴訟耗費年數為3.42年，民國94年的判決案件最多，有4件；訴訟案件方面，全部和治療相關，單以侵權行為為主要請求權基礎較多，北部地區法院訴訟較多，有委託醫事鑑定較多，病方勝訴佔33.3%，請求賠償平均金和為5,119,.256元，判決賠償平均金額為2,882,215元。另外針對訴訟時間判決結果做研究變項之相關統計。經過統計整理後，對於筆者最早動機問題之解決，即法院對於中醫師應注意的義務範圍，有無包括一般西醫師注意義務或分成若干等級，從法院的判決理由書並無特別提及或明確說明，但從其部份鑑定書和其他刑事判決案件之意見，仍認為中醫師應有一般西醫師之注意義務。筆者希望透過實務判決之實證分析，對中醫界和法界有所助益。 / Between physician and patient the relationship has been changed largely in recent, since the public health insurance was executed. Medical malpractice gains increasing attentions in Taiwan as well as other developed countries. Most of the studies of medical malpractice focused on Western medicine context. Suit for the breach of a civil duty was little studied in Traditional Chinese medicine (TCM). In past the highest account of civil compensation was up to nine million dollars in TCM malpractice suit..Whether the Chinese doctor must take note of both West and Chinese medicine attention during practicing Chinese clinic or not is my motive of this research. The purpose of this study is to investigate the actuality of medical malpractice of TCM in Taiwan. A total of 12 cases were identified. Out of the 12 cases, only 4 were won by plaintiffs (33.33%).The average time for the event of medical malpractice to district court decision was 3.42 years. The average monetary compensation award to plaintiffs was 5,119,256 NTD. I hope that this empirical evidence-based research of Chinese Medical malpractice judgment from civil district court can be useful both on medical and law sector.

國立政治大學風險管理與保險研究所八十七學年度第二學期碩士論文「醫療行為之法律責任與保險之研究」，旨在探討醫事人員執行醫療業務所生之責任與保險之相關問題。全文共分十章，約十六萬字，由研究生陳麗芬所撰，各章內容簡述如下： 第一章 緒論：隨著高等教育普及並醫學資訊發達，醫療糾紛可預期的有增無減，本章即說明本論文之研究動機、目的、所採行的方法及研究範圍。 第二章 醫療行為與醫療業務：醫療行為之意義為貫穿論文的重要概念，須就主管機關衛生署之見解與學理上加以定義。瞭解醫療行為定義後，須加以分類以適應不同醫療人員之業務範圍，並用以區別類似醫療行為之不同。最後論定不當醫療行為之內涵。 第三章 醫療行為實施者及其業務範圍：醫學科技分工精細，一件重大醫療行為往往需由整個醫療團隊合作始竟全功，故須區分醫療人員之身分與其法定業務，以明權責所在。本章另一重點為藥師、藥物、與藥害救濟的介紹，及醫師使用藥物治療時應盡之注意。 第四章 醫療契約：醫療契約之法律性質並非單純委任、承攬、或僱傭，而係非典型之混合契約。醫療契約當事人之身分，就病患的精神狀態與醫師之地位不同可組合成數種情形，並非絕對以病患或醫師為契約當事人。確定醫療契約之性質後，方能確認醫病雙方依契約所應盡之義務與所享之權利，並因此衍生出債務不履行之責任。 第五章 醫療契約之債務不履行：醫療債務不履行以不完全給付為最多，通常更因加害給付而致病患傷亡。欲要求醫師負債務不履行責任，除因醫師本身之故意過失外，醫療院所就醫療人員之故意過失要負同一責任。除故意過失之一般歸責原則外，消費者保護法創立無過失責任主義，至於是否適用於醫療服務爭議仍大。 第六章 醫療侵權行為：侵權行為之七要件，在醫師侵權責任領域同樣適用，但內容則不同。因病患同意而阻卻違法、疫學因果關係、醫師之監督過失、特異體質、醫療慣行及醫療團隊之共同侵權等為重點。 第七章 醫師業務責任保險市場概況：就我國目前狀況及英國、美國、日本的市場狀況說明。 第八章 醫師業務責任保險單之研究：首先認識醫師業務責任風險為何，是否為可保風險，然後再就保單條款重點部分加以研討，互相參照國內保單範本與業者實際出售之保單及美國保單，評析其間優缺點。主要有承保範圍、因果關係、除外不保、被保險人、責任限額、自負額、Claim Made Basis 及Occurrence Basis、索賠通知、擔保與先決條件、保險人之棄權與禁止抗辯、防禦義務、仲裁與強制調解、及第三人直接請求權等。 第九章 除保險外之其他避險方式：計有自己保險與專屬保險、相互保險（保險合作社）、行政上補償制度。 第十章 結論與建議：分別就醫學部分、法律部分、保險部分就所知提出結論並建議，希冀建構一個更和諧的醫療環境。 略 / 略

本文將負面醫療結果(醫療傷害)統稱為醫療事故(medical incident)，而醫療事故中又分為醫療過失(medical negligence)、醫療不幸（medical mishap，又名醫療災禍）及醫療意外(medical accident)三種情況。造成醫療傷害可能是因為醫療的過失責任，也可能是無醫療過失責任，本文特意將無醫療過失責任再細分為無過失責任、非過失責任與無法律責任（自然死亡或自然病程）三種，並將「無過失責任」no fault liability一詞泛以「無關過失責任」稱之；醫療行為中可預知的合併症與副作用的「醫療不幸」及不可預知、不可抗力的「醫療意外」屬非過失責任範疇，而不可避免性的自然死亡及自然病程，則屬無法律責任的範疇。 責任負擔可分為賠償、補償、救濟三種。賠償者，以不法之侵權行為，致使他人受損害時，因而填補其所受之損害，謂之賠償，英文為indemnity。補償者，指根據該法所指定的人員敲定的額度提供的金錢補助，而不是指針對不法行為或違反契約依法起訴所獲得的補償性賠償金，英文為compensation。救濟者，特別指由國家向貧困者提供的財政幫助，英文為relief。 過失責任的歸責原因是醫療疏失，所以是以損害填補原則及不當得利禁止原則，以填補受害者所受損害及所失利益；因此，過失責任要負的是損害「賠償責任」。非過失責任的歸責原因包括醫療不幸（即副作用、合併症）與醫療意外兩種，因為醫師客觀上已盡注意義務，不論有無結果預知義務或結果迴避義務，醫師已盡力防阻，仍不免發生醫療傷害，故並無醫療疏失可言，應由國家社會對受害者予以救濟；因此，非過失責任理應由福利國家的救濟制度來負責。無關過失責任no fault liability的歸責原因是危險責任，針對所有醫療事故，不論對錯無關過失下，只要有了醫療傷害，加害人就予以被害人限額補償的基本保障。因為醫師身為危險責任主體，依報償責任理論（利之所存，險之所擔）、危險控制理論及危險分擔理論下必須承擔危險責任，因以，無關過失責任應負醫療事故補償責任。 賠償、補償、救濟三種責任負擔都可以分別採用基金模式或保險模式來解決；本文則認為，醫療過失責任宜採取醫師專業責任保險，予受害人損害賠償。醫療無關過失責任宜採取醫事人員強制責任保險，輔以醫療事故特別補償基金，予受害人基本保障補償。醫療非過失責任宜採取醫療風險救濟基金，予受害人風險救濟，急難救助。 故本文結論提出事故補償、風險救濟、損害賠償三階層的保險與基金制度架構，以解決醫療糾紛民事責任問題即；第一層事故補償—針對醫療事故，以醫事人員強制責任保險無關過失，限額補償；第二層風險救濟—針對醫療意外，整合醫療風險救濟基金定額救濟；第三層損害賠償—針對過失責任，以醫師責任保險損害填補。 / In this paper, we study negative outcomes associated with the delivery health care, which are collectively referred to as “medical incident”. This is further divided into “medical negligence”, “medical mishap” (also known as “medical disaster”), and “medical accidents”. Medical injuries may be in consequence of medical negligence or otherwise, that is they may be with fault or without fault. In this paper we further medical injuries without fault into three categories: (1) liability regardless of fault, (2) liability without fault, and (3) no legal liability. Notably, we refer to “no-fault liability” as “liability regardless of fault” to better distinguish its legal implications with respect to other kinds of medical injuries without fault. Predictable complications and side effects of medical treatments are considered “medical mishap”; unavoidable natural death or nature course of disease have “no legal liability”. The burden of duty can be divided into three categories: indemnity, compensation, and relief. Indemnity is secondary to the violation of rights leading to injury and damages. Compensation is set by appointed experts and given in direct consequence of the occurrence of the injury, and is independently of the determination of legality and contract fulfillment. Relief specifically refers to financial assistance given by government entities to those in need. At-fault liability follows medical negligence, and as such indemnity is given for reparation of damages and the prohibition of gains from the provision of negligent medical care. Causes of liability with no fault include medical mishaps and medical accidents. In these cases, the physician has fulfilled duties as medical professionals and in so doing have done their best to prevent medical incidents. Nevertheless due to circumstances beyond control, medical injuries occur. Because there is no negligence on the part of the physician, these losses are ideally dealt with by the governmental agencies. Liability regardless of fault attributes liability based on risk alone. Under this system, for all medical incidents, whether or not they are the consequence of negligence, the victim receives relief at a pre-determined amount. This relief serves as the basic protection of patients. Since the physician as the chief medical care provider is also at the center of medical risk, by principles of risk management, liability regardless of fault should in addition be organized as medical incidents compensation. The three forms of duty burden–indemnity, compensation, and relief–can be organized either as foundations or as insurances. We argue that duty burden for medical negligence is best managed by professional liability insurance to provide compensation to the victims. Medical liability regardless of fault is best managed by compulsory medical provider liability insurance with additional medical incidence compensation fund to provide at least a basic level of compensation to the victims. Medical liability without fault is best managed by medical risk relief fund for assistance for the victims. In conclusion, in this paper we analyze various forms of liability and management of medical risks, and propose the use of professional liability insurance for medical injuries with fault, compulsory liability insurance for liability without fault, and relief fund for liability regardless of fault, in the setting of medical incidence. This provides a comprehensive, three-layered solution to the emerging problem of proliferation of medical incident cases in the courts. The first layer is incidence compensation, directed at all medical incidents, via compulsory medical personnel liability insurance regardless of fault. The second layer is risk relief, directed at medical mishaps and medical accidents, via risk relief funds. The third layer is damage indemnity, directed at at-fault liability, via physician professional liability insurance, to fulfill the victims’ damages.