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。

近年來有關醫療法律糾紛案件有逐漸增加之趨勢，本文嘗試藉由實證分析，剖析目前實務與學理上之不同見解，簡要提出個人淺見。於實證分析前，本論文先就文獻理論作簡略之論述，首要說明醫療行為與醫療糾紛之相關概念，以界定醫師或醫療機構對其醫療行為應負之責任。並從實體法上論述醫療過失民事責任之基礎及其內涵，如醫療契約責任、醫療侵權責任、消保法與醫療法之適用，以及醫療過失之因果關係等。次就程序法上探討民事醫療訴訟舉證責任分配之基本原則，同時就美國法與德國法有關醫療過失舉證責任分配的調整於我國實務上之運用，作概略分析及探討。再者，鑑於法官於具體個案中判斷醫療糾紛之相關要件，往往需將訴訟資料送請醫療專業機構加以鑑定，因此，本文亦加以說明我國醫療鑑定制度運作之現況，並據此指出現行醫療糾紛鑑定問題之所在。 最後，本文就最高法院民事案件，分別從醫療糾紛判決背景資料之「年度」、「醫療機構層級」、「科別」、「上訴人」與「上訴結果」，以及醫療糾紛審判實務，如「醫療過失」、「因果關係的認定」、「民事責任請求權基礎及舉證責任之分配情況」、「告知義務」、「醫療鑑定在醫療糾紛應用」，進行實證分析，並依實證數據成果，提出「醫療科別屬性與醫療糾紛案件量多寡密切攸關」、「法院對於醫師在個案是否盡注意義務，應以理性醫師之注意標準綜合評價」、「針對醫療訴訟特性，適度分配醫病雙方之舉證責任」、「宜建立醫療傷害補償基金制度」、「醫事人員確切履行告知說明義務」、「健全現行病歷表之相關問題」、「關於醫療糾紛鑑定實務」暨「透過消保法填補醫療（院）組織疏失之責任」等八項結論及建議，以供實務與學術研究者未來對於醫療糾紛訴訟案件研析時之參考。 / Recently, legal cases concerning medical dispute have a tendency to increase gradually. This article tries to explore different viewpoints between practice and academic theory by empirical analysis and then briefly indicates some of my humble views. Before doing the empirical analysis, this article will briefly introduce the related literatures and theories. Firstly, explains related concepts between medical behavior and medical dispute to define the liability that doctor and medical institution should bear because of their medical behaviors. Then, discuss the basis and connotation of the civil liability for medical malpractice from the substantive law viewpoint, such as the liability for medical contract, medical tort liability, the implementation of the Consumer Protection Law and the Medical Care Act and the causality from the medical malpractice etc. Secondly, this article will discuss the basic principles of allocation of burden of proof for civil medical dispute from the procedural law viewpoint and in the same time, briefly analyze and research that whether it is appropriate to adopt the allocation of burden of proof for medical malpractice from American and German law in our own practice. Furthermore, respecting the fact that for judges to make their decisions in particular medical dispute cases, they always have to send action materials to professional medical institutes for identification, thus, this article also wants to explain the current situation of implementation of our medical identification system, and points out the problems of current medical dispute identification system accordingly. Lastly, this article will proceed empirical analysis according to the Year, Levels of the medical institutions, Divisions, Appellant, Result of Appeal from the background of the verdicts of the civil medical dispute cases awarded by the Supreme Court and according to the medical malpractice, the determination of the causality, the condition of basis of civil title of claiming and allocation of burden of proof, obligation of informing, medical identification in the medical dispute from the medical dispute trial practice. Base upon these results, this article indicates eight conclusions and suggestions for reference for the active participants and academic researchers in future medical dispute lawsuits: the attribution of the medical care division and the number of the medical dispute cases are closely related, court should do omnibus assessment using the standard of due diligence as a rational doctor to determine whether a doctor fulfill his duty of care in a specific case, with the particularity of medical actions in mind, appropriately allocate the burden of proof between doctor and patient, it is better to establish the compensation foundation system for medical damage, medical personnel should literally perform their obligation of informing, to refine the problems of current medical record, things concerning medical dispute identification practice and using the Consumer Protection Act to fill the vacancy that caused by the negligence of the medical institutions.

在醫療糾紛與日俱增的趨勢下，醫療損害民事責任之研究，無疑是法學研究所必須面對的重要課題。除了在實體法層面上，建構適當的醫療損害賠償歸責體系外，程序法上發展出一套特別適用於醫療訴訟的舉證責任分配規則，對於司法審判實務尤具實益。此一舉證責任分配規則具有適當緩和過失責任與無過失責任爭論之作用，使民事損害賠償法面對醫療糾紛得以發揮功能，進一步正當化醫療傷害去刑化努力，並能減少體制外抗爭上演。 關於醫療行為所生損害賠償責任可概分為：基於「醫療瑕疵行為」與基於「自我決定告知義務違反」兩種類型之損害賠償責任。在一般舉證責任分配的基本原則—規範說之適用下，病患（或家屬）原則上仍必須就「醫療疏失行為」、「受有損害」、「兩者間存在因果關係」等要件負舉證責任，惟鑑於醫療資訊上的高度專業性、證據的構造性偏在情況及醫界組織上的專業自律性，不論在醫療疏失或因果關係之舉證上，病患都遭遇舉證上的困難。因此，有必要在一定條件下，適當修正規範說於醫療訴訟之適用，發展出醫療訴訟之舉證責任分配特別規則，以減輕病患的舉證責任。 就醫療瑕疵類型之舉證責任分配特別規則，實包括以下各種舉證責任減輕之制度：表見證明、民法第二二七條之舉證責任減輕、重大醫療瑕疵之舉證責任減輕、證明妨礙、違反文件義務與診斷報告作成及確保義務之舉證責任減輕、可完全控制危險領域之舉證責任減輕、損害賠償之舉證責任減輕等，及證明度之降低等制度。關此，本論文整理德國及我國學理看法、實務案例，並就上述各項制度逐一詳細討論，俾使讀者瞭解各項舉證責任減輕制度之實際運作功能。 另在「病患自我決定告知義務違反」之類型上，根據目前多數見解，每一個侵害身體完整性的醫療行為，都是構成要件該當的身體侵害，此一侵害本身即表徵出違法性，唯有存在「病患有效的同意」，始得排除之。因此，關於「對病患已善盡告知義務」且「已取得病患之同意」，醫師或醫院則負有舉證責任。關此，本論文乃以「醫師告知」、「病患同意」為主軸，分析「告知後同意」原則所衍生之舉證責任問題。 最後，本論文除了回顧歸納各章節之重要結論外，並再就醫療訴訟上之舉證責任分配規則體系，重新作一建構。