Cette étude se référera au caractère contractuel de la responsabilité civile médicale en droit chilien comparé avec le droit français. Je commencerai donc par une analyse historique de la privatisation de la santé et du phénomène de la contractualisation de l’activité sanitaire au Chili. Le principal problème a été que les demandeurs ont échappé au caractère contractuel de la responsabilité et ce principalement à cause du problème du cumul des responsabilités. Ce problème présent en droit chilien peut être résolu à travers une étude approfondie du contrat médical, de ses conditions d'existence et de validité, de ses principales caractéristiques et des différentes théories qui ont tenté d'expliquer sa nature juridique. Nous analyserons également les cas où la relation médicale initiale n'a pas pour source le contrat médical, bien qu’il ait de toute façon été considéré par la jurisprudence et la doctrine comme ayant un caractère contractuel. Nous étudierons dans le même temps les différentes théories qui ont eu comme finalité de contractualiser la responsabilité des centres hospitaliers, tant publics que privés, par le fait de leurs salariés, pour ainsi éviter que la responsabilité de ces centres devienne effective conformément aux normes de la responsabilité extracontractuelle. / The contractual nature of the medical liability had no the same interest in chilean law that french law. However, the increasing privatization of health and the phenomenon of contracting activity for Chilean takes us a deal to make a further study to determinate the contours from the French law. The main problem was that the applicants have escaped the contractual liability and mainly because of the problem of overlapping responsibilities. This problem present in chilean law can be resolved through a thorough study of the medical contract, the conditions of its existence and validity of its main characteristics and different theories have attempted to explain its legal nature and it provide a legal regime that atypical contracts. On the other hand we have to deal with all cases where the initial medical relationship does not source the medical contract, although it has been considered anyway by courts and commentators as having a contractual, and why try to analyze the different theories that have had the purpose of contractualize responsibility for private and public hospitals,, by the fact of their employees, to avoid the responsibility of these centers become effective in accordance with standards of tort.

Orientador: Daniele Cristina Cataneo / Resumo: Introdução: Considerando que no Brasil, observou-se um crescimento exponencial das demandas judiciais relacionadas aos serviços prestados pelos profissionais da saúde, entende-se necessário um estudo aprofundado à respeito do erro médico com abordagem direta a esse profissional, carecedor de tratamento especial e protetivo sempre que, diante das falhas oriundas do seu exercício profissional, forem verificados fatores de imprevisibilidade capazes de comprometer a exitosa prestação do serviço ofertado. Necessária também, a abordagem no presente trabalho, das mudanças na relação entre o profissional da saúde e o paciente, as prerrogativas de facilitação do acesso ao judiciário, o atendimento aos protocolos clínicos preestabelecidos, dentre outras variáveis, sendo que tais pontos são relevantes para o crescente aumento das ações judiciais e, por consequência, a forma que as decisões são proferidas ao apreciar problemáticas dessa natureza. Objetivos: Descrever acerca da problemática do erro médico quando analisado sob a ótica da responsabilidade civil. Explorar a teoria da responsabilidade civil, a extensão das variáveis de responsabilidade, legislações pertinentes, além de comparar decisões proferidas no Brasil e em outros países. Metodologia: Fora realizada uma revisão da literatura existente sobre o tema e assim elaborada uma dissertação que reuniu e analisou doutrinas acerca do erro médico. Dentre os materiais que foram utilizados, estão as legislações nacionais e internaciona... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Considering that in Brazil, there has been an exponential increase in the legal demands related to the services provided by health professionals, it is necessary to conduct an in-depth study about medical error with a direct approach to this professional, who needs special and protective treatment, whenever, in the face of failures arising from their professional practice, unpredictable factors are verified that can compromise the successful provision of the service offered. It is also necessary, the approach in the present work, of the changes in the relationship between the health professional and the patient, the prerogatives of facilitating access to the judiciary, the attendance to the pre-established clinical protocols, among other variables, and such points are relevant to the increasing increase in lawsuits and, consequently, the way in which decisions are rendered when considering problems of this nature. Objectives: To describe the problem of medical error when analyzed from the perspective of civil liability. Explore the theory of civil liability, the extent of liability variables, relevant legislation, and compare decisions made in Brazil and other countries. Methodology: A review of the existing literature on the topic had been carried out and a dissertation was prepared, which brought together and analyzed doctrines about medical error. Among the materials that were used, there are national and international laws covering the theme and existing leg... (Complete abstract click electronic access below) / Mestre

21世紀是經濟繁榮及醫療科技進步的時代，世界各國面對人口結構快速老化、生命延長、慢性疾病遽增，及流感與疾病的可快速傳播，使世界衛生組織的功能逐漸受到重視。台灣各級醫院的病床幾乎都是急性病床，植物人在健保醫療照護體系中，被歸屬於慢性病非重大傷病，並無特殊的減免醫療支出與補助，僅提供慢性病床及有限的居家護理給付。我國自實施全民健保以來，減輕了許多急重症病患家庭的醫療支出，但健保收入在政治因素的介入下，永遠跟不上醫療支出；且健保局預估今（2009）年收支短絀約320多億(健保局，2008)。不免讓我們憂心未來醫療資源的可能枯竭，加上植物人在病情穩定後即需出院，無法長期留在醫院受專業及妥適的照顧，使得植物人照顧家庭在精神及經濟層面更是雪上加霜陷入困頓。為此，內政、社福、衛生等行政部門，實需積極整合介力協助；如此或可與先進國家的長照體系接軌，使植物人照護得到兼具專業、人性與尊嚴的照應。 本研究採用質性研究中的深入訪談法，以台北縣市植物人照顧家庭的12位家屬為訪談對象，以深入探討都會地區照顧家屬難兼具照顧及就業。照顧者是無酬勞的工作，易在身心俱疲下陷於下一個被犧牲者的情境，植物人家庭對植物人照料與甦醒期待及照顧過程裡對自我生命成長價值觀。訪談所得資料，經歸納、分析所得研究結果: 都會地區家庭結構的轉變，使得家庭照護人力不足，何況目前尚無新醫療可預測植物人何時甦醒，況且頭部病變照顧已久植物人再甦醒的機會很渺茫。大台北地區雙薪家庭聘請外籍看護工的型態，確實讓蠟燭兩頭燒的雙薪家庭，減輕了部份照顧人力不足及精神壓力負擔，但此終究非長久之計。但是，如何讓受照顧的植物人，享有品質的醫療與照護，從而體現生命之尊嚴與國家、社會照護、互助的價值，這正是長照體系建立刻不容緩。或許在可預見的將來，因著教育及社會觀念的轉化，我們可以欣然接受安樂死或推行生前醫療契約，坦然接受自己或家人在面對需要長期療護，特別是可能造成植物人情況的事前自在選擇。所以，如何建構可長可久且結合醫療、勞工、社福用以嘉惠老人及植物人之機構，是政府在拼經濟、擴大內需建設及增加就業，不可不亟力擘劃貫徹的重大議題。但這需要政府與民間一起攜手打造，使台灣寶島實現老吾老以及人之老的平和尊嚴人生之樂土。 本研究依據研究結果，提一些建議：一、對家庭之建議：均衡飲食、養成運動習慣、強化家庭生命共同體。二、對醫療團隊：建立醫院網頁、建構植物人疾病成因及預防之道、社工諮商團隊協助家庭以落實社區長期照護系統。三、對學校建議：課程加入生死學課程、強化衛教觀念及基本照顧方式、培養怡情興趣、學習紓解壓力。四、對政府的建議：政府各部會平台資訊聯結化、行政作業單一窗口化、政策宣導口語化、政策推行離島實施而後推廣至全國，應快速實施長期照護系統。 關鍵字：全民健保、植物人、長期照護、安樂死、生前醫療契約 / The 21st century is a time of economic prosperity and technological advancement. However, the world is facing challenges from the problems of the rapidly aging population, increasing longevity, the surging of chronic disease, in addition to epidemics and flues spreading faster then before. Most hospital beds in Taiwan are considered to be “acute hospital beds”, where vegetative patients are considered by the National Health Insurance to be suffering from a chronic disease and not as major illness/injury. There is no extra medical subsidy for these vegetative patients, and only limited payments for home care. Unfortunately, due to the inefficient funding for health insurance, we are concerned that medical resources might become exhausted in the future. Also, a vegetated patient is required to leave the hospital whenever his or her condition becomes stable. They are unable to remain in the hospital for long-term and professional care, which causes the families with vegetated patients to suffer emotionally and economically. Thus, studying ways for vegetated patients to obtain more professional, human, and dignified care is an important issue worthy of research. This study uses an in-depth interview method from quantitative research. 12 families with vegetative patients in Taipei County are the subjects of the interview. In-depth discussions are conducted on the difficulties for families who take care of a vegetative patient, and who have employment in the urban area. The information obtained was categorized and analyzed. 1. Nursing manpower insufficiency Due to the shifting of family structure in the urban area, there are not enough people in the family to take care of the vegetated patient. It is not possible to predict when a medical breakthrough will enable the patient to regain consciousness. Moreover, there is only a slight chance a vegetated patient suffering from head trauma for a long period of time can be revived again. 2. Dependence on foreign nurse aides By hiring foreign nurse aids, the dual-earner families in the Taipei metro area are able to get relief from the burden of caring for a vegetative patient. However, it is not a long-term solution. 3. The need for long-term care. Therefore, it is very important to construct a long-term care system for the vegetated patient to be able to receive quality medical care. Furthermore, Taiwan will benefit from showing respect for life, the importance of social care, and the value of helping each other. 4. Trying new concepts. Perhaps in the foreseeable future, we will accept things such as euthanasia or pre-paid medical contracts due to the changes in education and social attitudes. We might accept that one of our family members might be facing long-term care in the future, so any one of us is able to make arrangements before an unforeseen accident or illness results in becoming a vegetated patient. 5. Co-operation between the government and the people. This is an important issue for the method of constructing a long-lasting system that can combine medicine, labor, social welfare, and benefits for senior citizens and vegetated patients. However, it will take the cooperation of both government and the people to make Taiwan into a peaceful land that will respect their elders and respect life. Some suggestions have been developed as a result of this study: 1. suggestions to families: a balanced diet, exercise regularly, and strengthen the unity between family members. 2. suggestions to the medical team: develop hospital websites, prevent diseases that can cause vegetation, and the social worker consulting team should help families to implement a long-term community care system. 3. Suggestions to schools: add life and death lessons into the school’s curriculum, reinforce the concept of health education and a basic caring method, as well as increase community service, and teach methods for relieving stress. 4. Suggestions to the government: linking information by using a single window to handle all processes, use colloquial language for promoting policies, the policies should first be implemented in off-shore islands before being used in the main island, implement a long-term care system, and provide subsidies to those who hire domestic nurse aids. Keyword： National Health Insurance, Vegetative, Long-Term care, Home care, Euthanasia, Pre-paid medical contract

Depuis l’arrêt « Mercier » en 1936, la jurisprudence française a consacré la présence d’un contrat médical entre médecin et patient. L’obligation de soins est l’obligation principale du médecin dans ce contrat, elle en est l’objet déterminant. Cependant, avec les progrès réalisés et l’accroissement des exigences de la société, la jurisprudence a renforcé les obligations imposées au médecin en créant ainsi, à sa charge, certaines obligations accessoires, l’obligation de sécurité et l’obligation d’information. Ces obligations ainsi consacrées légalement en France en 2002, sont pour les deux assez importantes afin de maintenir l’équilibre dans la relation de soins. Cette évolution considérable en France n’a pas eu la même importance au Liban. Il existe ainsi beaucoup de carences législatives et jurisprudentielles en matière des obligations médicales. Et bien que le Code de déontologie médicale libanais évoque l’obligation de soins et l’obligation d’information, pour dire que les dispositions du texte sont imprécises. Par ailleurs, il n’existe aucune loi régissant l’obligation de sécurité médicale. Malgré la promulgation de la loi n° 574 du 11 février 2004 relative aux droits des patients et au consentement éclairé, ses dispositions restent assez limitées et son application demeure délicate. Une intervention législative est donc, souhaitable au Liban s’inspirant du législateur français afin de créer des dispositions légales régissant ces obligations d’une manière plus claire, organisée et adaptée aux besoins de la société. / Since 1936 French courts acknowledged the presence of a contract between patient and physician. The obligation to treat was the determinant aspect in this binding document. The main goal was to ensure a balanced relationship between the physician and his patient and an efficient treatment services, therefore, other obligations had to be enforced by the Supreme Court to guarantee an efficient system in an evolving society. In 2002, security and information became an added legal bond between patient and doctor in France. Despite being mush needed, these innovations did not create the same positive echo inside the Lebanese legal system. On this matter, a law detailing the obligation of security is absent, physicians must only answer to ethical codes regarding the medical treatment of their patients. Progress was made in February 2004 with the n° 574 patient’s rights and consent law. Nonetheless, mirroring the French legal system with a new reform on this subject comes with a great value, and will give the Lebanese professional and his patient a new solid ground capable of coping with the evolution of our society.

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.

La thérapie génique est une recherche biomédicale qui a rencontré un certain succès, notamment la mise sur le marché du premier médicament en 2013. La thérapie génique souffre d’un encadrement juridique complexe en raison d’une disparité des règles applicables. L’encadrement des recherches biomédicales met à la charge du promoteur et de l’investigateur des obligations strictes visant à assurer la sécurité et la protection du patient. Cependant, on ne peut pas parler de droit spécial des recherches biomédicales, les rapports entre le patient et l’investigateur possèdent toutes les caractéristiques classiques de la relation médicale ordinaire. Bien que largement critiquée par la doctrine, la qualification des rapports entre l’investigateur et le patient ne peut être autre que celle de contrat médical. En conséquence, l’uniformisation du droit administratif et du droit civil est nécessaire en matière médicale. La reconnaissance du contrat médical dans les établissements de soins privés et publics est la première étape de cette uniformisation. Outre les rapports contractuels existants entre le médecin et le patient, la loi fournit une protection nécessaire au patient contre les manipulations génétiques. Parfois insuffisante, cette protection mérite discussion. / Gene therapy is a biomedical research that has met some success, including the placing on the market the first drug in 2013. The frame law of gene therapy is complex due to disparity rules. The frame law of biomedical researches imposes on the sponsor and the investigator obligations to ensure the safety and the protection of the patient. However, we can not talk about special rights in biomedical researches. The relationship between the patient and the investigator is not special, it have all the classic features of current medical relationship. Although widely criticized by the doctrine, the medical contract appears useful and irreplaceable in public or private health institutions. In consequence, civil law and administrative law must be standardized in medical field. The recognition of medical contract is the first step of this standardization. In addition to the contractual relationship between the patient and the physician, the law provides necessary protection to the patient against genetic engineering. Sometimes insufficient, this protection deserves discussions.

Le corps humain n’a pas échappé au mouvement de contractualisation protéiforme qui se généralise. En ce sens, notre thèse a permis de démontrer l’existence d’une nouvelle catégorie juridique : celle du contrat portant sur le corps humain. Il s’agit d’un genre contractuel qui abrite de nombreuses espèces. La spécificité de ces contrats et l’hétérogénéité des règles qui les gouvernent n’est pas un obstacle à leur systématisation : le contrat portant sur le corps humain est un accord de volontés par lequel l’une des parties met son corps à disposition de l’autre pour l’exécution de la prestation convenue entre elles. En vertu de ce contrat, le cocontractant exerce un pouvoir matériel sur le corps mis à sa disposition. La prestation peut se réaliser sur ou par le corps mis à disposition. Un régime commun a pu être mis à jour. En effet, le législateur prévoit des obligations d’information pour éclairer le consentement de la partie faible, des droits potestatifs extinctifs lui sont également attribués afin que son consentement soit toujours révocable et un encadrement de la sécurité corporelle est nécessairement assuré. Cette étude a conduit à l’élaboration d’une classification des espèces contractuelles, ce qui permet de bénéficier d’une vision d’ensemble de ces contrats et de comprendre que chacun d’entre eux doit s’apprécier suivant l’acte envisagé et le corps mis à disposition. Dès lors, des règles spécifiques s’appliquent, lesquelles sont entièrement dédiées à la protection du corps et, partant, de la dignité humaine. / The human body has not escaped the movement of protean contractualization that is becoming more widespread. In this sense, our thesis made it possible to demonstrate the existence of a new legal category: that of the contract relating to the human body. It is a contractual genus that houses many species. The specificity of these contracts and the heterogeneity of the rules governing them is not an obstacle to their systematization: the contract relating to the human body is an agreement of will by which one of the parties makes his body available to the other for the performance of the service agreed between them. Under this contract, the contracting partner exercises material power over the body placed at his disposal. The service can be performed on or through the body provided. A common regime has been updated. Indeed, the legislator lays down information obligations to enlighten the consent of the weaker party, extinctive potential rights are also granted to him so that his consent can always be revoked and a framework for bodily safety is necessarily ensured. This study led to the elaboration of a classification of contractual species, which allows us to benefit from an overview of these contracts and to understand that each of them must be assessed according to the act envisaged and the body made available. As a result, specific rules apply, which are entirely dedicated to the protection of the body and, therefore, of human dignity.