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.

Text in Afrikaans with summaries in Afrikaans and English / For many years divorce has been viewed exclusively as a legal problem that had to be addressed by the courts in our adversarial system of litigation. Divorce, however, also entails social problems which are not addressed in our legal system. It appears further that our adversarial legal system tends to heighten the conflicting interests of individual family members at divorce and to encourage animosity and irreconcilability. In an attempt to ameliorate the harsh consequences of the adversarial legal system at divorce, two no-fault grounds for divorce were introduced to enable divorcing spouses to make the decision about the termination of their marriage themselves. This greater freedom that no-fault divorce afforded parties quickly led to a demand for a new system of dispute resolution at divorce. The Hoexter Commission consequently, recommended the establishment of a family court with a social component where mediation services are offered. In both Australia and New Zealand the introduction of no-fault divorce was attended by the establishment of family courts where mediation services are offered. In mediation the parties involved, with the assistance of an impartial third, may sort out and find solutions to all their divorce-related problems. It also appears that mediation has always played a prominent role in the resolution of family disputes in the indigenous communities of South Africa. Owing to financial restrictions, South Africa is still without a family court. So far, only the Mediation in Certain Divorce Matters Act 24 of 1987 has emanated from the recommendations of the Hoexter Commission. This Act, which provides for the institution of enquiries by the office of the family advocate to determine the best interests of children at divorce, professes in its title to have introduced mediation as an alternative system of dispute resolution at divorce. From the contents of the Act it is apparent, however, that it provides for mediation only in a very limited sense. Consequently, it is necessary to amend this Act to make provision for real, comprehensive and accessible mediation services for the public in all family law disputes. This amendment could best be achieved by regulating existing private and community mediation services and integrating them into the formal legal process. / Egskeiding is baie jare lank as 'n regsprobleem beskou wat in ons adversatiewe stelsel van litigasie uitsluitlik deur die howe uitgestryk moes word. Egskeiding behels egter ook maatskaplike probleme wat nie deur ens regstelsel ondervang word nie. Ons adversatiewe regstelsel verskerp boonop die teenstrydige belange van individuele gesinslede by egskeiding en moedig verbittering en onversoenlikheid aan. Weens die probleme wat die skuldbeginsel en die adversatiewe stelsel vir gades met huweliksprobleme en vir die egskeidingsproses in die algemeen veroorsaak het, is twee skuldlose egskeidingsgronde in 1979 ingevoer wat aan gades wat wil skei, groter inspraak en seggenskap in die hele proses gegee het. Hierdie groter vryheid wat skuldlose egskeiding meegebring het, het spoedig 'n behoefte aan 'n nuwe stelsel van dispuutbeslegting by egskeiding geskep. Die Hoexterkommissie het gevolglik aanbeveel dat 'n gesinshof met 'n maatskaplike komponent ingestel word waarby onder andere bemiddelingsdienste beskikbaar meet wees. In sowel Australie as Nieu-Seeland het die invoering van skuldlose egskeiding inderdaad gepaardgegaan met die instelling van gesinshowe waar bemiddelingsdienste beskikbaar is. In die bemiddelingsproses kan mense self, maar met die bystand van 'n onpartydige derde, al hulle probleme by egskeiding uitsorteer en oplos. Dit blyk verder dat bemiddeling nog altyd 'n prominente rol by die beslegting van gesinsgeskille in inheemsregtelike gemeenskappe in Suid-Afrika gespeel het. Weens finansiele beperkings is Suid-Afrika nog steeds sonder 'n gesinshof. Al wat tot dusver uit die Hoexterkommissie se aanbevelings voortgevloei het, is die Wet op Bemiddeling in Sekere Egskeidingsaangeleenthede 24 van 1987 wat daarvoor voorsiening maak dat die kantoor van die gesinsadvokaat by egskeiding ondersoeke na die beste belange van kinders kan instel. Alhoewel die titel van die Wet voorgee om vir bemiddeling as 'n alternatiewe stelsel van dispuutbeslegting by egskeidng voorsiening te maak, blyk dit uit die inhoud van die Wet dat dit bloot vir 'n baie beperkte vorm van bemiddeling voorsiening maak. Dit is gevolglik nodig dat hierdie Wet gewysig word om by alle familieregtelike kwessies vir ware, omvattende en toeganklike bemiddelingsdienste aan die publiek voorsiening te maak. Die geskikste wyse waarop dit bewerkstellig kan word, is om bestaande private en gemeenskapsbemiddelingsdienste te reguleer en in die formele regsproses te integreer. / Private Law / LL.D.