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| Title: | 證據調查與舉證責任之研究-以醫療糾紛訴訟為中心 |
| Other Titles: | Investigation of Evidences and Burden of Proof：Centered upon Medical Litigation |
| Authors: | 黃清濱
Huang, Ching-Pin |
| Contributors: | 李成
Lee, Cherng
東海大學法律學系 |
| Keywords: | 醫療糾紛;舉證責任;證據調查
Investigation of Evidences;Burden of Proof;Medical Litigation |
| Date: | 2004 |
| Issue Date: | 2011-05-19T08:06:38Z (UTC)
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| Abstract: | 隨著社會遞嬗、人民知識水平普遍提昇，自我意識膨脹以及對自我權利保護之需求增強，造成既往醫療生態中父權主義思想之迅速衰退，醫療糾紛案件近年來在數量上與日俱升。不同於其他之案件，醫療糾紛案件有其存在之高度專業性及特殊性。法律所能評價的範疇，不是事後病人是否完全痊癒的問題，而是施行該項檢查之醫師，其施行前之評估與施行之過程是否均符合該類型或該等級之醫療機構之客觀專業水平。因為醫療行為本身被期望與評價者乃為一種手段（過程）債務，而非結果（發生傷亡結果）債務。調查證據與舉證責任是醫療糾紛訴訟類型之兩大議題。法院在調查證據之前，應將訴訟有關有關爭點曉諭當事人。此乃為了解決當日實務上一面整理爭點，一方面調查證據，造成整個程序散漫化並，造成無謂之調查及重覆訊問，以致於訴訟程序遲滯。又調查證據，應秉持審理集中化之精神。醫療糾紛之民事訴訟程序，屬於現代訴訟之重要類型，其重要性質與日俱增。主要理由係基於醫療行為發生之頻繁性（每天因身體病痛而就醫之人數與相較於其他日常生活關係之發生頻率）與醫療傷害之嚴重性（非僅涉及財產權而往往涉及健康權或生命權）。此類訴訟在本質上即有其困難性、複雜性與專業性。社會對於醫師之要求日益嚴厲，根本之道乃是以醫師責任保險方式加以緩和。在德國，醫療糾紛訴訟上一直並不願放棄過失責任主義，我國新修正之醫療法第八十二條亦顯然有如此之趨勢，因為過失責任主義本即為民事歸責之基本原則。因此對於此類型之民事責任制度，不但在實體法上，如民法、消費者保護法、醫療法之發展面上有討論空間，即使在民事訴訟之程序上之舉證責任分配之法則上，是否仍有調整之可能性，實為我國作為一個法治國家亟待發展與研究之重點。我國民事訴訟法第二百七十七條，在新修法時已經增定但書之規定，其中之立法理由，特別考慮到醫療糾紛之特殊性問題。因此，對於原告（病患）醫療訴訟舉證責任減輕之研究，對於相關民事訴訟法第二百七十七條但書理論之補充與闡釋，應有正面之價值。新修正之刑事訴訟法，在實質內涵上改良式當事人進行主義，並係採取當事人聲請調查證據為主之證據調查方式。我國刑事訴訟法採嚴格證明法則，而刑事訴訟法上嚴格證明法則包括「證據能力」及「調查程序」兩種概念。刑事訴訟程序上所提出之證據，必須先就形式上觀察，先判斷有無證據能力，如有證據能力，再要求進一步踐行法定調查程序，研求其證明力之問題。院之職責與檢察官本質上並不相同。檢察官之職責乃追訴犯罪，尤其在改成公訴人（公訴組檢察官）全程蒞庭之後，對於被告犯行之存在與否，必須在法庭之攻防中，為詳盡的說明並負起確實的舉證責任，而法院之職責為審理案件，即是釐清案情之真實性，其職責並非調查案件，調查之職責本就應該屬於具有強大調查犯罪能力的檢察機關身上，否則法官若兼負調查證據或蒐集證據之工作時，追訴者與審判者之角色似乎將嚴重混淆，即會造成法院有裁判兼球員之嫌。對於醫療行為是否適用消費者保護法之探討，對於醫界而言，始終是個議題，醫界認為新修正之醫療法規定，醫師與醫療機構此醫療行為將不受消費者保護法之規範，並擴大解釋為醫療行為並不屬於消費行為。對於新修正之醫療法第八十二條之概念，醫界若將之片面解讀為立法機關有意將醫療服務行為排除適用於消費者保護法之規定，本文認為仍有值得再行討論之的空間。因此，有學者認為，醫界費了好大功夫爭取來的新醫療法第八十二條第二項增訂條文，只是重申向來民事侵權行為一貫的歸責原則而已，並無賦予特別之意義，其射程並不及於排除消費者保護法的適用。就醫療行為而言，依據法律之規定以及綜合學理之討論，醫療行為並不適用於完全之無過失責任。亦即，符合客觀專業水平之醫療醫療行為，乃是屬於所謂「容許性風險」之範疇，應不必接受法律上違法或不當之評價。至於有過失或故意之醫療疏失行為，應可適用消費者保護法「懲罰性賠償金」之規定。如此，將消費者保護法上之科技或專業水準抗辯，當成舉證責任之轉換或減輕規定，不但避免法官認事用法時，裁量之不確定性，就醫療實務上，一個具客觀專業水準的醫療行為，在容許之風險下，醫師（或醫療機構）並不負損害賠償責任，但對於醫師之故意犯罪醫療行為或重大過失之醫療行為，則適用消費者保護法懲罰性賠償之規定，應較符合立法意旨，也較符合公平正義。醫療失敗與醫療風險（Medical Risk）必須加以區分。醫療失敗可導入醫療糾紛之過失範疇討論，醫療失敗可能是醫師積極行為的過失與消極不作為的過失所致，醫療行為並非單方面的過程，而是嚴密雙方互動的過程，醫療契約與保險契約一樣，均應屬於最大善意契約，保險法第六十四條所規範被保險人、要保人之告知義務，與醫療法、醫師法上所規範的告知義務，均不應該只存在於契約兩造當事人之任一方。就醫療契約而言，病人若未將詳實的病症告訴醫師，此時即存在病人不確定風險（patient un-definite risk），即病人在將來疾病的演進中即存在著可能急速惡化，甚至是疾病本身即是現今醫療技術所無法控制之情形，此時醫師本身即存在著執業風險（practice risk）。在傳統民事訴訟法上，證據契約是一個比較被忽略的領域。證據契約所約定之內容必須不侵害法院自由心證之核心領域，並且必須在辯論主義之領域之內，方可承認其效力。雙方當事人所訂立之仲裁鑑定契約，若得視為自認之變形，亦應該被認為有效。至於證據方法契約或證據限制契約，因為二者均可能會限制真實之發現與限制法院職權探知主義之領域，不宜承認其效力。對於在醫療契約中約定強制仲裁條款，因為醫療糾紛案件之本質，通常並非只有涉及財產權之損失，而兼有涉及身體、健康與生命之重大法益，故常涉有刑事追訴之問題，並含有公共利益之意涵，故涉及醫療糾紛之案件是否適宜仲裁，仍有相當疑慮。以醫療案件而言，另一個必須加以考量之重要因素，乃是證據契約訂立之時點。基於醫療的公益性與道德性，應在醫療糾紛發生之後，甚至在訴訟繫屬之後，才有意義。若在糾紛發生前，即訂定類似之證據契約，除了仲裁鑑定契約外，因為違反公共利益與善良風俗，並且隱含強烈防禦性醫療之性質，對於弱勢之病患而言並不公平，因此該類型之證據契約應不被允許。檢察官或法院、受命法官，不論是囑託行政院衛生署醫事審議委員會或是醫學中心作鑑定，實務上之醫療鑑定方式上仍存在若干瑕疵，例如送鑑定時未指明具體鑑定問題，而僅概括的囑託鑑定機關就係爭案件鑑定醫師有無過失，在醫療糾紛訴訟上，法院固得就鑑定人依其特別知識觀察事實，加以判斷而陳述之鑑定意見，依自由心證判斷事實之真偽。然就鑑定人之鑑定意見可採與否，仍應踐行調查證據之程序，而後定其取捨。倘法院不問鑑定意見所由生之理由如何，遽採為裁判之依據，不啻將法院採證認事之職權委諸鑑定人，與鑑定僅為一種調查證據之方法之趣旨，殊有違背。
As time pass by, people’s knowledge level promoting generally, expansion of self-consciousness and high awareness of self-right protection lead to the patriarchy doctrine of the previously medical ecology declines promptly, so that medical dispute cases have been rising in recent years.Different from other cases, the medical dispute case has its highly professional lines and particularity. The category that the law can evaluate is not whether the patient could recover fully afterwards, but if the doctor could check whether the assessment of before and period implement accord with the objective professional level of the medical practice. Because the medical treatment should be a kind debt of means (course), not debt of result (the injuries and deaths result takes place).Investigation of evidence and burden of proof are two major topics of the medical dispute lawsuit type. The court should inform the litigant the key point of litigation before investigating the evidence. In order to solve clean out the points in dispute and investigate the evidence, causes the meaningless investigation and re-examine with the result that the litigious procedure is sluggish. Furthermore;the investigation of the evidence should hold on the spirit of trial concentrated.Civil action procedure of the medical dispute belongs to the important type of the modern lawsuit; its important grows with each passing day. The main reasons are that the frequency of medical behavior takes place (Due to the frequency number of people seek medical advice for body illness per day relatively to other daily life relation) and the severity of medical injury (Not only involve the proprietary but often involves health right or life right). There are its difficulty, complexity and professional lines in essence in this kind of lawsuit. The society requests to the doctor is severe day by day; the basic settle way is by the way of doctor's liability insurance. In Germany, it is unwilling to give up the doctrine of the liability for medical malpractice on the medical dispute lawsuit all the time. Article 82 of medical law that our country revises recently also obviously has a trend like this, because the doctrine of liability for medical malpractice is originated from the basic principle of civil responsibility. So the civil liability system to this type, not only on the substantive law, such as civil law, consumer protected law, medical law have discussion space; moreover, it is the focal point that to be a legal state ,even whether there is possibility of adjustment on the rule of burden of proof in the procedure of civil action distributes.Article 277 of civil litigation law of our country has already increased the regulation of the proviso definitely while re-edit the newly law, the legislative reason considers the particularity question of the special medical dispute. So, there should be the positive value to the relevant supplementary and explanation of 277th proviso theory of civil litigation law for the research of lightening the medical burden of proof of lawsuit to the plaintiff (patient). Newly revised Code of Criminal Procedure not only improves the proceeding doctrine of the litigant, but the evidence investigation method of the main fact on the litigant please investigates the evidence. Our Code of Criminal Procedure adopts the strict proof rule, which include two kinds of concepts of “Burden of Proof” & “Investigation procedure”. Evidence put forward on the Code of Criminal Procedure must observe formally first to judge whether there is credibility of evidence. If yes, it should practice the legal investigation procedure to research its value of evidence further.The duty of the court in essence is quite different from the prosecutor. The duty of prosecutor is to prosecute the crime, Besides, the main duty of the prosecuting attorney is the production burden and persuasion burden in the court. Furthermore, the duty of the court is namely try the case to interpret the authenticity, but not investigate. The duty of investigation should belong to investigative organization, or if the judge shoulders both job of the evidence investigation and evidence collecting, that seems to confuse the role of judge with prosecutor and leads to the court is suspected that being referee and sportsman concurrently.With regard to the discussion of whether the medical behavior apply to the consumers protected law; however, it is still a topic for discussion as to medical circles. The medical circles think that the newly revised medical law regulation provides that the medical behavior of doctor and medical organization will not be regulated by the norm of consumer protected law, and also expansively interpret that the medical behavior is not the consumption behavior. Regarding to the concept of article 82 of medical law, if medical circles explain one-sided to the legislature act to intend to exclude the medical service act regulation form applying to consumers protected law, there would still be a space that is worth doing discussion. Hence, the scholar thinks that the newly revised the 82nd medical law of item 2 just reaffirms the responsibility principle of civil tort only, without endowing with any special meaning, and the application range is inferior to consumers protected law.According to the medical behavior, the regulation of the law, and the discussion of synthetic theory, the medical behavior is not suitable for the liability without any negligence. Namely that objective professional medical behavior belongs to the category of “Permitting Risk”, and needn’t accept the illegal or an improper appraisal. As for the medical careless behavior with fault or on purpose, should be applicable to the “Punitive Damages” regulation of consumers protected law. Like that, using the scientific and technological or professional counterplea level on the consumers protected law as the conversion of the burden of proof or the lighten regulation not only prevent from the uncertainty when the judge exercising law; in addition, by the objective professional level medical behavior, the doctor (or medical organization) does not shoulder compensation for damage responsibility under the risk that is permitted. But calculated medical behavior or culpable negligence medical behavior to the doctor should be applicable to the regulation that is the punishing compensation of consumers protected law, that is relatively accord with the legislative intention and fair justice.Medical failure and Medical Risk should be discriminated. Medical failure can be discussed about the mistake of medical dispute, and medical failure is probably due to the fault of positive and passive behavior of doctor, and the medical behavior is not the one-sided course, but tight both sides.The attribute of medical contracts and insurance contracts are ultimate good-faith contracts. The obligation of informed consent exists not only in doctor per se but also in patients. If patient covers up his illness history, then it means that patient is quite an un-definite risk factor himself, meanwhile, doctors have the practice risk. The concept of evidence contract should not be infringement of the core domain of court, in detail, the core territory of principle of discretionary evidence. For example, the contract of means of proof and contract of limited evidence should restrict the discovery of truth and investigation by court official right , then its effect should not be admitted. On medical litigation, expert testimony is one kind of investigation of evidence. The written expert testimony is only the assistance of court , the court should acknowledge the truth and make an adequate application of law by the principle of discretionary evidence. |
| Appears in Collections: | [法律學系所] 碩博士論文
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