胃癌術後第三天死亡判院方無過失【寰宇醫事裁判】 試閱
Hospital Found Not at Fault for Stomach Cancer Death on Third Day after Surgery
病人C於被告Y開設之醫院接受胃癌手術，過程中意外在膽囊底部發現腫塊，故一併切除膽囊。C術後有低氧血症狀，G醫師停止投與鎮痛藥並安裝心電圖監測儀；術後第3天，C呼吸費力而失去意識，雖經供氧等急救措施仍死亡。A醫師鑑定認為，肺栓塞是術後急性死亡首應考慮的原因，而C術後病徵都指向肺栓塞；B醫師反而認為，C術後尚未出現肺栓塞的特徵表現，尚不能診斷有肺栓塞。法院認為肺衰塞雖然難以診斷，G醫師也並未觀察到明顯病徵，惟若排除其他死因之可能，仍應認定C死於肺栓塞；其次，C的身體狀況、病史與臨床過程並非具有肺栓塞因子，也難以預見其病發，且依當下醫療水準，預防術後急性肺栓塞非醫療常規；最後G醫師雖未事前告知切除膽囊，但得推測事前若有告知C仍會同意，且被告Y有明確建議解剖以查明死因，亦遭家屬拒絕，故不能認定G醫師違反說明義務。
C underwent surgery for gastric cancer at a hospital run by defendant Y. A lump was accidentally found at the base of the gallbladder and the gallbladder was removed; C suffered from postoperative hypoxemia, so physician G stopped administering painkillers and installed an electrocardiogram monitor; on the third day after the surgery, C suffered from respiratory distress and became unconscious, and died despite the provision of oxygen and other emergency medical care; Physician A determined that pulmonary embolism was the first cause of acute postoperative death to be considered, and that all the postoperative symptoms of C pointed to pulmonary embolism; Physician B, on the other hand, considered that C had not yet developed the characteristics of pulmonary embolism, and could not yet be diagnosed with pulmonary embolism. The court held that although pulmonary embolism is difficult to diagnose and physician G did not observe any obvious symptoms, if other causes of death are ruled out, C’s death should still be determined to be due to pulmonary embolism; secondly, C’s physical condition, medical history, and clinical course did not have the factor of pulmonary embolism, and it was difficult to predict the onset of the disease, and according to the standard of medical treatment at the present time, it is not a common medical practice to prevent acute pulmonary embolism in the post-surgical period; and finally, even though physician G did not inform C of the removal of the gallbladder, he could have made an assessment if C had been informed of it in advance. Moreover, physician G’s explicit recommendation for an autopsy to find out the cause of death was rejected by the family, so it is not possible to conclude that physician G breached his duty to inform.
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