通訊診察治療芻議——由美國墮胎藥之實體診察（In-Person）要求改變談起【醫法新論】 試閱
A Discussion on Medical Diagnosis and Treatment by Telecommunications—Starting from the Changes in Face-To-Face Diagnosis and Treatment Requirements of Abortion Medication in the United States
通訊診察治療在新冠肺炎COVID-19疫情後之使用無論是在臺灣與美國皆大幅增加。臺灣於2024年修訂，並於同年7月1日施行「通訊診察治療辦法」，更增廣了通訊診察治療應用範圍。惟臺灣通訊診察治療長期受限於醫師法第11條之反面解釋，就醫師親自診察義務，以物理上的實體診查（in-person）為原則，並將通訊診療之使用限縮於特定情境，致時有爭議。本文由法律分析提出主管機關可透過函釋闡明親自診察義務並不等同於當面親自診療，結合美國墮胎藥物Mifepristone對診察與給藥in-person要求之法院判決態度轉變，提出醫師與患者是否同時存在同一空間中，並不影響醫師親自診察義務實踐之芻議；同時建議對於是否可以通訊診察治療係屬醫師專業判斷，不須由法律直接限制之。最後並建議，因通訊診察與面對面之傳統診察治療方式仍有專業需求上之差異，在放寬管制的同時，主管機關可與專業團體共同制定通訊診療指引，並於醫學教育、醫師考試、訓練與再教育之各體系皆確立通訊診療之訓練與認證制度，以確保醫療品質。
This article provides a legal analysis and recommendations regarding the regulation of telemedicine in Taiwan. Following COVID-19 pandemic, the use of telemedicine has rised significantly in both Taiwan and the United States. Taiwan’s “Rules of Medical Diagnosis and Treatment by Telecommunications,” amended in 2024 and effective as of July 1, expands the scope of telemedicine applications. However, Article 11 of the Physicians Act, which states that a physician should not “use telecommunications methods to inquire about illness, make diagnoses, issue prescriptions, or provide treatment without personally conducting the diagnosis,” except under specific circumstances such as “in mountain areas, on outlying islands, in remote areas, or under special or urgent circumstances,” has traditionally been interpreted as enforcing the "Physician’s Duty of Diagnosing in Person."Drawing from the evolution of U.S. court rulings on in-person requirements for abortion medication consultations and dispensing, this article argues that the fulfillment of a physician’s duty of care does not depend on the physical co-presence of the physician and the patient.Consequently, this article recommends that the decision on whether telemedicine is appropriate should be left to the professional judgment of physicians, without the need for direct legal restrictions. Recognizing the professional differences between telemedicine and in-person consultations, it is suggested that regulatory authorities collaborate with professional organizations to develop comprehensive telemedicine guidelines. Furthermore, to ensure the quality of healthcare, training and certification systems for telemedicine is supposed to be established within the existing frameworks of medical education, physician examinations, training, and continuing education.
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