控訴腰椎手術術式變更案：從告知說明義務探討醫師之顛末說明義務
Claim for Unauthorized Change in Lumbar Surgery Procedure: Exploring the Physician’s Duty of Subsequent Explanation from the Perspective of the Duty of Disclosure
因為醫療行為具有高度專業性及資訊不對稱之特性，現行醫療法制多著重於醫療行為前之告知說明及病患同意，對於醫療行為完成後，醫師是否負有向病患說明診療經過之義務，則較少著墨。本文以本件腰椎手術訴訟案件為例，從民法委任規定及醫療契約之特殊性，探討醫師之「顛末說明義務」，本文認為事前之告知後同意與事後之顛末說明，所保障之利益並不相同，醫師於一定情形下，應依醫療契約之性質、誠信原則及病患之資訊利益，負擔適當範圍之顛末說明義務；此一義務與醫療過失責任應予區分，並有助於促進醫病溝通及醫療爭議之預防與解決。若醫師違反「顛末說明義務」而拒絕說明，即使醫療行為無過失，仍可能構成債務不履行，病患仍可請求精神慰撫金之賠償。而為了建立說明顛末制度，在發生重大傷害或死亡結果之醫療糾紛中，可依臺灣醫療事故預防及爭議處理法組成醫療事故關懷小組向病患、家屬進行說明及溝通；一般醫療糾紛案件，則可參酌醫療事故預防及爭議處理法第6條、第7條之規範目的，以及參考英美法上之「道歉法」，規範事後溝通遺憾、道歉、讓步等陳述，不得採為證據或裁判基礎，以建立妥適之醫、病溝通機制。
Based on a lumbar surgery lawsuit, this article argues that current practices overemphasize pre-surgery “informed disclosure” while neglecting patients’ right to know the actual medical process. The author classifies medical contracts as quasi-mandate contracts; thus, under Article 540 of the Taiwan Civil Code, doctors have an ancillary “duty of subsequent explanation” to protect patients’ information rights. Citing Japanese precedents, breaching this duty constitutes a breach of contract, allowing patients to claim emotional distress compensation. To reduce litigation, the author suggests extending the Medical Accident Prevention and Dispute Resolution Act and the spirit of “Apology Laws” to general medical disputes. Excluding these communications from court evidence would foster genuine, defensive-free doctor-patient dialogue.
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