防禦性醫療的倫理評價與相應之管制建議【本期企劃】 試閱
Ethical Evaluation of Defensive Medicine and Related Regulatory Recommendations
防禦性醫療是醫療人員因為害怕醫療伴隨而來的糾紛風險，而採取的醫療行為。本文從動態倫理判斷出發，分析在臺灣，防禦性醫療如何導致醫療資源浪費與成本外部化、造成醫療排除與就醫權受損。進一步審視醫療法第82條修法、實務判決方向、健保品管與臨床指引之作用與侷限，進而指出面對防禦性醫療需多管齊下，結合健保支付制度與專業指引，縮限常規醫療的責任，並擴張消費型醫療的責任，方能兼顧醫療品質、公平正義與體系永續。
Defensive medicine refers to clinical actions taken by healthcare professionals primarily out of fear of malpractice disputes. From a dynamic ethical framework point of view, this article analyzes how defensive medical practices in Taiwan lead to resource waste, cost externalization, medical exclusion, and infringement of patients’ access to care. It further examines the impact and limitations of the 2018 amendment to Article 82 of the Medical Care Act, judicial signals from cases, National Health Insurance quality-control mechanisms, and clinical guidelines. The analysis argues that addressing defensive medicine requires a comprehensive approach that integrates payment reforms and professional guidelines, narrows liability for routine medical care, and expands responsibility for consumer oriented medical services. Such differentiation is essential for promoting care quality, distributive justice, and the long-term sustainability of the healthcare system.
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