醫療法第82條的修正與疑慮:以醫療糾紛拔牙案為例【月旦時論】 試閱
The Amendment of Paragraph 82 of Medical Care Act and Its Doubts: Focus on the Extraction Case in Medical Lawsuits
本文以一則相當尋常的牙科診療所涉的刑事醫療糾紛為討論主題。病人主張,牙醫師明知其罹患牙周病,屬於齲齒之高風險群,在就診期間從未以X光進一步檢查,而有違反醫療法第82條之規定。根據醫事審議委員會的判斷,該牙醫師違背了必要注意義務,不但逾越了合理臨床專業裁量,亦無臨床專業裁量權限的例外情況而有疏失。然而,違反必要注意義務,逾越合理臨床的裁量,還不必然有刑法上的過失。注意義務的違反與臨床專業裁量與傷害結果之間的因果關係仍需進一步檢視。根據醫療法第82條,成立過失犯罪的條件必須是「違反必要注意義務」,且「逾越合理臨床專業裁量」,而法院仍必須仔細斟酌刑法上的原則,對於醫療事故進行判斷其間是否具有內在的關聯性,方能成立刑事之醫療過失。
By introducing a normal case, the topic in this article would be the criminal medical lawsuits of dentistry. The patient accused the dentist about a breach of paragraph 82 of Medical Care Act that he didn’t take any X-ray to have a further examination during the visiting, while he knew that the patient had a periodontal disease, which lead to decayed tooth with high risks. According to the identification by Medical Review Committee, the dentist breached medical due care, and exceeded the reasonable exercise of professional clinical discretion without any exception. He had a medical negligence as the consequence; nevertheless, a medical negligence doesn’t lead to a criminal negligence. The causality between the breach of medical due care, professional clinical discretion and injury as the consequence should also be considered. According to the paragraph 82 of Medical Care Act, the conditions of the criminal medical negligence are a breach of medical due care and exceeding the reasonable exercise of professional clinical discretion. Furthermore, the court should examine the medical lawsuit, according to the principles of Criminal Law, whether there was an immanent coherence between the behavior and the injury to confirm a criminal negligence.
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