骨科醫師未經患者同意施作截骨手術之民事責任研究【本期企劃】 試閱
Research on Civil Liability of Orthopedic Surgeons Performing Osteotomy Without Patient Consent
本文探討骨科醫師於手術過程中變更術式或追加施作截骨手術（osteotomy）時，可能衍生之法律責任。告知後同意（informed consent）為現代醫療倫理與法律之核心，已見於我國醫療法第63條、病人自主權利法及相關司法實務。然於高度侵入性骨科手術中，其實際落實仍存有困難。近年醫療民事判決統計顯示，骨科已成為涉訟比例最高之科別之一，其中未盡告知說明義務為常見判賠原因。本文以臺灣高等法院高雄分院114年度醫上易字第1號民事判決為核心案例，結合侵權行為、契約責任、醫事法規及比較法觀點，分析截骨手術中告知義務之法律要件。研究發現，法院已由「形式同意說」轉向「實質同意說」，不再僅重視書面同意書之存在，而要求醫師確保病患對術式實質變更具有充分理解與自主選擇機會。本文認為，未經同意施作截骨術，可能同時構成民法第184條侵權行為責任與第227條債務不履行責任。最後，本文就自費醫材費用透明化、術中變更術式之補充同意程序，以及醫病共決（SDM）之制度化，提出臨床風險控管建議。
This study examines the civil liability of orthopaedic surgeons who modify surgical procedures or perform an additional osteotomy intraoperatively without obtaining adequate patient consent. Informed consent is a core principle of modern medical ethics and law, reflected in Article 63 of Taiwan’s Medical Care Act, the Patient Right to Autonomy Act, and relevant judicial practice. However, its implementation in highly invasive orthopaedic surgery remains challenging. Recent analyses of Taiwanese civil medical judgments show that orthopaedics is among the most frequently litigated specialties, and inadequate disclosure is a major cause of damages awards. Focusing on Taiwan High Court Kaohsiung Branch Civil Judgment No. 1 of 2025, this article analyses the legal requirements of disclosure in osteotomy procedures through tort law, contractual liability, medical regulation, and comparative law. The study discloses that courts have moved from a formal consent approach to a substantive consent approach, requiring not merely written documentation but meaningful patient understanding and autonomous choice when procedures are materially altered. Performing osteotomy without consent may therefore constitute both tort liability under Article 184 and contractual liability under Article 227 of the Civil Code. The article further proposes risk management strategies concerning cost transparency, supplemental consent for intraoperative changes, and institutionalisation of shared decision-making.
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