【作者】 曾森雄；

【导师】 李万瑶；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 近数十年来,中医医疗渐渐形成风潮,开始普遍受到世人之注意与重视,尤其如针灸等疗法,更盛行于东洋甚至欧美各国。鉴于此项发展趋势,国内之研究乃篷勃发展,各式新式教育之高等学校,创立中医学系与医药学系,专致力于研究与临床实验医疗。而医疗纠纷的案件,每年逐渐增加,而令人忧心的,是处理医疗纠纷的诸多方法,始终不能令人信服,这样会造成法院、医生、病患等三方面之压力与不安,更会加深医生与病患间的误会、猜忌,甚至于不断冲突的主要原因。海峡两岸同是中华民族,但由于历史上的关系,却形成了今日海峡两岸分离的状况。但是海峡两岸积极推动文化方面的交流,台湾地区的人民到祖国大陆地区开设医院也日渐增多,这有利于海峡两岸医疗技术的交流及人民健康的维护。可是由于海峡两岸的司法制度不同,万一发生医疗纠纷时,要知如何解决之道。本文通过对海峡两岸医疗纠纷在刑法的刑事责任上与民法的民事赔偿责任上,法制的异同与医疗纠纷之处理加以分析比较,了解海峡两岸刑法与民法之立法精神与规定的异同,加深对医疗纠纷法律法规条文的理解,对医疗人员的权益保护影响非常重大。论文通过古代文献资料,现代海峡两岸对于非法医疗行为在法律上规定的比较,由于台湾目前较无大陆中医师分类如此仔细的此种条件及背景,所以两岸此种中医类别的专业划分是差异很大,但均有其合理性。另外,大陆方面尚有乡村医生等,立法上的安排均基于法律不溯既往原则,接受现存的这些特种医师,且基于法律一致性和平等性考量,这些特种医师将来应逐渐淡出一般医师的法制外,使各地民众不分地区或乡城,都均有一定品质的医疗照顾；对于大陆的乡村医生未来建议由较完备的公医制度取代,即由国家负起照顾偏远地区民众健康权益的责任,对经济弱势的农村能够分派公职合格的医师驻诊,以人口的密集度来分为常驻或轮驻,并能够落实照顾广大农民的医疗需求,这也能符合大陆《宪法》。基于对1987年6月29日国务院曾经颁布了《医疗事故处理办法》与在台湾方面刑法处罚医疗之过失,主要的形态为业务过失致死罪及业务过失伤害罪等二种类型相比较。对医疗事故的定义、实习医师刑法的处理及医疗事故的技术鉴定方面做了比较。认为：1.适度减轻医疗过失犯罪的刑责：台湾现定刑法,对于过失犯程度之轻重,并没有普通过失与重大过失的分类规定。因此只要被认定为有过失,又有明文规定过失行为之处罚,且符合犯罪构成要件的,就可以成立过失犯。在医疗过失犯罪部分,也没有例外。只要在医疗上有过失致人伤亡者,就应成立医疗过失犯罪。台湾应否采行英美法系,对于刑事过失犯罪包括医疗过失犯罪在内只限于重大过失才负刑事责任。或者参考比台湾法律更进步的祖国中国大陆的刑法规定：医护人员,由于严重不负责任才负刑事责任之规定,做为台湾刑法这一部分修法的重要参考。通过两个医疗纠纷案例的探讨,对海峡两岸中医法律责任差异作比较,得出：1.台湾医疗过失犯罪的基本类型所适用的刑法第276条、第284条,虽然有其优点,但是还是必须参考祖国刑法修正限于过失重伤罪以及过失致死罪二大类型,以求诉讼经济并减轻刑事责任,而达到「简明易知易行」的理想要求。2.台湾有必要制定类似大陆医疗事故处理条例的特别法：随着时间大陆的经济和社会不断的发展,政府积极建设社会主义市场经济体制的建立,法制体系的日益完善,人民群众的法制观念也不断增强,在医疗实践中所发生的一些医疗事故无论在鉴定、处理以及认识上存在着分歧和争议,原来的医疗事故处理办法已不能适应新形势的需要。有鉴于此,国务院常务会议于2002年2月20日第55次会议审议通过了新制定的《医疗事故处理条例》,以中华人民共和国国务院令第351号公布,颁布新的《医疗事故处理条例》並于2002年9月1日起施行。3.大陆有关医疗损害责任之规定有侵权责任法规定更为深入：台湾方面民法有债篇各论的规定,将一般民事上常见的契约型態予以法制化,以適用各种不同契约的特性,台湾有学习大陆之必要修法设定專章。4.大陆法令用语相当白话,浅而易懂,值得作为台湾将来法制改革的参考：大陆法令用语相当白话,浅而易懂,台湾法制用语应简单化。例如以2010年7月1日起施行之“侵权责任法”第7章,医疗损害责任法第五十四条有以下规定：“患者在诊疗活动中受到损害,医疗机构及其医务人员有过错的,由医疗机构承担赔偿责任。”在台湾方面民法第二百十七条则规定：“损害之发生或扩大,被害人与有过失者,法院得减轻赔偿金额,或免除之。”所以,台湾法律用语精简又文言,对一般不是学法律的人自不容易了解,对于法律的推广和人民的认知,大陆方面法律用语较为通俗化,值得作为台湾将来法制改革的参考。5.台湾在刑法上有修正的必要：台湾地区方面对于医疗过失刑责的适用,可从刑法中修正,于刑法内订定医疗业务过失责任的专条,并且删除医疗业务过失轻伤刑责,仅保留医护业务过失致死法定刑五年以下修正为三年以下,及医疗业务过失致重伤罪之法定刑三年以下修正为一年以下,以对应医疗行为之特殊性。6.台湾应修正医疗纠纷鉴定之制度：台湾方面现行医疗纠纷仅设一级的鉴定制度,不服鉴定也仅能诉请委托鉴定机关提供卫生署参考。未来对于医疗纠纷鉴定制度的修正,可善用刑事诉讼法条规定的“增加鉴定人”、“另行鉴定”、“审查他人之鉴定”外,又可以仿照公路法分为“鉴定”与“覆议”二级制度,规定：“医疗纠纷案件,由卫生署或其指定之所属机关设立医疗纠纷鉴定委员会与医疗纠纷鉴定覆议委员会,办理医疗纠纷鉴定及覆议事项”,以求更加完善。未来应尽快修正医疗纠纷的鉴定制度之外,应培养更多的医师、法医师、专科医师及其它医事人员参与医疗纠纷的鉴定及覆议。也应鼓励更多的医事人员读法律,更多的法律人读医学,并参与医疗纠纷的鉴定及修法。如此可健全的鉴定制度与完善的鉴定成果。7.实施医疗过失保险制度：以台湾私立开业医众多的情况,实行强制医疗保险或成立保险合作社均属可行；大陆方面由于公立医院占多数,且医疗人员所引起的医疗纠纷,其赔偿责任均由医院承担,较不需要医疗保险,可是在个体开业医院有逐渐增多的趋势,保险仍有其实际需求,实施强制投保制度或较可行。8.海峡两岸有关举证责任之规定：台湾方面医事法制可借镜大陆之规定,修正之处如举证责任。台湾方面需由病患负举证责任,最好修正为像大陆方面之规定,由医师或医院负举证责任。因为病患较无医学知识,若由病患负责举证,常会吃亏。10.未来海峡两岸医疗纠纷的解决处理机制：对於未来海峡两岸医疗纠纷的解决处理机制,比较商务仲裁的方式,对于涉及伪劣药品、药品专利等,以超然中立、公正的机构设立在香港、澳门或者新加坡,成立仲裁机构,解决纷争。希能达到海峡两岸之规定各存其优点淘汰其不适的缺点,选择其长处补其缺处,俾为将来法令修改与海峡两岸医疗纠纷时之参考。更多还原

【Abstract】 Past few decades ago, gradually form a wave of Chinese medicine, generally begin by the world of attention and attention, particularly treatments such as acupuncture and more popular in Japan and even Europe and the United States. Given this trend, the vitality of the domestic research is the development of new kinds of higher education, the creation of the Department of Medicine, and Medicine, specifically dedicated to medical research and clinical trials. The medical malpractice cases, gradually increased each year, while worrying, is the method of dealing with the many medical disputes, and always convincing, this will result in the courts, doctors, patients and other three aspects of stress and anxiety, but will also deepen misunderstandings between doctors and patients, suspicion, and even the main reason for continued conflict. Across the Taiwan Strait with the Chinese nation, but because of the relationship between history, but today the formation of a separate cross-strait situation. However, actively promote cross-strait cultural exchanges, the people of Taiwan to the mainland to the increasing number of regional hospitals have opened, which is conducive to cross-strait exchanges in medical technology and people’s health maintenance. But because of the different judicial systems across the Taiwan Strait, in case of medical malpractice, you should know how to solution.Based on the medical dispute across the Taiwan Strait of criminal responsibility in criminal law and civil law on civil liability, the legal differences between the treatment and medical disputes to be analyzed and compared to understand the cross-strait criminal and civil provisions of the similarities and differences with the spirit of the legislation to enhance the medical Understanding dispute provisions of laws and regulations on the protection of the rights of medical personnel is very important. Paper through the ancient literature and modern medical practices across the Taiwan Strait for the illegal provisions of the law compared to the mainland as Taiwan is Chinese medicine than those without such a detailed classification of such conditions and background, so the two sides of this medicine is divided between the professional categories great, but has its own rationality. In addition, the mainland still rural doctors, legislative arrangements are based on the principle of non-retroactivity of the law, these specialty physicians to accept the existing, and the consistency and equality based on the legal considerations, these specialty physicians should be phased out in future legal general practitioner In addition, the public, regardless of region or around the Urban and Rural Areas, all have a certain quality of medical care; for the future of the mainland’s rural doctors recommended that more comprehensive public health system to replace that remote areas of the state to take care of the interests of public health responsibility on the distribution of economically disadvantaged rural areas to qualified physicians in public clinics to the population density to be divided into permanent or rotation in, and can be implemented to take care of the medical needs of the majority of farmers, which can meet China "Constitution. "Based on the June 29,1987 the State Council has promulgated the "medical approach" and the criminal penalties for health care in Taiwan is at fault, the main form for the professional negligence resulted in death and professional negligence of assault compared to other two types. The definition of medical malpractice, physician practice management and medical malpractice criminal law has done a comparative technical evaluation. That:1. Moderately reduce crime, the criminal medical negligence:Taiwan is scheduled to criminal law, the degree of severity of the fault committed, and not ordinary negligence and gross negligence in the classification rules. So as long as been identified as at fault, there are penalties for negligence expressly provided, and in accordance with circumstances of a crime, they can set up fault committed. Criminal negligence in the medical part, is no exception. As long as medically negligent victims to medical negligence should be set up crime. Taiwan should not adopt the common law, for the crime, including medical malpractice, criminal negligence is limited to gross negligence, including crime, criminal liability only. Or refer to the laws of Taiwan more advanced than the country’s criminal law in China:health care workers, only because of serious criminal liability provisions of irresponsible, as part of Taiwan’s Criminal Law Amendment Act of this important reference.In two cases of medical disputes, differences across the Taiwan Straits Chinese civil compare, draw:1. Taiwan, the basic types of criminal medical negligence applies section 276 of the Penal Code, Article 284, despite its advantages, but still must refer to the Criminal Law Amendment limited to the motherland and the crime of negligent injuries resulted in death two major types of fault, the economy and reduce the criminal proceedings in order to Responsibility to achieve the "concise and easy to easy to know, "the ideal requirements.2. similar to the mainland of Taiwan need to develop a special law Regulations of Medical Malpractice:As time continued the continent’s economic and social development, the Government actively building a socialist market economy system, legal system, improving, the legal concept of the people is also growing, what happened in the medical practice of some medical terms identification, processing, and understanding differences and disputes, the original approach can not meet the medical needs of the new situation. In view of this, the State Council executive meeting on February 20,2002 55th session adopted a new formulation of the "Regulations of Medical Malpractice" to the PRC State Council Order No.351 announced the promulgation of the new "Regulations on Handling Medical Malpractice "and in September 1,2002 shall come into force.3. Continental obligations related to medical malpractice tort law provides for a more in-depth:Taiwan Civil Code has provisions on the debt of all articles will be general civil type of contract to be a common legal system to apply a variety of different contract characteristics, Taiwan need to amend the law to learn the mainland to set a chapter.4. mainland Act vernacular language rather shallow and easy to understand, it is legal reform as a reference for Taiwan’s future:Vernacular language rather continental law, light and easy to understand legal terms of Taiwan should be simplified. Such as the July 1,2010 effective as of "Tort Liability Act, " Chapter 7, medical malpractice liability Law fifty-four provides as follows:"Patients with damage in the treatment activities, medical institutions and medical staff are at fault By the medical institutions liable for compensation. " in Taiwan seventeen Civil Code provides that:" the injury occurred or the expansion of victims and those at fault, the court may reduce the amount of compensation, or waive it. "Therefore, Taiwan law Lean and classical language, the general who is not a law school is not easy to understand since, for the promotion of law and the people’s awareness, popularization of the mainland legal language is more worthy of legal reform as a reference for Taiwan’s future.5. Taiwan the necessary amendments on criminal law:Taiwan aspects of the application of criminal liability for medical negligence, from the criminal law amendment stipulated in the Criminal negligence tertiary medical business section, and remove the criminal liability of medical professional negligence minor injuries, leaving only the negligence of health care services to death punishment to five years The following amendments to the following three years, and medical professional negligence cause severe injury crime revised the mandatory three years to one year to correspond to the special nature of medical practice.6. Taiwan should be amended to identify the system of medical malpractice:Taiwan has only set the current medical malpractice system-level identification, it can only sue for commission against identification identification authorities to provide the Department of Health reference. Identification system for medical malpractice future amendments to the Criminal Procedure Law stipulates that use of the "increased identification of people ", "be identified", "review of identification of another person", but they can be modeled on the road divided into "identified"and"reconsideration "Secondary system, states:" medical malpractice cases, the Department of Health or designated by the respective authorities to establish Medical Dispute Review Committee and the identification of medical disputes, the Commission proposed, for identification and review of medical disputes, matters arising "in order to be more perfect.Amended as soon as possible future identification system of medical disputes, it should train more doctors, law physicians, specialist physicians and other medical personnel involved in the identification of medical disputes and for reconsideration. Should also be encouraged to read more medical personnel laws, more laws were read medicine, and participate in the identification of medical disputes, and amended the law. This may sound identification system and improve the identification results.7. implementation of the medical malpractice insurance system:Private physicians or dentists in Taiwan are numerous cases, the implementation of compulsory health insurance or set up an insurance co-operatives are feasible; the mainland because the majority of public hospitals, and medical personnel arising from medical malpractice, the liability borne by the hospital, compared with no medical Insurance, but hospitals in the individual business, there have been a growing trend, the insurance still has its practical needs, the implementation of compulsory insurance system or the more feasible.8. Across the Taiwan Strait on the requirements of the burden of proof:Medical Taiwan can learn from the mainland legal system, the amendment of the Department, such as burden of proof. Taiwan has the burden of proof required by the patient, preferably as amended to the provisions of the mainland, by a physician or hospital burden of proof. Because patients are no medical knowledge, if the burden of proof by the patient, often at a disadvantage.10. future cross-strait dispute resolution mechanism for handling health care:The future cross-strait dispute resolution mechanism for handling health care, more commercial arbitration, involving counterfeit drugs, drug patents, in order to detached neutral, impartial body set up in Hong Kong, Macau or Singapore to set up an arbitration body to resolve disputes.Hope to achieve all the requirements of cross-strait out its not keep the advantage of the shortcomings, to choose their strengths make up for lack of place, modify the decree to serve as the future of medical disputes across the Taiwan Strait and Taiwan.更多还原