醫療訴訟慰撫金數額之可預測性— 高等法院暨其分院及地方法院醫療專庭(股)判決分析

Abstract

近年來台灣各級法院受理醫療民事損害賠償訴訟的案件量雖有增加的趨勢，醫病雙方對醫療訴訟損害賠償額卻有無法預測的疑慮，似成為發展醫療責任保險的障礙之一。而觀察我國法院判決，除慰撫金之外其他賠償項目如：醫療費、看護費、減少勞動能力等賠償額均已有固定之計算方式；因此，研究慰撫金是否具可預測性才是解開疑慮的關鍵。

慰撫金之所以難發展出客觀的計算方式，源於「非財產上損害」的本質；亦即，精神上痛苦無法依事故前後之財產差額計算。則醫療判決慰撫金數額是否淪由不同承審法官恣意決定，導致無任何酌定標準？本文以為，唯有分析我國醫療判決才是了解慰撫金量定實務的最佳途徑。考量「醫療專庭（股）」案件係由特定且持續培訓之法官承辦，醫療專庭（股）法官之見解不僅在事實審具有一定的重要性，統計分析之準確性亦較高，本文選擇以國內事實審八個醫療專庭（股）民事醫療訴訟判決為資料蒐集對象，將案件事實、判決理由、賠償金額等資料予以記錄，輔以大量圖表進行統計分析。

首先發現，法官裁量慰撫金時已有慣用之酌定標準，如當事人「資力」與「痛苦程度」。其次，慰撫金之中位數得依被害人所受傷勢區別。第三，請求權人為被害人之父母、配偶或子女，對慰撫金數額高低亦有影響。最後，醫藥費則可能為輕傷、重傷及植物人案件慰撫金之預測指標。

此外，鑑於長久以來醫療與車禍案件被告賠償責任懸殊的批評，本文嘗試將兩種案件類型之賠償總額及慰撫金進行對照。本文亦彙整了德國、英國、日本及美國實務如何酌定慰撫金，反思台灣現行酌定標準應予刪修之處，並對醫療訴訟慰撫金之定型定額化提出建議。

In recent years, the numbers of medical civil cases for damages have increased in different levels of courts in Taiwan; yet both physicians and patients cast doubt on the predictability of damages in medical cases, which become one of the obstacles to ripening the medical liability insurance. From observing the judgments, besides damages for emotional distress, courts have already developed calculation methods to award damages, such as medical expenses, nursing expenses, and decreasing in laboring capability. Hence, the predictability of damages for emotional distress is the key to this issue.

The reason why damages for emotional distress cannot build an objective calculation method derives from the nature of “non-pecuniary loss”; that is, pain and suffering may not be estimated by comparing the value of the property before and after the accident. Then, whether damages for emotional distress in medical cases are arbitrarily awarded by different trial judges without discretionary standard? This thesis deems that analyzing the judgments is the best way to realize the current practice. Considering that cases in the medical division (section) are adjudicated by designated and long–term training judges, the holdings of those cases are not only material in the trial on matter of facts, but also higher statistically precise, this thesis collects medical judgments from eight medical divisions (sections) to record their facts, holdings, compensation amounts, and analyzes the data with a number of statistical charts.

Conclusions drawn in this thesis are: firstly, courts have used to adopt fixed factors, such as “economic status” or “level of injury” of litigants, to determine damages for emotional distress; secondly, the median of the amount of damages for emotional distress are distinguished by different injury degrees; thirdly, damages claimed by parents, spouse or, children would affect the amount of damages for emotional distress; lastly, medical expense may become an index for damages for emotional distress in injury, serious injury and vegetative state cases.

In addition, given the criticism on the wide gap of liabilities between the defendants of medical malpractice and car accident, this thesis compares the amount of total compensation and damages for emotional distress between these two categories. This thesis also reviews relevant practices in Germany, England, Japan, and United States, and rethinks the modifications to the factors of awarding damages for emotional distress in Taiwan, then attempts to provide proposals to the fixed type (amount) indemnity theory in medical cases.