從美日訴訟外醫療糾紛處理之發展經驗論我國合用醫療仲裁機制之建置

Abstract

長年以來，我國行政主管機關及立法者曾多次將仲裁機制明文列入醫療糾紛處理專法草案中，向社會大眾提示了將醫療糾紛案件交由仲裁程序處理之可能性。可惜迄今我國實務鮮有交付仲裁之醫療糾紛案例。美國自1925年聯邦仲裁法制定以來，立法者及法院為了緩解法院案件量負擔，對於私人間仲裁協議之效力及可執行性持高度肯定的態度，於1970年代後，更促成了醫療照護領域中對於仲裁協議的使用。美國的醫療仲裁經過近四十餘年的發展，就醫療仲裁協議及仲裁程序累積了豐富的特別法律規定及實務運作經驗，包括各州立法對於醫療仲裁協議之特別規定、各州法院對於適用醫療仲裁協議之相關見解，以及仲裁機構對於醫療糾紛案件之態度與作法等。此外，日本近十年來也藉由特別法之制定，積極推動訴訟外紛爭解決程序，並提升了民眾於面對醫療糾紛時，使用訴訟外紛爭解決程序的機會與意願。

將醫療糾紛案件交付仲裁程序處理，當事人或可用比法院訴訟程序成本更低、更迅速的方式獲得救濟。又當事人可自由調整適用程序、並選任可信賴之仲裁人負責作成仲裁判斷，提升對於終局決定之信賴程度。故當事人選用仲裁處理醫療糾紛，應可享有許多實益。但因為醫療糾紛案件與一般商務案件不同，醫療糾紛當事人間存有協商地位、資訊地位及經濟地位不平等之情形，且對於醫療仲裁程序之熟悉度亦有所不同，恐會使當事人無法自由選擇是否作成仲裁合意，甚或有特定一方當事人受到偏惠、或濫用仲裁程序之情形。美、日兩國基於長年經驗，對於前述爭議均有充足的實例及討論供我國借鏡。我國得藉此預見採用醫療仲裁時可能產生之問題，進而事先採取防範措施。又經本文觀察美、日兩國發展經驗，認為由立法者及行政主管機關主導之政策，為促進醫療仲裁發展的重要因素，故本文將探討美、日兩國經驗，歸納出合用醫療仲裁協議及仲裁機制所應具備之要件、及應避免之弊端，並提出相關立法及政策建議。

During the past several years, Taiwan’s competent authorities and legislators tried to place arbitration system into bills specially designed for medical malpractice disputes, in order to show the public of the possibility to submit medical malpractice disputes to arbitration. However, Taiwan still has very few actual medical malpractice arbitration cases today. The United States’ legislators and courts’ opinions positively held for the validity and enforceability of medical malpractice arbitration agreements. Such attitude further formed the trend in health care content, and thus the United States has abundant special laws and operation experiences regarding medical malpractice agreements and procedures. In addition, Japan during the past decade also set up a special law to promote alternative dispute resolutions, and enhanced the chance and incentives of the public to use alternative disputes resolutions. By submitting medical malpractice disputes to arbitration, disputing parties can obtain compensation in a way cheaper and faster than usual litigation procedures. However, medical malpractice disputes differ from usual commercial disputes. The power regarding negotiation, information and economic status between the parties are usually not equal. Also, parties’ familiarity with medical malpractice arbitration is not the same. These factors may give either party the chance to abuse or be specially favored through the arbitration. The United States and Japan, based on their experience over the years, have abundant cases and discussions regarding the foregoing issues which worth our consideration. Taiwan may base on such experiences to predict possible issues which might arise in adopting medical malpractice arbitration, and take actions in advance. This article is of the opinion that policies raised by legislators and competent authorities are important factors to promote medical malpractice arbitration. Therefore, this article will make discussions based on experiences of the two countries, and conclude the requirements of agreements and system of medical malpractice arbitration, and the demerits which shall be avoided in advance. This article will further provide suggestions regarding legislation and policy making to establish feasible medical malpractice arbitration system.