醫療民事糾紛訴訟中之證據蒐集-以健康資訊權作為擴充手段

Abstract

醫療糾紛之證據偏在、當事人資訊不對等與專業知識能力的差距，病患及家屬不了解醫療行為的內容，證據蒐集不易，使得醫療糾紛層出不窮。醫療行為高危險性與不可預測性、人體組織之特異性，更使得責任歸屬難以判斷。

我國醫療糾紛多以刑事訴訟附帶民事請求，就證據蒐集的過程，乃由檢察官行使強制處分權取得重要的病歷書證與證人證言。惟醫療糾紛的類型不僅限於業務過失傷害或致死等刑事責任類型，以民事責任角度觀之，契約法上的債權請求權，即不完全給付之債務不履行與告知後同意等附隨義務的違反，亦為當事人據以請求的重要依據。

在民事糾紛中，法院居於中立審判者的地位，在程序的進行採取當事人處分權主義，當事人必須就其主張提出相關的事證。在醫療民事糾紛中，病人缺少強制處分權的蒐證手段，法院不主動蒐集相關事證，但病人在蒐集病歷與其他證據常常受阻，此時證據的保全與當事人就證據的近用權與訴訟實力的不平等，乃成為問題。

民國94年修正後之民事證據保全制度與保全程序制度，擴大了證據保全的範圍，就定暫時狀態假處分制度有所改革；在民事訴訟法大刀闊斧地修正下，是否更能夠實現武器平等原則，與保障當事人的程序權，在訴訟實力不均等的醫療糾紛訴訟中更值得關注；並且就實體法之蒐證手段，即資訊開示請求權的規定，如何影響當事人取得證據，亦為本研究著重的方向。

本文主張建立完整健康資訊權的內容，來擴充當事人近用自身健康資訊的權利，即賦予當事人就其健康資訊有近用、複製與修改的權利，配合假處分制度的運用，讓當事人得以取得解決糾紛所須證據，以實現訴訟法上武器平等原則，讓當事人更完足知悉紛爭內容與相關事證之後，自行衡酌採行訴訟外解決紛爭之方式，亦或在提起訴訟後，節省調查事證所須之勞費，以更公平圓滿地消弭糾紛。

The practice of medicine is dangerous and unpredictable and the result vary from one individual to another. Thus, when patients can not accept the result, they tend to file a suit to claim their own rights. Evidence in medical malpractice litigation is mostly under the control of physicians and hospitals. Patients injured do not know what exactly happened and do not understand what cause the harm. They can not get the relevant evidence easily. Patients do not have the full capacity of gathering relevant evidence and they do not professional questions at issue.

In Taiwan, patients usually take criminal action to fight for their claim. The prosecutors play an important role in gathering evidence. Prosecutors have enormous power gathering relevant evidence. But sometimes, there is no right for patients to take criminal action, they can only take civil action to ask for their loss. Therefore, we should empower patients the full right to gather and discover relevant evidence in medical malpractice law suit.

The amended provisional measures in Taiwan in 2005 have expanded the scope of secure of evidence. This thesis focuses on introducing the provisional measures in Taiwan and the Discovery of U.S. civil procedure. Comparing the regulations and laws of Taiwan and US, moreover, discussing how to help patients gather enough evidence to win the lawsuit.

This thesis suggests to establish the right to health information in order to let patients have the right to access , the right to copy and examine their own health information. Patients should have a variety of approach to gather the evidence and know the treatment and relevant health information. In this way, there will with no doubt be a balance of power between patients and physicians and medical malpractice litigation will certainly be a fair play.