醫療事故補償與醫療專業:兩條平行線?

吳全峰,中央研究院法律學研究所副研究員

醫療糾紛處理及醫療事故補償法(醫糾法)內容存在許多問題,本不宜草率通過。然最近醫界對醫糾法的批評,集中在醫療機構及醫事人員應否繳納醫療風險分擔金,其盲點亦待釐清。

醫糾法醫療事故補償之主要事件,為「有相當理由可懷疑醫療事故之發生非因醫事人員故意或過失之情形」。批評者認為,既然難以辨認因果或醫事人員沒有犯錯,醫療機構或醫事人員為何還要支付補償金。此論點乍看成理,但細究此類醫療事故發生原因,卻不難發現反對者盲點。

第一類非因醫事人員故意或過失所引起之醫療事故成因,為可預見(如副作用、併發症)及不可預見(如極度罕見之不良反應)的醫療傷害。此類事故應由社會共同負擔,故醫療風險分擔金中便設計有政府負擔部分,另亦可由藥害救濟法或預防接種受害救濟相關法規涵蓋。

另一類則是「系統性錯誤」,為不良技術、組織或行政等結構性問題所導致原可避免的醫療行為不良後果(醫糾法定義為醫療機構組織、制度、決策或設備等結構性問題所導致之不良後果)。系統性錯誤仍可能造成病患失能或死亡,如醫療機構未安排足夠人力值班導致病患出現狀況時未能及時開刀。但擁有改正系統性錯誤權力者,顯然不包括病人與一般民眾(他們甚至對是否發生系統性錯誤不了解亦不知情),而是掌握在醫療機構與醫事人員手中。既然病人或民眾無法掌握或改變系統性錯誤,則其被要求承擔此類錯誤之責任並負擔相關費用,顯非適當。若要求由政府「全額」負擔此類系統性錯誤之成本,則亦應相對賦予政府監督並介入醫療機構運作以改進系統性錯誤的強制權力;但醫糾法對此部分卻僅採宣示性規範,委由醫療機構與醫事人員之專業自主進行通報與改善。在此情況下,握有改善系統性錯誤權力與相關資訊者,顯然主要為醫療機構與醫事人員;但其對系統性錯誤所造成之民眾傷病或死亡,卻又主張不應負擔任何費用,論理不免矛盾。

不可否認醫糾法之設計有其結構性問題。但在政府與社會已負擔部分醫療風險分擔金的前提下,醫療機構或醫事人員卻在立場上迴避他們在系統性錯誤中所應負擔之責任,並進一步要求完全不負擔任何費用,此主張有必要重新思考。

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