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題 名 | 遠距醫療之民事過失責任標準=Malpractice Liability Standards in Telemedicine Litigations |
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作 者 | 陳鋕雄; 劉庭妤; | 書刊名 | 東吳法律學報 |
卷 期 | 22:1 2010.07[民99.07] |
頁 次 | 頁61-99 |
分類號 | 412.21 |
關鍵詞 | 遠距醫療; 遠距照護; 醫療過失; 注意義務; 告知後同意; 電子病歷; 病患隱私權; Telemedicine; Telecare; Medical malpractice; Duty of care; Informed consent; Electronic medical record; Privacy of patients; |
語 文 | 中文(Chinese) |
中文摘要 | 近年隨著資訊通訊技術的蓬勃發展,資訊通訊科技開始應用在各種不同的醫療領域,遠距醫療、遠距健康照護、或遠距諮詢會診等新型態的醫療照護服務也應運而生,不僅有助於避免特定醫療疏失再度發生、提升醫療服務的品質與效率,而可大幅減少醫療成本與不必要的人員移動、提高醫療照護服務之即時性與可近性,而成為先進國家亟欲發展的項目之一;然而,遠距醫療之施行雖然在臨床上並無太大困難,但因遠距通信技術在醫療領域的應用本身具有相當的不確定性,若套用傳統法律上有關醫師親自診察義務與過失責任之相關規定的解釋標準,相較於執行一般醫療業務,參與遠距醫療的醫師很可能會面臨更高的法律風險,導致國內醫師目前對於遠距醫療多抱持觀望態度,因此,要推行遠距醫療,就必須先移除醫界對醫療過失責任的疑慮。針對醫師在遠距醫療活動下的過失責任議題,本文首先探討資訊通訊科技的本質,及其在醫療領域應用之技術類型與態樣,了解相關科技發展為我國醫療體系帶來的轉變與具體影響,此外,則以傳統過失責任標準為重心,一方面在政策上對醫師的行為自由、病患的生命身體之完整性與醫療專業人員養成之成本等不同利益作權衡,並藉由我國侵權行為法之要件分析,配合美國法在遠距醫療實務基礎之上發展出的學理論述,探討傳統過失責任標準適用於新興的遠距醫療活動時,於從事醫療行為、醫療資訊之提供與病患資料的儲存處理等不同階段,可能遭遇到的注意義務內容與程度之確立、告知後同意之內涵與取得方式、病患隱私權保護等問題,而討論的重點在於將遠距醫療科技的特性納入個案作考量,如因應遠距醫療照護服務的多樣化、專業化,應更詳細界定醫療行為之範疇,並對風險層級不同的醫療行為課以醫師不同程度的注意義務標準,至於醫師在從事遠距醫療活動實應遵循的注意義務標準應如何調整,則必須參考遠距醫療執行之實際情況,輔以醫界自行形成的臨床準則,將法律上抽象的善良管理人所負注意義務標準予以類型化、具體化,並且確立特定阻卻違法事由以在醫師與病患之間作風險的合理分擔,以期能夠兼顧醫病雙方的利益、實踐遠距醫療推行的目的。 |
英文摘要 | With the flourishing development of Information and Communication Technologies industry in these years, the use of advanced telecommunication technologies in different fields of medicine was in a great expansion. Its application, such as telemedicine, telecare and teleconsultation, not only helps to reduce unnecessary medical cost resulting from the transportation of doctors or patients, but also enables doctors to avoid the reoccurrence of specific medical errors, and to provide medical services with higher quality, efficiency, timeliness and accessibility. Telemedicine totally changes the way doctors delivering medical services. Concerning the uncertainties of technologies in clinical medical practice, however, it brings malpractice liability issues. Lack of sufficient knowledge and experience about the practical nature of telemedicine makes it hard for judges to decide negligence issues. Applying traditional tort law elements in cases relating to telemedicine, though the rules were well-established, exposes doctors to great malpractice liability risk which definitely will restrain medical profession's willingness to practice telemedicine.This paper focuses on the challenges created by technology development and the ensuing liability issues in the practice of telemedicine. Part II first evaluates the utilization of Information and Communication Technologies in medicine and its impact on Taiwan's medical system. Based mainly upon domain traditional negligence theory and compared with American Law, Part III will the former examines the policy and traditional elements of negligence and its possible deficiencies when applied to telemedical malpractice case; as for Part IV, it divides liability issues into three sections to reflect different aspects of telemedicine: (1) the clinical activities of telemedicine, (2) the provision, storage and process of medical information, and (3) informed consent. After reviewing the existing rules and standards of interpretation in current legal system, it seems that telecommunication technologies had transformed medical services into higher level of diversity and professionalization. Aiming to distinguish different level of medical risk and ask each participant to follow proper standard of care, it is necessary for judges to keep in mind the nature of telemedicine and to clarify the scope of medical and non-medical activities when making case-by-case decision concerning doctors' liability. The purpose of such accommodations is to fit in with medical practice and make the abstract reasonable person standard more specific and more practicable in telemedicine case. |
本系統中英文摘要資訊取自各篇刊載內容。