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題名 | 從「往來義務」建構醫療機構之組織義務=The Organizational Obligations of Hospital in Law of Torts |
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作者 | 侯英泠; Hou, Ing-ling; |
期刊 | 國立臺灣大學法學論叢 |
出版日期 | 20120300 |
卷期 | 41:1 2012.03[民101.03] |
頁次 | 頁329-401 |
分類號 | 419.2 |
語文 | chi |
關鍵詞 | 醫院組織義務; 往來義務; 交易安全義務; 開放型醫院; 醫療外包; 安全管理義務; 病人照護義務; 周延人事組織; 病歷記載義務; 治療標準流程; 醫療指南; Neighbor principle; Outsourcing; Patient safety; Risk management; Risikomanagement; Patient documentation; Dokumentationsmanagement; Hospital organization; Medical guideline; Clinical practice guideline; Medizinische Leitlinien; Organizational guidelines; Organisationsleitlinien; Qualistätsicherung; Traffic duties; Verkehrspflichten; Safety duties; Verkehrssicherungspflichten; Organizational obligation; Organisationspflicht; Nosocomial infection; Nosokomial Infektion; Hospital infection; Krankenhausinfektion; Medical error; System error; |
中文摘要 | 〈摘要〉 醫療機構所提供的醫療服務,不是單純醫療行為,而是組織,以組織人事與硬體,獲取利潤,醫療行為僅是其營業活動(提供醫療環境組織)下所進行之過程與結果。在醫療院所擴大組織同時,除了會增加連繫疏失之產生外,還可能間接造成醫療意外產生,而且醫療疏失發生之原因,除了醫療人員之個人技術之外,其背後原因,經常是醫療組織疏漏。因此,醫院不僅應對醫療疏失行為負連帶賠償責任,且應對自己獨立營業行為(透過組織獲得企業利潤)所造成之損害,負獨立賠償責任,本文即在於建構醫療機構的獨立組織義務(侵權責任)。 面對醫療疏失訴訟,鑑於醫院組織與醫療分工日漸精細,以及過度重視個人疏失導致醫療防衛,也影響醫師的專業裁量,德國實務不再如過去重視個人疏失,轉而強調醫療機構組織疏失。期待透過嚴謹的醫療組織,以避免人為疏失,以及脫離法律實務對醫療專業鑑定之依賴。醫療行為本質即屬於危險行為,單靠個人的注意力提高,並無法完全避免意外發生,而且人非電腦,犯錯是人的特性,人的注意力,事實上也無法持續不間斷,對此特性唯有透過一個層層組織防堵網,來防堵危險發生,始有可能將人為疏失之醫療意外發生率降低。因此,德國實務逐漸強調醫療機構之組織責任,並將之與商品製造人責任同列,成為往來義務下的一個重要類型。本文希望透過德國往來義務(醫療機構組織義務)之介紹,提供國內對於醫療機構獨立組織責任建構之參考。 |
英文摘要 | Abstract The traditional risk management focuses on human error. But to err is human. That is the truth we have to accept. Adding more individual responsibility of provider bring the medicine to defensive medicine. The truth is many system errors may shelter under some of the provider errors, if we exact look over a medical malpractice case for system errors. Types of errors are Provider error only, Provider and system error, system error only and neither provider nor system error. So provider errors are not only the cause of patient injury. The medical accidents have several reasons. The system errors may be the root cause of medical accidents, particularly in the big hospitals. Total system errors contain Medication-related error, Communication error, Health care-associated infection, Medical record error, Identification error (wrong-site surgery), Medical device failure and surgical fires. Adding more regulations and mandates is not the only solution to improve patient safety. In consideration of legislation to reduce medical errors and improve medical safety and quality of care, legislators should first recognize that the mostly medical errors are not only personal negligence, also with system errors. We call for the transformation from a culture of individual blame to a more open and scientific evaluation of medical errors. We should only foreground the liability for organizational errors. So we can give medical leaders the initiative to re-examine issues related to patient safety and overall quality of care. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。