| 摘要: | 目前在醫學界最炙手可熱之議題「整型及美容醫療」，反映出原本以維護人類生命、身體以及健康為對象的醫療行為與技術，其型態之蛻變已不可同日而語，尤其關係到形體「美容醫學」這塊大餅，無論是「供給者」或「需求者」都想分吃一口的好滋味，就法律面而言有其概念上區別之重要性。面對形體美容醫學大行其道，而引發的醫療糾紛亦日漸增加，我國現有法律體系究竟應如何對之作妥適規範，如何處理爭議才能使關係人的權利都獲得確保，又能使社會成本降至最低，這些都是需要立法政策、實務運作、學說理論等多方提出建議、討論，認真並嚴肅加以解決之問題。本文將以「法律經濟分析」觀點論證「醫療責任再建構」的可能性。
本文首先，就侵權行為法之經濟分析理論加以介紹。其次，概述醫病關係與醫療行為之定義、醫療上之注意義務標準，並透過實務判決內容之探討評析，歸納出我國醫療行為侵權責任之標準。接著進入主軸，先討論整型美容醫療行為之概念、釐清美容外科(形體美容醫學)與傳統整型外科醫學分別之意義內涵，再將重心放在醫療行為如發生醫療事故或糾紛，究竟應如何檢討其法律責任，並運用法律經濟分析觀點(Hand公式、外部性、供需法則、成本效益、財富極大化、邊際效益、序列效用，以及風險承擔等經濟分析方法)，為整型及美容醫療侵權責任作出結論：「醫療責任再建構」—由「賠償責任制度之經濟分析」導出「醫療行為類型化」，區分為「非商品化的醫療行為」與「商品化的醫療行為(非侵入性美容醫學行為)」，經過法律經濟分析方法檢驗後，可知在兩者分別適用過失與無過失賠償責任制度之下，都是符合社會最低成本之考量，更可達提升社會整體福利之效。又本文建議應使「侵入性美容醫學行為」回歸整型外科醫療行為之範疇，亦即限制僅具合法醫師執照者始能進行具侵入性之醫療行為，方能使醫療需求者之權益獲得最佳保障。最後，本文並提出其他建議，諸如「善用醫療糾紛事件根本原因分析(RCA)制度」與「進級的TPR—公開揭露醫療錯誤機制」，期許法律與非法律機制併存之結論與建議，能為未來醫療糾紛之處理提供參考，並為本論文增添更多元化之色彩。
Currently one of the hottest issues of the medical profession, “Orthopedics and Cosmetics”, reflects the original goal of medical practices and technology for protecting human life, body and health as the object has transformed it quite differently, especially in relation to the “Aesthetic Medicine”. Regardless of “Provider” or “Demander”, both wants to eat a good taste of the piece of the pie and it is important to make a distinction between “Orthopedics and Cosmetics” from the legal point. Due to the popular of aesthetic medicine, medical dispute has been increasing. Under our current legal system, how to regular it properly and deal with the disputes in order to make the rights of people related can be ensured and also reduce the social cost to the minimum is the problem need to be solved seriously from many aspects, such as legislative policy, the practical operation, and doctrine theories. This article will demonstrate the possibility of “Reconstructing the Medical Liability” from the view of “Economic Analysis”.
At first, this article will introduce the economic theories of tort. Secondly, giving an overview of the doctor-patient relationship, the definition of medical practices, and the duty of care on the medical practices, and summarizing the standard of medical tort liability by exploring the content and comment on practical judgments. Then discussing the main shaft by first introducing the concept of Orthopedics and Cosmetics medical practices and clarifying the distinction between Cosmetics (Human Appearance) and traditional plastic surgery (Orthopedics) respectively, and then focusing on how to review its legal liability while medical malpractice or dispute occurs by using the theories of economic analysis of law (Hand Formula, Externalities, the Rule of Supply and Demand, Cost-Effectiveness, Wealth Maximization, the Marginal Benefit, Serial Utility, and Risk Taking etc.) and making the conclusion of Orthopedics and Cosmetics medical tort responsibility: “Reconstructing the Medical Liability”—from the outcome of the “Economic Analysis of Damage Liability Rule” leading to “the Classification of Medical Practices”, and dividing it into the type of “Non-Commercialization Medical Practice” and “Commercialization Medical Practice (Non-Invasive Cosmetic Medical Act)”. After reviewing the approach of economic analysis, both types are in line with the lowest social cost and further improving the efficiency of the social welfare as a whole under the rule of negligence and strict liability. In addition, this article suggests that the “Invasive Cosmetic Medical Act” shall be subject to the scope of Orthopedics medical practice and can only be performed by a legitimate licensed physician for providing the protection of best interest of medical needs. Finally, this article also proposes some other suggestions, such as adopting the “Root Cause Analysis (RCA) System” and “Upgrade TPR—Public Disclosure of Medical Errors Mechanism” to provide the co-existing Legal and Non-Legal mechanisms serving as a reference for dealing with medical disputes in the future, and hoping that this article will be more colorful and multivariate. |
