| 研究生: |
施憲佑 Shih, Hsien-Yu |
|---|---|
| 論文名稱: |
以「病人為中心」(patient-centered attitudes)思維下的
醫療契約民事法律關係變動 Under "patient-centered"(patient-centered attitudes) thinking, the changes of medical contracts in civil legal relations |
| 指導教授: |
侯英泠
Hou, Ing-Ling |
| 學位類別: |
碩士 Master |
| 系所名稱: |
社會科學院 - 科技法律研究所 Institute of Law in Science and Technology |
| 論文出版年: | 2011 |
| 畢業學年度: | 99 |
| 語文別: | 中文 |
| 論文頁數: | 116 |
| 中文關鍵詞: | 病人為中心 、醫療契約 、民事法律關係 |
| 外文關鍵詞: | patient-centered, medical contract, civil legal relation |
| 相關次數: | 點閱:157 下載:11 |
| 分享至: |
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現今人權意識抬頭,尤其是病人人權意識在第二次世界大戰後逐漸被許多國際醫療組織所重視,從而使各國醫療政策將病人之人權保護理念逐漸內化而形成醫療決定之一部份,甚至具體成為法規中之一部。例如告知後同意的觀念、手術同意書及目前國際醫療倫理與實務常談論到「以病人為中心 ( patient-centered attitudes )」的理念,都逐漸決定或影響醫療行為之方向或醫療策略之擬定。
然而,當病人人權意識逐漸提升重視的同時,醫療專業決定也逐漸由醫師主導轉而為「以病人為中心」的價值取捨,這樣的改變對於醫療生態是有很大的影響,因為以往治療疾病上是由醫師根據疾病型態,綜合病患病情,再加上自己臨床專業判斷後來決定最適合該病患的治療模式。然而,在人權意識的主導下,醫師的所有治療策略都必須告知病患並且得其同意下方才符合法律所規定而無侵犯人權之虞,這樣的模式對在從事與疾病對抗、生死交關的醫療人員不啻是綁手綁腳的行為。但反過來看,醫療的最終結果畢竟還是由病患來承擔,不管是併發症或是死亡的不幸結果。因此,由病患來決定或主導醫療策略方向其實也不為過;但是,若再思考醫療糾紛之層面,現今有關醫療糾紛之所以增加,其中的某些導致因素也是肇因於病患或其家屬不願接受疾病最後治療的結果而採取種種尋求司法檢驗醫療行為之正當與否的過程。然而不管司法檢驗醫療行為後情形如何,在司法檢驗的過程本身對醫療人員就是一種勞力、時間、費用的磨耗,這些過程所帶給醫療人員往往磨難多於檢討,也鮮少會有醫療人員喜歡這類司法檢驗過程,即便最後被認定無醫療疏失的情形。
所以,如何在現今醫療過程中清楚釐定醫病雙方在醫療行為上之責任與義務,為往後在醫療糾紛產生時快速解決紛爭之一項重要事情。尤其當醫師無法完全依照自己醫療專業主導醫療行為的同時,又必須承受中間司法檢驗與該醫療行為被判定不符合專業醫療的風險,這樣的情形對於醫病關係是相當不利也有害於醫病間的信任關係,更有可能導致全面防衛性醫療或拒絕醫療的惡性循環中。因此,本論文希望透過分析說明以「病人為中心」( patient-centered attitudes )思維下,對醫療契約民事法律關係的變動,來釐清醫病雙方之新責任義務範圍,藉以清楚瞭解彼此在新醫療行為中之行為決定與結果承擔關係,進而減少事後不必要的醫療爭執與司法檢驗過程,增進醫病關係和諧。
The promotion of consciousness of human rights today, particularly after World War II patient awareness of human rights in many international health organizations have been gradually paying attention, so that the national health policy concept of human rights protection of patients formed step by step within the medical decisions , even become a part of the specific regulations.
For example, the concept of informed consent, medical ethics and current international practice talked about the "patient-centered (patient-centered attitudes)" attitude, are gradually determine or influence the direction of health behavior or medical strategy formulation.
However, when the patient pay attention gradually to human rights awareness at the same time, the medical professional decision gradually transfer from physicians decided to the "patient-centered" value choice. The change to the medical environment is a great impact. Because the treatment of disease in past are based on disease patterns, physicians decisions, comprehensive patient conditions, and together with their clinical expertise to determine the most appropriate judgments of the treatment to the patient.
Under the guidance of awareness of human rights, all physicians must inform patients of treatment strategies to obtaining the consent for conformity with the law without fear of violating human rights, such this behavior pattern to the relevant medical staff engaging in confrontation with the disease, life and death is bound hands and feet.
But conversely, after all, patient bears the end of result, whether it is the unfortunate result of complications or death.
Therefore, the decision or lead the strategic direction of the medical treatment by the patient is right. However, if more considering the reasons of medical disputes are related to the patients or their family members unwilling accepting the results of the last treatment, and to seek judicial inspection to the medical practice or process.
Yet no matter how the situation after the judicial inspection the process of the medical practices, themselves are labor, time cost and bitter. These processes are often brought suffering to the medical staff, and also rarely medical personnel like such judicial inspection process, even finally there were no medical malpractice.
So, how to clearly define the responsibilities and obligations of today's medical physicians and patients in the medical behavior is an important thing for the subsequent medical disputes for quick resolution of disputes.
Especially when not fully according with their own physician-led medical practice in the medical process, they must bear the accompanied justice inspections of the medical process and the risk of judged malpractice. Such this situation for the doctor-patient relationship is very bad and harmful to the doctor-patient relationship of trust, is more likely lead to the vicious cycle of defensive medical treatment and refused medical treatment.
Therefore, the analysis present this thesis aims to "patient-centered" (patient-centered attitudes) thinking, the changes of medical contract relations between civil law, both doctors and patients to clarify the responsibilities and obligations of the new range, in order to clearly understand each other in the new medical behavior between decisions and results, thereby reducing unnecessary medical disputes and the inspection process of justice, to promote harmonious relations between doctors and patients.
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