本課程擬從系統性觀點切入，深入檢討刑事法應如何對應醫療事故所引發之諸課題。所謂系統性觀點係指，隨著社會組織體(social organization) 之日益複雜化、專業化、技術化，而在日常中常會發生各種重大的「系統性事故」(system accident) 在組織上所生「系統障礙」與「歸責」關係之新觀點。所謂「系統性事故」，係指所有依存於組織系統中之軟體（例如，人員、專業知識技術、程式設計、或規範等）或硬體（例如，機械、設備、或建物等）以及軟硬體兩方之交成作用(例如，組織文化等)所生之複雜因果而致的事故；例如，醫療事故，飛安、鐵道等大眾運輸系統、抑或核電廠等所生公安事故等 。而所謂「事故」，本課程將之定義為「因人為或非人為因素有導致人員之死亡、傷殘或疾病乃至於物之損壞或其他損失之發生或發生之可能性的意外情況」。系統性事故的起因，往往是在複雜的系統中（in a complex system）之某些環結，開始出現某些程度不一之非重大障礙，卻未能即時為改正，而致令密接的複數環節中之複數障礙產生連鎖反應，而發生難以預期的相互作用（unanticipated interaction of multiple failures），終致生成令人難以置信的重大事故。有論者指出，釀成事故悲劇的真正原因，與其說是個人的過失，還不如說是系統障礙所致。故有將系統性事故歸類為一種「特殊過失事件」。不過，具體上，究竟何謂「特殊過失事件」?對此，雖尚未有一致的定義，不過，此處所謂「特殊」，一般係用以描述系統性事故所具有之如下五點特徵:①交互作用的複雜性（interactive complexity）, ②各個環節的密接性（tight coupling）,③障礙的連鎖性（cascading failures）,④不透明性（opaqueness），⑤專業性、技術性(technical measures) 。而醫療事故正係系統性事故之一種典型例。
而我國醫界常年以來致力倡議所謂醫療過失除罪化之論，與上述系統性觀點正相契合。只不過，我國醫界，於此之上，更加強調，醫病關係和諧之維持以及醫護人員出走之遏止等政策性目的。相對於此，我國法界，立基於公平性與刑罰必要性之觀點，多數持反對意見。另一方面，有論者指摘，即使對組織體之構成員個人追究刑責，也無益於究明系統性事故之真正原因，甚或有害。具體以言，例如，此論認為，醫師於事故發生後，因為懼刑，通常不會自行向院內為事故通報，反而會選擇隱瞞真相，如此一來反而有害真相的釐清，也不利於防止事故的重演。要之，本課程欲從上述系統性觀點所揭示之各種嶄新視角，深入探討刑事實體法與刑事程序法有關醫療事故之咎責對應上，在理論上與實務上之重要諸課題。

This course intends to approach from a systemic perspective and conduct an in-depth review of how criminal law should respond to various issues arising from medical accidents. The so-called systemic perspective refers to a new perspective on the relationship between "system obstacles" and "responsibility" arising from various major "system accidents" that often occur in daily life as social organizations become increasingly complex, professional, and technical. The so-called "systemic accidents" refer to all accidents caused by complex causes and consequences of software (for example, personnel, professional knowledge and technology, programming, or specifications, etc.) or hardware (for example, machinery, equipment, or buildings, etc.) that depend on the organizational system, as well as the interaction between software and hardware (for example, organizational culture, etc.); for example, medical accidents, mass transportation systems such as flight safety, railways, or public security accidents in nuclear power plants, etc. The so-called "accident" is defined in this course as "an unexpected situation that may result in death, disability or illness of a person, or even damage to property or other losses due to man-made or non-man-made factors." The cause of systemic accidents is often that non-significant obstacles of varying degrees begin to appear in certain links in a complex system, but they fail to be corrected immediately. This causes multiple obstacles in multiple closely connected links to have a chain reaction, resulting in unanticipated interactions of multiple failures, eventually resulting in incredibly major accidents. Some commentators pointed out that the real cause of the tragic accident was not so much personal fault as it was caused by systemic obstacles. Therefore, systemic accidents are classified as a "special negligence event". However, specifically, what is a "special negligence event"? Although there is no consistent definition for this, the so-called "special" here is generally used to describe the following five characteristics of systemic accidents: ① interactive complexity, ② tight coupling of each link, ③ cascading failures, ④ opaqueness, ⑤ professional and technical. measures). Medical accidents are a typical example of systemic accidents.
The medical community in my country has been advocating the so-called decriminalization of medical negligence for many years, which is consistent with the above-mentioned systemic view. However, our country's medical community, on top of this, puts more emphasis on policy purposes such as maintaining a harmonious relationship between doctors and patients and curbing the departure of medical staff. In contrast, most of our country's legal circles hold opposing views based on the viewpoints of fairness and the necessity of punishment. On the other hand, some commentators have pointed out that even if individual members of an organization are held criminally responsible, it will not be helpful in elucidating the true cause of systemic accidents, and may even be harmful. Specifically, for example, this theory holds that after an accident occurs, doctors usually do not report the accident to the hospital on their own out of fear of punishment, but instead choose to conceal the truth. This is harmful to the clarification of the truth and is not conducive to preventing the recurrence of the accident. In summary, this course aims to explore in depth the theoretically and practically important issues related to the correspondence between criminal substantive law and criminal procedural law regarding medical malpractice from various new perspectives revealed by the above-mentioned systematic perspectives.

1. 劉芳伶自編教材以及指定參考文獻。
2. http://fjudkm.judicial.gov.tw/(司法智識庫)
3. http://jirs.judicial.gov.tw/Index.htm(司法院法學資料檢索系統)

1. Liu Fanling’s self-edited textbooks and designated references.
2. http://fjudkm.judicial.gov.tw/(Judicial Knowledge Base)
3. http://jirs.judicial.gov.tw/Index.htm (Judicial Yuan Legal Information Retrieval System)