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 starts from a systematic perspective and examines in-depth questions about how criminal law should respond to medical accidents. The so-called systematic viewpoint refers to the increasingly complex, professional and technical aspects of social organization, and various major "system accidents" often occur in daily life. The so-called "system accident" refers to all accidents caused by complex cause and effect caused by software (e.g., personnel, professional knowledge and technology, programming, or regulations, etc.) or hardware (e.g., machinery, equipment, or buildings, etc.) and software and hardware intersecting two parties (e.g., organizational culture, etc.); for example, medical accidents, public transport systems such as flight safety and railways, or public security accidents such as nuclear power plants. As for the so-called "accident", this course defines "an accident that may cause the occurrence or occurrence of death, injury, or disease or other damage to objects due to human or non-human factors." The cause of system accidents is often that some uneven and non-major obstacles begin to appear in complex systems, but they fail to correct them immediately, resulting in a locking reaction in the close-knot linking complex rings, and an unexpected interaction of multiple failures occurs, resulting in a surprisingly significant accident. Some commentators point out that the real cause of the tragedy of the accident is better than saying that it is a personal mistake, but it is caused by system obstacles. Therefore, systematic accidents are classified as a "special miscarriage incident". However, in particular, what exactly is "special misunderstanding incident"? Although there is no consistent definition yet, the "special" here is generally used to describe the following five characteristics of systematic accidents: ① Interactive complexity, ② Tight coupling of each ring, ③ Cascading failures, ④ Opacity, ⑤ Professional and technical measures. Medical accidents are a typical example of systematic accidents.
The Chinese medical community has been committed to advocating the so-called anti-criminalization of medical mistakes for many years, which is consistent with the above systematic views. However, above this, our medical community has been more focused on policy purposes such as maintaining harmony between medical relations and curbing the departure of medical personnel. In contrast, our country's legal community has mostly opposed the views on fairness and the necessity of punishment. On the other hand, some commentators accused that even if individuals of the organizational structure are held criminally responsible, it would not help to clarify the real cause of the systematic accident or even be harmful. To put it in detail, for example, this statement believes that after an accident occurs, the doctor will usually not report the accident to the hospital on his own due to the punishment. Instead, he will choose to hide the truth. This will make it harmful to clear the truth and will not help prevent the accident from happening again. In short, this course wants to explore in-depth theoretical and practical important subjects in terms of theoretical and practical matters in terms of criminal physical law and criminal procedure law, from various new perspectives revealed by the above 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 Fangling self-edited textbooks and designated references.
2. http://fjudkm.judicial.gov.tw/(Judgmental Intelligence Library)
3. http://jirs.judicial.gov.tw/Index.htm (Judicial Court Law Data Search System)
| 評分項目 Grading Method | 配分比例 Grading percentage | 說明 Description |
|---|---|---|
| 平時成績平時成績 Regular achievements |
50 | 出席，作業，以及課堂發言乃至於互動等表現。 |
| 期末成績期末成績 Final results |
50 | 學期報告：含「書面內容」與「口頭發表」兩部分。 |
