中國 醫療損害賠償에 대한 證明責任分配制度의 變遷과 構造

The Transition and Structure of Distribution of burden of proof system in Medical Tort Law Suit of China

사법방식(재판)을 통한 의료손해배상의 해결은 매우 효과적이다. 하지만 실무적으로 법관이 사건의 진실성을 판단하기에는 많은 어려움이 있다. 따라서 여러 나라의 경우 사건의 진실성 판단과 관련하여 證明責任分配制度가 중요한 재판 규칙이 되고 있다. 중국은 의료손해배상의 증명책임분배제도를 수십년 동안 입법적으로 보완하여 왔지만 현재시행되고 있는 제도의 변경과 발전을 위한 논의할 여지가 있다. 본 논문은 의료손해배상사건에 관한 중국제도의 변화 측면에서 증명책임분배제도의 구조와 관련된 개인적 의견을 피력하고자 한다.

Up to now, there are multiple dilemmas both within and outside judicial proceedings of medical tort lawsuit. The fundamental reason for those dilemmas is the concerns and helplessness of patients and judges over non liquet in the facts of cases , which may happen in any kind of litigations. In light of professional expertise involved in and complicatedness of medical services, the non liquet in facts in judicial proceedings of medical tort lawsuit is more prominent. The core at making breakthroughs in dilemmas lies in overcoming the non liquet in facts of cases. It is the consensus that the burden of proof system is the best tool by which non liquet can be overcome. But the process of building up this system in medical tort lawsuit is fraught with difficulties and there seems to be no single proof burden sharing rule that can meet the needs of achieving material justice. Therefore, classifying and analyzing medical torts, then applying different criterions of administrative liability and rules about burden of proof to different types of torts and in turn structuring a diversified burden of proof system is imperatively needed in development of modern tortious liability as well as the best option to break the dilemmas in modern medical tort lawsuit. 当前我国的医疗侵权案件，在诉讼程序内外都存在着诸多困局。造成这些困局的根本原因，是患方及法官对案件事实真伪不明的担忧和无奈。案件事实真伪不明在任何一种诉讼中均可能发生，但鉴于医疗服务的专业性和复杂性，医疗侵权案件事实真伪不明的问题相对更加突出。寻求医疗侵权诉讼困局的突破，其核心就在于克服案件事实真伪不明的状态。学界共识，证明责任制度是克服真伪不明的最佳装置。但医疗侵权诉讼证明责任制度的构建却一直充满着困难，似乎没有一种单一的证明责任分配规则可以完全满足实质正义的要求。所以，对医疗侵权进行类型化的分析，不同类型的医疗侵权适用不同的归责原则和证明责任分配规则，进而构建多元化的证明责任分配制度，是现代医疗侵权责任发展的迫切要求，也是破解当前医疗侵权诉讼困局的最佳选择。随着民众权利意识的加强，诉讼途径解决医疗侵权纠纷则成为当事人乐于选择的主要方式。司法在解决医疗侵权纠纷方面体现了无可替代的功效。但由于医疗纠纷较强的专业性和医患两者之间的特殊地位，造成了医患之间信息和知识的严重不对称，使医疗侵权案件的事实查明有着较高的难度。尽管实践中大多依赖鉴定机制予以克服，但司法和医学双重鉴定体制，以及不同鉴定机构出具的判断冲突的鉴定意见却又给司法审判带来新的困惑。此时一方面面对似乎说明医方侵权行为存在的患者残障甚至死亡的不争事实，另一方面又面临医方为自己的反驳提供了似乎充分的医学依据，来说明患者遭受的损害属于医学允许范围内的医疗风险。法官在科学与经验之间的彷徨和犹豫，往往使案件审理异常延误，反复进行调解，甚至用变相强制性的调解来避免判决面&#20020