Abstract
중국의 의료소송 중 증명책임의 분배원칙은 의료분쟁에 있어 환자와 의료기관 간의 화해에 있어서 중요한 영향을 끼친다. 이러한 이유로 오랫동안 과학적 이고 합리적인 의료소송에서의 증명책임분배원칙이 사회 각 분야에서 관철되고 있으며, 이에 대한 연구도 지속되고 있다. 즉, 의료소송에서의 증명책임분배원칙은 ‘준주장, 준거증’, ‘거증책임의 도치, ‘유형화 귀책원칙하의 증명책임분배’, ‘법 규범 요건설’, ‘유형화 귀책원칙하의 증명책임분배 체계화 구성’이라는 5가지의 다양한 학설을 낳았다. 이러한 증명책임분배원칙은 다시 ‘법규범요건설’, ‘거증 책임의 완화’, ‘증명방해’라는 민사소송의 기본원리로 발전하여 운용하고 있으 며, 그 중 독일학자 Rosenbäck가 주장한 ‘법규범요건설’은 앞서 언급한 증명책 임분배원칙을 확립하는 이론으로 자리잡았다. 필자는 의료소송영역은 ‘법규범요 건설’을 절대적 법리에 기초하는 것은 타당하지 않다고 본다. 의료행위는 고도의 전문성이라는 특징과 의료기관과 환자 쌍방이 진료에 대한 정보의 비대칭으로 인하여 ‘위험영역설’을 의료소송의 증명책임분배로서 기본 학설로 하여야 한다고 본다. 의료행위의 특수한 행위와 의환관계에 있어서의 정보비대칭으로 인하여 환자와 의료기관이 공정한 소송을 진행할 수 있도록 한다. 또한 ‘위험영역 설’을 기본 학설로 채용함으로써 분쟁이 발생할 경우 의료기관에 일정한 부담감을 주게 됨으로써 의료행위에 대한 질적 향상을 기대할 수도 있을 것이다. 본연구에서는 의료소송에서의 증명책임분배에 관한 기존의 원칙과 새로 학설에 대하여 분석한다. 이를 통해 의료소송 증명책임분배와 관련하여 기본원칙의 결함과 관련 시스템의 불안전을 검토함으로써, 중국의 의료소송에 관한 ‘소송실질 평등원칙’, ‘의환관계 협조원칙’, ‘공평정의 원칙’의 세 가지 기본원칙을 확립하 여야 함은 물론, 건전한 의료감정제도와 의료소송 전문보조인제도 및 의료책임 보험제도의 마련에 도움이 될 것이라 본다. 中国医疗侵权诉讼证明责任分配规则对医疗纠纷化解和建构和谐医患关系有着至 关重要的影响,中国高度重视相关立法完善和规则确立。如何建构科学、合理的医疗侵权诉讼证明责任分配规则也长期以来受到社会各方关切,亟待研究和完善。总 体而言,中国医疗侵权诉讼证明责任分配规则历经了“谁主张,谁举证”、“举证责任 倒置”、“类型化归责原则下的证明责任分配”、“法规范要件说”、“类型化归责原则 下的证明责任分配体系化建构”五个阶段。纵观这些不同阶段的证明责任分配规则, 不难发现主要其运用了“法规范要件说”、“举证责任缓和”、“证明妨碍”三个民事诉 讼基本法理,其中德国学者罗森贝克提出的“法规范要件说”是前述系列证明责任分 配规则确立的理论根基。笔者认为医疗侵权诉讼领域以“法规范要件说”为绝对法理 根基的顶层设计思路不当。基于医疗行为的高度专业性特征和医患双方对诊疗信息 掌握的不对称性,应当引入“危险领域说”作为医疗侵权诉讼证明责任分配规则确立 的理论根基,并在此基础上确立由医疗机构承担诊疗过错和医疗关系证明责任的规 则。为确保医疗事业的健康有序发展,可以增设医疗机构免责的具体情形,对前述 规则导致对医疗机构产生的个案不公进行修正。同时,针对The rules for distribution of medical litigation certification of China have a crucial impact on the resolution of medical disputes and the construction of a harmonious relationship between doctors and patients, so China attaches great importance to the improvement of relevant legislation and the establishment of rules. How to construct scientific and reasonable the rules for distribution of medical litigation certification has long been concerned by all social parts, and it is urgent to be studied and improved. Generally speaking, the rules for distribution of medical litigation certification of China have gone through five stages, including “who advocates, who has to put to the proof”, “Shifting of burden of evidence”, “the rules for distribution of litigation certification under the principle of typed imputation”, “the legal normative element”, and “the construction of rules for distribution of litigation certification under the principle of typed imputation”. Throughout these different stages of the rules for distribution, it is not difficult to find that it uses three basic theories of civil procedural law, including legal normative requirements , ease the burden of proof and obstruction of evidence , which the German scholar Rosenberg proposed the legal normative element is the theoretical foundation for the aforementioned series of rules. However, the author believes it is inappropriate that the legal normative element is look as top-level of the absolute legal basis in the field of medical infringement litigation. Based on the highly professional characteristics of medical behavior and the asymmetry of medical information between doctors and patients, the Dangerous area theory should be introduced as basic theories of civil procedural law for the rules for distribution of medical litigation certification, and on this basis, it is established by the medical institution. The rules of responsibility for diagnosis and treatment faults and medical relationships. In order to ensure the healthy and orderly development of the medical undertakings, it is possible to add specific circumstances for the exemption of medical institutions, and to correct the unfair cases arising from the medical institutions. At the same time, in view of the lack of guiding principles for the distribution of medical litigation certification and the lack of relevant supporting mechanisms, it is recommended to establish the three basic principles, including “principle of substantive equality of litigation”, “effectively coordinate the principle of doctor-patient relationship” and “principle of fairness and justice”, and three main system should be improved, including medical dispute appraisal system, the medical assistant expert support system and the medical liability insurance system.
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