論「性別差異」對醫療行為及病人同意的影響

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ઝݾऄᖂေᓵΔ6 ࠴ 2 ཚΔ଄ 219ΰ2009α

ࠋٲ๳ባ

፣ȶܒտ৯౴ȷᄇᚂᕛ՗࣏Ѕ

੾Ρӣཎޟኇ៪

*

Цד჏

**

_ǵᛥቼᔇ

*** ᄢ! ौ ψܫव৵ٵრωፖψࢤܑრᢝωΔএ२ڣࠐᄅᘋऱᤜᠲΔኙ᠔᛭ኔ೭ऱ ૹ૞ࢤ۞լߢױ໧ΔՈፖ᠔᛭ि౑ऱ࿇سஒஒઌᣂΖਚء֮ᚵ៶طഏփ؆མ ᠔᛭ि౑࿇سऱኔࠏ ψᜍ౥֫๬ఎ੾ூωא֗ψ๠Ֆᓂᐺါ႞୭ூωΔ ൕ᠔ᖂ଩෻ፖऄ৳ऱᨠរΔא֗ࢤܑؓ࿛ऱߡ৫Δ൶ಘ᠔᛭Ղψࢤܑ஁ฆω ኙ᠔᛭۩੡֗ఐԳٵრױ౨ขسऱᐙ᥼Ζ ψᜍ౥֫๬ఎ੾ூωऱ᠔᛭ि౑Δ׌૞এ᠔ஃኙ࣍ψॆ᧯ݮွΰ੾ ฉαωऱࢤܑඕტ৫ፖఐԳڶࣔ᧩ऱᆵ஁Δڼ࿛ᆵ஁ױ౨ഗ࣍س෻ࢤܑऱ஁ ฆࢬขسΔՈױ౨ഗ࣍षᄎࢤܑऱ஁ฆࢬขسΔ൫ਢܡᄎທګఐԳٵრऱྤ ய Δ ᚨ ط ఐ Գ এ ᠔ ᛭ ؾ ऱ ࢨ ભ ୲ ؾ ऱ ᛀ ီ ࠡ ٵ რ ऱ փ ୲ ܂ ੡ ܒ ឰ Ζ ψ๠Ֆᓂᐺါ႞୭ூωΔ׌૞Ոਢ᠔ஃ࢙ฃψ๠ՖᓂωኙఐԳऱრᆠΔ * ߚதགᖴٿՏ୓Ӝቩࢗہ঩ޑᝊ຦ཀـǴவݤᏢϷ܄ձޑᢀᗺܬ҅ϷံமҁЎޑፕ ᗺϷ౧ѨǴჹբޣڙ੻ؼӭǴ੝ԜठᖴǶ ** Οैᕴᙴଣৎ৥ᄤޗ୔ᙴᏢ೽Ьݯᙴৣǵ୯ٛᙴᏢଣᙴᏢسᖱৣǹܿֆεᏢݤࡓࣴ ز܌ӉݤಔറγғǶ *** Οैᕴᙴଣৎ৥ᄤޗ୔ᙴᏢ೽ЬҺǵ୯ٛᙴᏢଣᙴᏢس௲௤ǹऍ୯׹ើεᏢᙴ୍ᆅ ౛ᏢറγǶʳ ׫ዺВǺ2009 ԃ 6 Д 21 Вǹ௦ҔВǺ2009 ԃ 8 Д 21 В ɡʳ219ʳɡ

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ᎅࣔլߩࢬᖄીऱ᠔᛭ि౑Ζឈྥኙ࣍๠Ֆᓂऱૹီএط࣍ψषᄎࢤܑऱೣ ஁ωࢬขسΔᚨᇠਢ૞ధೈຍֱ૿ऱೣ஁Δ܀ਢຍլᚨᇠط᠔ஃ໢ֱ૿ެ ࡳΔ༉᠔ᖂ଩෻ऱᨠរΔսᚨీڇאψఐԳ੡խ֨ωऱ৸ەᑓڤΔഛ塄ࢤܑ რᢝΔթլી࿇س᠔᛭ि౑Ζ ڂڼΔൕ᠔᛭ऱߡ৫ᨠኘΔ᠔ஃᚨీڇאఐԳ੡խ֨ऱߡ৫Δ༇ૹఐԳ ऱ۞ݺެࡳᦞΔഛ塄ࢤܑრᢝΔᛵᇞ֗༇ૹࢤܑ஁ฆΔٵ෻ఐԳऱტ࠹Δթ ౨ᝩ܍᠔᛭ि౑ऱ࿇سΖ ᜢᗖӷǺ܄ձৡ౦ǵ܄ձཀ᛽ǵੰΓԾך،ۓ៾ǵ֋ޕࡕӕཀǵᙴᕍ ޟ઱

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Cite as: 6 TECH. L. REV., Oct. 2009, at 219.

On Gender Differences,

Patient’s Consent and Medical Disputes

Chih-Chia Wang, Ching-Hui Loh

Abstract

This article discusses the issues arising from the interaction between gender differences and medical practice & patient’s consent by the true cases of medical disputes. The first case is Korman v. Mallin, 858 P.2d 1145 (Alaska 1993), a case of breast reduction surgery. It indicates that physical image is very important and every physician should keep in mind. If a plastic surgeon neglects it and give in-adequate explanations or descriptions, it will result in medical dispute. The pa-tient’s consent may be invalid if she seeks the operation based on cosmetic demand and the physician may face criminal and civil liability. The second case of “vaginal examination and hymen tear” results from gender bias that people pay too much attention to hymen integrity. This gender bias should not be secured by criminal liability. On the other hand, if the patient values it, the physician should still afford the damages so produced on the basis of civil liability. The most important thing is that the physician should cultivate gender sensitivity so as to avoid and decrease medical disputes in this respect.

Keywords: Gender Differences, Gender Sensitivity, Patient Autonomy, Informed Consent, Medical Dispute

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2.1 ᚂᕛ՗࣏ޟݲࡡȞӗݲȟᢎᘈ

ൕऄ৳ऱߡ৫ᨠኘ4Δ᠔᛭۩੡ࠠڶψᠨ૿ࢤωΖൕؾऱֱٻࠐ઎Δਢԫ ጟኙఐԳسࡎߪ᧯೜ൈࠠڶإ૿ܓ墿ऱ۩੡ΖྥۖΔൕݮڤࠐ઎Δ᠔᛭۩੡ ڶױ౨ਢ៶طॿԵఐԳऱߪ᧯Εॿ୭س෻ᖲ౨ࢨਢທګߪ᧯լᔞऱֱڤࠐሒ ࠩআၞఐԳߪ᧯೜ൈΕፂ਍سࡎऱؾऱ5ΖڂڼΔኙ࣍᠔᛭۩੡ऱေᏝڶψ᠔ ᛭۩੡႞୭ᎅωא֗ψ᠔᛭۩੡ॺ႞୭ᎅωऱኙمߠᇞΔਚऄ৳ڕ۶ေᏝ᠔ ᛭۩੡Δլႛፖ᠔᛭Ղسࡎ଩෻؄଺ঞऱᚌ٣ࢤڶᣂΔՈፖ᠔ࠃԳ୉٩ࠃຂ ٚஒஒઌᣂΖ ڇᐚഏΔኙ࣍᠔᛭۩੡Δᖂᎅڍᑇאψ᠔᛭۩੡႞୭ᎅω੡ᇞᤩֱٻΔ ֟ᑇאψ᠔᛭۩੡ॺ႞୭ᎅω੡ᇞᤩֱٻΔ܀ڂ੡ဒڂܒެऱנ෼6Δመװԫ ۍڍڣࠐΔ᠔᛭۩੡ڇᐚഏ٩ऄኔ೭Ղ๯ᇞᤩ੡ฤٽ႞୭ᆞዌګ૞ٙऱ۩ ੡Ζਚ᠔᛭۩੡ྤऄ٦אψᄐ೭ᦞᓵωॴথࠡሔऄࢤ7Δ׽౨ຘመאՀԿጟࠃ طթ౨ॴথࠡሔऄࢤΔٍܛΚ1.๯୭ԳऱࢭᘭΰٵრαΰܛఐԳऱࢭᘭαΙ2. ࠠڶංྒྷऱࢭᘭΙ3.ጹ৺ᝩᣄ8Ζ 4 வᙴᏢউ౛ޑว৖ўᢀჸǴคፕவ໺಍ǵ߈жǵډ౜жǴӧᙴᏢউ౛ޑϣ఼ύவٰ όᇡࣁᙴᕍՉࣁࢂ཮ჹੰΓ೷ԋ໾্ޑǴջ٬౜жᙴᏢࣚ೯ҔޑȨғڮᙴᏢউ౛Ѥ চ߾ȩύ܌ᒏޑȨό໾্চ߾ȩǴځϣ఼߯ࡰȨᙴৣᆢ࡭ҁيԖؼӳޑᖏ׉ޕ᛽Ϸ מೌǵᙣ཈Ӧ୺Չаၲډ፾྽ޑྣ៝኱ྗȐstandard of due careȑǴ٠ᗉխᡣੰΓ܍ ᏼҺՖό྽ޑǵڙ໾্ޑ॥ᓀǶȩǴкځໆКၨ಄ӝӉݤၸѨޑཷۺǴࡺᙴᏢࣚவ ٰόᇡࣁᙴᕍՉࣁࢂ໾্ՉࣁǴԜ߯ᆶݤࣚᢀᗺόӕೀǶ 5 ЦࣤҏǴȨፕᙴᕍՉࣁᆶ཰୍΢ϐ҅྽ՉࣁȩǴѠεݤᏢፕᘀǴಃ36 ڔಃ 2 යǴ। 45Ȑ2007ȑǶ 6 1894 ԃቺཀדࡆ୯๲Ӣݤଣղ،߯Ύྃζ࠸Ӣᑡ஻่ӝ܄ମᡎᕎǴѸ໪ᄒަۈૈߥ Ր܄ڮǴζٽРܴዴ߄ҢϸჹǴՠᙴৣϝࣁځ୏ЋೌǶᏃᆅЋೌԋфǴᙴৣϝ೏а ໾্࿾ଆນǴݤଣΨᇡࣁԋҥ໾্࿾ǴԜջቺ୯ᙴᕍՉࣁ໾্ᇥޑۈ઒ղ،Ƕ 7 Ȩ཰୍៾౛ፕȩ߯ࡰǺᙴৣΏࢂڙډ୯ৎ೚ёԶ୺Չᙴᕍ཰୍ϐΓǴᙴᕍՉࣁޑ҅ ྽ϯ٣җࢂவᙴᏢޕ᛽΢ىаၲԋᙴᕍҞޑǴЪݤࡓؒԖܴЎ࿣З٬ҔޣǴ൩ڙډ Ϣ೚ǴԿܭੰΓӕཀᆶց٠όख़ाǶୖـЦࣤҏǴ߻ඟຏ5Ǵ। 46Ƕ 8 ӕ߻ຏǴ।48Ƕ

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ڇֲءΔ᠔᛭۩੡ܛࠌএ᠔ஃ௅ᖕ᠔ᖂܒឰፖݾ๬ࢬ੡Δࠡءߪ൅ڶኙ ఐԳߪ᧯ࢨس෻ᖲ౨հॿ᦭ࢤΔۖ᥆࣍ኙ൛ृߪ᧯հॿ୭ࢨٲᙠ۩੡Δਚኔ ೭֗ڍᑇᖂᎅᎁ੡᠔᛭۩੡ࠠڶ႞୭ᆞհዌګ૞ٙᇠᅝࢤΔ൫ૉࠠໂ᠔ᖂՂ ऱᔞᚨࢤΕ᠔๬ऱإᅝࢤΕא֗ఐԳऱࢭᘭΰٵრα࿛૞ٙॴথࠡሔऄࢤΔ ൫ٍڶ֟ᑇᖂᎅආ᠔᛭۩੡ॺ႞୭ᎅհߠᇞ9Ζ ڇݺഏΔኙ࣍ᣂ࣍᠔᛭۩੡10Δݺഏ٩ऄᖂᎅፖኔ೭ߠᇞΔႚอאࠐԫ ऴଘᘸ٩ऄร 22 යψᄐ೭Ղհإᅝ۩੡ω܂੡᠔᛭۩੡ॴথሔऄհࠃط11Ι ᖂᎅՂΔࡸױא၌ऄ๵ॴথሔऄࠃطψ๯୭ԳࢭᘭΰٵრαωΔ܂੡᠔᛭۩ ੡ॴথሔऄऱ௅ᖕ12Ζڇ٩ऄᇞᤩऱᨠរΔڕ࣠ᎁ੡᠔᛭۩੡ᚨאψᄐ೭Ղ հإᅝ۩੡ωࢨψ๯୭Գࢭᘭω܂੡ॴথሔऄࠃطऱᇩΔܛრᘯ᠔᛭۩੡๯ ᎁࡳਢฤٽ႞୭ᆞዌګ૞ٙհ۩੡Δრܛኙऄ৳ኙ࣍᠔᛭۩੡ေᏝழΔᄎ৬ مڇψ᠔᛭۩੡႞୭ᎅωऱ౧࿮ՂΖ ൕऄ৳ऱߡ৫ᨠኘΔᐚΕֲΕ֗ݺഏኔ೭֗ڍᑇᖂᎅߠᇞ݁ᎁ੡Δ᠔᛭ ۩੡ڂࠡࠠڶॿ᦭ࢤ֗ٲᙠࢤۖආ࠷ψ᠔᛭۩੡႞୭ᎅωΔء֮ឈྥ౨ജ෻ ᇞऄ৳ᇞᤩᖂՂऱᨠរΔ܀ڼߠᇞፖ᠔੺֗اฒኙ࣍ψ႞୭ωऱᨠტ෻ᇞࠀ լઌٵΔڶؘ૞٣۩ᎅࣔΔאܓ৵ᥛऱಘᓵΖ 9 ഋηѳǴȨᙴᕍ΢ȬкϩᇥܴᆶӕཀȐInformed Consentȑȭϐݤ౛ȩǴܿֆݤࡓᏢ ൔǴಃ12 ڔಃ 1 යǴ। 72-73Ȑ2000ȑǶ 10 ፁ࿿ᙴӷಃ 0920213851 ဦՉࡹڄញǺȨΥаݯᕍǵᕖ҅ǵ܈ႣٛΓᡏ੯ੰǵ໾্ූ લ܈ߥ଼ࣁޔௗҞޑǴ܌ࣁޑບჸǵບᘐϷݯᕍǹ܈୷ܭບჸ܈ບᘐ่݀Ǵаݯᕍ ࣁҞޑǴ܌ࣁޑೀБҔᛰࡼೌ܈ೀ࿼฻Չࣁޑӄ೽܈΋೽ǴᕴᆀࣁᙴᕍՉࣁǶȩǴ ᙴৣݤှញ༼ጓǴ।719Ȑ2004ȑǶ 11 ߈ය๱Ӝޑჴ୍ـှࣁനଯݤଣ94 ԃѠ΢ӷಃ 2676 ဦӉ٣ղ،ǴаϷനଯݤଣ 95 ԃ Ѡ ΢ ӷ ಃ 3476 ဦ Ӊ ٣ ղ ، Ƕ љ ݤ ଣ ݤ Ꮲ ၗ ਑ ᔠ ઩ س ಍ Ǻ http://jirs.judicial. gov.tw/Index.htmȐаΠ܌ЇҔϐղ،ٰྍҭ֡࣬ӕȑǹܭᏢᇥ΢ǴёୖـЦࣤҏǴ ߻ඟຏ5Ǵ। 56-57Ƕ 12 ୖـഋηѳǴӉݤᕴፕȐ΢ȑǴ।268Ȑ2005ȑǹ݅ξҖǴӉݤ೯ፕȐ΢ȑǴ। 367-369Ȑ2008ȑǹҒబ຦ǴӉݤϐख़ा౛ۺǴ। 73-75Ȑ1996ȑǹ݅✎໢ǴཥӉݤᕴ ߾Ǵ।267Ȑ2006ȑǶ

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ऄ৳Δਢᣤ᠃ऱ᧤ᙀᓵ૪Δڇ٩ऄՂ૞ᓵឰԫଡԳਢܡحᆞΔࠉᅃຏᎅ ؘႊᆖመψዌګ૞ٙᇠᅝࢤωΕψሔऄࢤωא֗ψڶຂࢤω࿛Կၸ੄ऱᛀ ᧭Ζ༉ψዌګ૞ٙᇠᅝࢤωۖߢΔࠡࢬൎᓳऱਢࢼွࢤऱΕᣊীࢤऱܒឰΔ ང؁ᇩᎅΔ᠔᛭۩੡႞୭ᎅΔإᒔऱᎅऄᚨᇠਢڇዌګ૞ٙᇠᅝࢤऱၸ੄Δ ൶ಘᇠ᠔᛭۩੡ءߪΔਢܡᄎψధᡏהԳߪ᧯ऱݙᖞࢤωΔਢܡᄎທګψה Գऱߪ᧯෼णऱޏ᧢ωΔהൎᓳऱਢψࠃኔωऱຫ૪Δࠀլ௫֗ψᏝଖωऱ ܒឰΔࠏڕΔψॿԵࢤऱ؆ઝ֫๬᠔᛭۩੡ωΔऱᒔਢฤٽ႞୭ᆞऱዌګ૞ ٙᇠᅝΔ܀ਢܡᄎዌګ႞୭ᆞΔսᏁၞԫޡຘመሔऄࢤऱᛀ᧭Δ઎ਢܡڶॴ থሔऄऱࠃط13Ζ ޓ壄ᒔऱᎅऄΔψ᠔᛭۩੡႞୭ᎅωऱψ႞୭ωΔڇ٩ऄՂ᥆࣍ψխࢤ ش፿ωΔ،׽ਢኙ࣍ࠃኔऱ༴૪Δਢԫଡড়ᨠऱणउΔ،լ௫֗Ꮭଖऱܒ ឰΔຍፖݺଚֲൄխ֮ࢬᎅऱψ႞୭ωΔࢨਢ᠔ᖂ଩෻ࢬᎅऱψ႞୭ωΔࠀ լݙ٤ઌٵΖڂ੡Δլᓵਢֲൄխ֮ࢨਢ᠔ᖂ଩෻Ղࢬᓫऱψ႞୭ωΔլႛ ਢထૹڇࠃኔऱܒឰΔՈ෰௫ࠩᏝଖऱܒឰΔࠏڕΔ᠔ᖂ଩෻ऱ௅ᄭ ψݦं܌ࢮࢍ৙ߢωΰThe Hippocratic Oathα14Δܛൎᓳψլױ႞Գԯ੡᠔ ஃհ֚៭ωΔױߠڇ᠔ᖂ଩෻ऱᨠរຏൄլᎁ੡᠔᛭۩੡ਢᄎኙఐԳທګ႞ ୭ऱ15ΔຍഗءՂਢ႞୭ጵٽܒឰऱ࿨࣠ΔឆܶထᏝଖऱᓵ૪Ζ ڂڼΔء֮ᎁٵ᠔᛭႞୭ᎅऱߠᇞΔڂ੡،ࢬז।ऱਢխࢤऱრᆠΔٍ ܛૉ᠔᛭۩੡ᄎທګψהԳऱߪ᧯෼णऱޏ᧢ωΔ༉ࠃኔՂΔ༉ড়ᨠՂΔऱ ᒔਢ᥆࣍႞୭ᆞዌګ૞ٙᇠᅝࢤऱ႞୭۩੡Δຍࠡኔਢᇿ᠔ᖂ଩෻ፖֲൄش ፿Ղऱ႞୭ਢլઌٵऱΖ ڂڼΔܛലಘᓵऱψᜍ౥֫๬ఎ੾ூωΔءᔆਢ֫๬ΔኙఐԳࠠڶॿ᦭ 13 ᎄຽণǴȨȬߟΕ܄ѦࣽЋೌᙴᕍՉࣁȭޑȬᄬԋाҹ၀྽܄ȭکȬߔࠅၴݤ٣ җȭȩǴݤзДтǴಃ60 ڔಃ 6 යǴ। 5-7Ȑ2009ȑǶ 14 ׆ݢլ܎ۭȐHippocrates, B.C. 469-399ȑрғܭ׆ᛪࣽථ৞ȐCosȑǶୖԵԾЦਇ ᅚǴᙴᏢ൨ਥϐਓǴᏢ൤ЎϯǴ।2-32Ȑ2009ȑǶ 15 ᎄຽণǴ߻ඟຏ13Ǵ। 5-6Ƕ

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ࢤ੷ՕΔྤጊऱਢ᥆࣍ॿԵࢤऱ؆ઝ᠔᛭۩੡Δ᥆࣍႞୭ᆞዌګ૞ٙᇠᅝऱ ႞୭۩੡Ιۖψ๠Ֆᓂᐺါ႞୭ூωΔឈྥ๠ՖᓂਢԳ᧯լؘ૞ऱิ៣Δ܀ ਢຘመᚅᏯΰឩອᕴαኙఐԳၞ۩ອሐփ်ऱᛀ਷Δսࠠڶԫࡳ࿓৫ऱॿ᦭ ࢤΔឈྥڼ࿛᠔᛭۩੡ኙఐԳऱᛧ墿੷ՕΔᛧ墿᎛Օ࣍႞୭Δ܀ీڇዌګ૞ ٙᇠᅝࢤࢬေᏝऱ۩੡᥆࣍ࠃኔՂऱ۩੡Δط࣍ᇠ۩੡ధᡏԱఐԳߪ᧯ऱݙ ᖞࢤΔՈທګψఐԳऱߪ᧯෼णऱޏ᧢ωΔਚսྥฤٽ႞୭ᆞዌګ૞ٙᇠᅝ ࢤࢬေᏝऱ႞୭۩੡Ζ

2.2 ॳᓎ֙ޣޟᏰᇳތដᇄ੾ΡӣཎޟԤਝܒ

ڇء֮ආ࠷ψ᠔᛭۩੡႞୭ᎅωऱছ༼Δ᠔᛭۩੡ਢ٩ऄ႞୭ᆞዌګ૞ ٙᇠᅝࢤऱ۩੡Δڇԫ౳ൣݮՀؘႊຘመ٩ऄॴথሔऄࠃطΔڕψ๯୭Գࢭ ᘭΰܫव৵ٵრαωΕψංྒྷऱࢭᘭωΕψጹ৺ᝩᣄωΕψࠉऄח۩੡ωΕ ψጹ৺ᝩᣄωΕࢨψᄐ೭Ղإᅝ۩੡16ω࿛ֱڤאॴথࠡሔऄࢤΖࠉຏᎅΔ ૉ඿א๯୭Գࢭᘭΰܫव৵ٵრαࢨਢᄐ೭Ղإᅝ۩੡ॴথࠡሔऄࢤΔᏁ࠷ ൓ఐԳڶயऱٵრΔڇԫ౳ൣݮՀڕ۶ᎁࡳ۶ृ᥆࣍ڶயऱψࢭᘭΰٵ რαωΔܛ੡ء֮๠෻ऱᣂ᝶ംᠲΖ ڇ᠔᛭۩੡ՂΔψٵრωऱംᠲ੷੡ᓤᠧΔ࿑ףޏ᧢ԫԲଡᜯݩणउࢨ ᧢ႈΔױ౨ທګऄ৳ய࣠ऱޏ᧢Ζڇᖂᎅࢨኔ೭ՂΔٵრਢܡڶய່ྤञᤜ ऱ༉ਢٵრᚨאψኔᔆऱٵრω੡ؘ૞Δૉႛ੡஼૿ऱݮڤٵრΔਢլࠠऄ ৳ய࣠ऱ17Δ׼؆Δψ၌נఐԳٵრऱᒤ໮ωڇऄ৳ՂՈਢྤயऱ18Ζ ࠃኔՂΔط࣍᠔᛭ि౑ऱݶຒᏺףא֗᠔ᖂ଩෻ऱૹီΔؾছ᠔᛭Ղآ ࠷൓ఐԳٵრऱൣݮ੷֟Δਚؾছڇ᠔᛭ፖ׹ऄኔ೭ՂΔఐԳٵრ່ࠠञᤜ 16 ཰୍΢҅྽ՉࣁǴ٩Ᏽ೯ᇥ໪хࡴǺᙴᕍҞޑǵᙴᕍ፾ᔈੱǵᙴᕍதೕǵаϷੰΓ ӕཀ฻ѤाҹǶ 17 നଯݤଣ94 ԃѠ΢ӷಃ 2676 ဦӉ٣ղ،ǵനଯݤଣ 95 ԃѠ΢ӷಃ 3476 ဦӉ٣ղ ،Ƕ 18 ᎄຽণǴ߻ඟຏ13Ǵ। 10Ƕ

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ृԯਢᚨڕ۶ܒឰψٵრऱயࢤωΖࠃኔՂΔڼຝ։௫֗٩ऄᖂᎅՂࢭᘭፖ ٵრਢܡઌٵऱञᤜ19Δഗ࣍១֏ംᠲΔء֮լᇡาಘᓵΔء֮ഗءՂᎁ੡ ٵრፖࢭᘭࡳۯՂࠀྤ೴ܑΔႛڇᇞᤩ़ၴऱ஁ฆ20Ζ ང؁ᇩᎅΔڇ᠔᛭۩੡ՂΔٵრਢܡڶயᏁ૞ەၦٵრऱփ୲Ζٍܛᖂ ᎅՂࢬᎅऱψଅᙠܫव࿓৫ωऱംᠲΔ௽ܑਢ௫֗ψࢤܑ஁ฆωࢬ֧ದऱञ ᤜΔڕ۶๠෻ፖܒឰ᠔ஃऱܫवᅕชΔࠡፖٵრڶயऱᣂຑࢤ੡۶Δ༉ڶಘ ᓵऱؘ૞Ζ ؾছڇ᠔᛭֗׹ऄኔ೭ՂΔޢᅝ᠔᛭ि౑࿇س৵Δ᠔ஃܛࠌམᇡาፖఐ Գᎅࣔ֫๬࿛ଅᙠΔ܀ఐԳ֗ࠡࡡٚ৳ஃࠉྥױאބࠩ᠔ஃآམᎅࣔऱ֫๬ ଅᙠΔࠀᖕڼאᇠ᠔ஃآ࿳ጐܫव৵ٵრ܂੡္๼ऱᓮޣΔڕ۶ᇞެଅᙠዥ آܫवऱംᠲΔၞۖܒឰࠡٵრਢܡڶயΔঞࠠڶኔ墿ΔਚאՀലಾኙଅᙠ ܫव࿓৫ऱኔ೭ߠᇞፖᖂᎅߠᇞףאᎅࣔΖ

2.2.1 ჴ୍ـှ

່೏ऄೃᎁ੡ఐԳߪ᧯۞׌ᦞΔᘯΚψ᠔᛭ԯ੡೏৫റᄐ֗ٲᙠհ۩ ੡Δऴ൷௫֗ఐԳհߪ᧯೜ൈࢨسࡎΔఐԳءԳࢨࠡ୮᥆ຏൄႊᘸ᠔ஃհᎅ ࣔΔֱ൓ࣔᛵ᠔᛭۩੡հؘ૞Εଅᙠ֗ய࣠Δਚ᠔ஃ੡᠔᛭۩੡ழΔᚨᇡา 19 ٣ჴ΢ǴԜ೽ϩੋϷӉݤᏢᇥ΢܍ᒍᆶӕཀࢂց࣬ӕޑୢᚒǶᜢܭ܍ᒍᆶӕཀǴന ߃٠όуа୔ձǴܭ 1950 ԃжቺ୯ݤើլᅽεᏢӉݤ௲௤ᇂᅟ૟ȐGeerdsȑ२Ӄග рǴᇡࣁ೏্ΓӕཀࢂߔࠅᄬԋाҹԋҥǴ೏্Γ܍ᒍ߾ࢂߔࠅၴݤǶՠԜᜪϩݤ ߈ԃٰӧቺ୯ᅌڙϸჹǴдॺᇡࣁӕཀᆶ܍ᒍޑਏ݀࣬ӕǶୖـ݅ܿपǴӉݤᆕ ំǴ। 1-127Ȑ2007ȑǹ஭᜽ঙǴӉݤᕴ߾౛ፕᆶၮҔǴ। 207-210Ȑ2007ȑǹ݅✎ ໢Ǵ߻ඟຏ12Ǵ। 267-268Ȑ2006ȑǶ 20 Ԝᇥ୷ҁ΢ᇡࣁǴӕཀᆶ܍ᒍޑ୔ձǴ٠όࢂӧ܌ᒏҍ࿾ᄬԋाҹ၀྽܄ᆶၴݤ܄ ޑቫԛཀက΢ޑ୔ձǴԶࢂӧှញ΢ޑޜ໔ৡձୢᚒǶӵ݀చЎҁيаȨ҂࿶೏্ ΓӕཀȩࣁόݤᄬԋाҹǴεठ΢ѝा೏্Γޑӕཀࢂ٣ჴǴ൩ૈߔࠅόݤǶ࣬ჹ ޑǴӧచЎҁي٠҂аȨ҂࿶೏্Γӕཀȩࣁόݤᄬԋाҹޑ௃ݩǴᜢܭ೏্Γ܍ ᒍࢂցёаߔࠅόݤǴϝฅԖሽॶղᘐ΢ޑ߻ගୢᚒѸ໪଺ԵໆǶୖـ໳ᄪ୲Ǵ୷ ᘵӉݤᏢȐ΢ȑǴ।348-350Ȑ2006ȑǶ

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ኙఐԳءԳࢨࠡᘣ᥆ጐઌᅝհᎅࣔᆠ೭ΔᆖఐԳࢨࠡ୮᥆ٵრ৵੡հΔאঅ ᎽఐԳߪ᧯۞׌ᦞΙՂၲ᠔ஃᚨጐհᎅࣔᆠ೭Δೈመ࣍റᄐࢨาຝ᛭ऄ؆Δ ۟֟ᚨץܶΚΰԫα်ឰհఐټΕఐउΕቃ৵֗լ൷࠹ए᛭հ৵࣠ΖΰԲα ৬ᤜए᛭ֱூ֗ࠡהױ౨հཙזए᛭ֱூዄࠡܓኤΖΰԿαए᛭ଅᙠΕൄ࿇ سհࠓ࿇఑֗೫܂شឈլൄ࿇سΔ܀ױ౨࿇سᣤૹ৵࣠հଅᙠΖΰ؄αए᛭ հګפ෷ΰڽՋ෷αΖΰնα᠔ೃհ๻ໂ֗᠔ஃհറᄐ౨Ժ࿛ࠃႈΙٍܛڇ ԫ౳ൣݮՀΔڕམᎅࣔΔఐԳܛڶࢴ࿪᠔᛭հױ౨ழΔܛڶᎅࣔհᆠ೭Ι࣍ ڼΔ᠔ஃૉآጐՂၲᎅࣔհᆠ೭Δೈڶإᅝ෻ط؆Δᣄᘯբጐࣹრհᆠ೭Ι ԾՂၲᎅࣔհᆠ೭ΔאኔᔆՂբղᎅࣔ੡ؘ૞ΔૉႛחఐԳࢨࠡ୮᥆ڇٱڶ ᎅࣔࠃႈհٵრ஼ՂΔ၉ྥ᡽ټΔࡸᣄᎁբጐᎅࣔհᆠ೭Ζ21ω Ղ૪ܒެΔቤࡳଅᙠܫव࿓৫ΰᒤ໮αऱࢼွ଺ঞΔץਔΚψլൄ࿇ سΔ܀ױ౨࿇سᣤૹ৵࣠ଅᙠऱࠓ࿇఑֗೫܂شωΔא֗ψڇԫ౳ൣݮՀΔ ڕམᎅࣔΔఐԳܛڶࢴ࿪᠔᛭հױ౨ழΔܛڶᎅࣔհᆠ೭ωΖ

2.2.2 Ꮲᇥـှ

2.2.2.1ʳ լױಭଅᙠܫवᎅ ڇᖂᎅՂՈᎁ੡Δڇ᠔ஃܫवኔ೭ՂΔ່ࠠञᤜृ੡Δଅᙠܫवऱം ᠲΖࠏڕΔ֫๬ࠓ࿇఑ࢨٲᙠࢤ࿇سᖲ෷መ՛ΔਢܡᚨᇠܫवΛٚ۶᠔᛭۩ ੡ױ౨࿇سڽՋଅᙠΔࢨױ౨࿇سլױಭऱߪ᧯ჾ႞Δܛࠌᇠଅᙠױ౨ࢤৰ ՛ΔսྥᚨᇠܫवΖٍܛψឈլൄ࿇سΔ܀ױ౨࿇سᣤૹ৵࣠հଅᙠωΔܛ ᚨᇠܫवΖ֘հΔૉଅᙠ࿇س෷੷܅Δ׊ჾ୭ॺ᥆լױಭृΔ᠔ஃլ੡ܫ वΔࡸॺሔ֘ࠡܫवᆠ೭Ζ።ٚ۶პ՛ଅᙠ݁ᏁܫवΔኔ᥆լױ౨Δ׊ྤؘ ૞ΖࠏڕΔ֨ᖄጥ֫๬ױ౨ᖄીఐԳڽՋ࿨࣠Δឈྥଅᙠ࿇س෷ৰ܅Δ᠔ஃ սྥᚨᇠܫवΖԾڕΔఏఐڶۍ։հնऱ༚࿇෷Δ᠔ஃլؘܫवڼଅᙠΙ܀ ڶۍ։հնऱ᧻ጏ෷ଅᙠΔ᠔ஃঞᚨᇠܫव22Ζ 21 ߻ඟຏ17Ƕ 22 ླྀذሺǴȨऍ୯Ȭ֋ޕࡕӕཀȭݤ߾ϐԵჸϩ݋ȩǴДѿݤᏢᚇᇞǴಃ 121 යǴ।

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2.2.2.2ʳ މ಑ଅᙠܫवᎅ ᠔ஃܫवᆠ೭এء࣍൛ृհ۞ݺެࡳᦞΔਝྥਢψ۞ݺωެࡳᦞΕլਢ ψ܃ݺωެࡳᦞΔᚨᇠਢࠠ᧯ऱψݺωऱެࡳᦞΔۖլਢᚵࠫऱԫ౳ఐԳऱ ެࡳᦞΔޓլᄎਢ᠔ஃऱެࡳᦞΔ܀ਢఐԳऱփ֨׈੺᠔ஃྤऄᗭवΔᏁط ᠔ఐᠨֱ٥ٵ೶ፖ23ΖڂڼΔψܫवփ୲ΰଅᙠαωਢܡߩജؘႊ࿨ٽψܫ वऱᆠ೭ᑑᄷωΔթ౨ܒឰ᠔ஃਢܡڶ࿳ጐܫवᆠ೭Δᣂ࣍ܫवऱᆠ೭ᑑ ᄷΔᖂᎅߠᇞڶڕՀ׌്24Κ

1.෻ࢤ᠔ஃᑑᄷΰreasonable physician standardαΔٍጠ੡റᄐᑑᄷᎅ ΰprofessional standardαΔലܫवᆠ೭ऱᒤ໮Εփ୲ٌط᠔᛭റᄐܒឰΖ

2.෻ࢤఐԳᑑᄷΰreasonable patient standardαΚ׌്ܫवऱᒤ໮Ε࿓৫ ᚨᇠਢאψԫଡ෻ࢤऱఐԳΰॺ௽ࡳఐԳαΔڇߓञଡூऱൣउՀΔ墵ᄎუ ૞वሐऱᇷಛω

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STACK: /3 /CSA /3 /CSA -mark-

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