兩醫生被控誤殺

看到鄧桂思案兩醫生被控誤殺的新聞, 我即時聯想到麥允齡案。大家對麥允齡案不會陌生, 她是受僱於DR美容集團的醫生, 2012年發生嚴重醫療事故, 導致其中一位接受CIK療程的病人死亡, DR創辦人周向榮, 技術室化驗員陳冠忠及麥允齡被控誤殺, 經審訊後, 前者被定罪, 陪審團未能對麥允齡的控罪達成裁決因而重審。張慧玲法官在重審的時候要求上訴庭釐清法律元素, 最終上訴至終審法院。 法律問題是:

“In the offence of manslaughter by gross negligence, should the gross negligence referred to in the last element of the offence as enunciated in R v Adomako [1995] 1 AC 171, namely ‘the breach of the duty by the defendant being capable of being characterised as gross negligence and therefore a crime’ be proved based on the objective reasonable man test only or that in addition to the objective reasonable man test, the prosecution is also required to prove that the defendant’s subjective state of mind was culpable in that the defendant was subjectively aware of the obvious and serious risk of death to the deceased?”

簡單講就是除了用客觀的合理的人的判斷為準則外, 是否要考慮被告人主觀的意識, 即是被告要察覺到死者具明顯及嚴重風險致死才能定罪。終審法院確定香港跟從Adomako案訂立的原則, 只需以客觀合理人的準則來判斷, 而無需考慮被告人的主觀意識。說到這裏大家可能還是一頭霧水, 讓我進一步解釋麥允齡案跟兩醫生開漏藥被控誤殺的關係。

Adomako案討論嚴重疏忽誤殺(Gross Negligence Manslaughter)(GNM))罪的元素, 列出4項要求:

(i) the existence of a duty of care(謹慎責任) on the part of the accused vis-à-vis the deceased;
(ii) that such duty was breached;
(iii) that the breach caused the death of the deceased; and
(iv) that the accused’s conduct involved gross negligence.

討論得最熱烈的是怎樣才構成「嚴重疏忽」, 終審法院主要跟隨的案例在判詞裏闡述了:

7. The law has evolved over the last century principally involving three leading authorities. The first is the judgment of the English Court of Criminal Appeal in R v Bateman,[9]a case in which a doctor was charged after his patient died as a result of his delivery of her child. Hewart LCJ explained that criminal liability for manslaughter by gross negligence shared the same elements of duty, breach and causation required to prove negligence in civil cases but entailed the added requirement that the jury be satisfied that the accused’s negligence “amounted to a crime”.[10] His Lordship stated:

“To support an indictment for manslaughter the prosecution must prove the matters necessary to establish civil liability (except pecuniary loss), and, in addition, must satisfy the jury that the negligence or incompetence of the accused went beyond a mere matter of compensation and showed such disregard for the life and safety of others as to amount to a crime against the State and conduct deserving punishment.”[11]

簡而言之, 控方先要證明被告的民事責任, 繼而證明疏忽程度至罔顧死者的生命安危, 才足以構成嚴重疏忽。

終審法院釐清法律元素後, 麥允齡在重審時被定罪, 判監3年半, 2022年3月定罪上訴被上訴庭駁回, 2022年7月被醫委會裁定專業失德被停牌5年。麥允齡案確定了醫療事故致死構成嚴重疏忽的誤殺的法律元素, 律政司自此決定是否檢控醫療事故致死就有明確的依據。兩名醫生治療一名患有腎病及肝病的病人漏了處方肝藥, 控方要證明這兩醫生存着謹慎責任及違反謹慎責任相當容易, 兩醫生可能會在抗辯時互相推諉。違反謹慎責任而致死(causation)是由法醫舉證, 既然已落案控告兩名醫生, 控方一定有這方面的表面證據, 辯方也大概會作出爭論, 但爭論焦點會是嚴重疏忽的元素, 這會是陪審團的決定。Adomako案涉及麻醉師嚴重疏忽, 死者在接受視網膜手術期間, Dr Adomako接班為麻醉師, 病人氧氣喉管脫落也不察覺, 病人缺氧後血壓下降, 監察血壓的儀器發出警號, Dr Adomako檢查該儀器幾分鐘也毫無頭緒, 不知道是因為氧氣喉脫落, 直至眼科手術醫生發覺才搶救病人, 病人腦缺氧腦幹死亡, 6個月後離世。論案情Dr Adomako的嚴重疏忽比較容易證實, 現階段不清楚控方指責鄧桂思案兩名醫生的證據是甚麼, 純粹漏處方藥物不容易證明罔顧病人死活的態度, 現時比較難評論, 我相信處方的時候大概電腦會彈出紅旗警示, 如果醫生漠視這些警號或者可構成嚴重疏忽, 若只涉一般疏忽就難以定罪。 氧氣喉管脫落可致死是明顯的後果, 處方失誤可致死就不會有同樣明顯的程度, 所以這次檢控是相當震撼的。醫生會惴惴不安, 不知道斷錯症、開錯藥引致病人死亡, 又會不會被檢控GNM。