美國是世界上對醫療糾紛此一議題研究的最為廣泛並深入的國家。其於1970及80年代分別發生一次「醫療糾紛危機」之後，針對醫療傷害制度之改革研究便如雨後春筍般紛紛出現，其中不少論者主張以「無過矢」制度來根本地取代傳統的「過失」制度。1987年維吉尼亞州通過了「新生兒腦部傷害無過失補償法」，為北美洲第一個施行醫療無過失的法域。1991年針對「醫療傷害」所進行的大型研究計畫─「哈佛研究」出爐，計畫主持人保羅•偉樂(Paul Weiler)教授針對其研究發現，亦不遺餘力地鼓吹一個全面性的企業主醫療傷害無過失賠償責任。詳究此二「無過失」制度，會發現其背後所代表的意識型態、制度內容、補償方式均大不相同。這些不同面相的無過失制度，對臺灣目前約「醫療行為應否適用消保法之無過失責任」爭議有何啟發呢？ 本文彙整相關之法案文獻、實證資料，探討維吉尼亞州制度之發展背景、制度內容以及實施現況；並對偉樂教授所主張之「企業主醫療傷害與過失賠償責任」予以詳細的評析析，藉此希望能夠提供臺灣當前對醫療傷事故補償制度比較法上之借鏡。 本文之研究結論為：(1)從美國40年約發展經驗看來，「醫療糾紛」不僅僅是其表面上所暴露出之醫師、病人兩造間責任分配的問題，醫療糾紛事件背後所隱蔽的「醫療傷害」，及「醫療錯誤」更可能是攸關全民健康的公共衛生議題。臺灣目前關於「醫療糾紛」之探討尚只停留在醫病之間各說各話的情緒性指控上，而無關於「醫療傷害」與「醫療錯誤」之系統性研究。醫界及法界應儘速建立對話管道以及臺作機制，對醫療糾紛進行深度的實證砰究。(2)維吉尼亞州的局部無過失制度乃保險基金型的無過失補償制度，其係以解決特訂之社會問題而設立，故實施經驗無法擴張至一般醫療傷害中。而「哈佛研究」主持人之一的保羅•偉樂教授倡議之「企業主醫療傷害無過失賠償責任」之性質和臺灣消保法第七條之責任類型最相似，但因政治因素亦未通過立法，故無實證資料可以借鏡。(3)保險基金類型的無過失也好，嚴略責任類型的無過失也好，都是將醫療糾紛的責任由「個別」醫師的肩頭移到一個「集體」的基金或企業身上；因此，對個別的行為人來說，其行為便不再與賠償責任掛勾，在醫病關係疏離、病人權利普遍低落的臺灣，醫療無過失制度乍看之下有利病人，但實則為醫療品質埋下了一顆不確定的炸彈。所有關心病人權利者，實應對「醫療無過失」制度再度深思。

　　　　　Due to the "medical malpractice crisis" in the mid-1970s and 1980s, the United States has generated the most extensive and comprehensive studies on the subject of medical malpractice law over the past 40 years. For anyone who is interested in medical malpractice, the American experience is a must to begin with. The author has studied medical malpractice of the United States for more than 10 years. I will summarize in this paper the causes and impacts of medical malpractice crisis, the corresponding legislative reforms, and the latest relating studies. Focus is on the medical no-fault debates. Many American scholars have proposed "no fault" as an alternative to solving the problems caused by the current fault-based liability system. While most no-fault suggestions are rejected by the policy makers because of their financial feasibility, two jurisdictions in the United States, the States of Virginia and the State of Florida, have adopted a selective no-fault compensation scheme covering "birth-related neurological injury" since 1987 and 1988, respectively. The second part of this paper discusses the Virginia no-fault compensation scheme in detail to examine its legislative background, statutory' requirements, and empirical effectiveness. The 1990 l-larvard Study led the medical malpractice debates to a new direction: the epidemiology of medical injury. The research team, under the leadership of Harvard Law Professor Paul Weiler, proposed a comprehensive no-fautt enterprise liability system as a policy suggestion to respond to the many problems identified by the study. Weiler's version of no-fault received national attentions and was accepted by the Clinton Administration. The third section of this paper introduces Weiler's proposal, in depth to analyze its pro and cons regarding compensation, deterrence, and cost-efficiency. Moreover, the political reason for the failure to enact Weiler's proposal in to law will also be discussed. While most discussion of medical malpractice in Taiwan remains emotional speculation and unproven assumption, the abundant experience in the United States provide good lessons to learn. First, underlying the hot topic of medical malpractice are the more important public health issues of medical injury and medical errors. More attentions and efforts should be directed into avoiding medical injury and reducing medical errors. Second, there are different types of medical no-fault serving different goals. Weiler's no-fault proposal, for instance, characteristically differs from the Virginian no-fault. In proposing medical no-fault, it is necessary to deliberate its concrete contents