진료보조인력(Physician Assistant)의 법적지위에 관한 고찰: 자격조건과 업무범위를 중심으로

권오탁 한국법제연구원 2021 법제연구 Vol.- No.61

If a person who is not a physician is medical practice as a physician, it is an unlicensed medical practice under the current law. And it's an illegal act. However, due to the lack of physicians now, health professionals other than physicians are engaged in medical practice. And they know that their actions are illegal. However, it is undesirable to allow anyone other than a physician to perform medical practice that deals with the life of a patient for any reason. Therefore, in order for a person other than a physician to medical practice, strict qualifications must be met. In addition, the scope of work must be determined. As a result, it is necessary to give a solid legal status as a new health professionals who can legally assist physicians. Three conditions must be met to clarify the legal status of physician assistants. First, physician assistants must have a certain level of qualification. In order for physician assistants, a new type of health professionals, to perform physician's work, they must go through a reasonable curriculum and strict verification process. Therefore, it is necessary to complete the curriculum of university education or higher, and have at least one year of basic medical education and clinical field practice. In addition, only those who have passed the national examination should be granted a license and perform physician assistance services. Second, the scope of work should be clarified. Physician assistants must be directed and supervised by a Physician. In addition, physician assistants cannot perform essential medical practices such as diagnosis, prescription, and surgery under any circumstances. Third, the scope of responsibility for work must be determined. Physician assistants form a vertical work relationship with physicians. Therefore, physician assistants are implementation assistants. So physicians are responsible for contracts under civil law and for management and supervision under criminal law. In addition, physician assistants and health professionals such as medical resident, nurses, and medical service technologist form a horizontal work relationship. Therefore, their scope of responsibility is determined by the degree of fulfillment of their respective duty of care. The fundamental solution to the problem of physician assistants is to increase the number of physicians. However, increasing the number of physicians is not an easy problem. So it takes a lot of time to solve the problem. Therefore, in order to save the patient's life, it is necessary to improve the system so that qualified physician assistants can work stably. And work is already subdivided in the medical field. Ultimately, legalizing physician assistants reflects the reality of the medical field. And this will be a condition for faithfully fulfilling the duty of the state to save the patient's life. 의사가 수행하는 의료행위를 의사 이외의 자가 수행하면 현행법상 무면허의료행위이며따라서 불법행위이다. 그러나 부족한 의사인력의 공백을 채우기 위해 의사 이외의 보건의료인력이 불법행위임을 알면서도 무면허의료행위를 수행하고 있는 것이 현재 우리 의료현장의현실이다. 그리고 이들을 진료보조인력이라고 명명하고 있다. 그러나 이처럼 검증되지 않은자가 지속적으로 환자의 생명을 다루는 직무를 수행하도록 용인하는 것은 바람직하지 않다. 따라서 의사가 아닌 진료보조인력이 의사업무를 수행할 필요가 있다면 엄격한 자격조건을갖추고 일정한 업무범위 내에서 합법적으로 의사의 업무를 수행하거나 또는 의사의 진료를보조할 수 있도록 새로운 보건의료인력으로서의 명확한 법적지위를 부여할 필요가 있다. 진료보조인력의 법적지위를 명확히 하려면 첫째, 자격조건을 갖춰야 한다. 진료보조인력이 새로운 형태의 보건의료인력으로써 의사만이 수행할 수 있는 업무를 수행하기 위해서는합당한 교육과정과 엄격한 검증과정을 거쳐야 한다. 따라서 대학교육이상의 교육과정을 이수한 자가 최소 1년 이상의 기초의학교육과 임상 현장실습을 이수하고 국가시험을 통해 검증된 경우에만 면허를 부여하고 해당업무를 수행하도록 하는 것이 바람직하다. 둘째, 업무범위를 명확히 해야 한다. 진료보조인력이 의사업무를 수행한다고 하더라도 이는 의사의 지시와 감독권 내에서 수행해야 하며 진단‧처방‧수술과 같은 핵심적이고 필수적인 의사의 고유업무는 이들이 수행할 수 있는 업무범위에서 환자의 안전을 위해 필연적으로 제외시켜야 한다. 셋째, 업무에 대한 책임범위가 확정되어야 한다. 진료보조인력은 수행하는 업무에 대한 지시와 감독을 의사에게 받는다는 점에서 의사와 수직적 업무관계를 형성한다. 따라서 진료보조인력과 의사간의 법률관계에서 진료보조인력은 이행보조자의 지위에 놓이게 되며, 의사는민법상으로는 계약책임을, 형법상으로는 관리감독책임을 진다. 그러나 전문의에게 지시와감독을 받는 전공의, 간호사, 응급구조사 등의 보건의료인력과 진료보조인력은 수평적 업무관계를 형성한다. 따라서 전공의, 간호사 등 보건의료인력과는 각자의 주의의무 이행 여부에따라 책임범위를 판단해야 한다. 이미 의료현장에서는 상당한 역할을 수행하고 있으나 규범적으로는 무면허의료행위를 하는 진료보조인력의 문제를 근본적으로 해결하는 방안은 충분한 의사인력을 확충하는 것이다. 그러나 의사인력 확충 문제는 다양한 이해관계가 복잡하게 얽혀있어 해결되는데 상당한시간이 필요할 것으로 예상된다. 따라서 현재 환자의 생명을 살리기 위해 의료현장에서 무면허의료행위를 하고 있는 진료보조인력이 충분한 자격조건을 갖추고 합법적인 지위에서 안정적으로 근무할 수 있도록 제도를 정비할 필요가 있다. 또한 이미 의료행위가 세분화되면서다양한 형태의 보건의료인력이 협력할 수밖에 없는 것이 임상의료현장의 현실이라는 점에서도 진료보조인력의 합법화를 위한 제도보완이 필요하며 이는 종국적으로 환자의 생명, 더 나아가 국가의 국민건강보장 의무를 충실히 이행하기 위한 전제조건이 될 것이다.

의사보조인력(Physician Assistant)에 대한 법적 검토

김한나,김계현 전남대학교 법학연구소 2016 법학논총 Vol.36 No.3

Large hospitals have carried out medical assistance actions by hiring new physician assistants according to its practical needs. In recent years, the medical community has been discussing the institutionalization of physician assistants. Although the so-called 'PA' is performing medical service in domestic cases, an official survey is lacking as well as having an insufficient legal basis. Accordingly, a legal dispute can possibly be held regarding physician assistants’ support task. Since their medical support may directly impact patients’ life and health, related jobs’ status and legal character should be understood and specific improvements should be sought regarding the physician assistants’ use. The main issues related to the physician assistants in the country are as follows: To begin with, the work scope of physician assistants is not clear. Also, since most physician assistants’ works can be evaluated as medical practices, it could be viewed as unlicensed medical practices depending on the specific scope of work. In addition, the relationship with other similar type of jobs that is currently institutionalized can be a problem. In particular, setting of relationship with medical specialist is important and a legal evaluation can be varied depends on the license, eligibility and types. Taking into account these problems, it is needed to seek improvements suitable to the domestic medical environment. 국내의 경우 의료현장에서 현실적인 필요성에 따라 의사보조인력(Physician Assistant) 을 두고 구체적인 의료 보조행위를 하도록 해왔다. 이렇게 의사보조인력으로 업무를 수행하고 있는 직군이 있으나 해당 직군의 업무수행과 관련하여 법적 근거는 물론 관련연구도 많지 않은 상황이다. 의사보조인력과 관련하여 이들의 업무 수행에 있어서 법적분쟁이 발생할 소지가 있어 문제되고 있으며, 이에 대한 제도화 여부에 대한 논의가 지속적으로 이루어지고 있다. 국내에서 의사보조인력과 관련된 몇 가지 주요 쟁점은 다음과 같다. 먼저 의사보조인력에 대한 업무의 범위가 명확하게 설정되어 있지 않다는 점이다. 다음으로 의사보조인력이 수행하는 업무의 대부분이 의료법상 의료행위로 평가될 수 있어 무면허의료행위로 볼 소지가 있어 문제된다. 또한 현재 제도권 내에서 업무를 수행하고 있는 타 유사 직종과의 관계도 문제될 수 있다. 이에 이러한 쟁점사항들을 검토하여 국내 의료환경에 적합한 개선방향을 모색할 필요성이 있다. 의사 인력 수급 문제 등을 이유로 새로운 의사보조인력의 활용 및 제도화의 필요성에 관한 논의가 이루어지고 있으나 의료인 면허제도의 취지를 고려해 보았을 때, 현행제도의 기본적인 틀을 벗어나는 대안을 마련하는 것은 바람직하지 않다. 즉, 새로운 의사보조인력을 활용하기 위하여 별도의 제도 신설을 추진하기 보다는 팀의료를 활성화하거나, 전문간호사제를 활용하는 등 현행 제도를 활용하여 해결책을 모색하려는 노력이 요구된다.

평등과 존엄 논증을 통한 의사조력자살의 정당화

배성민 새한철학회 2020 哲學論叢 Vol.102 No.4

Physician-assisted suicide seems to be compatible with respect for humanity and go against it. If you let the suffering and dying man out of his misery, he can die like a human being. But if life is stopped to alleviate pain, pain relief will also lose its meaning. This is because people who will enjoy pain relief will disappear. Also, if you intend to stop life as a means of mitigating pain, it is against respect for humanity. This is because life is used as a means of relieving pain. But if you respect humanity, you shouldn't treat human life just as a means. To justify physician-assisted suicide, we must solve this difficulty. This paper presents two arguments for this. Equality argument argues that it is allowed to give the opportunity to physician-assisted suicide in accordance with the equality. People who die from natural causes can take an attitude toward their own death. On the other hand, a desperate man who only wants death because of pain does not get such an opportunity. If he could get the opportunity to die like them through physician-assisted suicide, this would be acceptable. Dignity Argument argues that allowing physician-assisted suicide is a better interpretation of respect for humanity than banning it. If physician-assisted suicide is allowed, the suspension of life and the relief of pain is compatible. But if it is not allowed, the preservation of life and the relief of pain is compatible. If the former case proves to be a better interpretation of respect for humanity than the latter case, allowing physician-assisted suicide would be more appropriate for respect for humanity than against it. Thus, through equality argument and dignity argument, we can strengthen the argument for justification of physician-assisted suicide by answering the main counterargument against it. 고통을 당하며 죽어가는 자를 고통에서 벗어나게 한다면, 그는 인간답게 죽을 수 있다. 하지만 고통 경감을 위해 생명을 중단한다면, 고통 경감도 의미를 잃어버릴 것이다. 고통 경감을 누릴 사람이 사라지기 때문이다. 또한 생명 중단을 수단으로 의도하여 고통 경감을 얻어낸다면, 이는 인간 존중에 어긋난다. 생명이 고통 경감을 위한 수단으로 사용되기 때문이다. 하지만 인간을 존중한다면, 인간 생명도 단지 수단으로 취급하면 안 된다. 의사조력자살을 정당화하려면, 이 난점을 해소해야 한다. 이 논문은 이를 위해 두 개의 논증을 제시한다. 평등논증은 평등 이념에 따라 의사조력사의 기회를 주는 것이 허용된다고 주장한다. 자연사하는 인간은 자신의 죽음에 대해 일정한 태도를 취할 수 있다. 반면 고통으로 인해 오직 죽음만을 바라는 절박한 인간은 그런 기회를 얻지 못한다. 그가 의사조력자살을 통해 그 기회를 얻을 수 있다면, 이는 허용될 것이다. 존엄논증은 의사조력자살을 허용하는 것이 금지하는 것보다 인간 존중에 대한 더 나은 해석이라고 주장한다. 의사조력자살을 허용하면 생명 중단과 고통 경감이 양립하며, 이에 반대하면 생명 유지와 고통 경감이 양립한다. 만약 전자가 후자보다 인간 존중에 대한 더 나은 해석임을 입증한다면, 의사조력자살을 허용하는 것이 반대하는 것보다 인간 존중에 더 부합할 것이다. 따라서 평등논증과 존엄논증을 통해 의사조력자살에 대한 주요한 반론에 답변함으로써 의사조력자살 정당화 논증을 강화할 수 있다.

미국헌법상 의사조력자살

허순철(Huh, Soon-Chul) 한국토지공법학회 2010 土地公法硏究 Vol.49 No.-

소생가능성이 없는 말기의 환자가 의사의 도움을 얻어 품위있는 죽음을 맞이할 수 있는 권리가 헌법상 보장되는 것인가의 문제, 즉 의사조력자살의 문제가 미국연방대법원의 Washington v. Glucksberg 판결에서 논의된 바 있다. 이러한 의사조력자살은 연명치료중단과는 고의와 인과관계의 측면에서 구별된다는 것이 동법원의 입장이다. 즉, 환자가 연명치료를 거부하는 경우에는 자신의 질병으로 사망하는 것이지만, 의사가 처방한 극약을 먹었다면 그 약으로 인해 살해된 것이며, 연명치료중단의 경우 의사는 환자의 바람을 존중하는 것인 반면에 의사조력자살의 경우에는 의사가 환자의 사망에 대해 고의를 가지고 있으므로 양자는 명확히 구분된다는 것이다. 그러나 이에 대해서는 연명치료중단의 경우에도 치료중단이 환자 사망의 원인이며, 의사가 사망이라는 결과를 의도한 것은 아니라고 할 수 없을 뿐만 아니라, 연명치료중단 행위 역시 작위로 봐야 한다는 점에서 양자의 구별은 비판받고 있다. 한편 연방대법원은 Washington v. Glucksberg 판결에서 다음과 같이 판결하였다. 즉, 미국법상 자살방조는 범죄이며, 워싱턴주는 의사조력자살을 금지하는 법률을 가지고 있다. 의사조력자살은 연명치료거부와는 달리 법적 보호를 받지 못하며 양자는 전혀 다른 것이다. 워싱턴주는 인간의 생명을 보호하는데 있어서 무조건적인 이익을 가지고 있으며, 사회적 약자의 보호와 의사의 직업적 윤리를 보호할 책임이 있다. 또한 네델란드와 같은 외국의 사례에서도 보듯이 의사조력자살이 남용될 위험이 있다. 연명치료중단 이후에도 환자가 장기간 생명을 유지하는 경우에는 의사의 연명치료 중단 시술과 환자의 사망 사이의 인과관계는 단절된다고 볼 것이므로 미국연방대법원이 연명치료중단과 의사조력자살을 구별하는 것은 논리적으로는 타당해 보인다. 그러나 의사조력자살이 일반적인 의미의 자살을 허용하는 것은 아니며, 말기 환자의 자발적인 결정에 따라 품위 있는 죽음을 맞이할 수 있도록 하는 것이 자기결정권 내지 인간의 존엄에 상응한 것이라는 점을 유의하여야 할 것이다. There was a constitutional question whether a terminally ill patient has a right to physician assisted suicide to end his or her life with dignity before the U.S. Supreme Court in Washington v. Glucksberg. In Vacco v. Quill, the Court had already decided that the distinction between assisting suicide and withdrawing life-sustaining treatment is reasonable with regard to the fundamental legal principles of intent and causation. The Court decided that when a patient refuses life-sustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication. Furthermore, a physician who withdraws, or honors a patient's refusal to begin, life-sustaining medical treatment purposefully intends, or may so intend, only to respect his patient's wishes. However, a doctor who assists a suicide must, necessarily and indubitably, intend primarily that the patient be made dead. But the decision has been criticized because in case of withdrawing life-sustaining treatment the withdrawing act would be the main cause of death, and it seems difficult to say that the doctor had not intended to produce death. It is also contended since ending treatment and administering substances to end life are both acts of commission with the same purpose and effect. In Washington v. Glucksberg, the Court decided that in almost every State it is a crime to assist a suicide, and the Washington statute prohibits physician assisted suicide. The Court also said that there is a distinction between withdrawing treatment and administering drugs to end a person's life which is not protected by law. The State has an unqualified interest in the preservation of human life and in protecting the vulnerable persons and groups and the integrity and ethics of the medical profession. The concern about the abuse of physician assisted suicide is further supported by evidence about the practice of euthanasia in the Netherlands. The fact that a patient may live for a long time after ending the treatment logically reinforces the distinction between withdrawing treatment and administering drugs to end a patient's life. We should be careful that physician assisted suicide does not mean to permit all people to suicide and terminally ill patient has the right to self determination and human dignity in deciding matters affecting life or death.

전담간호사의 PA (Physician Assistant) 업무에 대한 의료인의 인식

김민지 ( Min Ji Kim ),손도리나 ( Dorina Sohn ),정미은 ( Mi Eun Jeung ),강인순 ( In Soon Kang ) 부산대학교 간호과학연구소 2015 글로벌 건강과 간호 Vol.5 No.1

Purpose: This study was aimed to investigate healthcare professionals`` perception and to provide the basic data for the establishment of the Physician Assistants’ role. Methods: This study was conducted with 179 healthcare professionals (29 physicians assistants (PA), 90 nurses and 60 physicians). Structured questionnaire was used to collect data. Results: The importance and satisfaction were highly perceived by nurses but there was no statistically significant difference in healthcare professional groups (p=.22, p=.12). Wound care was highest and prescription, medication, research and education were relatively low in the perception of the importance. In the satisfaction, wound care was highest and prescription, medication were lowest. The importance perceived by medical PA and physicians was significantly higher than by surgical PA and physicians (p=.02). The satisfaction on subjects who interacted with PA was significantly higher than that of them who didn``t interact with PA (p=.00). Conclusion: This study shows we need efforts to develop and expand role of nurses for the change of PA``s role as assistant in the future. Therefore we should improve PA``s professionalism and standardize PA``s role in the important part realized by healthcare professionals for elevation quality and satisfaction of medical services.

국외 의사조력자살 입법례 고찰

차승현,이봄이,전우휘,백수진 (재) 국가생명윤리정책원 2023 생명, 윤리와 정책 Vol.7 No.1

In June 2022, the “Act on hospice and palliative care and decisions on life-sustaining treatment for patients at the end of life (Partial Amendment Act)” (hereinafter referred to as the “Partial Amendment to the Life-Sustaining Treatment Decision Act”) was proposed. This amendment introduces “assisted death with dignity” and stipulates that a terminally ill patient whose application is already accepted after a review by the Assisted Death with Dignity Review Committee, has the right to end his or her own life with the assistance of a physician in charge. This is essentially the same mode of action commonly referred to as physician-assisted suicide (PAS). Other countries that have legislated practices in this regard, consider expressions such as death with dignity, Aid-in-Dying, and Medical Assistance in Dying (MAiD), voluntary assisted dying, and euthanasia. These legislative examples can be classified into the same category in that they decriminalized or institutionalized the act of assisting others in a certain form during their process of dying. However, since each legislative precedent has slight differences in specific categories of assistance or conditions for requesting assistance, comparisons are rather difficult. Since there are often sharp conflicting opinions in bioethical discussions, it is more important to clearly recognize what we are currently discussing and to set the limits of discussion in advance. Therefore, this paper explores foreign legislative examples related to physician-assisted suicide, presenting them as major arguments during this discussion, following by the examination of current end-of-life bioethical policies, which can be settled in the current social context. 2022년 6월, 「호스피스·완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법률 일부개정법률안」(이하 “연명의료결정법 개정안”)이 발의되었다. 이 개정안은 말기 환자로서 조력존엄사심사위원회 심사를 거쳐 신청이 인용된 자가 본인의 의사로 담당 의사의 조력을 통해 스스로 삶을 종결할 수 있도록 하는 “조력존엄사”에 관한 규정을 포함하고 있다. 해당 개정안에서는 “조력존엄사”라는 용어를 사용하고 있으나 그 본질은 사실상 “의사조력자살(physician-assisted suicide, PAS)”에 해당한다. 의사조력자살에 대한 행위를 인정하여 입법한 국가 중 해당 행위를 존엄사(death with dignity)로 표현하고 있는 국가도 있지만, 사망 시 조력(Aid-in-dying), 사망에 대한 의료적 지원(Medical Assistance in Dying, MAiD), 자발적 조력 사망(Voluntary assisted dying), 안락사(Euthanasia) 등 다양한 용어를 사용하고 있다. 이러한 입법례는 한 개인의 죽음에 대하여 일정한 형태에 타인의 조력 행위를 비범죄화하거나 제도화했다는 점에서 동일한 범주로 분류할 수 있다. 그러나 각국의 입법례마다 구체적인 조력의 범주나 지원을 요청할 수 있는 조건 등에 있어서는 조금씩 차이가 있으므로 이를 동 선상에서 단순 비교하기에는 어려움이 있다. 생명윤리정책 논의에 있어 중요한 전제는 논의하고자 하는 바에 대한 기본 이해를 공유하는 것이다. 특히, 생명윤리 논의 과제들은 첨예하게 의견이 대립하는 경우가 많기 때문에 현재 우리가 논의하려고 하는 것이 무엇인지 명확하게 인지하고 논의의 한계를 사전에 정하는 것이 더욱 중요할 것이다. 이에 본 논고에서는 현재 우리 사회 맥락에서 안착가능한 생의 말기 생명윤리정책 논의를 시작함에 앞서 의사조력자살 논의에서 주요 논거로 제시되는 국외 의사조력자살 관련 입법례를 살펴봄으로써 논의점에 대한 정확한 이해를 공유하고자 한다.

Euthanasia and Physician-assisted Suicide in the Netherlands : The Experiential, Logical, and Legal-historical Evidence of the "Slippery-slope"

Lee, Sang-Won Presbyterian General Assembly Theological Seminary 2006 CHONGSHIN THEOLOGICAL JOURNAL Vol.12 No.1

In this thesis I tried to show that the Slippery-slope progression had been realized in the Netherlands by examining the Dutch understanding of euthanasia, and concrete legal cases and the process of the decision of the Dutch court. The Remmelink committee's survey, which reflects the experience of the Dutch medical community, shows that the practice of euthanasia has gradually expanded beyond the standard Dutch definition of euthanasia: the practice began with the legalization of active and voluntary euthanasia, under certain conditions; then it became permissable as a treatment for non-physical pain; finally it was practiced without the request of a patient. The history of the Dutch Penal Law regarding euthanasia exemplifies the "slippery slope." The Dutch Criminal Law enacted in 1886 ruled euthanasia and physician-assisted suicide as criminal offence, but gradually exempted these two practices from punishment by adding various exceptions to the law. In 1973 the conditions which would be quoted in later legal decisions about euthanasia and physician-assisted suicide were formed. In 1981 the conditions for physician-assisted suicide upon which the appeal to necessity in emergent situations could be accepted was formed. In 1983 euthanasia was widely permitted, when the argument of necessity was accepted as a condition for legitimate euthanasia. In 1995 physician-assisted suicide not caused by diseases was permitted legally, and the discussion about the physician-assisted suicide for the normal people who were tired of monotonous life began. Finally in 2002 [The Law Proving the Act to Help to Terminate Life or Assist Suicide with Request] came into effect and the related Criminal Law article 293 and article 294 were revised. In conclusion, the medical and legal conditions for euthanasia and physician-assisted suicide in the Netherlands show vividly that the slipperyslope progression argument has been gradually realized, and proves that the strict definition of and the strict conditions for euthanasia and physicianassisted suicide cannot prevent the practice of euthanasia and physicianassisted suicide from growing. It is important to remember Jesus' teaching, "What good will it be for a man, if he gains the whole world, yet forfiets his soul? or what can a man give in exchange for his soul?" (Mt.l6:26) We must prohibit euthanasia and physician-assisted suicide ethically and morally in their initial stages. Then we will be able to protect human life from the merciless practice of euthanasia and physician-assisted suicide.

의사조력자살에 대한 고찰

이기헌 ( Ki Hun Lee ) 홍익대학교 법학연구소 2014 홍익법학 Vol.15 No.1

In Korea, it seems that due social interest is not paid on legalizing physician-assisted suicide while withdrawing life-sustaining treatments is expected to be legalized in the very near future. However, the quality of death in Korea is quite poor in terms of social perception of death, legal system related to death, pain control on dying patient, treatment level and burden of expenses. It must be the last happiness we can enjoy to determine the way of ending one`s life, because no one can escape death and no one can tell what kind of terrible pain would accompany death. Therefore, I referred to three major logical bases against active euthanasia, under which physician-assisted suicide comes. To find out whether there is a fundamental ethical difference between physician-assisted suicide and withdrawing life-sustaining treatments to the extent of prohibiting the former and allowing the latter, I examined into following arguments into detail. (1) Do we have the right to death? Affirmative. Because the right to death involves the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, it is the essential to right of freedom and liberty. (2) Is physician-assisted suicide more immoral than withdrawing life-sustaining treatments? Negative. As long as the patient wants to die, it makes no sense to appeal to the patient`s right not to be killed. Therefore, there is no moral difference between terminating treatment that keeps him alive, and helping him to end his life by providing lethal pills. (3) Does concern for abuse or misuse justify a total prohibition on all physicianassisted suicide? Negative. The various risks following physician-assisted suicide apply equally to withdrawing life-sustaining treatments, and the state is capable of addressing such dangers through proper regulations. After that, I introduced the current regulations and operation situation of Death with Dignity Act(1997) of Oregon state. Finally, I examined into the pros and cons of the physician-assisted suicide in the field of criminal law, and briefly presented my personal opinion.

호스피스ㆍ완화의료와 의사조력자살 간 경계에 관한 규범적 고찰

엄주희 ( Ju-hee Eom ),김명희 ( Myung-hee Kim ) 연세대학교 법학연구원 2018 法學硏究 Vol.28 No.2

의사조력자살이란 의사조력사망, 조력사망, 조력자살이라는 용어와 혼용되는 죽음의 한 형태이다. 미국과 유럽 등 여러 나라에서 의사조력자살에 관한 법률이 제정되거나 이미 법원 판례를 통해 그 정당성에 관해서 다루어지고 있다. 권리의식이 높아지고 자율성을 삶의 전 시기에 걸쳐 모든 영역에서 확대하려는 움직임은 사망과 근접한 시기인 임종기에 말기 진정요법을 포함한 완화의료의 이중효과의 정당성을 인정하는 판례와 의사조력자살의 법제화로 이어져왔다. 우리나라에서는 2018년부터 연명의료 결정에 관한 법이 발효 중인데, 이 법에는 호스피스ㆍ완화의료도 함께 규율되어 있다. 호스피스ㆍ완화의료, 특히 말기 완화요법은 그 실행에 있어서 의료의 간접효과에 의해 죽음을 앞당길 수 있는 가능성이 존재하고, 그 의료의 방법이 의사조력자살과 유사한 부분이 있다. 이 때문에 외국의 경우 의사조력자살에 관한 판례와 법제화 과정에서 있어서, 호스피스ㆍ완화의료, 특히 말기 진정요법의 이중효과 원칙 등 정당성 논리를 빗대어 의사조력자살의 정당성이 주장되고, 그에 대한 찬반논쟁이 활발하게 진행되어 왔다는 점에 주목하고 말기 진정요법과 의사조력자살의 경계에 관한 연구를 수행하였다. 이로써 한국의 호스피스ㆍ완화의료 법제에도 의미 있는 시사점을 줄 수 있다고 판단된다. Physician-Assisted-Suicide is a form of death that can be classified as a same category with Assisted Suicide, Assisted Dying and Aid in dying. Worldwide, such as US, Canada, Europe, Australia, laws on Physician-Assisted-Suicide have been enacted, or the justification of that has already been addressed through court precedents. Increasing awareness of rights and a movement to expand autonomy in all areas have led to claims and legalization of Physician-Assisted-Suicide in the last few decades. In Korea, the law on decision-making at the end of life about forgoing life sustaining treatment has been in force since 2018 as a single law with Hospice palliative care. In the implementation of Hospice palliative care especially, palliative sedation, there is controversy that the indirect effect of medical care can lead to hastening death, and in part, the appearance and method of sedation is similar to Physician-assisted-Suicide. Therefore, it should be noted that there has been controversy in claiming the legitimacy of Physician-Assisted-Suicide with the legitimacy logic of hospice palliative care in the case of foreign cases and legislation. By analyzing the differences between palliative sedation and Physician-Assisted-Suicide and the reason of legal justification, implications will be derived that can be applied to Korean legislation which made the first step on the legal medical decision-making system at the end of life.

공법 : 의사의 연명치료중단행위에 대한 형법적 정당화 요건과 구조

이백휴 ( Baek Hyu Lee ) 한양대학교 법학연구소 2010 법학논총 Vol.27 No.4

The purpose of this study is to search the requirements and structure of the "Physician`s Withdrawal of Life-Sustaining Treatment(LST)" or "physician-assisted suicide(PAS)", and to justify their actions in the context of the Criminal Law. If the patient died by "(Murder by) "the Physician`s Withdrawal of LST" or "PAS", this comes under Article 250 Section 1(Murder), Article 252 Section 1(Murder upon the Request), Article 252 Section 2(aiding to commit suicide) of the Criminal Code. But, if this meets certain conditions, "the Physician`s Withdrawal of LST" or "PAS" could be justified. (1) The basic conditions: i) The Physician must behavior. ii) It must meet the Justification of medical Treatment. (2) The objective conditions : i) The patient must be in an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death. ii) Treatment of this stage must be a medical futility in the end-of-life care. (3) The objective condition : It must be a patient`s informed consent, self determination about "the Withdrawal of LST" or "PAS". If the case meets all the conditions for its justification or if it does not meet some conditions, we will study the structure of justification about "the Physician`s Withdrawal of LST" or "PAS" in criminal law. (1) First, since this issue is related to people`s lives, there are various types of conflicts about the value. Thus, it is necessary to enact laws for physicians to be relieved from the legal disputes and to resolve specific problems (procedural legitimacy) related this process. (2) Meanwhile, it is necessary to solve the problems, related legislations are not exist, or legislation exists, but its interpretations are controversial, or exempted from the legislation. i) If it is clear that the patient is in an incurable and irreversible disease, the withdrawing of LST or aiding the patient to commit suicide would be legally allowed depending on their medical decision, regardless of the patient`s own will. But if it is clear that the patient is in an curable and reversible disease, the Physician should continue the treatment for patients. ii) If it is not clear whether the patient has an incurable and irreversible disease or not, and if treatment in this situation is medical futility-within reasonable medical judgment-, "the Physician`s withdrawing of LST" or "PAS" can be allowed according to patient`s current, voluntary and explicit will for the purpose of ending his or her life (legitimacy on right to self determination). Thus, if the legal requirements for justification, including the patient`s will, are established, then they can be evaluated, it is an act which does not violate the Normal Social Rules (Korean Criminal Act Article 20).