조직검사와 임상학적 검사의 관계에 대한 연구

최병규 한국경영법률학회 2017 經營法律 Vol.27 No.4

보험금청구의 요건은 보험계약자 측에서 증명하여야 한다. 그리고 면책사유 등 보험금 지급을 거절하려면 그 면책사유의 존재를 보험자가 증명하여야 한다. 암과 같은 질환은 보험금도 많고 중대질병으로서 증명이 더욱 중요하다. 그리하여 조직학적 증명이 이루어져야 암보험금을 지급함을 원칙으로 한다. 그러나 그것이 어렵거나 곤란한 경우, 예외적으로 임상학적 진단을 암의 증거로 활용하는 것이 최근에 논란이 되고 있다. 최근에는 대법원은 병리학적으로 양성 종양임이 명백하더라도 그 위험성 등에 비추어 실질적으로 악성 종양에 준하는 것으로 볼 수 있은 경우까지도 보험금 지급 사유에 포함하는 조항으로는 해석하기는 어려운 바 조직검사 결과를 토대로 진단비를 지급하여야 한다는 입장이다. 그리고 하급심에서도 뇌 부위에 발생한 종양은 악성종양세포를 포함하고 있지 아니할 뿐만 아니라 신체부위에 관계 없이 검사일 현재 병리학적으로 양성종양에 해당하므로 문제의 사건 보험계약에서 보장하는 중대한 암에 해당한다고도 볼 수 없고 소정의 사실조회만으로는 피보험자에 대하여 해당 사건 보험계약에서 정하는 중대한 암의 진단이 확정되었음을 인정하기에 부족하다고 하였다. 또한 종양의 완전 적출을 기대할 수 없고 나아가 재발가능성이 있어 방사선 치료 등 암치료에 준하는 치료 방법이 요구되는 특성이 있어도, 단지 그러한 특성이 있다는 사정만을 근거로 뇌 부위에 발생한 모든 양성종양을 암에 해당한다고 볼 수는 없다는 것이 하급심법원의 태도이다. 그리고 특정암만을 보장하는 경우에 상피내암은 보장대상에서 제외된다는 사실은 굳이 보험자가 설명하여야 하는 설명의무의 대상이 되지 않는 다는 것이 대법원의 태도이다. 비록 조직학적으로는 암이 아닌 양성, 경계성종양이라 하더라도 실질적인 위험도가 암에 필적하는 사례들이 있는데 이러한 사례를 조직학적 근거만을 예로 들어 암에서 배제하는 것은 불합리한 면이 있다. 그런데 임상학적 진단을 기초로 보험금청구를 인정하는 것은 신중할 필요성도 있다. 즉 조직학적 진단이 가능하지 않을 때에는 피보험자가 암으로 진단 또는 치료를 받고 있음을 증명할 만한 문서화된 기록 되는 증거가 있어야 한다는 약관의 문언을 해석함에 있어서는 주의를 요한다. 보험금청구의 요건을 증명하는 부담은 보험계약자측에게 있다. 이 때 완벽한 증명을 요하는 것은 아니고 법관의 심증이 확신의 정도에 달하게 하는 것을 가리키는 것이다. 이때 그 확신이란 자연과학이나 수학의 증명과 같이 반대의 가능성이 없는 절대적 정확성을 말하는 것은 아니지만, 통상인의 일상생활에 있어 진실하다고 믿고 의심치 않는 정도의 고도의 개연성을 말하는 것이고, 막연한 의심이나 추측을 하는 정도에 이르는 것만으로는 부족하다는 것이 판례의 입장이다. 그런데 특히 암보장의 경우 보험금이 크고 분쟁도 많으므로 압의 증명은 조직학적 증명으로 명확하여야 하며, 단순히 임상학적으로 인정하는 것은 신중할 필요가 있다. 앞으로도 보험금청구의 요건으로서의 증명의 정도에 대하여 각 보험종목마다 명확히 하는 연구가 더욱 정치하게 진행되어야 할 것이다. Nowadays the cancer insurance plays very important role for the welfare of the citizens. The insurance money volume is also very large. Therefore the proof of cancer should be strict. There are two methods to approve cancer, namely histological examination and clinical examination. The former is original and accurate method to recognize cancer. The latter is substitutive method for the case of difficulty of histological recognition. The histological inspection is very difficult one to get. But the clinical inspection is comparatively easy to get. The standard contract terms of insurance says as follows: “The histological inspection is required to get cancer insurance money. Only in the absence of histological inspection, the record of document of treatment of cancer is required.” The problem is whether the clinical examination can be recognized as document of treatment of cancer. The former court decision has allowed it. But the recent court decision denies it. The burden of proof of insurance accident goes to the insured. In the regard of the degree of proof, it requires not the 100% correct proof, but high probability of the required accident. A vague suspicion is not enough. The German insurance contract law(VVG) was enacted in the year of 1908. It was reformed severely in the year of 2007. The German insurance contract law has regulation that assumption of contingency in accident insurance (§ 178 II). But in Korean commercial law, there is no such a regulation. Therefore the insured should offer full of proof. In this sense, the clinical examination can not be accepted easily in cancer insurance. The recent supreme court also recognizes it. It is correct in the regard of importance of accurate proof demand in cancer insurance. We can consider foreign laws and cases. The German insurance contract law can give us useful suggestions. The Korean laws are based on the continental law. It is charactered as system of statute law. We should further give efforts to get the appropriate and correct proof method in insurance contract law.

5년간 집단 검진에 의한 연취급 사업장 근로자들의 건강수준 평가

차영수,이성수,안규동,한구웅,이병국 순천향 대학교 산업의학연구소 출판부 1995 순천향산업의학 Vol.1 No.1

To evaluate the health status of workers in lead using industries under supervision by Soonchunhyang University Institute of Industrial Medicine as part of program of group occupational health service and find out longitudinal changes of health status of lead workers through the service for 5 years from 1989 to 1993, authors analyzed 5 years's periodic health examination data which comprised 29 lead using industries with 40,035 total cumulative number of workers. Selected variables for this study were screening results of general health examination and final results of confirmative health examination for the general health examination which dealt with office workers and blue collar workers with no exposure of hazardous condition. For the special health examination, zinc protoporphyrin in whole blood (ZPP) and screening results of special health examination were selected for study variables. For the confirmative special health examination with screening positive workers, blood lead(PbB), delta-aminolevulinic acid in urine, ZPP, and final result were selected for study variables. Information on age, sex, and type of industries were also collected. The results obtained were as follows; 1. The five years screening positive rate for general health examination was 13.7% and 5 years rate for C category which did not need further confirmative recheck was 5.2%. 2. While the proportion of liver disease in C category in primary general health examination was 49.2% those of anemic disease and hypertensive disease were 23.3% and 27.5% respectively. 3. Five years screening positive rate and negative rate for storage battery industries, secondary smelting related industries, telecommunication related industries and other industries were 83.4% and 12.4 %, 76.5% and 17.5%, 75.5% and16.4%, and 79.5 and 14.4% respectively. 4. Screening positive rate for 5 years were increased as age increased from 9.0%(age less than 30 years ) to 21.1% (age more than 40 years). 5. Only 22.1% of screening positive workers for 5 years general health examination were diagnosed as confirmed general diseases and 33.1% were revealed as normal. The rate of confirmed general diseases were differed by the type of industries and they were increased by age increased. 6. The rate confirmed general disease and non-disease in screening positive of liver, cardiovascular, tuberculosis and chest, anemic and renal disease category were 25.5% & 14,5%, 22.8% &37.2% 21.5% &23.0% 62.0% & 7.0%, and 16.5% & 53.9% respectively. 7. The 5 years prevalence rate of confirmed general disease(D_(2)/total workers) and prevalence rate of abnormal finding(C+D_(2)) were 3.21% and 14.9% as a whole. By the screened disease category, those rate were 1.23% &6.89% for liver disease, 1.17% & 5.43% for cardiovascular disease, 0.96% &1.64% for tuberculosis and chest disease, 0.76% & 1.02% for anemic disease and 0.03% & 0.06% for renal disease respectively. 8. The five years screening positive rate of all lead workers with the criteria of the measurement of ZPP(>=100㎍/㎗) was 10.2% (female lead workers :25.5% male lead workers :8.1%). The positive rate has tendency to decrease year by year from 1989 to 1993. The phenomenon of decrease of rate was significant in storage battery industries, but not apparent in secondary smelting related industries. 9. The proportion of lead poisoning (D_(1)) among screening positive of lead workers was 14.9% for 5 year special health examination and rest of screening positive were diagnosed as high lead absorption. White the proportion of D_(1) was 8.8% in storage battery industries, that was 23.9% in secondary smelting related industries. 10. The distribution of screening positive lead workers by the group of ZPP for 5 years as a whole was 48.3%, 20.9%, 20.5% and 10.3% in the group of ZPP 100-149㎍/㎗, 150-199㎍/㎗, 200-299㎍/㎗ and above 300㎍/㎗, respectively. 11. The proportion of screening positive lead workers whose blood lead were above 60㎍/㎗ and whose urine ALA were above 10㎎/ℓ were 53.3% and 61.4%, respectively. 12. The 5 year overall prevalence rate of lead poisoning (D_(1)/all lead workers) was 0.142%(female lead workers:0.116%, male lead workers:0.145). For the rate of high lead absorption((C+D_(1))/all lead workers) was 0.945%(female lead workers:2.36, male lead workers :0.756). The above prevalence was decreased in later year of study period than early year of study period.

대입 논술 문제 유형 분석

김슬옹(Kim Seul-ong) 우리말교육현장학회 2008 우리말교육현장연구 Vol.2 No.2

이 논문은 대입 논술 기출 문제를 유형별로 분석하였다. 다섯 가지 기준을 세워 모두 14개 유형으로 나눴다. 제시문 유형에 따른 갈래로 ⑴ 자료제시형(유형1-1), ⑵ 논점제시형(유형1-2), ⑶ 자료와 논점 복합형(유형1-3)으로 나눴다. 논제 조건에 따라 폐쇄형 논술과 개방형 논술로 나누고, 폐쇄형은 다시 ⑷ 소극적 폐쇄형(유형2-1), ⑸ 적극적 폐쇄형(유 형2-2)으로 갈라 보았다. 논제 성격에 따른 갈래로 ⑹ 논쟁형(유형2-1),⑺ 논증형(유형3-2), ⑻ 설명형(유형3-3), ⑼ 문제해결형(유형3-4) 등과 같이 네 가지로 구분하였다. 논술문 성격에 따른 갈래로 ⑽ 시사형(유형4-1), ⑾ 고전형(유형4-2), ⑿ 일반형(유형4-3)으로 나눴다. 주제와 사고 영역에 따른 갈래로는 특정 교과나 주제, 관점으로 한정하는 ⒀ 비통합교과형(유형5-1)과 그렇지 않은 ⒁ 통합교과형(유형5-2)으로 나누었다. 이러한 갈래 틀에 따라 2008학년도 각 대학 문제를 분석하여 대입 논술의 주요 특징과 문제를 밝혀낼 수 있었다. This paper analyzed by type the college admissions essay examination problems. The problems were categorized into 14 types, based on five criteria. Based on text type, they were divided into ⑴ information presentation type(1-1), ⑵ point at issue presentation type(1-2), and ⑶ multi-information and point at issue type(1-3). Bas ed on the topic condition, the problems were categorized into closed-type essay and open-type essay; and the closed-type were fur ther divided into ⑷ passive closed-type(2-1) and ⑸ active closedtype(2-2). Based on topic characteristics, four types of categorization were made: ⑹ argumentation-type essay(3-1), ⑺ proof-type es say(3-2), ⑻ explanation-type essay(3-3) and ⑼ problem-solving-type essay(3-4). Based on essay writing characteristics, the proble ms were divided into ⑽ classics essay(4-1), ⑾ current events essay(4-2), and ⑿ general essay(4-3). Categories based on subject and domain of thinking were ⒀ non-combined subject type(5-1) and ⒁ combined subject type(5-2). The non-combined subject type was further divided into a) special subject type and b) special theme type, while the combined subject type was further divided into a) theme essay and b) reasoning essay. From the analysis of each college’s examination problems based on this categorization framework, the detailed characteristics, features and problems of each essay examination question could be known in various aspects, and the strategy and problems in making the examination questions by each college, along with the main features and problems of the overall college admissions essay examination for the 2008 academic year were revealed.

율곡(栗穀) 이이(李珥)의 권학론(勸學論): 범인(凡人)에서 성인(聖人)으로

유연석 ( Yon Seok Yoo ) 율곡학회 2010 율곡학연구 Vol.21 No.-

栗穀 李珥는 儒家의 學問에 입문하는 자들에게 반드시 聖人을 목표로 삼을 것을 권고하고 있는데, 이는 불완전한 凡人이 자신의 결함을 제거한다면 모두 완전한 인격을 지닌 聖人이 될 수 있음을 시사한다. 그리고 모든 인간이 동일하게 善한 本性을 지니고 있다는 점을 언급하여 凡人이 聖人으로 변화될 수 있는 근거를 제시하고 있다. 따라서 學問에 종사하여 聖人이 된다는 것은 인간의 善한 本性을 완전하게 실현함을 의미한다. 李珥는 인간의 本性을 萬物의 생명현상의 전체적인 신장을 도모하는 원리인 理로 규정한다. 그리고 외부의 사물들을 대면하면 仁義禮智信의 五性으로부터 喜怒哀懼愛惡欲의 七情이 유발되는 ‘性發爲情’의 단일한 경로를 설정한다. 여기서 七情은 자아와 타자의 생존욕구를 포괄하는 마음의 총체적인 반응이고, 五性은 七情을 유발하는 내면의 단일한 원천이다. 善한 本性으로부터 유발된 七情이 善과 惡으로 분기되는 것은 氣의 품질차이에 기인하는 것으로 설명된다. 즉 淸氣가 本然之性을 온전하게 담지하는 것은 ‘虛·明’의 상태인데, 이는 七情의 적중[中節]을 유발한다. 반면 濁氣가 本然之性을 엄폐하는 것은 ‘昏·亂’의 상태인데, 이는 七情의 오차[不中節]를 유발한다. 여기서 七情의 적중[中節]과 오차[不中節]가 善惡을 판정하는 유일한 기준이 된다. 따라서 學問의 방법으로 제시된 立志·窮理·省察·涵養은 凡人의 마음에 내재한 결함인 ‘昏·亂’을 제거하고 마음의 정상적인 기능인 ‘虛·明’을 확보하는 과정이 되는데, 이것이 곧 氣質을 교정하는 작업이다. 1단계의 立志는 태만한 상태인 ‘氣昏’을 제거하여 學問의 목표를 설정하는 것이고, 2단계의 窮理는 是非에 어두운 ‘智昏’을 제거하여 本性을 실현하는 상황 합당성을 인식하는 것이며, 3단계의 涵養·省察은 ‘亂’의 문제점인 惡念과 浮念을 제거하고 마음의 안정을 확보하여 ‘虛·明’을 지속적으로 견지하는 것이다. 이와 같이 李珥에게 있어서 學問은 시행착오를 반복하는 凡人이 일종의 심리적 질환으로 간주되는 자신의 결함을 제거함으로써, 善한 本性을 실현하는 마음의 정상적인 기능을 확보하는 작업이라는 점에서, 권장사항 이상의 의미를 지닌다고 할 수 있다. Yulgok Yi Yi advocates to men who are just beginning to study Confucianism that they make it their goal to become a sage, which implies that an ordinary person can transform into a sage of perfect characters if the imperfect man eliminates his defects. Moreover, Yi Yi presents a basis for the possibility that an ordinary person can transform himself into a sage by stating that all men are born with human nature which is good. Therefore, becoming a sage through learning means the perfect realization of man`s human nature which is good. Yi Yi defines man`s human nature as li (理), which is the principle that makes the vital phenomena of myriad things grow on the whole. And further, by establishing a single path in which "human nature becomes the feelings when it is aroused," he makes it clear that the Seven Feelings of joy, anger, sorrow, fear, love, dislike, and desire are triggered by the Five Essences of benevolence, righteousness, propriety, wisdom, and loyalty when man comes into contact with outside things. The Seven Feelings here are the general response of the mind-and-heart which includes the desire of the self and others to survive, and the Five Essences are the single internal origin that causes the Seven Feelings. The difference in the quality of qi (氣) is given as the root of the Seven Feelings, which arise from originally good human nature, diverging into the good and the bad. In other words, the state of "openness" and "clarity" is when pure qi (氣) contains the original human nature in its entirety, from which arises proper Seven Feelings. In contrast, however, the state of "vagueness" and "chaos" is when impure qi (氣) conceals the original human nature, from which arises improper Seven Feelings. Here, the sole standard that determines goodness or badness is the proper or improper response of the Seven Feelings. Therefore, presented as a method through learning establishing one`s will, investigating the principle, examining oneself, and nourishing oneself as presented by Yi Yi is a way of rectifying one`s temperament through learning, which can be attained through a process of eliminating inherent imperfections such as "vagueness" and "chaos" in an ordinary man`s mind-and-heart and, instead, obtaining "openness" and "clarity" that are normal functions of the mind-and-heart. The first stage, establishing one`s will, sets the goal of learning by eliminating the careless state that "makes qi vague." The second stage, investigating the principle, recognizes the situational appropriateness of realizing human nature by eliminating the inability to clearly distinguish right from wrong that "makes wisdom unclear." The third stage, examining and nourishing oneself, eliminates evil and superficial thoughts that are problems of "chaos" and attains stability of the mind-and-heart, thereby strictly adhering to "openness" and "clarity." As mentioned above, learning means more to Yi Yi than mere recommendation in that, through learning, man attains the normal function of the mind-and-heart that realizes his original nature of goodness when an ordinary man eliminates his imperfections which are repeated and are considered to be a type of psychological disorder.