의료과오 사건에서 인과관계 증명에 관한 최신 대법원 판결 - 대법원 2023. 8. 31. 선고 2022다219427 판결 및 대법원 2023. 8. 31. 선고 2021도1833 판결을 중심으로 -

문현호 대한의료법학회 2023 의료법학 Vol.24 No.4

의료과오 민사소송의 주된 쟁점은, 과실, 과실과 손해 사이의 인과관계이다. 진료 상 과실이 증명된 경우 인과관계 추정과 관련하여 종래 대법원 1995. 2. 10. 선고 93다52402 판결이 있으나, 위 판결 문언 상 요건을 충족하는 사안은 찾기 어렵고, 그럼에도 실무는 위 판결을 인용하면서 인과관계를 추정하는 경우가 많아 위 판결 문언과 정합성이 없다는 비판이 꾸준히 제기되었다. 대법원은 대상 민사판결에서, 민사소송에서 진료 상 과실이 증명된 경우 인과관계 추정에 관한 법리를 정비하여 새롭게 제시하였다. 이에 의하면, 환자 측이 의료행위 당시 임상의학 분야에서 실천되고 있는 의료수준에서 통상의 의료인에게 요구되는 주의의무의 위반 즉 진료 상 과실로 평가되는 행위의 존재를 증명하고, 그 과실이 환자 측의 손해를 발생시킬 개연성이 있다는 점을 증명한 경우에는, 진료 상 과실과 손해 사이의 인과관계를 추정하여 인과관계 증명책임을 완화한다. 여기서 손해 발생의 개연성은 자연과학적, 의학적 측면에서 의심이 없을 정도로 증명될 필요는 없으나, 해당 과실과 손해 사이의 인과관계를 인정하는 것이 의학적 원리 등에 부합하지 않거나 해당 과실이 손해를 발생시킬 막연한 가능성이 있는 정도에 그치는 경우에는 증명되었다고 볼 수 없다. 한편 진료 상 과실과 손해 사이의 인과관계가 추정되는 경우에도 의료행위를 한 측에서는 환자 측의 손해가 진료 상 과실로 인하여 발생한 것이 아니라는 것을 증명하여 추정을 번복시킬 수 있다. 한편 민사사건과 달리 형사사건에서는 ‘합리적 의심이 없을 정도의 증명’이 기준이고, 인과관계 추정 법리가 적용되지 않는다. 이에 따라 동일한 의료사고에 관하여 같은 날 동일한 재판부에서 선고된 업무상과실치사 형사사건에서는 진료 상 과실과 사망 사이 인과관계에 대한 증명 부족을 이유로 무죄 취지로 파기환송하였다. 대상 형사판결은, 의료과오 관련 형사 사건에서 ‘업무상 과실’이 인정되더라도 ‘인과관계’에 대한 확실한 증명이 부족하면 유죄로 판단하지 말라는 취지의 판결이다. The main issue in medical malpractice civil litigation is medical negligence and the causal relationship between medical negligence and damages. Regarding the presumption of causality in cases where medical negligence is proven, there is a previous Supreme Court decision 93da52402 on February 10, 1995, but it is difficult to find a case that satisfies the textual requirements of the above decision, and yet, in practice, the above decision is cited. In many cases, causal relationships were assumed, and criticism was consistently raised that it was inconsistent with the text of the above judgment. In its ruling, the Supreme Court reorganized and presented a new legal principle regarding the presumption of causality when medical negligence is proven in a civil lawsuit. According to this, If the patient proves ① the existence of an act that is assessed as a medical negligence, that is, a violation of the duty of care required of an ordinary medical professional at the level of medical care practiced in the field of clinical medicine at the time of medical practice, and ② that the negligence is likely to cause damages to the patient, the burden of proving the causal relationship is alleviated by presuming a causal relationship between medical negligence and damage. Here, the probability of occurrence of damage does not need to be proven beyond doubt from a natural scientific or medical perspective, but if recognizing the causal relationship between the negligence and the damage does not comply with medical principles or if there is a vague possibility that the negligence will cause damage, causality cannot be considered proven. Meanwhile, even if a causal relationship between medical negligence and damage is presumed, the party that performed the medical treatment can overturn the presumption by proving that the patient's damage was not caused by medical negligence. Meanwhile, unlike civil cases, the standard is ‘proof beyond reasonable doubt’ in criminal cases, and the legal principle of presuming causality does not apply. Accordingly, in a criminal case of professional negligence manslaughter that was decided on the same day regarding the same medical accident, the case was overturned and remanded for not guilty due to lack of proof of a causal relationship between medical negligence and death. The above criminal ruling is a ruling that states that even if ‘professional negligence’ is recognized in a criminal case related to medical malpractice, the person should not be judged guilty if there is a lack of clear proof of ‘causal relationship’.

3차원 깊이 변화 탐지과정에서 드러난 시야와 양안의 상호작용효과

문현호,남종호 한국인지및생물심리학회 2015 한국심리학회지 인지 및 생물 Vol.27 No.2

시각 정보가 제시되는 눈과 좌우 시야의 위치를 조합하면 망막에서부터 형성되는 네 가지 시각경로를 분리하고 이를 행동적으로 측정할 수 있다. 본 연구는 3차원 깊이 지각 과정에 눈과 시야, 좌우뇌가 차별적인 기여를 할 가능성을 구분해서 알아보고자 하였다. 이를 위하여 두 눈에서 오는 정보를 모두 필요로 하는 깊이 변화 판단 과제를 구성하였다. 좌우 시야의 위치와 제시되는 눈의 조건을 독립적으로 조정하여 깊이 변화를 탐지하기 위한 정보를 관찰자에게 체계적으로 제공하였다. 정보가 조합되는 조건에 따라 수행차이가 있는지를 반응시간으로 측정하였다. 실험 참가자는 가상의 두 원주(작은 원, 3.43°; 큰 원 8.13°) 상에 제시된 12개의 자극 중 어느 하나에서 깊이 변화가 탐지되면 다가오거나 멀어지는 변화의 방향에 따라 적합한 반응을 하도록 하였다. 결과로는 자극의 공간 이동 방향, 깊이 탐지 정보가 제시되는 눈과 시야에 따라 탐지 수행이 달라지는 것으로 나타났다. 또한 변화의 방향에 대한 좌우 손 반응 요구를 상호 뒤바꾸는 두 실험조건에서 수행 안정성의 차이가 관찰되었다. 이런 결과는 3차원 깊이 지각 과정이 정보가 입력되는 시각 경로가 동측인지 대측인지에 따라 차이날 수 있으며, 자극에 대한 행동 반응의 적절성은 깊이 변화 방향과 밀접한 관련이 있을 가능성을 논의하였다. It is investigated whether the visual pathway starting from retina could be separated and measured behaviorally. It could be possible to separate visual pathways with four combinations of left/right visual fields and viewing eyes. 12 spheral stimuli along two imagery concentric circles were presented against dark background, and then one of stimulus was shifted rightward or leftward. Since a stimulus shift occurred on one of two visual displays viewed exclusively by one of two eyes, an observer perceived it as shifted its depth position closer or further away. We manipulated the stimulus shifting conditions, consisting of viewing eyes, visual fields, stimulus shifting directions, and measured observers’ reaction time performance as promptness to its change. Several interaction effects among visual fields, viewing eyes, and shift directions were obtained to show that there could be a performance difference between contralateral and ipsilateral visual pathway of the 3-D related information processing. In addition, the interaction effect with response assignment might be caused by the natural human response tendency to the 3-D motion direction.

진단서, 처방전과 관련된 최근의 쟁점

문현호,김영태 대한의료법학회 2013 의료법학 Vol.14 No.2

The Issuance of false medical certificates on Criminal Law or the Medical Service Act are frequently applied to the insurance fraud cases related with the medical certificate, prescriptions. The meaning of medical certificate is not defined on the crime of Issuance of false medical certificates, but considering the rule of Paragraph 1 of Article 17 of the Medical Service Act, which punishes drawing up the medical certificate by anyone except the doctor who has directly examined, and the principle of legality, the medical certificate applied with the crime of Issuance of false medical certificates should (1) include the judgment after current medical examination, (2) be written for the purpose of verifying the health status and (3) have a style that can be recognizable as medical document usually written by doctors. In addition, since there have been many argues on the range of application of the Paragraph 1 of Article 17 of the Medical Service Act, which generally regulates various kinds of documents such as medical certificates, prescriptions and others, which have different purpose and characters, the range of application of the clause above is needed to be interpreted strictly.

혈액제제 제조물책임 소송과 증명책임 - 대법원 2011. 9. 29. 선고 2008다16776 판결과 관련하여

문현호 대한의료법학회 2011 의료법학 Vol.12 No.2

This article analyzes the case (2008Da16776) which has the issue how patients have to prove causal relationship when patients claim against pharmaceutical companies alleging that patients were infected with virus due to contaminated blood products. The Supreme court held that: (1) if patients prove that they didn't have symptoms suggesting virus infection before administration of blood products, the virus infection had been confirmed after administration of blood products, and there were significant potential of contamination of the blood products with the virus, the defect in blood products or the negligence of pharmaceutical company in making blood products shall be presumed to cause the infection of the victim. (2) The pharmaceutical companies could reverse the presumption by proving the blood products were not contaminated, but the fact that the victims were treated with the blood products manufactured by other companies or had received blood transfusions is not enough to reverse the presumption. The case is the first decision whether the burden of proof about causal relationship could be reduced in pharmaceutical product liability lawsuit. Hereafter pharmaceutical product liability cases, it would be necessary to reduce the burden of proof about causal relationship in order to make substantive equality between patients and pharmaceutical companies.

유사의료행위 대체의료행위 등에 관한 법정책적 쟁점의 검토

문현호 대한의료법학회 2010 의료법학 Vol.11 No.2

분산전원의 경제적 운전을 고려한 배전계통의 최적구성에 관한 연구

문현호,윤창대,이종주,신명철,최상열 제어로봇시스템학회 2008 제어로봇시스템학회 국내학술대회 논문집 Vol.2008 No.10

Optimal Configuration of Distribution System considering the Economic Operations of a Microgrid

문현호,이종주,최상열,신명철 한국조명.전기설비학회 2010 조명·전기설비학회논문지 Vol.24 No.7

With the diversification of distribution facilities, existing distributed generation can be subdivided into Microgrids, which are smaller units for application. These Microgrids, subdivided as such and connected to distribution systems, should operate under driving plans that will ensure their economic efficiency and, accordingly, the configuration of those distribution systems that include Microgrids should also be changed. The perception of the necessity to secure the economic efficiency of distribution systems is gradually increasing and studies intended to assess the economic efficiency of Microgrids and Smartgrids are ongoing. In this paper, the power generation capacity of an economically operative Microgrid was calculated using the MonteCarlo simulation, which is a method based on the probability theory considering the power generation cost of Microgrids linked with power supply systems and reverse sales costs, etc., and an optimum distribution systems was configured based on the results of these calculation.

국민건강보험공단의 요양급여비용 환수과정에 있어서 법적용 정밀성에 관한 검토

문현호 대한의료법학회 2012 의료법학 Vol.13 No.2

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4050교육목회 지도자 앙케이트 나눔

문현호 장로회신학대학교 기독교교육연구원 2019 교육교회 Vol.483 No.-

만성 조현병 당사자 밴드가 경험한 커뮤니티 음악치료 사례 연구: <광장프로젝트>를 중심으로

문현호,문소영 한국문화융합학회 2022 문화와 융합 Vol.44 No.8

The purpose of this study is to analyze the contents and meanings of the band consisting of chronic schizophrenia patients through community music therapy. The researcher and 2 musicians made five songs with this band for a year and three months from February 2021 to April 2022. During that period we recorded them in a professional studio, released an album through music platforms. Also filmed and released live videos. In this study, named ‘The Square Project’, the top topics of the experience felt by the participants are as follows. First, the psychological and musical growth of individuals and band are mentioned. Second, a unique identity as a band with mental disabilities was derived. Third, the band's wish for future activities to improve creative contribution and overcome social prejudice was experienced. Based on these results, the significance of this study is that community music therapy can be a powerful practice in which the marginalized people become the main participants.