최신판례분석 : 판결에 기한 연명치료 중단 시 의료비 부담의 문제 - 대법원 2016. 1. 28. 선고 2015다9769 판결 -

안병하1 ( Ahn Byung Ha ) 법조협회 2016 法曹 Vol.65 No.8

환자의 추정적 의사에 근거하여 연명치료의 중단을 명하는 판결이 내려진 경우 환자 측은 연명치료 관련 비용을 언제까지 부담하여야 하는가와 관련하여 근래 대법원2016. 1. 28. 선고 2015다9769 판결은 그러한 연명치료 중단 판결이 형식적으로 확정될 때(구체적 사안에서는 상고기각 시)까지 환자 측은 연명치료 비용을 부담하여야 한다고 판시하였다. 하지만 그 구체적 근거에 대해서는 밝히고 있지 않아 많은 아쉬움을 자아낸다. 본고는 이와 같은 대법원의 견해는 다음 두 가지 점에서 납득하기가 어렵다고 본다. 우선 환자의 추정적 의사에 대한 법원의 판단은, 이미 존재하지만 불확실한환자의 추정적 의사를 확인해 주는 역할을 하는 것이지 환자의 추정적 의사를 법원이 형성해 주는 것은 아니라는 점이다. 그러므로 항소심, 상고심 모두 환자의 추정적 의사에 대한 1심판결에 동의하는 경우에 굳이 1심에 의해 확인된 환자의 추정적 의사의 효력발생을 판결확정 시까지 미룰 이유가 없다. 다음으로 환자의 권리에 대한 침해의 위험에도 불구하고 결과적으로 근거 없는 항소, 상고를 제기한 원고가 아무런 실체법상의 부담을 지지 않고, 오히려 환자가 그로 인해 증가한 진료비용을 부담한다는 것은 법정책적으로도 옳지 못하다. 그러므로 인공호흡기의 제거를 명하는 1심판결이 원고에게 송부됨으로써 그에게 환자의 반대의사가 명백하게 된 때부터 원고의 인공호흡기 유지행위는 더 이상 적법한 진료채무의 이행으로 볼 수 없게 되며, 이에 따라 그때부터 발생한 인공호흡기 관련 비용 또한 원고는 의료계약에 기하여 청구할 수 없다. 사무관리에 기한 비용상환청구권이나 부당이득반환청구권 또한 원고에게는 아무런 도움이 되지 못한다. Im Jahre 2009 hat sich der koreanische oberste Gerichtshof (KOGH) erstmalig dafur entschieden, die lebensverlangernden Maßnahmen einer Patientien abzubrechen. Diese Patientin befand sich damals im permanenten vegetativen Zustand und konnte nur mittels einer Beatmungsmaschine am Leben erhalten werden. Kurz nach der Feststellung des schlimmen Zustands der Patientin hatten die Kinder der Patientin von Anfang an aufgrund des mutmaßlichen Willens der Patientin vom Krankenhaus auf den Abbruch der kunstlichen Beatmung verlangt, was dieses aber abgelehnt hat. Anschließend hatten die Kinder diese Sache vor das Gericht erster Instanz gebracht und das Gericht hat den Antrag der Kinder angenommen. Das Krankenhaus hat dagegen eine Berufung eingelegt, jedoch ohne Erfolg. Die vom Krankenhaus hiergegen weiter eingelegte Revision ist vom KOGH ebenfalls zuruckgewiesen worden. Danach ist ein neuer Streit zwischen den Kindern der Patientin und dem Krankenhaus entstanden. Dieses Mal ging es darum, wer die wahrend des Gerichtsverfahrens entstandenen medizinischen Kosten tragen muss. Anfang dieses Jahres hat der KOGH diese Kostenfrage zugunsten des Krankenhauses entschieden. Nach ihm musse die Patientin alle Kosten der medizinischen Behandlung tragen, welche bis zur Revisionsentscheidung angefallen sind. Die vorliegende Arbeit bezweifelt aber die Richtigkeit dieses Urteils. Der mutmaßliche Wille der Patientin fur den Abbruch der kunstlichen Beatmung spatestens zur Zeit der den Abbruch bejahenden Entscheidung des erstinstanzlichen Gerichts auch dem Krankenhaus klar geworden. Deshalb sollte das Krankenhaus die wahrend der im Ergebnis unbegrundeten Berufung bzw. Revision angefallenen Kosten der kunstlichen Beatmung selbst ubernehmen. Denkt man auch daran, dass die gerichtliche Entscheidung nicht den mutmaßlichen Willen der Patientin gestaltet, sondern nur ermittelt und feststellt, scheint die Entscheidung des KOGH bezuglich der Behandlungskosten besonders problematisch zu sein. Wegen der mutmaßlichen Verweigerung der Einwilligung der Patientin ist die Fortsetzung der kunstlichen Beatmung ab dem erstinstanzlichen Urteil nicht mehr als eine gerechtfertigte Erfullung der Behandlungspflicht anzusehen, so dass auch der vertragliche Vergutungsanspruch des Krankenhauses hierfur nicht mehr bestehen beleiben kann. Ausßerdem hilft weder die GoA noch die Leistungskondiktion.

항행 및 항법 : LX대한지적공사 위성측위 인프라 구축 및 네트워크 실시간 이동측위 성능 분석

하지현 ( Ji Hyun Ha1 ),김현호 ( Hyun Ho Kim ),김재복 ( Jae Bok Kim ) 한국항행학회 2014 韓國航行學會論文誌 Vol.18 No.6

대한지적공사 공간정보연구원에서는 네트워크 RTK의 효율성을 향상시키기 위하여 전국에 30개소의 LX 위성측위 인프라를 구축하고 MAC기반의 네트워크 RTK 서비스를 시험운영하고 있다. 본 논문에서는 LX 위성측위 인프라의 구축 현황을 소개하고 MAC기반의 네트워크 RTK 서비스의 측위 성능 분석 결과를 기술하였다. 성능 분석을 위하여 임시 고정점을 설치하고 국토지리정보원의 VRS와 동시관측을 실시하였다. 그 결과 두 인프라는 동서, 남북 방향으로 평균 1~2 ± 1 cm 차이를 보였으며 , 초기화 시간도 10초 이내에서 근소한 차이를 보였다. For improvement of network RTK performance in survey field, Spatial Information Research Institute (SIRI), LX Korea Cadastral Survey Corporation installed 30 GNSS permanent stations in Korea Peninsula, and has been running the MAC-based network RTK service as a test version. In this paper, we introduce the LX GNSS network and analyze the positioning accuracy of the LX MAC RTK service. For field test of the LX MAC RTK service, we installed temporally fixed anchor points and observed simultaneously with VRS of National Geographic Information Institute. As a result, the horizontal position differences and initial times of LX MAC with respect to NGII VRS are 1~2 ± 1 cm and <10 seconds, respectively.

Bovine botulism outbreak associated with incidental consumption of presumably contaminated leftover food

( Jae Won Byun ),( Kyung Hyun Lee ),( Ha Young Kim ),( Soon Seek Yoon ),( Ji Youl Jung1 ),( Woo Seog Jeong1 ),( Jae Ku Oem ),( Jong Soo Lim ),( Myoung Heon Lee ),( You Chan Bae ) 한국예방수의학회(구 한국수의공중보건학회) 2013 예방수의학회지 Vol.37 No.1

Nine cattle among 18 in a native Korean herd died or were euthanized within 3 days. The affected cattle showed cowshed. The pigs and dogs had been fed leftover food originating from nearby restaurants, and the cattle could presumably reach the contaminated food in the pig troughs. Necropsy revealed a few chicken bones and red pepper pieces as well as large amounts of grain and rice straw hay mixed in the rumen. Botulism type D was isolated in the ruminal contents of one of the cattle. We speculated that the outbreak was associated with the cattle incidentally eating presumably contaminated leftover food from the pig trough.

Regeneration of Bovine Mammary Gland in Immunodeficient Mice by Transplantation of Bovine Mammary Epithelial Cells mixed with Matrigel

Woo Tae Ha1,Hyun Jung Park,Won-Young Lee,Ha Yeon Jeong,Hyuk Song 한국동물생명공학회(구 한국동물번식학회) 2017 Reproductive & Developmental Biology(Supplement) Vol.41 No.2

With the global demand for dairy protein for consumption growing annually, there has been increasing activity in the research field of dairy protein synthesis and production. From a manipulation perspective, it is more difficult to use live cattle for laboratory studies on the production of milk as well as of dairy protein such as casein, as compared with using laboratory animals like rodents. Therefore, we aimed to develop a mouse model of bovine mammary alveolar ducts for laboratory-scale studies. We studied the formation of the bovine mammary gland ductal structure by transplanting the MAC-T bovine alveolar cell line into mice. MAC-T cells (1×107) were suspended in Matrigel and injected into the dorsal tissue of 8-week-old male BALB/C nude mice. Histological analysis of tissue dissected from the MAC-T cell-transplanted mice after 6 weeks showed the typical morphology of the tubuloalveolar female gland, as well as glands made up of branching ducts that were surrounded by smooth muscle with small alveoli budding off the ducts. In addition, the epithelial markers CK14 and CK18 were expressed within the duct-like structure. Prolactin was detected in the duct interior in these CK14+ and CK18+ cells but not in the non-transplanted MAC-T cells. These results showed that duct-like tissue had been successfully formed after 6 weeks of transplantation of the CK14+ and CK18+ MAC-T cells into mice dorsal tissue. This mouse model will be a useful tool for further research on the bovine mammary gland.

Soybean growth and yield response to elevated temperature and light intensity

Young-Son Cho,Sok-Dong Kim,Bon-Chul Koo,Won-Ha Yang,Jin-Chul Shin,Young-Han Yun1,Joung-Gon Kim 한국작물학회 2008 한국작물학회 학술발표대회 논문집 Vol.2008 No.10

Changing climate could be effect on the growth of soybean and seed yield, so we evaluated newly developed soy cultivars in the point of the physiological characteristics by changing temperature and light intensity in the phytotron. Two soy cultivars evaluated in three temperature levels (T1, 20/15; T2, 25/20; T3, 30/25oC at day/night) the pot experiment in phytotron between winter and spring in 2006 and spring and summer in 2007. Increased temperature from T1 to T2 and T2 to T3 enhanced crop growth parameters greatly and shortened growth duration and increased seed yield, however, grown in winter and spring enhanced too much plant height, so plant stems were very slim and weak and it resulted in the lodging problem. In this results we can estimate warming in Korean peninsular which might be increase temperature with low light intensity, so plant breeders and physiologists should be develop improved lodging resistance cultivars under low light intensity and high temperature.

Progastrin-releasing peptide as a diagnostic and therapeutic biomarker of small cell lung cancer

오형주,( Ha Young Park ),( Tae Ok Kim1 ),( Chul Kyu Park ),( Hong Jun Shin ),( Hee Jung Ban ),( In Jae Oh ),( Yong Soo Kwon ),( Yu Il Kim ),( Sung Chul Lim ),( Young Chul Kim ),( Soo Hyun Kim ),( Myung G 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Background: Progastrin-releasing peptide (proGRP) is a recently identified biomarker of small cell lung cancer (SCLC). We aimed this study for evaluating the usefulness of automated proGRP measurement for diagnosis and treatment monitoring in patients with SCLC. Methods: From January 2011 to December 2013, plasma samples were prospectively collected from 452 [213 non-small cell lung cancer (NSCLC), 104 SCLC, 135 other diseases] patients visited for tissue diagnosis and tested by two-step automated immunoassay using the ARCHITECT proGRP assay kit (Abbott Diagnostics, USA). The cutoff level of proGRP was set at 63 pg/mL. Results: The mean proGRP was higher in SCLC (1823.0 ± 2684.0 pg/mL) than in NSCLC (61.0 ± 341.7 pg/mL) and other diseases (51.5 ± 222.6 pg/mL, p<0.001). The sensitivity of proGRP was 85.7% (90/105) in SCLC and 11.8% (25/212) in NSCLC. The specificity was 90.2%, positive predictive value was 72.5%, and negative predictive value was 95.4% in SCLC. The mean proGRP was higher in extensive disease (2158.1 ± 2980.6 pg/mL) than in limited disease (901.4 ± 1216.0 pg/mL, p=0.033). Among the 39 patients with SCLC could be followed, the mean proGRP levels of 23 responders were significantly decreased after chemotherapy (from 1651.5 ± 1386.4 pg/mL to 290.0 ± 524.8 pg/mL, p<0.001), whereas those of the 16 non-responders were not. (from 572.5 ± 790.3 pg/mL to 494.4 ± 610.9 pg/mL, p=0.583). Conclusion: Plasma proGRP could be a useful biomarker of SCLC for diagnosis and treatment monitoring. And the initial level may represent the tumor extent of SCLC.

‘2012Architecten’의 사례 조사를 통한 재사용 디자인 전략

하숙녕(Sook Nyung Ha1),이정교(Jung Kyo Lee) 한국디자인학회 2013 디자인학연구 Vol.26 No.1

General Condition of Drinking Water in Nepal

Kyu-Jae Lee,Ma Easter Joy Sajo1,Yang-Suk Yoon,Eun-Ha Kim,Dong-Heui Kim,Dong-Won Ahn 한국물학회 2013 한국물학회 학술대회 Vol.2013 No.03

In the context of Nepal, the issue of easy access to safe drinking water has always been a hot debate mainly because though the country is generally recognized as one of the richest country on the basis of consisting high water density, the proportion of people suffering from water borne diseases is significantly massive. According to the census report of Central Bureau of Statistics 2011, nearly 85percents of households in the country have access to improved drinking water. However these statistics necessarily does not determine and ensure that the stated proportion of households have easy and sufficient access to safe drinking water mainly because most often it is seen that most of the water supplies contain high bacterial contamination and found hardly chlorinated to adequate levels. Whereas the existing major sources and supply systems of drinking water in Nepal are concerned, people heavily depend on inadequate, unhygienic and poor water quality sources like rivers, tube- wells and spouts. Besides that, Poor storage system, practice of open defecation around water sources, traditional operative system, improper drainage system and negligence from concerned stakeholders for the proper maintenance of water supply system are also viewed as most common reasons for the unavailability of sufficient safe drinking water in Nepal. Prominently if we focus on the condition of safe drinking water of Far Western Region of Nepal, it has always been considerably below the national coverage. In the Mountain areas, the water is generally considered to be safe however the contamination of Iron in water is found frequently. In the hill sides lime contaminated water is most commonly available which has further led for the emergence of water and skin borne diseases. In this area the access to safe water is primarily based on gravity system but the availability of limited water sources, insufficient allocation of budget and improper distribution have played vital role for the lack of access to safe to water. Since the hill and mountain districts of this region suffer from the lack of easy access to drinking water, they have to labor hard by walking long distance for the storage of water for which they have to spend healthy amount of time and simultaneously it is not sure that whether that water is safe or not. Access to water is better in Terai region in comparison to the rest because of the availability of underground water sources through tube and dug wells. However, though the sources and access are easier, the worst effect aroused by the lack of access to safe drinking water in this region is more pathetic where a lot of citizens are badly affected by the arsenic contaminated water. Most importantly, the high proportion of patients visiting hospitals for the checkup due to the consistent and acute outbreaks of intestinal parasitic diseases seems emerging from the use of arsenic contaminated water in Terai region which has underscored the prevalence of unsafe water. Even in city areas of the country. Water supply systems are typically occasional, having supply only for relatively few hours per day. Since the facility of water supply through piped system is limited, many people are compelled to depend on the traditional and unprotected sources like ponds in hill region and open dug- wells in Terai region. Since Terai is located in plain areas, people have to rely on diverse types of water sources and mechanisms like streams, tube and dug- wells, underground water systems, small rivers and other sources as well which are undoubtedly do not confirm the reliability and quality of the water. In contrast to Mountain and hill districts of Far West, sources of water in Tikapur Municipality are much more heavily based on underground water but have no easy access to surface water system, though only few who are rich does have. In addition to it, unavailability of drainage system, lack of land for the construction of tube wells due to dense settlements in urban areas and absence of felt need are also other highly functioning factors for the scarcity of safe drinking water. Additionally unsafe water storage habits of people living in this Municipality have created water quality problems. Due to the lack of access to safe water, water borne diseases like cholera, skin diseases and even typhoid are also common in the municipality. In some of the rural and drought affected areas of the Municipality, people use unprotected dug- wells and surface water as the source of drinking water without any scientific treatment.

국제기업가정신과 해외진출 성과와의 관계

김미정(제1저자) ( Mi-jung Kim ),채명수(교신저자) ( Myung-su Chae ),( Jong W. Ha(공동저자) ) 한국국제경영학회 2016 國際經營硏究 Vol.27 No.2

1990년대 이후 전 세계적으로 설립 직후부터 해외시장 진출을 모색하는 국제신생벤처기업들이 늘어나고 있는 추세를 보이고 있는데, 이러한 진출과 관련된 많은 연구들을 살펴보면 대부분 자원기반관점(resource-based view, RBV)을 바탕으로 한 국제기업가정신에서 그 원인을 찾고 있다. 그러나 국제기업가정신의 구성요인들은 개인의 역량관점과 조직역량관점에서 연구자마다 다양하게 제시되고 있다. 이에 본 연구는 국제기업가정신의 구성요인을 개인의 역량이 아닌 조직문화적 차원에서의 조직역량으로써 국제기업가정신 개념의 차원을 규명하고자 하였다. 즉, 본 연구에서는 기존 국제신생벤처기업의 Zhang, Tansuhaj와 McCullough(2009)와 Dimitratos, Voudouris, Plakoyiannaki와 Nakos(2012)의 연구에서 공통적으로 제시한 속성들을 바탕으로 국제기업가정신을 기업의 조직문화적인 측면에서 2차요인으로 정의하여 국제위험감수성/혁신지향성, 국제시장지향성, 국제학습지향성, 국제동기, 그리고 국제경험 등으로 살펴보았다. 또한 이러한 국제기업가정신이 기술지식 향상과 해외시장 지식습득 및 해외진출 성과에 미치는 영향 정도를 실증적으로 분석하고자 하였다. 이를 위해 설립 후 5년 이내에 해외시장에 진출한 147개의 국내 국제신생벤처기업을 대상으로 조사하였으며, SPSS(18.0 version)과 AMOS(18.0 version)을 사용하여 확인적 요인분석과 구조모형분석을 통해 변수들 간의 인과관계를 분석하였다. 분석결과, 국제기업가정신은 다섯 개의 1차요인으로 구성되어 있는 것으로 나타났다. 또한 국제기업가정신은 기술지식 향상과 해외시장 지식습득에 긍정적인 영향을 미쳤으며, 기술지식 향상과 해외시장 지식습득은 해외진출 성과에 긍정적인 영향을 미치는 것으로 확인되었다. 한편, 국제기업가정신이 해외진출 성과에는 직접적인 영향을 미치지 않는 것으로 확인되었다. 이상의 연구결과는 자원이 부족한 국내의 국제신생벤처기업의 국제화와 경영성과에 있어 이론적, 실무적 시사점을 제공할 것으로 기대된다. A growing stream of research on new venture internationalization has recently documented that some young firms are capable of achieving success in global markets much sooner, and more rapidly than what has been observed previously. Such firms have been described as International New Ventures or Born Global Firms. Existing studies on the expansion of international new ventures typically point towards the resource-based view of international entrepreneurship. In response to such studies, this paper seeks to identify the effects of international entrepreneurship on knowledge acquisition and overseas performance in international new ventures. This paper first examined the multidimensional concept of international entrepreneurship of international new ventures composed of international risk-taking/innovation orientation, international market orientation, international learning orientation, international motivation, and international experience based on the study of international entrepreneurship culture. Additionally, we also empirically analyzed how international entrepreneurship influenced technical knowledge improvement, knowledge of overseas markets, and performance. After a review of extant studies, we designed a research model and proposed hypotheses. Based on responses from CEOs and managers of 147 international new ventures in Korea, the proposed model was tested with structural equation modeling with AMOS (18.0 version) and SPSS (18.0 version). The results suggested that international entrepreneurship positively influenced technical knowledge improvement and knowledge of overseas markets as well as performance. However, we were unable to find evidence that international entrepreneurship positively influenced overseas performance.

흉막침범을 보인 Waldenstrom

이은하,류남희,김상경,전창호,서헌석,신동건 대한임상병리학회 1999 대한임상병리학회지 Vol.19 No.2