Subjectivity Death with Dignity Recognized of Nursing Students

Sunyoung Jang,MeeSuk Wang 보안공학연구지원센터 2016 International Journal of Bio-Science and Bio-Techn Vol.8 No.5

This study was to identify the subjective attitudes on “death with dignity” perceived by nursing students, and to describe the characteristics of each category. Twenty-nine nursing students at H University located in Chungcheongnam Province, Korea were asked to classify 70 statements on “death with dignity.” The collected data was analyzed utilizing QUANL PC program, SPSSWIN 21.0 program. The study concluded that there were 6 types of attitudes from the nursing students towards “death with dignity.” The types of attitudes towards “death with dignity” were “recognizing value in death with dignity,” “inevitability of choosing death with dignity,” “societal regulation of death with dignity,” “death with dignity electivity,” “death with dignity criteria identification” and “preparing for death with dignity.” The results of this study will provide assistance for organizing a “death with dignity” education program for nursing students and establish a value system towards “death with dignity” through categorization of the nursing student attitudes. The findings will also play a crucial role in identifying the attitudes of nurses towards “death with dignity” after students become nurses and start working in various departments, possibly facing patients considering or being considered for end of life choices, including “death with dignity. Lastly this study meaning of death with dignity would be to the development well dying or death with dignity training program nursing student.

존엄사의 헌법적 보장-죽음에 대한 자기결정권의 구성요건 설정을 중심으로-

주재경 원광대학교 법학연구소 2022 圓光法學 Vol.38 No.4

South Korea recognizes death with dignity only in the form of cessation of life-sustaining treatment for patients in the process of dying. Accordingly, a terminally ill patient or a patient in a persistent vegetative state cannot make a decision to die with dignity, and even if he or she is the target, there are limitations in choosing a method of dying with dignity such as physician-assisted suicide. These limitations cannot preclude discussion from the stage of component requirements. Therefore, in the decision to die with dignity, it is necessary to ensure that death with dignity is sufficiently guaranteed through the establishment of the component requirements for the right to self-determination on death. Regarding the requirements for becoming the subject of the right to self-determination on death in the decision to die with dignity, the requirements of irreversibility and the uselessness of treatment become the focal points. Accordingly, it is against the principle of equality to exclude a patient who has no essential difference from a patient in the process of dying and who meets the requirements from the subject. Therefore, in principle, it is desirable to acknowledge the subjectivity of the right to self-determination on death for these patients. First, in terms of the right to defense of the right to self-determination on death, the subject of the decision to die with dignity can request that the state stop restrictions on physician-assisted suicide. In the same respect, it is possible to ask the state to make a decision to discontinue general life-sustaining treatment. Next, based on the social rights aspect of the right to self-determination on death, the subject of decision to die with dignity can claim the right to receive social insurance and public assistance from the state. In particular, it can be requested that the state prepare overall welfare conditions such as hospice and palliative care systems so that patients' self-determination can be free from economic pressure. And, in terms of the protective right of the right to self-determination on death, the subject of the decision to die with dignity may claim the right to receive assistance from a doctor to the state. For example, if death with dignity is carried out by a private person other than a doctor, the right to self-determination on death may be violated, so the patient can request legislation to the state that obligates the participation of doctors in the decision to die with dignity. Lastly, in terms of the procedural right of the right to self-determination on death, in relation to organizations, supplementary legislative requests can be made to the state to expand the establishment or vitalize the operation of the Medical Institution Ethics Committee or the Public Ethics Committee. Regarding the procedure, it may be possible to request the state to prepare legislation to supplement the procedure for implementing death with dignity.

A Buddhist Critique of the So-called “Dignity of Life” and “Death with Dignity” from the Perspective of Temporality

Yao-ming TSAI 금강대학교 불교문화연구소 2021 불교학 리뷰 Vol.29 No.-

본 연구는 『아함경』으로 알려진 불교 문헌에 근거하여 ‘삶의 존엄성’과 ‘존엄사’를 시간성의 관점에서 비판적으로 탐구하려는 것이다. 관련 주제에 대한 분석은 ‘존엄성’, ‘삶’, ‘죽음’과 같은 몇 가지 핵심 개념을 정의하고 명확히 하는 것에서 시작한다. 그 후 존엄성을 삶이나 죽음과 연결하는 것이 적절한가에 대한 비판적인 검토가 이어진다. 강조하려는 요점은 비록 존엄성이라는 개념이 시간적인 맥락 속에서 경험되는 사회적이고 문화적인 범주에서는 중요한 역할을 할 수 있지만, 시간성이 결여된 생사의 과정(윤회)이라는 범주에서는 매우 큰 어려움에 직면한다는 것이다. 만일 ‘삶의 존엄성’과 ‘존엄사’라는 문구가 당연한 것으로 받아들여진다면, 잘못된 용어 적용 범주의 오류를 범하게 될 수 있고, 따라서 생명윤리나 생사학의 상호 연관된 담론은 우리를 기만하거나 오도할지도 모르는 것이다. 나는 생사의 과정(윤회)이 무엇보다 존엄성이나 모욕에 관한 것이 아니라, 오히려 우리가 갇혀 있는 괴로움과 그 갇혀 있는 괴로움의 지멸에 관한 것이라고 주장한다. 본 연구의 비판적 통찰은 삶과 죽음의 어려운 상황에 대처하도록 철학도의 마음을 열어 줄 수 있을 뿐 아니라, 삶과 죽음의 철학과 관련된 향후 연구에 있어 지침이 될 수 있을 것이다. This study, drawn from Buddhist scriptures known as the Āgama-sūtras, critically investigates “dignity of life” and “death with dignity” from the perspective of temporality. The analysis starts by defining and clarifying some key concepts such as dignity, life, and death. This is followed by a critical examination of the appropriateness of connecting dignity either with life or with death. A point that should be emphasized is that although the concept of dignity can play a significant role in the social and cultural categories experienced in a temporal context, it encounters enormous difficulties in the category of the process of life-and-death devoid of temporality. If the phrases “dignity of life” and “death with dignity” are taken for granted, then the fallacy of misplaced categories of terminological application can be committed, and therefore the correlated discourses of bioethics or thanatology may be deceptive or misleading. I argue that the process of life-and-death is, first and foremost, neither about dignity nor about indignity, but about entrapped suffering and the cessation of the entrapped suffering. The critical insight of this study may not only be able to open the mind of the students of philosophy to tackle difficult situations in life-and-death, but also serve as a guideline in the future studies related to philosophy of life-and-death.

존엄한 죽음에 관한 철학적 성찰

이은영(Lee Eun Young) 가톨릭생명윤리연구소 2018 인격주의 생명윤리 Vol.8 No.2

이글은 호스피스 완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법, 일명 연명의료결정법을 기존의 언급된 안락사, 그 중에서도 소극적 안락사와 존엄사와의 연관성과 차이성을 해명하려는 시도이다. 현재 시행 중인 연명의료결정법은 존엄사법인가. 또는 소극적 안락사로 수용될 수 있는가. 연명의료결정법을 제정하면서 법원은 안락사나 존엄사의 표현을 사용하지 않았고, 그 이유를 다음과 같이 밝혔다, 즉 안락사는 역사적으로 잘못 사용된 사례가 있고(예컨대, 나치의 인종개량정책등), 존엄사는 죽음을 과도하게 미화할 가능성이 있어 안락사나 존엄사라는 표현을 사용하지 않았다는 것이다. 그럼에도 불구하고 다수의 대중매체 또는 일부 학계에서 연명의료결정법이 소극적 안락사 또는 존엄사와 혼용되고 있다. 물론 연명의료결정법이 법제화되기 이전 무의미한 연명의료에 대하여 소극적 안락사 또는 존엄사라는 명칭으로 논의가 있었던 것은 사실이다. 따라서 필자는 안락사와 존엄사와의 연관성과 차이성을 통하여 연명의료결정법이 어느 지점에 위치해 있는가에 대하여 논의하는 데 이 글의 목표를 두었다.이 목표에 도달하기 위한 여정에서 연명의료결정법과 안락사(자연적 죽음과 의도된 죽음에 의한 구분) 그리고 존엄사와 그것과의(환자 대상범위, 연명의료결정권은 선택권인가 아니면 죽을 권리인가) 연관성과 차이성을 고찰하였다. 그 결과 연명의료결정법은 진통제 투여, 물과 산소공급 등은 유지함으로써 ‘자연스러운 죽음’을 맞이할 수 있는 연명의료 결정에 대한 선택권이라는 점이다. 반면에 안락사는 그것이 소극적 안락사일지라도 영양과 수분공급 차단과 같은 방법을 통해 의도된 죽음을 유발한다는 점에서 연명의료결정법과 구별되는 것이다. 또한 존엄사가 지속적인 식물인간 상태에서와 마찬가지로 ‘환자가 의식이 없고 인공호흡기에 의해 생명만이 연장되어 있는 경우 품위 있는 죽음을 위해 생명연장조치를 중단’하자는 의미를 담고 있다면, 연명의료결정법은 환자 대상 범주에서 ‘임종과정에 있는 환자’라는 범주를 분명히 하고 있으며, 그런 한에서 지속적 식물인간 상태 환자라는 조건은 연명의료결정법의 적용대상이 될 수 없다. 이와 함께 연명의료결정법은 임종 과정에 있는 환자가 존엄하게 ‘죽을 권리’를 부여 받은 것이 아니라, 무의미한 연명의료를 중단하거나 유보할 수 있는 ‘선택권’이 법적으로 제도화 되었다는 점에서 그들과의 차이성을 드러낸다. 즉 이 글에서 필자는 연명의료 결정법이 종래의 안락사와 존엄사와 어떻게 같으면서, 어떻게 다른가에 대한 의미를 드러냄으로써 현재 시행 중인 연명의료결정법의 올바른 이 해를 강조하고자 하였다. This paper is an attempt to explicate laws on Life-sustaining Treatment Act for patients on deathbed in relation to previously referenced euthanasia, in particular, the correlation and difference between passive euthanasia and death with dignity. Is Life-sustaining Treatment Act a law identified with for death with dignity? Or could it be considered as passive way of euthanasia? When the law was legislated, court did not use like euthanasia and death with dignity. I explained the reason as follows: As euthanasia has a history of being misused (for example, Nazis’ racial hygiene policies, etc.) and death with dignity might immoderately glamorize death, the court avoided using the terminologies of euthanasia and death with dignity. However, in a number of public media and some academic fields, Life- sustaining Treatment Act is misidentified with passive euthanasia or death with dignity. It is true that before the Act was legislated, there has been a debate on using terminologies of passive euthanasia or death with dignity for medical care for life prolongation. However, Life-sustaining Treatment Act understood differently from passive euthanasia and death with dignity. This paper tries to discuss whereabouts of Life-sustaining Treatment Act through discovering its similarities and differences from passive euthanasia and death with dignity.

무의미한 연명의료의 중단과 존엄사의 제 문제

문성체 ( Seong Jea Moon ) 법조협회 2009 法曹 Vol.58 No.6

Modern medicine started from struggles for overcoming a variety of incurable diseases and has made steady and successful efforts to liberate human being from suffering of diseases, but involves unprecedented side effects as well, including those related to holistic medicine primarily for terminal diseases. On the one hand, the advancement of medical science and technologies has its own implications in a sense that it contributed to prolonging the life of patients. On the other hand, physical and mental pain patients feel has robbed terminal patients of even their own dignity. In this context, patients` self-determination right for death of dignity is to give a chance to terminal patients to opt for liberate themselves from overplus of pain. And this study focuses primarily on discussing how to resolve potential conflicts concerned with those issues of life. In order to respect the self-determination of patients, American judicial precedents and legislation has permitted patients` right to deny any medical treatment for prolonging life, i.e. passive euthanasia(easy death) since 1970`s, to the certain extent allowable legally. In particular, Oregon Death with Dignity Act has acknowledged that terminal patients may commit physician-assisted suicide. Such a physician-assisted suicide of patients becomes a new way of death which has been never discussed in terms of active euthanasia since 1990`s. Unlike passive euthanasia in which physician administers lethal dose of medicine to a patient for the purpose of his death, the active euthanasia is a mean for patients to use such lethal dose of medicine as prescribed by physician at their option for suicide. Crucial difference between active and passive euthanasia can be determined by whether ultimate behavior causing death of a patient is committed by physician or the patient himself. Thus, it is found that active euthanasia has faced relatively low objections against legitimation of physician-assisted suicide of patients in a sense that ultimate behavior to cause death of a patient is attributed to the patient himself, so it is easier for active euthanasia to attribute the death of a patient to his own responsibility than passive euthanasia, and the former also has relatively low risk of misuse or abuse in comparison with the latter. In reality, it is obvious that physician-assisted suicide of patients is an issue unacceptable among the public, since physician`s behavior for active euthanasia may face other legal responsibilities such as aiding and abetting suicide as provided in criminal law. However, there have been proposed needs for exemption from any legal responsibility for physician-assisted suicide of terminal patients in respect of their self-determination right, as mentioned above. In order reflect such needs and perspectives on local legislation, the Oregon state(USA) has newly established and enforced the Oregon Death with Dignity Act. The ultimate purpose of this study is to address historical backgrounds concerned with legislation of the Oregon Death with Dignity Act as well as major legal contents in said act to examine the issues about death of dignity, which may be pointed out in terms of hospice medicine in the future, and thereby consider potential problems concerned with death of dignity.

무의미한 연명의료의 중단과 존엄사의 제 문제

문성제 법조협회 2009 法曹 Vol.58 No.6

Modern medicine started from struggles for overcoming a variety of incurable diseases and has made steady and successful efforts to liberate human being from suffering of diseases, but involves unprecedented side effects as well, including those related to holistic medicine primarily for terminal diseases. On the one hand, the advancement of medical science and technologies has its own implications in a sense that it contributed to prolonging the life of patients. On the other hand, physical and mental pain patients feel has robbed terminal patients of even their own dignity. In this context, patients' self-determination right for death of dignity is to give a chance to terminal patients to opt for liberate themselves from overplus of pain. And this study focuses primarily on discussing how to resolve potential conflicts concerned with those issues of life. In order to respect the self-determination of patients, American judicial precedents and legislation has permitted patients' right to deny any medical treatment for prolonging life, i.e. passive euthanasia(easy death) since 1970's, to the certain extent allowable legally. In particular, Oregon Death with Dignity Act has acknowledged that terminal patients may commit physician-assisted suicide. Such a physician-assisted suicide of patients becomes a new way of death which has been never discussed in terms of active euthanasia since 1990's. Unlike passive euthanasia in which physician administers lethal dose of medicine to a patient for the purpose of his death, the active euthanasia is a mean for patients to use such lethal dose of medicine as prescribed by physician at their option for suicide. Crucial difference between active and passive euthanasia can be determined by whether ultimate behavior causing death of a patient is committed by physician or the patient himself. Thus, it is found that active euthanasia has faced relatively low objections against legitimation of physician-assisted suicide of patients in a sense that ultimate behavior to cause death of a patient is attributed to the patient himself, so it is easier for active euthanasia to attribute the death of a patient to his own responsibility than passive euthanasia, and the former also has relatively low risk of misuse or abuse in comparison with the latter. In reality, it is obvious that physician-assisted suicide of patients is an issue unacceptable among the public, since physician's behavior for active euthanasia may face other legal responsibilities such as aiding and abetting suicide as provided in criminal law. However, there have been proposed needs for exemption from any legal responsibility for physician-assisted suicide of terminal patients in respect of their self-determination right, as mentioned above. In order reflect such needs and perspectives on local legislation, the Oregon state(USA) has newly established and enforced the Oregon Death with Dignity Act. The ultimate purpose of this study is to address historical backgrounds concerned with legislation of the Oregon Death with Dignity Act as well as major legal contents in said act to examine the issues about death of dignity, which may be pointed out in terms of hospice medicine in the future, and thereby consider potential problems concerned with death of dignity. 서울서부지방법원 2008가합6977사건 판결에서 무의미한 연명의료장치의 제거를 청구한 원고들의 주장을 받아들임으로써 무의미한 연명의료와 관련된 소극적 안락사에 대한 사회적 논의를 야기하였다. 현대 의료기술의 발전은 치유 불가능한 말기환자들에게 있어 생명연장이 가능하게 되었다는 점에서는 큰 의미를 부여할 수 있으나, 연명만을 위한 무의미한 의료를 통하여 환자들이 받는 육체적·정신적인 고통은 생명연장의 기쁨보다 인간으로서 존엄마저 상실시킬 수 있음이 지적됨에 따라, 환자들에게 스스로 고통으로부터 해방할 수 있는 선택권을 부여해야 한다는 주장이 제기되기에 이르렀는데 이것이 바로 소극적 안락사와 존엄사의 제 문제이다. 제 외국의 경우 치유 불가능한 말기환자에 대하여 치료중단으로 인한 소극적 안락사를 인정하려는 추세이며, 존엄사는 유일하게 미국 오리건 주에서 존엄사법을 제정하여 시행하고 있다. 우리나라 2008가합6977 판결은 무의미하게 연명만을 위한 의료에서 나타나는 문제에 대한 해결의 대한 방향성을 제시하였다는 점에서 매우 의미 있는 판결이다. 그러나 본 판결이 우리 사회에서 보다 설득력을 갖기 위해서는 의료와 환자의 자기결정권의 갈등의 문제를 어떻게 조화시키느냐에 따라 그 방향성이 정해질 것으로 본다. 이 같은 문제의식을 가지고 본 연구는 치유 불가능한 환자와 의료상의 제 문제를 중심으로 무의미한 연명의료장치의 제거와 환자의 자기결정 및 의사표시에 관한 제반문제를 검토하고 미국 오리건 주의 존엄사법의 주요 내용과 그 이후의 동향을 살펴보았다.

존엄사 관련 법안에 대한 검토

김종일(Kim, Jong-Il) 한국법이론실무학회 2016 법률실무연구 Vol.4 No.1

사람은 한번 태어나 반드시 죽는 것이 인류 보편의 원리이며, 가능하면 고통없이 편안하게 인간의 존엄을 유지한 채 죽음을 맞이하고 싶은 것이 공통된 소망일 것이다. 그렇다고 해서 이를 위하여 안락사나 존엄사의 방법으로 죽음을 선택하는 것이 인류 보편의 원리라고 할 수는 없다. 지금까지 의료계와 학계는 그 가능성 여부를 중심으로 논의가 이루어져 왔으며 그 논의의 핵심은 환자의 자기결정에 따른 치료중단의 정당성 여부에 관한 것이었다. 인간은 살아가면서 많은 결정을 하지만, 생명 유지 장치를 중지하여 줌으로 해서 존엄한 죽음을 맞이할 것을 결정하는 것은 명백히 죽음에 직결되기 때문에 그렇게 간단한 것이 아니며, 생명을 그 대상으로 한다는 점에서 매우 민감한 문제이다. 우리나라에서 존엄사에 관한 논의는 1997년 ‘보라매병원사건’에서부터 시작하였으며, ‘첫 존엄사 판결’이라 일컬어지는 일명 ‘세브란스 김씨할머니 사건’ 이후부터 본격적으로 논의되기 시작하여 존엄사에 대한 법제화의 노력이 이루어져 왔으며, 드디어 존엄사법안이라고 불리는 “호스피스 완화의료 및 임종과정에 있는 환자의 연명의료 결정에 관한 법률안”이 2016년 1월 8일 국회를 통과하였다. 이 법안은 공포 후 1년 6개월간의 유예기간을 거쳐 2018년부터 시행될 방침이다. 본 논문은 존엄사의 의미, 2009년 이후 발의된 법안들의 추진 경과를 살펴보고, 2016년국회에서 통과된 ‘존엄사법안’에 대한 평가와 향후 방향에 대해 검토하고자 한다. There is a growing conflict between physicians and terminally ill patients and their families; physicians wish to protect the sanctity of life and will everything in their means to save a life from death, while more and more terminally ill patients and their families sometimes wish to face death with dignity. One of the very few certainties in life is that a human being will eventually pass on, and it is a universal desire for a person to die without pain. However, there is a huge controversy as to whether choosing to die by euthanasia or so-called death with dignity is a natural course of life or a universally accepted notion. The medical profession and the academia have constantly debated on the foregoing issue, and the topic of debate was whether a terminally ill patient has the right to refuse life-sustaining treatment. A human being makes many decisions throughout ones life, however, a decision to refuse life-sustaining treatment in order to die with dignity, is clearly linked to the ultimate end of a human life, therefore, a matter of great sensitivity. A recent Korea Supreme Court decision 2009 da 17417, which pertains to life-sustaining treatment and death with dignity (which some prefer to refer to as passive euthanasia), is a meaningful precedent in the sense that it established a new direction to help resolve social conflicts surrounding the issue of the treatment of a terminally ill patient. However, there is also a criticism that the decision did not contain sufficient discussion with regard to right to self-determination and right to life. The issue of death with dignity requires a careful balancing of the right of self-determination, right to life, a states duty to preserve human life. Not an easy task indeed. After which, the issue would be whether a terminally ill patients right of self-determination, is in reality recognized by medical professionals. There were several bills that were pending pertaining to the issue of death with dignity (e.g., death with dignity bill, right to face a natural death at the final stage of life bill, hospice and easing of medical treatment bill). Through this efforts of the legislation for the death with dignity, the dignity act was finally passed through January 8th Congress in 2016. This Act plans to be implemented from 2018 through the six months grace period, one year after promulgation. In this paper, we seek to review the assessment and future direction for the legislations death with dignity by examining the concepts dignity, outturn of the bill related to death with dignity since 2009.

미국헌법상 안락사와 존엄사에 관한 연구

김명식(MyeongSik Kim) 한국헌법학회 2010 憲法學硏究 Vol.16 No.1

2009년 5월 21일 우리나라 대법원은 최초로 ‘회복 불가능한 사망의 단계’에 진입한 환자에게 무의미한 연명치료의 중지를 허용하는 판결을 내렸는데, 흥미로운 것은 판결문 어디에도 ‘존엄사’라는 용어를 사용하고 있지 아니함에도 불구하고, 언론 등에서는 이를 ‘존엄사판결’이라 칭하고 있으며, 이 문제와 관련하여 2009년 2월 5일 국회에 ‘존엄사법(안)’까지 제출되어 있는바, 과연 그 용어의 사용이 적절한지 논란이 되고 있다. 또한 이 판결에서 인정한 ‘치료거부의 권리’는 이른바 소극적 안락사와 동일한 개념으로서 넓은 의미에서 의사조력자살이나 적극적 안락사까지 포함하는 이른바 ‘죽을 권리’의 범주에 포섭되느냐도 논란이 될 수 있다. 나아가 치료거부권을 포함한 죽을 권리의 헌법적 근거가 과연 헌법 제10조의 인간으로서의 존엄과 가치 및 행복추구권인가 아니면 헌법 제17조의 사생활의 비밀과 자유의 권리인가도 논란이 될 수 있다. 이러한 문제에 대해 미국헌법학계에서도 많은 논의가 있었는바, 첫째 미국에서 ‘존엄사법’이라는 용어는 의사조력자살을 허용하는 법률명칭이기도 하고 연명치료 거부의 권리를 구체화시키는 법률명칭이기도 하고, 연혁적으로 적극적 안락사 등을 미화시키려는 정치적 의도 등에 의해 그 개념의 확장이나 轉用이 이루어지고 있었다는 점을 고려한다면, 미국에서의 ‘존엄사법’의 용어와 개념을 평면적으로 수용할 경우 오히려 개념의 혼란이 초래될 위험이 있음을 직시해야 할 것이다. 둘째, 미연방대법원의 전통적 해석론은 연명치료를 거부할 권리를 수정헌법 제14조의 적법절차조항의 프라이버시권 내지 근본적 자유이익에 포섭하는 것으로 이해하고 있으며, 이러한 소극적 안락사는 모든 주에서 허용되고 있으며 이를 보다 구체화시킨 자연사법이 제정되어 있는 형편이다. 그러나 아직까지 연방대법원은 의사조력자살을 포함한 적극적 안락사에 대한 권리를 근본적 권리로 인정하지 않고 있으나, 의사조력자살에 대해서는 각 주별로 입법을 통해 ‘죽을 권리’를 구체화시키려는 노력이 진행되고 있으며, 현재 오리건州와 워싱턴州에 존엄사법이라는 법명으로 입법이 이루어져 있다. 셋째, 치료거부의 권리를 헌법상 기본권으로 인식하고 이익형량의 방식으로 이 권리의 구체적 실현 여부를 판단하고 있는 연방대법원의 분석틀은 이익형량(Balancing Test)이라는 용어뿐만 아니라 공익과 사익의 조화를 도모한다는 법익균형의 관점에서도 우리의 비례성원칙과 매우 유사한 기본권심사구조를 가지고 있음을 알 수 있다. 넷째, 치료거부권을 포함한 넓은 의미의 ‘죽을 권리’에 대한 헌법적 근거를 논함에 있어, 수정헌법 제14조의 적법절차조항에 터 잡은 프라이버시권으로 이해하는 견해와 수정헌법 제9조의 열거되지 않은 기본권 경시불가조항을 근거로 제시하는 견해의 대립이 있는바, 이는 우리나라의 경우에 헌법 제10조의 인간으로서의 존엄과 가치 및 행복추구권에 기초한 자기결정권의 행사로 이해하는 견해와 헌법 제17조의 사생활의 비밀과 자유의 권리를 근거로 한다는 견해의 대립과 유사한 구조를 보여주고 있다. On May 21, 2009, the Supreme Court of Korea ordered to eliminate device for meaningless life-suspending treatment from a 78-year-old female patient, accepting her children's claim that she had always opposed keeping people alive on life-extending machines and her self-determination right, protected by right to human dignity and right pursuing happiness under Article 10 of the Constitution of Republic of Korea, should be guaranteed as a fundamental right. It is very interesting that although that decision has never used the terminology of ‘Death with Dignity’, many domestic media called it as the first Death with Dignity decision in Korea. But the concept of ‘Death with Dignity’ in Korea is mingled with the similar concepts of 'Withdrawal of Life-sustaining Treatment' or 'Assisted Suicide', etc., on an advocate's own point of view. It is also difficult matter to classify the concepts and to make legislation handling 'Death with Dignity', because the meaning of 'Death with Dignity' has been changing and it does not exactly square with the meaning from the general classifications on euthanasia. On the basis of the critical mind on these problems, this Article reviews the possibility of acknowledging the self-determining right to 'Death with Dignity' of terminally ill patient as a basic right and its constitutional basis, for example, under the Ninth Amendment or the Fourteenth Amendment in U.S. Constitution. And it also examines the leading cases on passive euthanasia and physician-assisted suicide, such as In re Quinlan(355 A.2d 647 (N.J. 1976)), Cruzan v. Director, Missouri Department of Health(497 U.S. 261 (1990)), Washington v. Glucksberg(117 S. Ct. 2258 (1997)), and Vacco v. Quill(117 S. Ct. 2293 (1997)). Futhermore, it overviews a diversity of opinions on whether 'Death with Dignity' should be protected as a constitutional fundamental right in U.S.

연명치료중단에 관한 사례비교 및 존엄사의 정당화 가능성 연구

권혁남(Hyeok-Nam Kwon) 한국생명윤리학회 2010 생명윤리 Vol.11 No.1

지난해는 존엄사와 관련하여 몇 건의 의미 있는 죽음이 있었다. ‘사전의료지시서’를 통해 연명치료를 거부했던 고(故) 김수환 추기경, 똑같이 ‘사전의료지시서’를 남겼지만 연명치료를 원했던 고(故) 김대중 전대통령 그리고 대법원의 존엄사 인정 판례를 최초로 끌어냈던 김 할머니의 죽음 등이 그것이다. 저들의 죽음이 의미를 띨 수 있는 이유는, 각각 다른 방식으로 죽음을 맞이함으로써 존엄사와 관련한 공론의 장을 마련할 수 있었다는데 있다. 하지만 저들의 죽음을 매개로 이루어지는 이른바 죽음 담론에는 많은 철학적, 생명윤리학적 문제점이 내포되어 있다. 특히 존엄사를 최초로 인정한 대법원의 판례는, 그 결과에는 동의할 수 있을지 모르나 존엄사 인정의 논증 과정에는 결코 찬동하기 어려운 논리적 난점이 숨어 있었다. 자기결정권을 존엄사 인정 근거로 삼되 그 자기결정권 자체에 대한 철학적/윤리적 반성 작업에는 소홀히 했기 때문이다. 또한 공익적 관점과 그 기저에 깔려있는 형식적 공리주의의 견지는 존엄사를 찬성하는 진영의 논리적 허점만을 노출시키는 꼴이었다. 이에 본 논문에서는 김 할머니, 김수환 추기경, 김대중 전 대통령을 다루는 기존의 죽음 담론과 대법원 판례에 비판적으로 접근하였다. 이러한 작업을 통해 존엄사와 안락사를 아우르는 죽음 담론의 이론적 기초를 확고히 하고자 했다. 아울러 존엄사를 인정하는 근거로서 실존적 인간의 결단으로서의 존엄사라는 새로운 관점을 제시하고자 하였다. In last year, with regard to death with dignity, there were some meaningful deaths- Cardinal Kim Soo-Hwan refusing life-sustaining care through ‘Advance Directives’, former president Kim Dae-Joong wanting life-sustaining care through ‘Advance Directives’ and old woman Mrs. Kim leading approval of death with dignity from Supreme Court for the first time. Their death was meaningful since their death led discussions on death with dignity by coming to death in each other way. However, in discourse on death by the medium of their death, a lot of philosophical and bioethical problems are included. Especially, in the case of Supreme Court which approved death with dignity for the first time, the result may be accepted. However, in the process of arguing approval of death with dignity, there were logical problems difficult to get people’s approval. For, the Supreme Court regarded self-actualization as a ground to approve death with dignity. However, it neglected philosophical/ethical reflection in self-actualization itself. In addition, the viewpoint of public interest and underlying formal utilitarianism exposed only logical weak points of the party supporting death with dignity. Therefore, the study approached the existing death discourse and Supreme Court’s case treating old woman Mrs. Kim, Cardinal Kim Soo-Hwan and former president Kim Dae-Joong in a critical way. Through such works, the study attempted to make a firm theoretical foundation of death discourse including death with dignity and euthanasia. In addition, as a ground to support death with dignity, the study suggested a new viewpoint which was death with dignity as decision of existential human.

자발적인 소극적 안락사와 소위"존엄사"의 구분 가능성

최경석 ( Kyung Suk Choi ) 한국의료윤리학회 2009 한국의료윤리학회지 Vol.12 No.1

The concept of "death with dignity" has received a great deal of attention in South Korea recently. While some believe that death with dignity is different from euthanasia, others maintain that it is a form of voluntary passive euthanasia. Medical futility and autonomy clearly play an important role in the moral justification of death with dignity. This article argues for the necessity of introducing a new criterion of medical futility into the classification of euthanasia, for there may be moral differences between medically futile treatment and basic treatment such as antibiotics, hydration, and nutrition. The patient`s views on what constitutes medical futility may also be relevant. One notion of death with dignity examined in this article is the idea of not interfering with "natural death." This notion of death with dignity is distinct from any form of euthanasia defined as hastening a patient`s death for him/herself. However, as is shown in this article, this notion is impractical due to the vagueness of the concept of "natural death." Thus, this article defends the claim that death with dignity is a form of euthanasia.