현대 의료기기의 사용과 한의사의 면허 범위 - 서울행정법원 2016. 6. 23. 선고 2015구합68789에 대한 평가 -

박덕봉 ( Deokbong Bak ),명순구 ( Soon-koo Myoung ) 고려대학교 법학연구원 2016 고려법학 Vol.0 No.83

면허를 받아 한의원을 개설·운영하던 한의사가 엑스선 골밀도측정기 (GPA-1000)를 설치하여 환자들에게 성장판 검사를 한 것에 대하여 검찰청 은 의료법 위반을 이유로 기소유예 처분을 하였다. 보건복지부장관은 이 행 위를 이유로 1개월 15일 동안 한의사면허 자격정지 처분을 하였다. 연구대 상판결은, 해당 행위가 한의사의 면허범위를 벗어나지 않았으므로 한의사면 허 자격정지처분은 부당한 것으로 취소해 달라는 원고의 청구를 기각했다. 우리나라는 전통적인 의학기술인 한의학과 외국에서 들어온 서양의학을 다른 진료행위로 구분하므로, 한의사는 의사의 영역에 속하는 의료행위를 할 수 없고 의사는 한의사에 속하는 의료행위를 할 수 없다. 그런데 최근 의료기술의 발달로 한의학과 서양의학의 진료 기술 및 방법이 서로 접근하 면서 양자의 한계를 명확히 구분하기 힘든 경우가 자주 발생하고 있다. 그 중 빈번히 문제되는 사안이 한의사가 영상의료기기를 사용하는 경우이다. 특히 초음파 기기의 경우 한의사가 이를 사용하여 환자의 병상과 병명을 진 단하고 치료행위를 하는 것은 한의학적 지식이나 방법에 기초한 것이 아니므로 한의사에게 면허된 의료행위로 보기 어렵다는 두 차례의 헌법재판소 결정 이후에도 논란이 계속되었다. 연구대상판결은 이러한 사회적 맥락 속 에서 나온 것이다. 의사와 한의사의 이원적 면허체계를 기조로 하면서 면허 범위에 대한 추상적 기준을 설정하지 않은 현행법에서 연구대상판결과 같은 분쟁은 당 연한 것이다. 치과의사가 환자의 눈가와 미간에 보톡스 시술을 한 것이 치과의사의 면허 범위를 벗어난 의료행위가 아니라고 한 최근의 대법원 전원 합의체 판결이 화제가 되었듯, 의료기술의 발전과 시대 상황의 변화, 의료서비스에 대한 수요자의 인식과 필요는 전통적인 의료행위, 치과의료행위, 한방의료행위 개념의 경계를 모호하게 만들고 있다. 의사와 한의사의 이원적 면허체계를 유지하면서 각 의료인의 면허범위를 법해석의 문제로 돌린 것 은 입법부가 입법사항에 관한 문제를 회피한 것으로 볼 여지도 없지 않다. 그런데 다른 한편으로는, 의료행위·치과의료행위·한방의료행위의 경계에 관 한 다툼을 해결할 수 있을 정도의 개념 정의를 실정법적으로 제시하는 것이 가능할까 하는 생각도 든다. 어쩌면 핵심 문제는 각 의료행위의 개념 설정 이라기보다는 의료일원화와 같은 면허제도에 관한 근본적 해결책이 아닐까 하는 생각이 든다. A licensed Korean medicine doctor ran a Korean medicine clinic in which he operated an X-ray bone density scanner(model number GPA-1000) in order to take growth plate images. In this regard the prosecutor`s office suspended indictment for reasons of violating the Medical Act. The minister of health and welfare suspended the license of the Korean medicine doctor for 1.5 months. The Seoul Administrative Court dismissed the plaintiff`s motion for vacating the suspension of license, although the plaintiff argued that the treatment he provided was within the scope of his Korean medicine license. In Korea there is a strict differentiation of medical treatment provided in the realm of Korean medicine and Western medicine. Therefore Korean medicine doctors cannot practice Western medicine and Western medicine doctors are barred from practicing Korean medicine. However with the latest development of medical appliances it is becoming increasingly difficult to draw a clear line between the two types of medicine. Problems arise when Korean medicine doctors use medical imaging devices. Of particular significance is when Korean medicine doctors use ultrasound devices in diagnosing and treating patients. Although the Constitutional Court has twice delivered its Opinion on the matter by saying that such medical acts cannot be seen as being based on Korean medicine the debate continues to exist in this regard. The Seoul Administrative Court`s decision is in the vein of the Constitutional Court`s Opinions. Unless the current dual license system is revised and a new abstract standard for setting the scope of license is introduced the court has no choice but to deliver decisions like the one studied here. As witnessed from the Supreme Court en banc decision that recognized a dentist`s botox injection into an area around the eyes and eyebrows of a patient, the circumstances surrounding the development of modern medical technology, the changing perception of medical treatment, and other factors are blurring the line between traditional western medicine, dental treatment, Korean medicine. By maintaining the dual system between Western and Korean medicine and leaving the scope of license of doctors to the realm of interpretation, lawmakers are in a sense abdicating their duty. On the other hand, it is not easy to define the precise boundaries between traditional westernmedicine, dental treatment, Korean medicine. This is why rather than attempting to provide for a definition, a fundamental solution to the problem may be the unification of the license system of doctors.

의사.한의사 복수면허자의 특성 및 근무현황에 대한 조사 연구

최병희,한경연,임병묵,정민정,윤영주,Choi, Byung-Hee,Han, Gyung-Yeon,Lim, Byung-Mook,Jeong, Min-Jeong,Yun, Young-Ju 대한예방한의학회 2011 대한예방한의학회지 Vol.15 No.1

Objectives : This study was performed to investigate the status of dual medical license holders who have both the medical doctor (MD) and the Korean medicine doctor (KMD) license in Korea, and provide basic data for developing the cooperational strategy between conventional western medicine and traditional Korean medicine. Methods : The questionnaires on the general characteristics and working status were developed and administered for both dual license holders and medical students with MD or KMD license. The data of 187 persons were collected and analyzed. Results : Mean age of dual medical license holders is $42.28{\pm}6.54$ and most of them are male(86.0%). 75.2% of them obtained MD license first. However among the students who had MD or KMD license, 73.7% had KMD license. The mean time for obtaining the additional license was $10.11{\pm}4.905$ year. Forty nine dual license holders are opening both medical clinic and Korean medicine clinic. Conclusions : To promote the role of dual license holders for collaborating traditional Korean medicine and western medicine, developing an integrative medical curriculum should be enhanced, and the studies investigating the practice characteristics, and self-consciousness of dual license holders are required.

근대일본의 의사면허의 변천: 의제부터 의사법까지

김영수 ( Young Soo Kim ) 연세대학교 의과대학 의사학과 의학사연구소 2013 연세의사학 Vol.16 No.1

In Japan, the modern medical and health administrative framework was created by the implementation of Isei, which was enacted in 1874. The qualification of general practitioners (medical doctors) and their duties were determined by the law. Existing medical doctors could get a temporary license to practice medicine; however, the new rules required medical doctors to pass a qualifying examination (醫術開業試驗, Ijutsu kaigyo siken), which eventually asked questions concerning modern western medical knowledge. New institutions for medical education were built and produced medical doctors educated under the new scheme. By consolidating regulations related to medical and health administration, medical doctors who studied western medical education performed a primary role in medical and health administration. Most doctors trained in traditional chinese medicine and Rangaku (蘭學) became excluded from the medical and health administration gradually. The Medical Act (舊醫師法, kyu-Ishiho) was legislated in 1906 and provided new stipulations for the granting of medical licenses. Only those who graduated from domestic and foreign medical schools became accepted as medical doctors. As a result, the examination for qualifying medical doctors was no longer used. This meant that the new medical license signified a certain status for medical doctors. During wartime, medical doctors were insufficient, and doctors trained as technicians were mass produced. This detracted from the quality of medical doctors and the medical care system, so a new Medical Act (醫師法, Ishiho) was established in 1948 after the war. It enacted a provision for the qualification of medical doctors. They were required to have formal medical school education, pass the National Medical Practitioners Qualifying Examination (醫師國家試驗, Ishikokkashiken), and train at a hospital for a year in an internship system.

의료인 결격사유와 면허취소의 개정 배경과 법적 제문제

김형선 한국의료법학회 2023 한국의료법학회지 Vol.31 No.2

의료계의 지속적인 반대에도 불구하고 ‘모든 범죄행위’를 면허결격사유 및 면허취소, 면허 재발급 기간을 규정한 「의료법」이 2023. 11. 20. 시행되었다. 의료인 면허는 「헌법」 제15조에서 보장하고 있는 직업선택의 자유에 근거한 기본권 중 하나이다. 즉 직업선택의 자유는 그가 선택한 직업을 자기결정에 따라 자유롭게 수행할 수 있는 직업수행의 자유를 포함하고 있으며, 각각의 제한 원리에 따라 엄격히 해석되어야 한다. 이에 의료인 단체는 일명‘의료인 면허취소법’에 대하여 헌법소원을 청구하였다. 현행 「의료법」은 전문 직군인 특히 변호사와의 “법적 형평성”과 의료인의 범죄 현황을 반영한 결과이다. 이에 「의료법」 연혁과 의료법과 변호사법의 형평성 문제, 의사의 범죄 현황을 검증하고자 하였다. 검토 결과 다음과 같은 결론을 도출하였다. 첫째, 국가시험응시 제한 사유로 의과 대학 입학 요건 및 국가 응시제한 사유를 구분할 필요가 있다. 둘째, 의료인 면허발급 시점을 기준으로 의료인 결격사유와 의료인 면허취소 사유를 구분하며, 의료인 면허 발급 신청과 면허 발급 후를 구분하여 취소, 철회, 면허 반납과 같은 법률 용어를 명확히 규정하여야 한다. 모든 범죄 행위로 인한 형선고 및 정신적·신체적 결격사유의 열거방식은 직무상 범죄와 직무상 건강 부적합자로 개정하고, 절차적 요건을 보완하여야 할 것이다. 마지막으로 모든 범죄 행위는 직무상 범죄로 한정하거나 면허관리 및 징계의 실효성을 제고하기 위하여 의사 단체에게 면허관리 권한을 위임 또는 최소한 변호사법과 같이 단체와 관할 관청이 동시에 행사할 수 있는 제도를 도입하여야 할 것이다. Despite continued opposition from the medical community, the 「Medical Act」, which stipulates grounds for license disqualification, license cancellation, and license reissue period for ‘all criminal acts,’ was implemented on November 20, 2023. A medical license is one of the basic rights based on freedom of occupational choice guaranteed in Article 15 of the Constitution. In other words, the freedom to choose an occupation includes the freedom to perform one's chosen occupation freely according to one's own decision, and must be interpreted strictly according to each limiting principle. Accordingly, a medical professional association, filed a constitutional petition against the so-called ‘Medical Person License Cancellation Act’. The current “Medical Act” is the result of reflecting “legal equity” with professionals, especially lawyers, and the criminal status of medical professionals. Accordingly, we sought to verify the history of the 「Medical Act」, issues of equity in the Medical Act and the Attorney-at-Law Act, and the current status of doctors' crimes. As a result of the review, the following conclusions were drawn. First, it is necessary to distinguish between medical school admission requirements and reasons for national application restrictions. Second, based on the time of issuance of a medical practitioner's license, reasons for disqualification and cancellation of a medical practitioner's license must be distinguished, and legal terms such as cancellation, withdrawal, and return of license must be clearly defined by distinguishing between application for medical practitioner license issuance and after license issuance. The method of enumerating sentences and mental and physical disqualifications for all criminal acts should be revised to include occupational crimes and health unfit for work, and procedural requirements should be supplemented. Lastly, in order to limit all criminal acts to occupational crimes or to improve the effectiveness of license management and disciplinary action, license management authority should be delegated to a medical group, or at least a system that can be exercised simultaneously by the group and the competent government office, such as the Attorney Act, should be introduced.

한국 의사의 역사적 정체성 형성

여인석,Yeo, In-sok 연세대학교 의과대학 2021 의학교육논단 Vol.23 No.2

In modern society, doctors are a representative example of professionals-that is, doctors are members of an occupation with high barriers to entry. For doctors, long-term education, training, and licensing are factors that make it difficult to enter medical practice. These external characteristics, which have mainly arisen in the modern era, play an important part in the professional identity of doctors. Nonetheless, the core of the doctor's identity is the identity of the healer. In today's Korean society, the universal identity of doctors as healers results from a combination of the special historical identity of professionals with high entry barriers. Korean society currently demands a high level of ethical awareness from doctors. These demands are partly derived from the nature of the practice of medical care, but they also reflect demands for strong social responsibility as professionals. It is difficult to cultivate professional ethics simply by imposing legitimate virtues, presenting an ideal model, or emphasizing moral education that is not fully realistic. A deep-rooted sense of professional ethics stems from a clear awareness of professional identity. Education plays an important role in the formation and awareness of doctors' professional identity, and various types of content and methods can be used in education. However, since the identity of an entity is formed through the process of historical experience, it is thought that the historical process of the formation of doctors as a profession should be included as an important part of education.

의사-한의사 복수면허자의 진로 선택, 학습 경험 및 업무 경험에 관한 질적 연구

박인효 한국보건사회학회 2023 보건과 사회과학 Vol.- No.62

This study investigates the experiences of individuals holding dual medical licenses, including both medical doctor and Korean Medicine (KM) doctor licenses. The study examines their motivations for obtaining dual licenses, their study and work experiences, and their relationships with fellow students and physicians. The objective of the study is to gain insight into how dual license holders establish their identities in the South Korean medical system, which is strictly divided into modern and traditional sectors. To achieve this objective, a qualitative interview survey was conducted with six multiple licensees of medical doctors and KM doctors. The data indicate that interview participants were interested in obtaining multiple licenses either before, immediately after, or long after completing their first medical schools. During the process of acquiring multiple licenses, respondents recognized differences between biomedicine and traditional Korean medicine, and encountered conflicts between medical doctors and KM doctors in their learning process and relationships with their professors and fellow physicians. In this process, it can be observed that dual license holders are often required to choose between their Western medical identity and their KM identity, in situations where conflicts arise between Western medical doctors and KM doctors. Consequently, they may face challenges in fully utilizing their medical skills within the South Korean healthcare system. Unlike previous studies that relied on quantitative analysis, this study provides a comprehensive understanding of how the lives and experiences of medical holders of both medical doctor and KM doctor licenses are linked to the characteristics of the Korean medical system, from the perspective of medical pluralism. 본 연구는 의사 면허와 한의사 면허를 복수 취득한 의료인들의 복수면허 선택 과정 및 학습경험, 면허 취득 후의 진료 경험 및 동료 의료인과의 관계를 살펴봄으로써, 현대 의학과 전통의학 분야로 엄격히 분리이원화된 한국의 전문직 의료체계의 환경에서 이들은 어떠한 경험을 하며 자신의 의료적 정체성을 만들어가는지를 살펴보고자 한다. 이를 위해 의사-한의사 복수면허자 6명을 대상으로 질적 면접 조사를 시행하여 자료를 수집하였다. 수집된 자료에 따르면, 면담참여자들은 첫 번째 의학 계열에 진학 후 면허 취득 전, 첫 번째 면허 취득 직후, 혹은 면허 취득 후 임상/연구직에 오래 종사한 후 복수면허 취득에 관심을 갖게 된 것으로 답하였는데, 이들은 상대측 의학지식에 대한 관심과 처음 선택한 분야의 의학지식에 대한 의구심, 의학적 지식의임상적 구현과정에서 한계 인식, 상대측 의료인과의 만남과 처음 선택한 의료인과의 갈등 관계속에서 복수면허 취득에 관심을 갖게 된 것으로 답하였다. 복수면허 취득 과정에서 응답자들은학습과정과 동료 학생 및 교수와의 관계 속에서 의학과 한의학의 차이, 의사와 한의사 간의 갈등에 대해 인식하게 되는 한편, 복수면허 취득 후에도 이러한 차이와 갈등은 경력을 이어가는과정에서 이들의 직업적 선택과 정체성 형성 과정에 영향을 끼치는 것으로 해석되었다. 이러한과정에서 복수면허자들은 의사, 한의사 간 갈등이 첨예한 상황에서 한쪽으로의 의료적 정체성을 선택해야 하는 상황에 놓이거나, 자신들의 의료적 역량을 최대한 발휘하는 데에 어려움을 겪게되는 환경에 처해있는 것으로 볼 수 있었다. 본 연구는 양적분석을 바탕으로 한 선행연구와 달리 의사-한의사 복수면허자들이 자신의 실제 경험 속에서 복수면허 취득 동기와 학습 및 임상경험 등 복수면허자로서 자신의 의료적 정체성을 형성하는 과정에 대해 스스로 해석하고 의미를 부여하는 과정을 살펴봄으로써 이들의 삶과 경험 속에 한국 의료체계의 분리이원화된 특성이 어떻게 드러나는지에 대해 의료다원주의 개념을 바탕으로 보다 깊이 있게 이해할 수 있는 기회를 제공하고 있다.

의사에 대한 행정처분과 자율적 규제- 의료안전을 위한 현행 행정처분 운용의 한계를 중심으로 -

박정일 서울시립대학교 서울시립대학교 법학연구소 2013 서울법학 Vol.21 No.2

For secure Medical treatment, doctors must be qualified. For this doctors’ quality, medical ethics as well as doctors’ ability to cure people should be considered. If a doctor commits a serious crime like murder, he/she should be excluded from the medical field. This role has usually been left to the administrative means such as revocation of license or suspension of license. However, the conventional disposition about doctors has been focused on mostly breach of duty as medical doctors. So, in this paper, ethical qualification as a medical doctor will be first discussed for secure Medical treatment. And then, concerning this aspect, it will be discussed which is better and more effective, the voluntary regulation of doctors or the government's administrative regulation through foreign regulatory practices. 안전한 의료를 위해서는 의사로서의 자질이 무엇보다 중요하다. 이 자질요건은기술적․능력적․윤리적인 면 등에서 종합적으로 고려되어야 한다. 의사의 자질은안전한 의료확보에 직접 연결되므로, 그 자질이 높은 수준에 있다고 말할 수 없는의사는 의료현장으로부터 당연 배제되어야 한다. 우리는 그동안 위와 같은 역할을 의사면허취소․의사면허자격정지라는 행정수단에 맡겨 왔다. 그러나 종래의 의사에 대한 행정처분은 안전한 의료를 할 수 있는의사로서의 자질요건 구비여부보다는 주로 일정한 법적의무 불이행을 대상으로 했다. 그래서 이 글에서는 첫째, 안전한 의료확보를 위해서는 법적의무의 불이행 뿐만아니라, 의사의 자질요건 구비여부도 규제의 대상에 포함시킬 것, 둘째 아직은 의사의 자율규제에 대한 국민의 기대와 신뢰에 비추어 볼 때 성급한 면이 없지 않지만, 위와 같은 목적을 달성하기 위해서는 정부주도의 행정규제보다는 의사들의 자율적규제가 더 효과적일 수 있음을 외국의 자율적 규제사례를 통하여 기술하였다.

한국 의사면허제도의 정착과정 - 한말과 일제시대를 중심으로 -

여인석,박윤재,이경록,박형우 대한의사학회 2002 醫史學 Vol.11 No.2

Medical license is to qualify a person for medical practice and to attribute him/her a privileged right in the practice. This privileged and exclusive right asks for protection from the side of a state and the state in turn needs qualified medical personnel in order to carry out her task of public health, one of the main duties of modern states. In Europe, physicians succeeded in obtaining medical license that guarantees the privileged right in a highly competitive medical market against other practitioners. The first regulation for medical license in Korea was made in 1900 when few Korean doctors trained in Western medicine was in practice. The regulation aimed at controlling traditional medical practitioners who had been practicing medicine without any qualification as a physician. The regulation was very brief, consisting of only seven articles. A newly revised regulation appeared in 1913 when Korea was under the occupation of Japan. The Japanese Government-General enacted a series of regulations about medical personnel, including dentists and traditional medical practitioners. This heralds its full-scale engagement in medical affaires in Korea. Unlike the case of European countries where medical license was obtained after a long struggle with other practitioners, in Korea, medical license was given to doctors too easily from the state. And this experience played a very important role in the formation of identity of Korean doctors.

竝存과 折衷의 二重奏 : 日帝下 韓醫學의 西洋醫學 認識과 受容

辛圭煥(Sihn Kyu-Hwan) 歷史敎育硏究會 2007 역사교육 Vol.101 No.-

Through the Student Doctor(Ui-saeng) Ordinance promulgated in November 1913, traditional Korean doctors were relegated to the lower status of Student Doctors, inferior to that of Western Doctors(Teacher Doctor, Ui-sa) or Traditional Doctors(Gentry Doctor, Ui-sa). As the Government-General of Korea(GGK, Joseon Chongdokbu) reorganized national health care system along the lines of Western Medicine(WM), the survival of Traditional Korean Medicine(TKM) became precarious with no institutional guarantee such as license of medical doctor or medical education. The GGK was inclined to construct a national health care system along the lines of WM, but Western doctors were few in number. Therefore, the GGK hoped to increase the number of Western doctors through the Licensing Exam of Western Doctor, and mobilized Student Doctors in public health work. However, there was little practical effect in the proliferation of Western doctors. Rather the GGK’s efforts to mobilize Student Doctors in public health work through the Licensing Exam of Student Doctor were strengthened. Because TKM had to learn WM to survive, they could not but accept WM in part. Most of the questions on the Licensing Exam of Student Doctor were based in WM. Despite little change in the Licensing Exam of Student Doctor, there was no fundamental change in the necessity of learning WM, thus rendering that the Student Doctor’s associations came in the end to accept WM. Despite the coercion of the GGK, TKM’s interests lay in medical treatment and pharmacopeia. To control the prescription of Western drugs, the GGK established a new examination in Western pharmacology. Earlier research explains the 1920s as a time of “East-West eclecticism” and the 1930s as a time of “recovery of traditional medicine.” On the whole, they place emphasis on TKM’s eclecticism, taking only what is need from the West by the East under the coercion of the GGK. However, my paper asserts that rather there was a coexistence of the two autonomous elements, the East and the West, within KTM. This coexistence was necessitated by the need to protect TKM’s identity. TKM’s coexistence and eclecticism represented TKM’s ideal and reality.

한의사의 진단을 위한 의료기기 사용에 관한 소고

김성은(Sung-Eun Kim),백경희(Kyoung-Hee Baek) 충북대학교 법학연구소 2023 과학기술과 법 Vol.14 No.1

South Koreaʼs medical system is dualized into Western medicine and oriental medicine, and accordingly, the doctorʼs license and oriental medical doctorʼs license system are in operation. Until now, the Supreme Court has judged the criteria for determining whether an unlicensed medical practice is established for the use of diagnostic medical devices by oriental doctors as follows. First, the legislative purpose of the dual medical system, Second, the provisions and purposes of laws related to the medical practice, Third, the academic principles underlying the medical practice, and Fourth, the course, purpose, and appearance of the medical practice, Fifth, it is necessary to comprehensively consider whether medical schools and oriental medicine universities have secured expertise through curriculum or national tests, and to make a reasonable judgment in light of social norms. However, the recent Supreme Court's Decision 2016Do21314 Decided December 22, 2022 ruled that oriental doctorsʼs using an ultrasound diagnostic device did not constitute unlicensed medical practice. The criteria for judging the majority opinion of the en banc judgment are as follows. First, the relevant laws and regulations should prohibit oriental medical doctors from using the medical device. Second, in light of the characteristics of the device and the level of basic and professional knowledge and technology required for its use, oriental medicine doctors should use it as an auxiliary means of diagnosis. Third, in light of the circumstances, purpose, and appearance of the entire medical practice, it should be considered whether it is clear that the use of the diagnostic device by oriental doctors is irrelevant to the application and application of it based on the principle of oriental medical practice. Fourth, from the perspective of criminal justice, the meaning of oriental medical practice should be clearly and strictly interpreted from the perspective of oriental medicine doctors, it was judged that diagnostic medical devices should be excluded from criminal punishment unless it is clear that they are not related to the principle of oriental medical practice. The use of medical devices by oriental doctors presupposes or links to oriental doctorsʼ diagnosis and treatment behavior, and diagnosis has a significant role in determining whether to treat or not and setting treatment methods. This paper aims to reduce the possibility of harm associated with medical accidents and help establish a reasonable doctor and oriental medical doctor license system by comprehensively examining diagnostic medical devices that have been mainly problematic.