현행법상 존엄사의 허용요건과 과제: 연명의료결정법을 중심으로

주호노 한국의료법학회 2018 한국의료법학회지 Vol.26 No.1

This article suggests solutions after grasping situations and analyzing causes of problems caused by enforcement of so-called ‘Death with Dignity Act’, that is ‘Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life’(shortly named ‘Act on Decisions on Life-Sustaining Treatment’). The withholding or withdrawal according to the Act on Decisions on Life-Sustaining Treatment can be principly justified by the principle of the right to self-determination. However, if patient is a minor or can not confirm his or her intention, the withholding or withdrawal according to the Act on Decisions on Life-Sustaining Treatment can be exceptionally justified by decision of minor’s parents or agreement of all members of his or her family, that is so-called others-determination, granted as an exception to the self-determination. Here, regarding ‘Act on Decisions on Life-Sustaining Treatment’, it is criticized as problems that the above Act can not thoroughly carry out the principle of the right to self-determination and leads to legal blank space in the case of a person without any family member. Because the principle of the right to self-determination has so-called exception of others-determination and the above Act has legal blank space. This article proposes a limitation theory of doctor’s treatment obligation as a solution to above problems. In other words, a limitation theory of doctor’s treatment obligation is suggested as a justification basis for withholding or withdrawal of life-sustaining treatment at the end of life in addition to the principle of the right to self-determination. According to above limitation theory of doctor’s treatment obligation, is a doctor’s legal treatment obligation ended when there is no medical indication which is composed of justification requirements for medical treatment togather with medical righteousness and informed consent. Thus, for the patients at the end of life, the medical indication can be denied under certain conditions, so that treatment obligation can be terminated as a result. If the treatment obligation has been terminated, withholding or withdrawal of life-sustaining treatment may already be outside of legal protection. Therefore, a limitation theory of doctor’s treatment obligation leads to the conclusion that it can substitute for criticism of others-determination and resolve the legal blank space against a person without any familymembers. 이 논문은 연명의료결정법이 초래하고 있는 문제의 현상을 파악한 후 그 원인을 분석하고 그에 대한 대책을 제시하고 있다. 연명의료결정법은 임종과정에 있는 환자의 연명의료의 보류 또는 중단에 대한 정당화근거로서 원칙적으로 환자의 자기결정권에 입각하고 있다. 다만, 환자가 미성년자인 경우나 본인의 의사를 확인할 수 없는 경우에는 친권자의 의사에 의하거나 가족 전원의 합의에 의하여 연명의료의 보류 또는 중단을 인정하는 자기결정의 예외로서 타인결정을 인정하고 있다. 여기서 연명의료결정법에 대하여는 환자의 자기결정권을 철저히 관철하지 못하고 있다는 점과 가족도 없는 무연고자의 경우에는 자기결정이 불가능한 경우 타인결정도 불가능하게 되어 법적 공백이 발생되고 있다는 점에 대하여는 문제점으로서 비판되고 있다. 이 논문은 이러한 문제점들에 대한 해결책으로서 의사의 치료의무한계론을 제시하고 있다. 다시 말해서, 연명의료의 보류 또는 중단에 대한 정당화근거로서 환자의 자기결정권 외에 의사의 치료의무한계론을 추가적으로 제시하고 있다. 의사의 치료의무한계론에 의하면 연명의료를 포함한 치료행위는 의술적 타당성과 설명후동의의 원칙과 함께 치료행위의 정당화요건인 의학적 적응성이 없는 경우에는 의사의 치료행위는 종료한다는 원리를 내용으로 하고 있다. 따라서 임종과정에 있는 환자에 대하여는 일정한 요건하에 의학적 적응성이 부정될 수 있고, 그 결과로서 치료의무가 종료된다고 할 수 있게 된다. 치료의무가 종료된 상황이라면 연명의료에 대한 보류 또는 중단은 이미 법적 보호의 대상이 아니라고 할 수 있게 된다. 따라서 의사의 치료의무한계론은 타인결정에 대한 비판이나 무연고자에 대한 법적 공백을 해결할 수 있는 대안이 될 수 있다는 결론에 이르게 된다.

생명권의 헌법적 근거와 연명치료중단에서의 생명권의 보호범위

엄주희 韓國憲法學會 2013 憲法學硏究 Vol.19 No.4

과학기술과 의학이 발전하면 할수록 인간 생명의 시작과 끝에서 생명권의 주체가 될 수 있는 경계선이 모호해진다. 생명의 끝에서 본다면, 연명치료중단, 의사조력자살이 생명권 침해나 제한에 해당되는지 최근 논란이 되고 있다. 헌법의 개정사를 통해 생명권의 근거가 되는 헌법 조항을 살펴본바 다음과 같은 결과에 도달하였다. 생명권은 기본권의 가장 본질적이고 핵심적인 보호 영역이면서 기본권 보장의 기초와 토대가 되며, 우리 헌법에 명시적으로 나타나지는 않지만 제헌헌법부터 현행헌법까지 명문화된 신체의 자유, 열거되지 아니한 권리의 경시 금지 조항으로부터 도출할 수 있고, 1962년 5차 헌법 개정에서부터 도입된 인간의 존엄과 가치 조항을 근거로도 인정될 수 있다. 무엇보다도 생명권은 기본권의 본질적이고 핵심적인 영역으로서 헌법에 명문 규정이 없더라도 인정될 수 있는 기본권이나, 생명권은 그 중요성과 기본권 체계 내의 질서를 감안할 때 독자적인 기본권으로 헌법에 규정하는 것이 바람직하다고 판단된다. 생명의 끝과 관련한 생명권의 최근 해석을 보면, 임종기에 직면한 환자의 연명치료중단의 권리는 생명권의 침해가 아닌 생명권의 보호범위 내에 있는 것으로서 환자의 의사결정에 의거하여 인정될 수 있는 헌법상 권리이다. 죽음이 임박한 환자에 대한 연명치료 중단은 생명권의 포기나 침해가 아닌 생명 활동의 보호이자 생명권 자체의 특성으로부터 도출되는 것으로서 인간으로서의 존엄과 가치와, 본인이 원치 않는 신체 침해를 배제할 권리 즉 치료거부권을 포함한 헌법상 자기결정권으로부터 나오는 것이다. 죽음에 이르는 과정도 삶의 일부분이며, 불치의 질병이나 신체손상에 의하여 죽음에 이르는 것이 생명활동의 자연스러운 현상이므로 환자의 진지한 의사결정에 기한 연명치료중단의 권리는 생명권을 보호하는 헌법 질서와 상통하는 삶의 마지막 권리라고 할 수 있다. Scientific and medical advances have made unclear the boundary line of one's life- the object of the right. From the viewpoint of the end of life, it has been a controversial issue whether the forgoing treatment and physician-assisted suicide apply to the violation and restriction in right to life. After studying articles of constitution through the constitutional history in Korea, I came to the conclusion as the followings. The right to life is the fundamental and essential protection area of constitutional right. Moreover, it is the foundation and basis for protection of constitutional rights though it has not been clearly implied in Korean constitution. The right to life is based on the personal liberty and the article which is about the right to prohibit the disparagement of other right and liberty only because of enumeration. These articles has been implied since the first constitution of Korea. It is based on the dignity of man which has been implied since the fifth amendment in 1962. It can be acknowledged as constitutional right regardless of legalizating its regulation. However it is desired that it is implied in Korean constitution in respect of the order system of constitutional rights. The recent interpretation of 'right to life' in the end of life is the following. The right of withholding or withdrawing of life-sustaining treatment for terminally ill is not the violation of right to life, but protection of the right and constitutional right which is based on the dignity of man and the constitutional right of self-determination. The process from life to death in the end of life is the part of living and natural phenomenon occurring in activity of life. Therefore the right of withholding or withdrawing of life-sustaining treatment according to terminally ill's genuine decision-making is the last right which coincides with constitutional order system to protect right to life and the right which is based on the right to life because of the nature of itself.

환자의 생명 종결 결정에 관한 헌법적 고찰

엄주희(Ju Hee Eom) 한국헌법판례연구학회 2013 헌법판례연구 Vol.14 No.-

임종기에 직면한 환자의 죽음을 앞당기거나 치료를 중단하는 행위에 관한 결정, 즉 생명 종결 결정에 관하여 연명치료중단, 의사조력자살, 호스피스 완화의료의 3가지로 분류하여 검토할 수 있다. 본고에서는 연명치료중단, 의사조력자살 그리고 호스피스 완화의료에 관한 미국 연방대법원의 판례와 우리나라의 헌법재판소 판례를 함께 검토하여 환자의 생명 종결 결정의 헌법적 권리에 대해 다음과 같은 결과를 도출하였다. 임종기에 직면한 환자의 연명치료중단의 권리는 생명권의 침해가 아닌 생명권의 보장으로서 의료진의 설명을 바탕으로 내린 환자의 진지한 의사결정에 의거하여 인정될 수 있는 헌법상 권리이다. 한국과 미국에서 모두 연명치료중단을 헌법상 권리로 인정하는데 이견이 없으며, 죽음이 임박한 환자에 대한 연명치료 중단은 환자 본인이 원치 않는 치료를 거부할 수 있는 치료거부권으로부터 나오는 것이다. 미국 헌법상 적법절차원리, 평등권이나 열거되지 아니한 권리 등의 근거로도 의사조력자살이 인정될 수 없다. 우리 헌법에서도 생명에 대한 개인의 처분권이 인정되지 않으므로 포괄적인 죽음에 대한 자기결정권이 인정될 수 없고 의사조력자살이 허용될 수 없다. 오히려 회복 불가능한 사망의 단계에 진입한 환자의 생명이라도 마지막 삶을 온전히 살아갈 수 있도록 법의 보호를 받도록 하는 것이 생명권을 보호하는 헌법 질서에 부합한다. 호스피스 완화의료는 말기환자의 고통을 완화하기 위하여 의료진으로부터 제공되는 치료로서 의사조력자살과는 명백히 구분되며, 임종기에 삶의 마지막까지 환자가 누릴 수 있는 권리이다. A constitutional analysis on decision-making at the end of life can be summarized into forgoing (withholding or withdrawing) life-sustaining treatment, physician-assisted suicide and hospice palliative care. After studying constitutional cases of the United States and Korea about forgoing (withholding or withdrawing) life-sustaining treatment, physician-assisted suicide and hospice palliative care, I came to the conclusion as the followings about constitutional rights of decision-making at the end of life. The right of withholding or withdrawing of life-sustaining treatment for terminally ill is not the violation of right to life, but protection of the right to life and constitutional right which is based on the right not to be damaged involuntarily. It is acknowledged as a constitutional right both in the United States and Korea. The right of physician-assisted suicide(PAS) is not acknowledged as a constitutional right neither from due process clause nor the right to equality nor the right to prohibit the disparagement of other right and liberty only because of enumeration under the constitutional system of the United States. The comprehensive right of self determination for death (right to die) and PAS cannot be acknowledged as a constitutional right because nobody hold dealing right to life under the constitutional system of Korea as well. It is rather consistent with the constitutional order defending right of life that the terminally ill should be protected legally for leading his own life to the end. As the care to alleviate pain and suffering provided by medical team as ruled by the supreme court, Hospice palliative care is the right for the terminally ill totally different from PAS.

공법 : 의사의 연명치료중단행위에 대한 형법적 정당화 요건과 구조

이백휴 ( Baek Hyu Lee ) 한양대학교 법학연구소 2010 법학논총 Vol.27 No.4

The purpose of this study is to search the requirements and structure of the "Physician`s Withdrawal of Life-Sustaining Treatment(LST)" or "physician-assisted suicide(PAS)", and to justify their actions in the context of the Criminal Law. If the patient died by "(Murder by) "the Physician`s Withdrawal of LST" or "PAS", this comes under Article 250 Section 1(Murder), Article 252 Section 1(Murder upon the Request), Article 252 Section 2(aiding to commit suicide) of the Criminal Code. But, if this meets certain conditions, "the Physician`s Withdrawal of LST" or "PAS" could be justified. (1) The basic conditions: i) The Physician must behavior. ii) It must meet the Justification of medical Treatment. (2) The objective conditions : i) The patient must be in an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death. ii) Treatment of this stage must be a medical futility in the end-of-life care. (3) The objective condition : It must be a patient`s informed consent, self determination about "the Withdrawal of LST" or "PAS". If the case meets all the conditions for its justification or if it does not meet some conditions, we will study the structure of justification about "the Physician`s Withdrawal of LST" or "PAS" in criminal law. (1) First, since this issue is related to people`s lives, there are various types of conflicts about the value. Thus, it is necessary to enact laws for physicians to be relieved from the legal disputes and to resolve specific problems (procedural legitimacy) related this process. (2) Meanwhile, it is necessary to solve the problems, related legislations are not exist, or legislation exists, but its interpretations are controversial, or exempted from the legislation. i) If it is clear that the patient is in an incurable and irreversible disease, the withdrawing of LST or aiding the patient to commit suicide would be legally allowed depending on their medical decision, regardless of the patient`s own will. But if it is clear that the patient is in an curable and reversible disease, the Physician should continue the treatment for patients. ii) If it is not clear whether the patient has an incurable and irreversible disease or not, and if treatment in this situation is medical futility-within reasonable medical judgment-, "the Physician`s withdrawing of LST" or "PAS" can be allowed according to patient`s current, voluntary and explicit will for the purpose of ending his or her life (legitimacy on right to self determination). Thus, if the legal requirements for justification, including the patient`s will, are established, then they can be evaluated, it is an act which does not violate the Normal Social Rules (Korean Criminal Act Article 20).

Reflections on the Movement for the Legalization of “Death with Dignity as Withdrawal of Futile Life-Sustaining Treatment” in South Korea

( Kyongjin Ahn ),( Hyuna Bae ) 서울대학교 법학연구소 2011 Journal of Korean Law Vol.10 No.1

In this article, we will introduce Korea’s medico-legal cases that are related to the withdrawal of life-sustaining treatment. This paper examines the issue of the legalization of “death with dignity” by investigating Korea’s leading cases on the withdrawal of life-sustaining treatments and the current medical and legal situation in Korea. This paper also examines several preconditions for drafting a bill for such legislation. Considering the complexity of medical circumstances, laws and policies on end-of-life decision-making may not address every possible scenario. Thus, the laws and the policies would have to reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status. Therefore, it should be recognized that a public consensus is necessary for devising successful public policy and guidelines with respect to euthanasia and “death with dignity” in Korea. So proper guidelines and public debates that incorporate the views of the public, the government, and medical and legal professional associations will help create a firmer foundation for making better laws and policies regarding the end of life care issues.

연구논문 : 연명치료중단에 대한 환자측 사전 의료지시서의 법적효력에 대한 연구

고명환 ( Myung Hwan Ko ) 연세대학교 법학연구원 의료·과학기술과 법센터 2012 연세 의료·과학기술과 법 Vol.3 No.2

소위 김할머니 사건 판례는 환자 본인의 자기결정권을 어떻게 해석하여 연명치료를 중단할 것인가의 문제에 대하여 과감하게 접근한 판례이다. 다만 가족의 진술에 의한 추정적 의사해석을 주변인의 진술에 의존하여 판단하는 한계가 있다. 아직 의학적으로 명확하게 연명치료중단의 기준을 판별하기란 어려운 것이 현실이다. 그러나 법원이 본인의 추정적 의사에 관하여 판단하도록 일임할 것인지의 여부와 중단에 대한 의학전문가들의 판단에서 결정적으로 중요한 요소가 되는 것이 본인의 의사해석이다. 법원의 판단을 거치지만 결국 자기결정권을 최대한 존중해주는 것이 법적·윤리적으로 타당한 처신인가에 대한 물음에 대하여 외국의 앞선 존엄사법 등의 선례들을 보건데 결국 본인의 의사에 부합하도록 의사결정 방식에 대한 법원과 입법부의 고민이 최대의 관건이었다. 대법원이 밝힌 연명치료 중단에 대한 허용요건은 의학적으로 환자가 회복불가능한 사망의 단계에 진입했을 것과 환자의 의사표시를 인정할만한 사유가 있을 것 그리고 법원의 판결 또는 병원위원회의 판단이 있을 것을 요구한다. 이 중 다수의견과 소수의견간 첨예하게 대립한 부분은 환자의 자기결정권을 침해하지 않는 범위에서 환자 본인의 추정적 의사해석의 문제였다. 이에 대한 반성적 고려에서 사전의료지시서에 대한 논의가 추후 법학계와 의료계에서 이슈가 재점화 되었다. 법원에서 유효한 사전의료지시서의 요건을 명시화함으로써 실제의료기관과 환자, 보건복지부 등 관련 기관에서 사전의료지시서의 요건과 효력에 대한 구체적 논의가 진행중이다. 이에 대하여는 환자의 의사능력과 의사의 설명의무의 범위, 환자 대리인의 권한, 사전의료지시서의 요식성을 요구하는 문제 등에 대한 국내외의 다각적인 검토가 필요하다. 특히 환자의 의사능력과 관련하여 환자의 행위능력과 동의 능력과의 관계, 포괄적 대리권 행사, 의사 설명의무의 세부적 명문화 범위 등이 주요 고려사항이 될 것이다. 우리나라 국민 감정상 말기환자에 대하여 현재 상태에 관한 언급을 의사가 직접 하는 경우가 별로 없으며, 죽음에 관한 언급을 회피하는 경향이 있다. 또한 아직까지 사회적 함의 부족과 환자의 인식도가 성숙하지 않은 관계로 실행에 대한 한계 또한 고려된다. 그러나 보라매병원사건, 신촌세브란스 김할머니 사건처럼 본인 의사 확인이 안되어 야기되는 법적, 윤리적 수고스러움과 관련 분쟁의 해결을 위하여 본 지시서의 작성이 의료계약의 일환으로서 제도적 정착되어야 한다. The Supreme Court of Korea ruled that patients have the right to terminate medically meaningless treatment upon confirmation that their terminal illness is indeed irreversible. The Supreme Court`s decision thus makes proof of the irreversibility of a patient`s condition an important process in legitimatizing a patient`s decision to terminate life-sustaining treatment. However, since medical practice rejects explanation in terms of "essences" and is affected by issues of subjectivity, some argue that physicians cannot give indisputable confirmation of the irreversibility of a patient`s terminal illness, as required by the Supreme Court`s ruling. Medical decision-making is influenced by a variety of factors, including cultural norms, regional practices, patient values, physician responsibilities, and patient autonomy, Whether or not a patient`s family members should also influence the medical decision-making process is a legitimate question. Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. It is the so-called Shinchon Severance Hospital Case brought to an end by the decision of the Supreme Court that opened the real discourse of withholding or withdrawing of LST(Life-Sustaining Treatment) in the legal profession as well as medical profession in Korea. People has sympathy with the validity and necessity of legal regulation on withdrawing-including withholding-of LST save the requirements & procedure of withdrawing of LST. In this situation, the legislative bill of amendment to the Korean Civil Law introducing of adult guardianship was pre-announced by the Ministry of Justice on September 18th 2009. The adult guardianship is a guardianship system that supports an mentally handicapped adult to deal with his affairs by support of a guardian. The object of adult guardianship includes affairs of body or well-being as well as property of adult wards. In particular, affairs of medical matters are of importance in the duty and authority of adult guardians. So, the introduction of adult guardianship is of much importance de lege lata as well as de lege ferena in th discussion of withdrawing of LST as a medical treatment. Since the legislation on withdrawing of LST intents to protect the right of death with dignity on the basis of patients` autonomy, the ratio legis of withdrawing of LST is variant from that of adult guardianship. In this context, it seems reasonable to legislate the withdrawing of LST separately from the adult.

연명치료중단과 유보 결정에 대한 한국 중환자 전담의사 인식과 실행

김소윤 ( So Yoon Kim ),강현희 ( Hyun Hee Kang ),고윤석 ( Youn Suck Koh ),고신옥 ( Shin Ok Koh ) 한국의료윤리학회 2009 한국의료윤리학회지 Vol.12 No.1

Purpose: This study was performed to evaluate both the attitudes and practices of critical care physicians in Korean ICUs regarding end-of-life care decisions as well as the factors that influence those attitudes and practices. Methods: A questionnaire was developed and delivered to 100 members of the Korean Society of Critical Care Medicine in September 2007. The questionnaire was divided into six parts including personal information, decision-making processes, the withdrawing and withholding of life-sustaining treatment, informed consent, consultation with ethics committees, and guidelines. Results: Eighty eight responses from 53 different institutions were received. The results of the questionnaire include the following. There was a significant difference between the attitude and practices of respondents concerning family consent and patient`s consent. Attitudes toward patient and family consent differed significantly according to the clinical experiences of the respondents (p<.05). There was a significant difference between the attitudes and practices of respondents concerning how often caregivers effectively communicated with patients and family members. Attitudes toward family participation in decision-making processes differed significantly according to the respondents` gender. There was also a significance difference between the attitudes and practices of respondents regarding the withdrawal of life-sustaining treatment. Attitudes and practices on this issue varied according to the type of ICU where the respondents worked and their medical specialty. Practices concerning informed consent for "do not resuscitate" orders varied significantly according to respondent`s age and type of ICU. Finally, attitudes on the participation of ethics committees in decision-making processes varied significantly according to respondent`s clinical experiences (p<.05). Conclusions: This study found significant differences in the attitudes and practices of critical care physicians in Korean ICUs concerning end-of-life care decisions and the withdrawing and withholding of life-sustaining treatment. The study also found that the factors influencing these attitudes and practices include age, specialty, clinical experiences, and the types of ICU in which physicians work. However, there are some limitations in generalizing these findings.

호스피스ㆍ완화의료 및 연명의료결정에 관한 법률의 쟁점과 향후 과제

최경석 한국의료윤리학회 2016 한국의료윤리학회지 Vol.19 No.2

This article examines some of the legal issues and future tasks related to The Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act. It is argued that the following issues should be resolved before the Act is enforced: the medical criteria involved in the definition of “dying patient,” the relationship between hospice and life-sustaining treatment, the writing of physician orders of life-sustaining treatment (POLST), the establishment and activation of hospice ethics committees, the facility and personnel requirements of Advance Directive Registry units, the legal effects of advance directive (AD), and the confirmation of AD and POLST. Additionally, the article identifies other issues that are in need of public debate and discussion: the use of feeding tubes, the double criteria problem of surrogate decisionmaking, the review of POLST made by proxy decision-makers, the Korean culture of family-oriented surrogate decision-making, the necessity of understanding the standards for surrogate decision-making, and ethics consultation. 이 글은 “호스피스ㆍ완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법률” 제정이 지닌 의의를 밝힌 후, 연명의료결정의 문제를 중심으로 법률 제정 이후 풀어나가야 할 쟁점과 향후 과제를 다루고 있다. 필자는 법률 시행(2017년 8월 4일)을 위해 시행이전에 풀어야 할 쟁점과 과제로서, 임종과정에있는 환자의 의학적 판단 기준 마련, 호스피스와 연명의료의 관계에 대한 명확한 설명의 필요성, 연명의료계획서 작성을 누가 먼저 언급할 것인지의 문제, 병원윤리위원회의 기능 정립 및 활성화, 사전연명의료의향서 등록기관의 시설ㆍ인력 등의 요건 마련, 사전연명의료의향서의 효력 관련 문제, 사전연명의료의향서 및 연명의료계획서의 확인과 관련된 쟁점을 다루고 있다. 나아가 이번 법률제정에도 불구하고 연명의료결정의 문제와 관련하여 향후 우리 사회가 풀어나가야 할 장기적 과제로 남겨진 법률적 쟁점과 향후 과제로서 급식관 문제, 대리결정에 대한 이중적 태도의 문제점, 연명의료계획서의 대리 작성에 대한 검토와 가족 중심 의사결정 문화의 문제, 대리결정의 표준에 대한 이해의 필요성, 의료윤리 상담의 과제에 대해 논의하고 있다.

연명의료의 중단 - 대법원 2009.5.21. 선고 2009다17417 판결과 관련하여

석희태 대한의료법학회 2009 의료법학 Vol.10 No.1

Is it lawful to withhold or withdraw life-sustaining treatment applied to a patient in a terminal condition or permanent unconscious condition? In Korea, there are no such laws or regulations which control affairs related to the withholding or withdrawal life-support treatment and active euthanasia as the Natural Death Act or the Death with Dignity Act in the U. S. A. And in addition there has had no precedent of Supreme Court. Recently Supreme Court has pronounced a historical judgment on a terminal care case. The court allowed the withdrawal life-sustaining treatment from a patient in a permanent unconscious state. Fundamentally the court judged that the continuation of that medical treatment would infringe dignity and value of a patient as a human being. And the court required some legal grounds to consider such withdrawal or withholding of medical care lawful. The legal grounds are as follow. First, the patient is in a incurable and irreversible condition and already entered a stage of death. Second, the patient executed a directive in advance or at least the patient's will would be presumed through his/her character, view of value, philosophy, religious faith and career etc. I regard if a patient is in a incurable and irreversible condition or in a terminal condition, the medical contract between a patient and a doctor would be terminated because of the actual impossibility of achievement of it's purpose. So I think the discontinuation of life-sustaining care would be legally allowed without depending on the patient's own will.

Reflections on the Movement for the Legalization of “Death with Dignity as Withdrawal of Futile Life-Sustaining Treatment” in South Korea

안경진,배현아 서울대학교 아시아태평양법연구소 2010 Journal of Korean Law Vol.10 No.1

In this article, we will introduce Korea’s medico-legal cases that are related to the withdrawal of life-sustaining treatment. This paper examines the issue of the legalization of “death with dignity” by investigating Korea’s leading cases on the withdrawal of life-sustaining treatments and the current medical and legal situation in Korea. This paper also examines several preconditions for drafting a bill for such legislation. Considering the complexity of medical circumstances, laws and policies on end-of-life decision-making may not address every possible scenario. Thus, the laws and the policies would have to reflect the differing views of people based on their social status, moral values, religious beliefs, and economic status. Therefore, it should be recognized that a public consensus is necessary for devising successful public policy and guidelines with respect to euthanasia and “death with dignity” in Korea. So proper guidelines and public debates that incorporate the views of the public, the government, and medical and legal professional associations will help create a firmer foundation for making better laws and policies regarding the end of life care issues.