다이설피람-에탄올 반응에 의한 저체온증 1례

배현아,어은경,Bae, Hyun-A,Eo, Eun-Kyung 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1

Disulfiram (tetraethylthiuram disulphid) is used in the treatment of chronic alcoholism since it causes an unpleasant aversive reaction to alcohol. It works by inactivating hepatic aldehyde dehydrogenase, leading to pronounced rise in the acetaldehyde concentration when ethanol is metabolized. Acetaldehyde causes alcohol sensitivity, which involve vasodilation associated with feeling of hotness and facial flushing, increased heart rate and respiration rates, lowered blood pressure, nausea, headache. One of its metabolites, diethyldithiocarbamate (DDC) can inhibit the enzyme dopamine $\beta$-hydroxylase (DBH), this may account for the profound refractory hypotension and hypothermia seen with the disulfiram-ethanol reaction (DER), resulting from norepinephrine depletion. This report is presents the case of a patient we met, who presented with hypothermia caused by the disulfiram-ethanol reaction, and along with a brief review of the subject.

급성 약물중독 환자에서 위세척의 의료법학적 고찰 -대법원 2005.1.28, 2003다1419 판결을 중심으로-

배현아,Bae, Hyun-A 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.1

Gastric lavage is now known to be ineffective, unnecessary or hazardous in some circumstances where it used to be performed as a routine. This article concerns the medico-legal aspect of forced gastric lavage. The Supreme Court 2005.1.28, 2003da14119 is the case where a patient, who ingested the organophosphate insecticide to attempt suicide and refused lavage. At first we discuss the effectiveness or hazards of lavage because a very high degree of proof -of negligence, not error of clinical judgment - would be required. Lavage, with or without the informed consent, performed negligently which result in harm could, of course, give rise to a claim in negligence. A doctor might also be held negligent in failing to perform an act which he/she had a duty to perform.

성희롱 피해자 보호를 위한 법적 조치 강화 방안 -건강권 보장 관점의 적용-

권문영 ( Kwon Mun-nyoung ),강민아 ( Kang Min-ah ),배현아 ( Bae Hyun-a ) 제주대학교 법과정책연구소 2016 法과 政策 Vol.22 No.2

이 논문은 그동안 간과되어 왔던 문제인 성희롱 피해자의 건강 피해로부터의 회복과 보상을 지원함으로써 성희롱 피해자를 보호하기 위한 법적, 제도적 조치가 강화되어야 함을 주장하고 그 방안을 고찰하는데 목적이 있다. 이를 위해 첫째, 성희롱 피해자의 건강 피해를 간과하고 있는 현재의 법적 규정의 문제와 이로 인해 가중되는 건강 피해가 구체적으로 어떠한지 살펴보았다. 둘째, 성희롱 예방과 피해자 보호를 위한 조치가 다양하게 마련되어 있는 유럽연합을 비롯한 각 회원국의 성희롱 규제 내용을 개괄한 후 시사점을 제시하였다. 성희롱 피해자를 적극적으로 보호하기 위해서는 우선, 성희롱을 괴롭힘의 하위 범주로 구성하는 법적 노력이 필요하다. 성희롱 행위로 인한 피해는 정신적ㆍ신체적 건강 피해만이 아니라, 주변인이 가해자가 아닌 피해자를 비난하고 괴롭히는 행위 등에 의한 추가적인 피해와 함께 노동권과 학습권이 침해되어 삶이 불안정해지는 것이 모두 포함된다. 그러나 현재는 이처럼 광범위한 피해를 보호할 수 있는 법적 근거가 마련되어 있지 않다. 따라서 괴롭힘을 규제할 수 있는 법적 근거를 마련하는 것은 성희롱으로 인해 야기되는 건강 피해에 대한 사후적 접근을 포함하여 안전한 생활환경을 조성하는 사전적 예방 조치로서의 건강권이 보장될 수 있다는 점에서 매우 유효하다. 둘째, 성희롱 피해자를 위한 상담체계의 구성 및 휴가제도의 도입이다. 성희롱의 경우 행위가 이루어짐과 동시에 정신적ㆍ신체적 건강 피해가 야기되고 피해자가 속한 공동체 구성원에 의해 추가적인 피해가 발생할 가능성이 매우 높다. 따라서 전문가와의 상담과 가해자와의 분리, 그리고 피해자가 원할 경우에는 성희롱 행위가 발생한 공동체와 거리를 두는 것도 다양한 피해를 최소화할 수 있는 방안이다. 셋째, 산업재해에서의 상해의 기준을 트라우마 후의 심리적 트라우마로 확장하고 직업훈련생, 채용을 위해 지원한 자, 고용관계가 이미 종료된 자 등으로 적용 대상의 범위를 확대할 필요가 있다. 마지막으로 성희롱이 발생하는 한국 사회의 구조적인 성별 위계 시스템에 대한 적극적인 문제제기로 건강한 생활환경을 조성하여 성희롱이 발생하지 않도록 예방하는 것이 무엇보다 필요하다. This study examines issues, heretofore neglected, which have negative impacts on the health of victims of sexual harassment in South Korea. We review the current status of legal and institutional measures inteded to support victims in their recovery from sexual harassment, as well as the available assistance in he form of financial compensation. At the outset, in order to bring about increased attention to this issue, this study reviews current South Korean legal provisions, observes the extent to which these provisions actually overlook damage to victims’ health, and furthermore, how current practices aggravate damages to the victims. Next, after reviewing the European Union’s measures, as upheld by its member states, for the prevention of sexual harassment, the protection of its victims when it does occur, and corroborating regulatory health reports, this study lays out its proposed recommendations for the South Korean system. As for the improvements of measures to protect the victims of sexual harassment, first there needs to be a legal effort to define sexual harassment as a sub-category of harassment. Damage caused by the sexual harassment not only consists of mental and physical health violation but also additional damage caused by the act of bystanders and bullies blaming the victim rather than the perpetrator. Also the incident evokes violation of victim’s labor rights and their rights to learn where their lives become unstable. However, currently, Korea lacks a legal basis to protect such extensive damage of the victims. Therefore, by providing a legal basis for regulating the harassment is very effective in guaranteeing the right to health in a reactive approach to health damage caused by sexual harassment and a proactive preventive measure to ensure a safe living environment. Second, is to introduce the ancillary health system such as providing a therapeutic consultation and a leave system. In the case of sexual harassment, the moment when the violation happens, it causes both mental and physical health damage and there is a high chance of additional damage that can be caused by the community members where the victim resides. Thus providing a therapeutic consultation with the expert, separating victim and offender, and if the victim wishes, keeping the victim away from the community where the sexual harassment occurred is a way which can minimize other various damages. Thirdly, there is a need for expanding the criteria of injury in an industrial accident as a psychological trauma and comprehensively expanding the range of subject to vocational trainees, people who have applied for the position and employees whose contract has been terminated. Lastly, there is a need to actively raise issues about the structure of hierarchical gender system which perpetrates sexual harassment in Korea to create a healthy living environment where it could prevent the occurrence of sexual harassment.

우리나라 일부 병원에서 환자, 보호자, 의료진의 연명치료 중지 관련 의사결정에 관한 태도 연구

권복규 ( Ivo Kwon ),고윤석 ( Youn Suck Koh ),윤영호 ( Young Ho Yun ),허대석 ( Dae Seog Heo ),서상연 ( Sang Yeon Seo ),김현철 ( Hyeon Chul Kim ),최경석 ( Kyung Suk Choi ),배현아 ( Hyun A Bae ),안경진 ( Kyung Jin Ahn ) 한국의료윤리학회 2010 한국의료윤리학회지 Vol.13 No.1

A survey was conducted from September to December 2008 to examine the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients and other related issues. The subjects for the study were 91 cancer patients, 96 family members of cancer or other terminally ill patients, and 140 physicians. Most subjects acknowledge the need for an appropriate regulatory framework for the withdrawal of treatment for terminal patients. However, some discrepancies were found among the different groups (patients, family members, physicians) in this study. Patients showed a stronger preference for the withdrawal of treatment than did family members. Also, most patients claimed they wanted to receive the diagnosis of a terminal illness from their physician, while most family members seem to think it is their own duty to convey such a diagnosis to the patient. Both groups prefer co-decision-making about the withdrawal of treatment over individual decision-making by the patient. However, most family members admit that they do not know much about the patient`s wishes and lack the time for sufficient conversation with the patient. Physicians are skeptical of the authenticity of the decisions made by family members, and some physicians also regard hospital ethics committees as being ineffective for resolving these issues. The results of this study paint a unique picture of clinical culture in Korea, where family members still exert strong influence on clinical decision-making and little information is shared between patients, family members, and physicians. The study points to a need for greater public education in Korea on the practical and ethical issues surrounding the withdrawal of treatment for terminal patients.

119 구급대원의 직무과실에 대한 국가배상책임

배현아 ( Hyun A Bae ),정구영 ( Koo Young Jung ),이경환 ( Kyung Hwan Lee ) 한국의료법학회 2004 한국의료법학회지 Vol.12 No.2

The public law liabilities of 119 rescue officers as public service workers include national indemnity liability and public service worker's compensation liability. The national indemnity liability makes 119 rescue officers concentrate on their works not by contracting their emergency medical practice. At the same time, it considered the distinctiveness on their works which deal with human life and body and emphasized on the indemnification liability of public service workers to the government.

미토콘드리아 대체 기술 적용의 윤리적·법적 문제

배현아 ( Bae Hyun A ) 한남대학교 과학기술법연구원 2017 과학기술법연구 Vol.23 No.2

미토콘드리아 DNA 변이(mutation)로 인한 모계 유전 질병을 치료할 수 있는 미토콘드리아 대체(mitochondrial replacement)이 적용된다면 다음 세대로 전달될 수 있는 생식세포에 대한 유전자 조작, 부모됨과 부모의 수와 관련된 정체성의 문제, 미끄러운 언덕길 논리 등 이 기술이 인간의 존엄성을 침해한다는 윤리적 문제의 발생가능성에 대한 우려가 있다. 이 연구는 미토콘드리아 유전의 특성을 고려하여 기존 치료법이 적용될 수 없는 한계와 새로운 기술의 불확실성에 따른 위험의 문제, 적용가능한 과학적 근거 등에 대하여 살펴보았고, 이러한 기술을 적용하기 위한 국내 생명윤리 및 안전에 관한 법률 등과 같은 법제에서 생식세포에 대한 유전자 치료와 그에 대한 연구, 배아 및 태아를 대상으로 한 유전자 검사의 허용 여부, 미토콘드리아 기증 등을 검토하고 향후 이러한 미토콘드리아 대체 기술을 적용하기 위하여 고려하여야 할 법적 문제에 대하여 연구하였다. Inherited genetic disorders caused by mutated mitochondrial DNA are progressive and can cause a wide spectrum of severe health problems. Symptoms of these disorders can appear at any time from birth, on wide range of severity. There is no cure for these disorders. So new variations of IVF techniques are being developed that aim to replace damaged mitochondria by using part of donated egg from a healthy individual. But such techniques are not currently permitted for treatment use under Korean legislation. In this article, I reviewed the legal considerations arising from possible use of such techniques for treatment in the future. The ethical issues that it discussed include that implication of identity, gemline therapy, parentage of child, the status of the mitochondrial donor and the implication for wider society and future generations.

응급 환자 진료에서 설명 의무와 환자 사생활 보호 의무가 상충될 때의 대처

배현아 ( Hyun A Bae ),이석배 ( Seok Bae Lee ),장혜영 ( Hye Young Jang ) 한국의료윤리학회 2007 한국의료윤리학회지 Vol.10 No.1

This article provides guidelines for obtaining informed consent in medical emergencies. Obtaining consent from patients in the emergency room can prevent appropriate and timely access to their evaluation and treatment. While mentally competent adults always have the right to consent, whether or not a minor has the right to consent depends up his or her mental capacity. As such, there is room for flexibility concerning the legal age for informed consent. After a judgment is made on the patient`s capacity for consent, the urgency of the situation should be considered. If medical treated is needed immediately, it should be provided, even if the patient is a minor. When there is enough time for getting consent, a physician should try to obtain consent from a patient or legal surrogate.

임상시험에서 취약성(vulnerability) 판단 기준 재정립과 임상시험심사위원회의 역할

배현아 ( Hyun A Bae ) 한국의료윤리학회 2011 한국의료윤리학회지 Vol.14 No.1

Vulnerability typically has been understood in terms of the ability to give or withhold informed consent and the likelihood of being misled, mistreated, or otherwise taken advantage of in research. The re-conceptualization of vulnerability from something that emerges primarily from membership in a specific population to a reality that emerges from characteristics of persons or the environment in which research is conducted also can inform IRB(Institutional Review Board)s` interpretation and application of the regulations and guidelines on clinical trials. Vulnerability should be evaluated by IRBs, which have the responsibility of identifying those persons who may require additional protections. This article argues that the widespread and inconsistent use of the concept of vulnerability in Korea has hindered the development of substantive ethical guidance and concrete regulations. It is argued, furthermore, that in order to protect patient welfare and justice, the category of vulnerability should be specified at the time at which a subject consents to participate in medical research.

보건의료법제 하에서 정밀의료기술 연구와 적용 : 수집 대상 정보 관련 법제를 중심으로

배현아(Bae, Hyun-A) 원광대학교 법학연구소 2020 의생명과학과 법 Vol.24 No.-

정밀의료기술은 개인의 유전 정보, 임상 정보, 생활습관 정보 등을 분석하여 질병의 진단, 치료, 예측, 예방 및 관리를 위한 최적의 맞춤형 의료헬스케어 서비스를 제공하는 기술로 정의된다. 이러한 정의에 따라 정밀의료기술 개발을 위한 수집대상 정보는 유전 정보, 임상 정보, 생활습관 정보 등으로 구분되며 그에 따라 생명윤리법과 의료법, 개인정보보호법에 따른 관련 법제들의 규제대상이 된다. 또한, 정밀의료기술 개발을 위한 연구는 인간대상연구로 기관위원회의 심의 대상임과 동시에 연구 과정에서 가명처리 등을 통해 개인정보보호법에 의한 과학적 연구 특례 대상이 될 수 있다. 정밀의료기술을 적용하여 활용하기 위해서는 이러한 각 정보보호 관련 법제의 정합성을 확보하고, 정보보호와 정보 활용의 균형을 고려한 새로운 법정책이 필요하다. 정밀의료기술과 같은 새로운 의생명과학기술의 도입과 활성화를 위해서는 법률의 경직성을 극복하기 위한 보건의료법체계 상 변화가 필요한데, 구체적으로는 의료서비스 제공 주체 제한, 제공되는 서비스 내용의 한계 등을 극복할 필요가 있다. 또한 정밀의료기술을 적용하여 실제로 맞춤형 의료와 헬스케어 서비스를 제공하기 위해서는 수요자를 대상으로 한 사회적 합의와 충분한 정보 제공 과정을 통해 불확실성이 내재된 과학기술에 대한 대응과 위험관리 절차가 필요하다. 그래야만 기존 전통적인 의료서비스의 한계를 극복하고 정밀의료기술의 실질적인 활용이 가능해질 것이며 이를 통해 바이오산업의 경쟁력을 확보할 수 있을 것이다. Precision medical technology is defined as a technology that analyzes genetic information, clinical information, lifestyle information, etc. to provide personalized medical practice and healthcare services for diagnosis, treatment, prediction, prevention and management of diseases. The information to be collected for the development of precision medical technology is classified into genetic information, clinical information, lifestyle information, etc., and related laws according to the Bioethics and Safety Act, Medical Service Act, and Personal Information Protection Act are subject to regulation. Research of precision medical technology is categorized as human subject research by Bioethics and Safety Act and is subject to examination by the institutional review committee, and at the same time, it may be subject to scientific research exceptions under the Personal Information Protection Act through pseudonymization. In order to apply and utilize precision medical technology, it is necessary to secure the consistency of each of these information protection-related laws, and a new governance for considering both information protection and utilization. In order to applicate precision medical technology, changes in medico-legal system are needed to overcome the rigidity of the law. Specifically, it is necessary to overcome the limitations of the subject and the contents of the heath care service provided. In addition, in order to actually provide personalized medical and healthcare services by applying precision medical technology, it is necessary to respond to inherent uncertainty and risk management procedures through social consensus and sufficient information process for consumers. Only then will it be possible to overcome the limitations of traditional medical services and to make practical use of precision medical technology, thereby securing competitiveness of the biotechnology and heathcare service industry.

병원 전 응급의료체계에서 의료지도와 무면허의료행위

배현아(Bae Hyun A) 한국형사법무정책연구원 2009 형사정책연구 Vol.79 No.-