연명중단에 관한 관련법 제정에서의 주요 내용과 방향성을 위한 소고 - 네덜란드「연명중단 및 자살방조를 위한 심사법」의 내용을 중심으로 -

문성제 법조협회 2010 法曹 Vol.59 No.2

On May 21, 2009, all medical instruments for sustaining the life of an old woman patient were legitimately removed in accordance with final judgment of the Supreme Court by her will and the consent of her family, but she has still survived with stable breathing. As a result, this case has involved social controversies about termination of meaningless life-sustaining medical treatment. In Korea, it is not so many years that there have been social interests and discussions formed concerning the termination of meaningless life-sustaining medical treatment. In terms of terminal care, however, some advanced foreign countries have even limitedly approved the right to refuse any medical treatment only for sustaining the life of patients in accordance with relevant judicial precedents since 1970's. Furthermore, there have been many discussions about certain hot issues such as physician-assisted suicide, death with dignity and natural death. As an example of actual disputes concerning the termination of life-sustaining medical treatment, the Right of Terminally Ill Act (a law regarding the rights of terminal patient) was enacted by the Legislative Assembly of Northern Territory in 1995 with a view to legalizing active euthanasia even under social controversies. Ultimately, the said Act was rejected by the Senate of Australian Parliament. In particular, the Netherlands already enacted Review Procedures for Termination of Life on Request and Assisted Suicide and Amendment to the Penal Code and the Burial and Cremation Act (hereinafter called ‘Euthanasia Act’) in 2001. This Act concludes that attending physician may disclaim any responsibility or liability for death with dignity which complies with certain requirements and procedures. Some foreign countries have already proceeded with a series of active discussions on death with dignity, and have enacted laws concerning the termination of life-sustaining medical treatment or have still addressed active discussions on enactment of such laws. On the contrary, Korea has just begun to discuss this issue with interests in recent years. The purpose of this study is to investigate what is covered by overseas laws regarding termination of life on request as well as details behind the enactment of such laws, so that it can examine what is discussed concerning this issue in Korea, major considerations of legal provisions required for future enactment of relevant laws, and possible orientation of such enactment in the future. Starting from such a critical mind, this study focused on discussing the ‘Euthanasia Act’ in the Netherlands, because Netherlands contemporary social and medical settings at the enactment of the Euthanasia Act were more or less similar to those of Korea, so the said Act may be a good reference for Korea to enact the law on death with dignity. Notably, the Netherlands had limitedly approved the euthanasia in accordance with judicial precedents before the enactment of Euthanasia Act. In this respect, it is inevitably consequential to review social environment and major judicial precedents before the enactment of said Act. Hence, this study deals with major considerations about Netherlands Euthanasia Act, major considerations for Korea to enact laws concerning the termination of life on request in near future, and also gives suggestions for possible orientation of such enactment. 2009년 5월 21일 대법원 판결에 의하여 환자의 연명을 위한 의료장치 등을 제거하였으나 환자가 스스로 안정적인 호흡으로 연명을 함으로서 충분한 논의과정 없이 판결을 내린 법원은 물론 병원의 환자에 대한 과잉진료 등을 둘러싸고 사회적 논란을 야기하게 되었다. 그러나 제 외국에서는 이미 활발한 논의 과정을 거쳐 연명중단을 위한 관련법을 제정하였거나 제정을 위한 논의가 활발하게 진행되고 있는데 반하여 우리의 경우 최근에 들어 관심을 가지고 논의가 시작되었다는 점을 고려할 때 관련법을 제정하여 시행하고 있는 국가들의 관계법의 내용과 법 제정 과정에서 나타난 제 문제 기타 사회 환경 등을 살펴봄으로서 향후 우리나라에서 논의될 경우를 대비하여 사전적으로 제 외국의 입법을 연구하는 것은 매우 의미 있는 일이라고 생각한다. 이 같은 문제의식을 가지고 본고에서는 그 논의의 범위를 한정하여 네덜란드의 ‘연명중단 및 자살방조를 위한 심사법’의 내용을 중심으로 살펴보았다. 논의의 범위를 네덜란드의 관련법으로 한정한 것은 본 법을 제정할 당시 네덜란드의 사회 및 의료 환경이 오늘 우리나라의 상황과 다소 유사하다는 점에서 향후 법 제정을 위한 논의과정에서 참고가 될 수 있다고 판단했기 때문이다. 그러나 우리나라의 경우 충분한 논의가 이루어지지 않은 상태에서 관련법의 제정은 예상하지 못한 위험에 처할 수 있다는 점에서, 법제정 이전에 충분한 논의와 연구를 통하여 법제화로 이어져야 할 것이다. 이를 위해서 우선 의사의 치료의무 및 범위 나아가 말기환자에 대한 치료의무와 그 한계에 대한 개념에 대한 정립이 필요하다고 보며, 의학적 적응이 없는 무의미한 치료라 하더라도 말기 환자들을 위한 통증완화 등을 목적으로 하는 호스피스의료 등과 같은 대체시설과 환경도 필요하다. 인간의 존엄을 강조하면서 무의미한 치료로 간주하여 생명을 중단하려는 그 자체는 이미 인간의 존엄을 해치는 것이다. 결국 연명중단을 위한 법제화의 노력보다 현대 의학으로 치유 불가능한 말기환자들의 마지막 삶을 영위할 수 있는 사회적 관심과 보장이 우선되어야 하며, 이 같은 보장이 없는 상태에서의 법제화는 인간의 존엄을 유지하기 위한 법제화가 아니라 인간의 존엄을 말살하고 생명을 경시하기 위한 법제라는 점에서 반대한다.

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.

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.

중화민국(타이완)「안녕완화의료조례(安寧緩和醫療條例)」의 연혁과 내용

석희태 대한의료법학회 2008 의료법학 Vol.9 No.2

In Republic of Chaina (Taiwan), Natural Death Act named “Anning Huanhe Yiliao Tiaoli” which means palliative and hospice care act was enacted in year of 2000. And enforced in the same year. Many scholars say that Taiwan's Act took Many U.S.A.'s acts such as ‘Federal Patient Self-Determination Act 1990’, ‘California Natural Death Act 1976’ and ‘Washington Natural Death Act 1979’ for a model. Taiwan's Act adopts a few outstanding systems - ‘advance declarations’ including ‘living will’ and ‘durable power of attorney for health care’, ‘family-determination system’ for a patient who is in a persistent unconscious state. This paper disusses this Act. The content is as follow : 1. A background of legislation. 6. Keeping documents. 2. The purpose of legislation. 7. Punitive provision. 3. The concept of terms. 8. The relationship with euthanasia. 4. Patient's self-determination. 9. Controversial issues. 5. Subrogated determination by family.

북한의 보험법 연구 - 보험계약 통칙적 내용을 중심으로 -

전우현 한국재산법학회 2012 재산법연구 Vol.29 No.1

The recent death of Kim Jong Il in North Korea is looked on to affect South-North Korea's economic cooperation as well as the policy of reunification in Korea. A variety of insurance contract can be included in the economic cooperation between South and North Korea, and accordingly there can be conflict in the insurance contract. I wanted to analyze the characteristics of North Korea's Insurance Act and compare it with that of our Insurance Act, which will help us to solve(arbitration) the dispute in insurance premium and insurance money. And it is required that we know the norms of a society to understand its structure of social consciousness. When it comes to look at insurance contracts, it is impossible for the government to recompense all private damages caused by the natural disaster or other accident even in the communist distribution system. Thus, insurance serves as a useful safety device to the victims of individual, enterprises, institutions, cooperative farms in North Korea, which tells capitalist insurance system is inevitable even in North Korea. We need to research the North Korea's insurance system because South-North Korean economic cooperation will become much more closely than now if the North Korea's foreign policy changes to open its economic system. In the dispute on the damages in the land, sea or aviation accident, insurance contract will be useful to solve it. So North Korea's Insurance Act is needed to be examined closely. North Korea is an anti-liberty society, so it blames liberal insurance contract system as a means to sqeeze out the people. Nevertheless, North Korea admits the liberal economic principles of insurance law wholy. North Korea's insurance business is monopolized by the government. A social security system has been developed in the communist economy theoretically, and North Korea's insurance system is connected with this social security system. North Korea's insurance has dual system, which are insurance contract agreed by both parties and social insurance(labor insurance), which explains that North Korea's insurance contract may be interpreted like the social insurance. North Korea's Insurance Act was not aimed to avoid the risk in free business, but supervise the economic activities. The accumulation of premiums and the management of insurance fund are regarded as means of national economic stability and economic policy. North Korea's Insurance Act classifies insurance as personal insurance and property insurance, which has the characteristic classifing the insurance contract according to the insured objective. The parties of the insurance contract in North Korea are the insurer and the insured (policyholder). There is only insurance broker system among the insurance contract's intermediaries. But insurance broker's authority, right, obligation and responsibility are not clearly prescribed. The regulation of under insurance, excess insurance, double insurance is not clear, though North Korea's insurance contract law requires insurable interest. It has only the subrogation system as to the third party, without one as to the insured object. Insurance contract is null and void in North Korea, if it infringes the interests of society and the community, or is concluded illegally, or is concluded after insurance accident broke out. Nevertheless, its interpretation is not clear. And, revocation and cancellation of the contract can not be distinguished in North Korea's Insurance Act. Insurance contract can not be revoked arbitrarily by the insurer, which is like the liberal insurance contract law. When insurance premium is not payed, its sanction is strict as much as the insurer don't pay insurance money at all, though insurance accident breaks out. The reinsurance contracts are needed in North Korea particularly, as he original insurers cannot cover all the damages caused by the natural disasters and other risks. However, reinsurers should bear the burden to pinpoint the de... 북한의 보험법은 사경제 주체의 자유로운 사업상 위험을 회피하게 하려는 것이 아니라 경제감독적 차원에서 제정된 것이다. 보험사업도 공행정의 하나로 보고, 보험료의 축적과 보험금 기금의 관리는 국가 경제안정의 수단임과 동시에 경제정책의 일종으로 간주된다. 보험법의 원리로서 자발성(자원성), 의무성, 신용성이 거론되는데 그 중 자발성(자원성)과 의무성은 상호 모순되는 성격을 지니고 있고 신용성은 보험계약상 국제적으로 정립된 원칙을 수용한 것으로 평가된다. 북한에서도 보험계약의 당사자는 보험계약자와 보험자이다. 보험사업자인 보험자는 원칙적으로 국가기관(국가보험감독기관)만이 담당하고 특수경제지대에서만 그 예외가 인정된다. 보험모집 종사자로서는 보험모집인, 보험대리상은 없고 보험중개인제도만 존재한다. 그런데 보험중개인의 권한, 권리, 의무, 책임이 어떠한지에 대해서는 전혀 정한 바가 없다. 북한의 보험계약법도 피보험이익을 요구하지만 일부보험, 초과보험, 중복보험 등에 관한 규율이 분명하지 않고, 보험계약 자체가 우리처럼 원칙적으로 낙성․불요식 계약이 아니라 요물계약성, 요식계약성의 성질을 띠고 있다. 보험자 대위에 있어서도 제3자 대위만 규정하고 잔존물 대위에 대해서는 명문이 없다.

연명의료 보류・중단에 대한 환자 가족의 결정

김천수 원광대학교 법학연구소 2022 의생명과학과 법 Vol.28 No.-

In this paper, the legal system is discussed in which a patient's family decides to withhold or discontinue life-sustaining treatment on behalf of the patient. After many decades of discussion in Korea, the Korean Act on Hospice and Palliative Care and Decisions on Life–sustaining Treatment for Patients at the End of Life was enacted in order that patients might decide whether to receive life-sustaining treatment or withhold or discontinue it. However, the Act has many errors or flaws related to the Korean Civil Code. This Act permits the decision by the family decision to withhold or discontinue life-sustaining treatment for the patient that lead to the earlier arrival of his or her death. This permission does not suit the purpose of introducing a system that allows the life-sustaining treatment to be withheld or discontinued by the patient’s intent. Examples of issues that reveal these points are as follows. First of all, the error can be pointed out that the decision to withhold or discontinue life-sustaining treatment was recognized as an expression of intention or legal act, not a quasi-legal act. Accordingly, minors are improperly specialized in the decision to withhold or discontinue life-sustaining treatment. In addition, many problems are identified in relation to the legal representative who has the parental authority to decide on withholding or discontinuing life-sustaining treatment for minors. The above mentioned Act has flaws in legislation in the case of sole parental authority, the situation of conflict of interests, the case of acting parental authority on behalf of underage children over their children, the case of deprivation of parental authority, and the case of a parent with parental authority alone without the status of a legal representative. There is also a problem in the composition of provision related with each proxy decision for minor patients and general patients. The ambiguity of the reasons for restricting the right to decide makes it difficult to judge who the members of a group of decision makers. The fact that various requirements for exercising the right to decide must be supplemented by interpretation causes difficulty in implementing the decision to withhold or discontinue life-sustaining treatment in the medical field. Furthermore, the flaw in legislation that makes it impossible to withhold or discontinue life-sustaining treatment for patients without any family to decide shows the need to accept the theory of an abstract hypothetical intention to replace the present family decision system. Finally, the fundamental point to be mentioned is that we should remember that the design of the present system for the decision to withhold or discontinue life-sustaining treatment is to ensure that the patient's own conviction to choose the path of ‘natural death’ be properly respected. 환자 쪽에서 연명의료를 받을 것인지 여부를 결정하여 연명의료를 보류하거나 중단할 수 있는가에 대하여 오랜 세월 논의 끝에, 이를 허용하는 법률(호스피스・완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법률)이 제정되었다. 그런데 이 법률은 민법과 관련하여 오류나 흠결을 많이 안고 있다. 더구나 근본적인 문제는 환자의 사망 시기를 보다 조기에 도래하게 하는 연명의료 보류・중단의 결정을 가족 결정에 맡길 수 있도록 한 것이다. 이는 연명의료 보류・중단의 허용이라는 제도 도입의 취지에 맞지 않는다. 이러한 문제점을 드러내는 쟁점들을 예시하면 다음과 같다. 연명의료 보류・중단의 결정을 준법률행위가 아니라 의사표시 내지 법률행위로 인식하였다는 점을 우선 지적할 수 있다. 그에 따라서 미성년자를 연명의료 보류・중단 결정의 규율에서 부적절하게 특별 취급하고 있다는 점이다. 그리고 미성년자에 대한 연명의료 보류・중단의 결정 권한을 법으로부터 부여받은 친권자인 법정대리인과 관련하여 많은 문제점들이 확인된다. 단독친권자인 경우, 이해상반의 상황, 미성년 자녀의 자녀에 대한 친권 대행의 경우, 친권 박탈 등의 경우, 법정대리인 지위 없는 친권자의 경우 등에 대한 규율의 흠결이 있다. 미성년 환자와 일반 환자에 관한 각 대행 결정의 구성에도 문제점이 있다. 결정권자 전원 합의에서 그 전원을 구성하는 사람을 확정함에 있어서 결정권 제한 사유의 규율이 모호한 점, 결정권 행사의 요건 다수를 해석으로 보충해야 하는 점 등은 의료현장에서 연명의료 보류・중단의 결정을 실행함에 어려움을 야기한다. 나아가서 결정할 가족이 전혀 없거나 연락이 안 되는 환자에 대한 연명의료 보류・중단이 불가능하다는 규율상 흠결은 가족 결정을 대신할 추상적 가상의사 이론으로 전환할 필요성을 보여준다. 마지막으로 언급할 근본적인 점은 연명의료 보류・중단의 결정에 관한 제도의 설계는 자연사(natural death)의 길을 선택하고자 하는 환자 본인의 소신이 제대로 존중되도록 하여야 한다는 점이다.

‘존엄사’ 법안의 분석과 평가 ― 입법학적 관점에서 ―

홍완식 한국입법학회 2009 입법학연구 Vol.6 No.-

This article evaluates Bills of 'Death with Dignity Act' in Korea. This seeks to provide a overview of the legislative process on Bills of 'Death with Dignity Act'. Now several Bills of 'Death with Dignity Act' are introduced by 3 member of the National Assembly and NGO. The Bills of 'Death with Dignity Act' in Korea regulate how a patient can refuse life-sustaining medical apparatus in what condition. The purpose of these bills is to permit patients to determine a dignity or natural death himself/herself. The self-determination of patients must be informed. The right to self-determination of patients includes life-sustaining medical care and the right to refuse life-sustaining medical care. The Korean Constitution can be interpreted that the right of dying patients to refuse life-sustaining medical care be respected. The right to refuse life-sustaining medical care for dying patients was established in the case of 'Severance Hospital', decided by the Korean Supreme Court in 2009.

연명의료결정법의 개정방안

손경찬(Son, Kyoung chan) 한국법학회 2020 법학연구 Vol.79 No.-

이 연구는 현행 연명의료결정법의 바람직한 개정방안을 찾아보기 위한 연구이다. ‘존엄사(자연사)’ 문제는 2004년 의료진에게 살인죄를 적용한 보라매 병원 사건으로 촉발되었고, 2009년 대법원 판결에서 지속적 식물상태(VS/UWS)인 김 할머니의 연명치료 장치를 제거할 것을 허용하면서, 그 찬반여부를 둘러싸고 폭발적인 논쟁과 사회적 격변을 거쳤다. 그리고 2018년부터 소위 연명의료결정법이 시행되고 있다. 연명의료결정법은 2000~2018년까지 각계각층의 고민과 염려를 담은 훌륭한 노작이다. 그런데 연명의료결정법은 지속적 식물상태 환자에게 적용할 수 없다는 한계를 가지고 있다. 동법의 제정으로 환자는 인간의 존엄권에 기한 자기결정권을 보장받게 되었고, 의료진은 연명의료결정에 관한 법적인 책임에서 벗어날 수 있게 되었다. 무엇보다 동법은 인간이 자신의 삶을 돌아보고 죽음을 어떻게 준비할 것인가를 결정할 수 있게 하였다는 의미가 있다. 다만, 동법은 지속적 식물상태 환자의 연명의료를 어떻게 결정할 것인지에 대한 규정이 누락되어 있다. 비교법적으로 미국・독일・일본의 판결과 법제에서도 지속적 식물상태 환자의 연명의료를 지속할 것인지 말 것인지가 문제된 사례가 많았으며, 한국에서 이 논의를 촉발하게 한 김 할머니 사건의 당사자도 지속적 식물상태였다. 따라서 앞으로 동법에서는 지속적 식물상태의 환자인 경우 연명의료결정을 어떻게 할 것인가를 신중히 논의한 뒤 규정하여야 한다. 특히 지속적 식물상태 환자의 추정적 의사를 판단할 수 없는 경우에는, 병원윤리위원회의 판단 만으로 연명의료중단을 할 수 없고, 행정기관 혹은 법원의 판결을 통해 해결하는 것이 필요하다. 다만 급식관 중단의 문제는 의사조력자살에 비견될 수 있어, 이를 합법으로 판단하기는 곤란하다. 따라서 환자가 자발호흡이 없는 뇌사상태에 준하는 지속적 식물상태인 경우 국가기관의 엄격한 심리와 판정을 거쳐 삶을 끝낼 수 있는 길을 열어주어야 한다. 이러한 주장은 종국에는 안락사를 허용하자는 미끄러운 경사길 논증은 결코 아니다. This study aims to find a desirable amendment for the current 「Act on Life-Sustaining Medical Care Determination」. The issue of ’Death with dignity (Natural death)’ was triggered by the incident at Boramae Medical Center, in which some medical staffs were convicted of murder by the Supreme Court in 2004. Further, it went through explosive debate over the pros and cons after the incident in 2009, that the Supreme Court released its final decision to approve the removal of life-sustaining medical device from elderly women Kim who had been in persistent vegetative state (vegetative state/unresponsive wakefulness syndrome [VS/UWS]). From 2018, the so-called 「Act on Life-Sustaining Treatment Determination」 has been in effect. The 「Act on Life-Sustaining Treatment Determination」 is an excellent work that contains the concerns of all walks of life from 2000 to 2018. With the enactment of this law, patients are guaranteed the right of Self-Determination based on human dignity, and medical staff can be free from legal responsibility for life-sustaining medical treatment. Furthermore, this law is meaningful as it allows each individual to take a moment to look back on his or her life and prepare for death. However, the 「Act on Life-Sustaining Medical Care Determination」 has limitations that it cannot be applied to patients in VS/UWS. It fails to contain regulations on how to determine life-sustaining medical treatment in patients with persistent vegetative state. Comparatively, there are numerous cases in which the permanent vegetative state of patients has been a problem even in the cases and legal systems of the United States, Germany, and Japan. The elderly women Kim, the party to the case which initiated the discussion on life-sustaining treatment in Korea was also in VS/UWS patients. Therefore, this act must discuss how to deal with life-sustaining treatment in patients in VS/UWS and define the results. Particularly in cases where presumptive intention of patient in VS/UWS is cannot be determined, it is not possible to stop life-sustaining treatment only by the judgment of the hospital ethics committee, so thus it is necessary to resolve the cases through the verdict of an administrative agency or court. However, it is difficult to legalize the removal of feeding tube from patients in VS/UWS, as it can be considered as a doctor-assisted suicide. Thus, if the patient is in a VS/UWS comparable to a brain-death state without spontaneous breathing, it is necessary to open a way to end life through strict screening and confirmation by administrative agency. This argument is definitely not a slippery slope argument to allow euthanasia in the end.

말기의료에 관한 미국 법제의 연구 - 말기의료결정 제도를 중심으로

석희태 대한의료법학회 2013 의료법학 Vol.14 No.1

The first legislation for terminal health-care decision was California’s Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life–sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self- Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

의사조력자살에 대한 고찰

이기헌 ( Ki Hun Lee ) 홍익대학교 법학연구소 2014 홍익법학 Vol.15 No.1

In Korea, it seems that due social interest is not paid on legalizing physician-assisted suicide while withdrawing life-sustaining treatments is expected to be legalized in the very near future. However, the quality of death in Korea is quite poor in terms of social perception of death, legal system related to death, pain control on dying patient, treatment level and burden of expenses. It must be the last happiness we can enjoy to determine the way of ending one`s life, because no one can escape death and no one can tell what kind of terrible pain would accompany death. Therefore, I referred to three major logical bases against active euthanasia, under which physician-assisted suicide comes. To find out whether there is a fundamental ethical difference between physician-assisted suicide and withdrawing life-sustaining treatments to the extent of prohibiting the former and allowing the latter, I examined into following arguments into detail. (1) Do we have the right to death? Affirmative. Because the right to death involves the most intimate and personal choices a person may make in a lifetime, choices central to personal dignity and autonomy, it is the essential to right of freedom and liberty. (2) Is physician-assisted suicide more immoral than withdrawing life-sustaining treatments? Negative. As long as the patient wants to die, it makes no sense to appeal to the patient`s right not to be killed. Therefore, there is no moral difference between terminating treatment that keeps him alive, and helping him to end his life by providing lethal pills. (3) Does concern for abuse or misuse justify a total prohibition on all physicianassisted suicide? Negative. The various risks following physician-assisted suicide apply equally to withdrawing life-sustaining treatments, and the state is capable of addressing such dangers through proper regulations. After that, I introduced the current regulations and operation situation of Death with Dignity Act(1997) of Oregon state. Finally, I examined into the pros and cons of the physician-assisted suicide in the field of criminal law, and briefly presented my personal opinion.