의료과오사건의 특성과 법률적 구성

이정환 원광대학교 법학연구소 2013 의생명과학과 법 Vol.10 No.-

Medical malpractice means that is caused by medical professional to harm in medical process, preterm birth, nursing process or health hygiene. It is wrong or mistake in Medical personnel of the average level who had lazy own's duty to take caution. This is an accident of medical malpractice due to medical malpractice. The medical malpractice case, because it is a concept that encompasses up to something that is not litigation, rather than the concept of medical malpractice litigation, is a comprehensive concept. Unlike the general case, it is an area that requires highly specialized knowledge. In that case, the process of the medical know only patients, families and a doctor. In addition, medical technology for achieving the result of the treatment it depends on the discretion of the doctor. Therefore, the direct cause of loss whether the negligence of a medical doctor has the characteristic only know doctor. In particular, If an accident of medical malpractice is litigation, that has important implications in connection with the information. For liability due to malpractice, it can be divided into criminal liability and civil liability. Civil liability has an object that compensate for damage on relief of victims in relation to person-to-person. In contrast, criminal liability is that it is an object of national sanctions that punishment to pursue the anti-norms of the actors about certain acts in relation to state-to-nation. In this way, Criminal liability and civil liability are different in nature and purpose. Therefore, it is not necessarily responsible to occur at all times to individual medical malpractice. In modern society, it is expanding to the part of the recognition to medical practices that were not considered in the past. As a result, medical malpractice cases increased year by year, damages case of medical malpractice is also increasing. In this paper, we understand the characteristics of a medical malpractice case that is a prerequisite of medical malpractice litigation has increased gradually, and I examine what is the cause of the claim's legal structure of the theory for overcome about difficulties of medical malpractice's evidence.

의료과오사건의 특성과 법률적 구성

이정환(Lee Jeong Hawn) 원광대학교 법학연구소 2013 의생명과학과 법 Vol.10 No.-

Medical malpractice means that is caused by medical professional to harm in medical process, preterm birth, nursing process or health hygiene. It is wrong or mistake in Medical personnel of the average level who had lazy own's duty to take caution. This is an accident of medical malpractice due to medical malpractice. The medical malpractice case, because it is a concept that encompasses up to something that is not litigation, rather than the concept of medical malpractice litigation, is a comprehensive concept. Unlike the general case, it is an area that requires highly specialized knowledge. In that case, the process of the medical know only patients, families and a doctor. In addition, medical technology for achieving the result of the treatment it depends on the discretion of the doctor. Therefore, the direct cause of loss whether the negligence of a medical doctor has the characteristic only know doctor. In particular, If an accident of medical malpractice is litigation, that has important implications in connection with the information. For liability due to malpractice, it can be divided into criminal liability and civil liability. Civil liability has an object that compensate for damage on relief of victims in relation to person-to-person. In contrast, criminal liability is that it is an object of national sanctions that punishment to pursue the anti-norms of the actors about certain acts in relation to state-to-nation. In this way, Criminal liability and civil liability are different in nature and purpose. Therefore, it is not necessarily responsible to occur at all times to individual medical malpractice. In modern society, it is expanding to the part of the recognition to medical practices that were not considered in the past. As a result, medical malpractice cases increased year by year, damages case of medical malpractice is also increasing. In this paper, we understand the characteristics of a medical malpractice case that is a prerequisite of medical malpractice litigation has increased gradually, and I examine what is the cause of the claim's legal structure of the theory for overcome about difficulties of medical malpractice's evidence.

의료과오에 있어서의 인과관계론

이정환(Lee Jeong Hawn) 원광대학교 법학연구소 2014 의생명과학과 법 Vol.11 No.-

If he is medical personnel of average according to principle of medical technique and medical common sense, Medical malpractice can be mistake or fault caused by neglecting medical obligation, generally which can be said in two case: One is the time someone must take charge of legal liability about medical treatment, the other is its own wrongdoing. Of course, you can see the mistake being included intentional doing, but usually Medical malpractice is used without intentional doing because already the mistake get out of medical practice's sphere as intention was involved. In order to be admit as a claim for damages due to medical malpractice, it needs causality between doctor's action and patient's damage caused by the action. usually causality premises cause and effect between a harmful act and loss occurrence, mean causality between a harmful act and indirectly damage, and is treated with connecting matter of trade imputation. However, in medical malpractice, doing particular action or nothing is unclear whether loss occurrence is attributed to doing or not, and it is frequently doubtful that wether misdiagnosis can be acknowledged by cause. In other words, naturalistically or scientifically judging causality is of course, difficult to judge empirical causality because causality in medical malpractice is related to specialized medical field. Therefore, judgement of causality must be performed by medical point of view, and when it comes to medical malpractice suit, it is demanded that you perceive how this specificity interact in causality. this fact is specificity of causality in medical malpractice. When it comes to malpractice suit in this specificity, default's cause on monetary debt is not independent with causality, and illegal act's cause will be considered with mistake including illegality or causality. Causality is sufficient to be proving as historical fact and scientific proof is unnecessary, which is also unnecessary because purpose of a civil trial focus on fairly solution. In the rapidly changing modern society, awareness about medical practice seems to grow extent to unimaginable part, medical malpractice accident and damage claim suit about medical malpractice is also annually increasing. Hence, we arrange the concept about object of obligation proof mitigation. On the basis of this arrangement, we check several theories with concerning causality in medical malpractice, A causal relationship theory fairly, recently disputed probability theory or realistic causality theory, and dynamic causality theory. We want to make sure of objectivity about standard setting of causality by examining a standard of judgment of causality existence.

한국과 일본에서 의료형법판례의 동향

김창렬 ( Chang Ryeol Kim ) 경상대학교 법학연구소 2015 法學硏究 Vol.23 No.1

최근 의료과실이 형사사건으로 되는 경우가 많다. 의료과실은 독특한 특징이 있다. 과실의 개념으로 주의위무위반은 행위당시의 구체적 상황에서 행위자의 사회적 지위에 속한 사려 깊고 양심적인 보통사람으로서 취할 수 있는 주의력으로 보호법익에 대한 위험을 인식하고 정확하게 판단하여, 그러한 위험을 회피하기 위한 정보를 수집하고 적절한 조치를 취하는 것을 게을리 하는 것이다. 과실의 체계적 지위는 고의와 마찬가지로 이중적 지위이다. 과실범의 성립요건으로서의 주의의무위반의 판단에 있어서 판례는 통설과 마찬가지로 객관적으로 평가하고 있다. 대법원은 “의료과실에 있어서 의사의 과실을 인정하려면 결과 발생을 예견할 수 있고 또 회피할 수 있었음에도 이를 하지 못한 점을 인정할 수 있어야 하고, 위 과실의 유무를 판단함에는 같은 업무와 직무에 종사하는 일반적 보통인의 주의 정도를 표준으로 하여야 하며, 이때 사고 당시의 일반적인 의학의 수준과 의료환경 및 조건, 의료행위의 특수성 등을 고려하여야 한다”라고 판단하고 있다. 주의의무 유무의 판단기준에 대해 개별 행위주체 의료인인 의사, 한의사, 간호사들에 대한 판례를 보았다. 또한 주의의무 인정의 전제조건으로 회피가능성과 예견가능성에 관한 판례도 보았다. 일본의 판례는 “이 임상의학 실천에서의 의료수준은 일률적으로 절대적인 수준으로 생각해야 할 것이 아니라 진료에 해당하는 당해 의사의 전문분야, 소속된 진료기관 성격, 그 소재하는 지역의 의료환경과 특성 등의 제반 사정을 고려해 판단해야 하는 것이지만 의료수준은 의사의 주의의무의 기준이 되는 것이기 때문에, 평균적 의사가 현재 행하고 있는 의료관행과는 반드시 일치하는 것이 아니고, 의사가 의료관행에 따른 의료행위를 했다고 해서 의료수준에 따른 주의의무를 다했다고 말 할 수 있는 것은 아니다”라고 하고 있다. 일본에서 의료형법판례의 동향은 처음에는 엄격한 의료과실책임을 묻다가 의료과실책임을 완화하려는 경향이 있다. 신뢰의 원칙과 과실의 충돌 또는 경합에 대해서도 판례를 보았다. 일본에서 독자적인 이론으로 “과실범에서 이탈”이 있다. 즉, 위험성의 전조가 보였던 경우에 최선을 다해 결과회피를 위한 주장을 한 사람에 대해서는 최소한 처벌은 하지 말아야 한다. 형법이론으로는 단적으로 인과관계를 부정하든지 그것이 곤란한 경우라도 정범에서 공범(종범)으로 낮춘다. 그렇게 하면 과실의 공범이라는 것은 일본에서는 사실상 처벌이 불가능하기 때문에 행위자는 무죄가 된다는 이론이다. 의료과실에 관한 분쟁이 증가하고 있는 현재의 시점에서 한국과 일본의 의료과실에 대한 형법판례의 동향을 통해 의료과실의 방지에 조금이나마 기여하고자 한다. Recent medical is often a criminal case. Medical malpractice is a unique feature. As a the concept of malpractice note pacification violation aware of the risks to the attention of the protected legal interests to take a thoughtful and conscientious people usually belong to the social status of the actors in the act at the time of the specific situation and determined exactly, gather information to avoid risks and to neglect to take the appropriate action. Systematic status of malpractice is a double post just as deliberate. Requirements as established in the judgment of the breach of the duty of care criminal of malpractice case law as well as common view has been evaluated objectively. The Supreme Court is able to predict the occurrence results in order to acknowledge Malpractice and negligence of the doctor should be able to admit that it did not even were able to avoid and again, the error in determining the presence or absence of the above tasks and duties involved in such and generally should be noted that usually the standard for the degree, this time at the time of the accident the level of general medicine and healthcare environments and conditions, you should consider the specificities of such medical care and decided it was time. Whether or not the individual actors duty of care to the criteria of the medical doctor, acupuncturist, saw a precedent for the nurses. In addition, attention is also seen cases on avoidance possibilities and predictability as a precondition for recognition obligations. Japan``s case law is medical expertise in the clinical practice of that profession uniformly doctor for the treatment not to be considered as an absolute level, belonging to the nature of medical institutions, the area of the environment and the characteristics of the material, such as medical but because of the need to consider the various factors determining health levels, that is the basis for the duty of care of a doctor, a medical practice and that the average doctor is currently carried out not necessarily match, doctors cautioned that the medical care according to medical practices not to say that all the obligations under the medical care level and said. Japanese trend of medical criminal law cases at first that stick to strict Malpractice liability tends to mitigate the Malpractice liability. Saw a precedent for the conflict or contention principles of trust and negligence. In Japan, a personal theory is away from the criminal of malpractice is. In other words, for a person who claims to avoid the best results when the harbinger of danger seemed minimal punishment should not. Criminal law theory is either deny the causal relationship exemplifies it lowers as an accomplice (accessory) any principal offender in difficult cases. Doing so is the fruit of an accomplice theory that the actor is not guilty because the punishment is virtually impossible in Japan. In the current time of a dispute regarding the Malpractice on the rise over the trends in criminal law cases for Malpractice in South Korea and Japan to contribute a little bit for the prevention of Malpractice.

의료과오에 있어서의 인과관계론

이정환 원광대학교 법학연구소 2014 의생명과학과 법 Vol.11 No.-

If he is medical personnel of average according to principle of medical technique and medical common sense, Medical malpractice can be mistake or fault caused by neglecting medical obligation, generally which can be said in two case: One is the time someone must take charge of legal liability about medical treatment, the other is its own wrongdoing. Of course, you can see the mistake being included intentional doing, but usually Medical malpractice is used without intentional doing because already the mistake get out of medical practice’s sphere as intention was involved. In order to be admit as a claim for damages due to medical malpractice, it needs causality between doctor’s action and patient’s damage caused by the action. usually causality premises cause and effect between a harmful act and loss occurrence, mean causality between a harmful act and indirectly damage, and is treated with connecting matter of trade imputation. However, in medical malpractice, doing particular action or nothing is unclear whether loss occurrence is attributed to doing or not, and it is frequently doubtful that wether misdiagnosis can be acknowledged by cause. In other words, naturalistically or scientifically judging causality is of course, difficult to judge empirical causality because causality in medical malpractice is related to specialized medical field. Therefore, judgement of causality must be performed by medical point of view, and when it comes to medical malpractice suit, it is demanded that you perceive how this specificity interact in causality. this fact is specificity of causality in medical malpractice. When it comes to malpractice suit in this specificity, default’s cause on monetary debt is not independent with causality, and illegal act’s cause will be considered with mistake including illegality or causality. Causality is sufficient to be proving as historical fact and scientific proof is unnecessary, which is also unnecessary because purpose of a civil trial focus on fairly solution. In the rapidly changing modern society, awareness about medical practice seems to grow extent to unimaginable part, medical malpractice accident and damage claim suit about medical malpractice is also annually increasing. Hence, we arrange the concept about object of obligation proof mitigation. On the basis of this arrangement, we check several theories with concerning causality in medical malpractice, A causal relationship theory fairly, recently disputed probability theory or realistic causality theory, and dynamic causality theory. We want to make sure of objectivity about standard setting of causality by examining a standard of judgment of causality existence.

연구논문(硏究論文) : 중국의 의료분쟁해결에 있어 의료손해감정

김정진 ( Jung Jin Kim ) 단국대학교 법학연구소 2012 법학논총 Vol.36 No.2

Since reforme and opening up, China has achieved rapid economic development. As economic achievement improves the welfare of Chinese people, the improvement of law system through Chinese society is consequently required. During the 1990s, China had extensively modified law systems, which provided legal basis for medical field. Even though the legal basis in medical field, China is still based on the general provision of Civil Law about the law issues related with civil case. Furthermore, any proper regulation and law to resolve medical dispute over medical malpractice did not exist. It was not until the year of 2009 that China legislated Tort Law by which illegal acts are regulated. Tort Law also regulated the liability of damage caused by medical malpractice, and with this, the legal system to resolve medical malpractice could be established. In this analysis, technical authentication of medical malpractice will be discussed, which is in the important position as an objective evidence in order to resolve medical malpractice. Recently, in China the medical malpractice is resolved through the process of either litigation or non-litigation, so-called ADR(alternative dispute resolution). However, the medical dispute would be resolved more frequently by administrative resolution and arbitration than litigation sued by the victim. In this case, of course, technical authentication of medical malpractice is indeed playing an important role to resolve medical dispute. Nevertheless, it still has many problems in terms of the results which are different depending on who authenticates, and the standard of authentication. Thus, the analysis will research on the basic understanding of Chinese medical dispute and dispute circumstance, first, and then examine how the process of technical authentication of medical malpractice would go through and what the problems are.

의료안전과 형사법의 역할

이재석(Lee, Jae-Suk) 한국법학회 2014 법학연구 Vol.53 No.-

본고에서는 의료사고가 발생한 경우, 의료인의 과실유무의 판단과정에서 제기되어지는 문제, 특히 의료안전과 관련한 형사책임 추급의 당부에 대해 우리나라와 일본의 논의상황을 중심으로 검토한 다음, 최근 시행된 의료분쟁조정법상의 의료분쟁해결제도에 대해 고찰하였다. 첫째 의료사고가 발생한 경우, 우리의 의료인들이 진료과정의 은폐본질을 완전하게 불식하지 않으면 영원히 의료과오소송에서 헤어나지 못한다는 것을 자각할 필요가 있다. 또한 의료안전과 신뢰를 구축하기 위한 법적 기반으로 의료기관의 감시가 감독관청의 감시밖에 없는 법체계는 시대의 조류에 부합하지 않는 것으로, 사회에 개방된 의료전문직의 자율적 질서형성을 핵심으로 한 의료조직법의 정비가 필요하다. 둘째 의료사고의 진상규명과 관련하여 중립적인 제3의 합의제 조사위원회의 설치가 요청되어진다. 의료인들이 직면하고 있는 의료과오소송의 격증은 의료인과 환자사이의 신뢰관계의 붕괴에 기인하고 있음은 부인할 수 없으며, 이러한 위기현상을 타개하기 위해서는 상호간의 공정한 감정만 보장된다면 크게 줄일 수 있을 것으로 보인다. 이와 관련해 의료분쟁조정법상의 조정중재원이 이러한 역할수행의 대행자가 될 수 있는가에 대해서도 진지한 검토가 필요하다. 셋째 의료인들의 의료과오에 대한 형사책임을 어느 범위에서 추급할 것인가의 여부는 궁극적으로 개별국가에 있어 법질서의 선택의 문제이다. 그러나 환자의 건강회복이라는 의료행위의 구명성, 선의성, 강제성 등을 고려할 때 형사책임의 추급에 있어 부당하게 의료인에게 관대한 것이 아닌 유보는 가능하며, 여기에서 의료과오가 경미한 과실에 의하여 발생한 경우에는 책임보험법적 통제에 만족해야 한다. 그리고 이것은 압도적 다수의 의료사고가 민사사건으로 해결되는 지금까지의 실무의 동향과도 기본적으로 일치한다. 넷째 최근 시행된 의료분쟁조정법의 조정ㆍ중재의 활성화를 위해서는, 피신청인의 참여확대방안으로 해당 법안의 발의에 주도적 역할을 한 의료계가 가지는 제도내용에 대한 반감이나 불신원인의 당부를 검토한 후, 이를 해소할 제도적 보완이 요청되어진다. 특히 피신청인의 소극적인 참여율 제고를 위해서는 실무 기구들에 있어 의료인의 구성 비율이 소수라는 견해에 대해서는 경청할 필요가 있다. 이외에도 동법이 규정하고 있는 형사처벌특례규정은 피해자에 대한 신속하고 공정한 구제에 기여할 수 있는 점에서 일반인의 이익은 물론, 최근 강조되어지는 회복적 사법의 이념과도 부합한다 하겠다. In the vast majority of situations, health care providers offer professional and invaluable services to their patients. But mistakes happen, good intentions aside. Medical malpractice occurs when a hospital, doctor or other health care professional, through a negligent act or omission, causes an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, aftercare or health management. To be considered medical malpractice under the law, the claim must have the following characteristics: A violation of the standard of care, An injury was caused by the negligence, The injury resulted in significant damages. Medical malpractice cases often share two characteristics: on the practical side they come charged with emotion and stress, and on the legal side they are extremely complex and challenging. The patient must prove that the negligence caused the injury. To pursue a medical malpractice claim, the patient must show that the injury resulted in disability, loss of income, unusual pain, suffering and hardship, or significant past and future medical bills. Therefore, malpractice suits are often complex and costly to win. Most experts would agree that the current medical malpractice system in the United States does not work effectively either to compensate victims fairly or prevent injuries caused by medical errors. In our case, after many twists and turns, the National Assembly finally passed the Bill on Malpractice-related Damage Relief and Medical Dispute Resolution on March 11, 2011. And the Korea Medical Dispute Mediation and Arbitration Agency (KMDMAA) was established on April 8, 2012. This act aims to secure just, speedy and inexpensive resolution of medical disputes, focusing on alternative dispute resolution (ADR) procedures. This thesis considers ‘Medical Safety and the Role of Criminal Law’ and explores several solutions to the problem. This thesis consists of six main parts. Ⅰ. Introduction, Ⅱ. An overview of the judicial management about medical malpractice, Ⅲ. The role of the Criminal Law about the medical safety, Ⅳ. Medical Safety and Accident Investigation, Ⅴ. Medical dispute settlement system in the Medical Dispute Mediation Act, Ⅵ. Conclusion.

“의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률”에 있어서 조정제도 및 향후전망

신은주 ( Eun Joo Shin ) 한국의료법학회 2011 한국의료법학회지 Vol.19 No.1

의료사고처리와 의료분쟁을 처리하기 위한 법안이 국회에 발의된 지 23년만에 의료분쟁조정법이 제정됨으로써 의료분쟁 해결에 큰 전환점을 가져 오게 되었다. 즉 종래 합의에 이르지 못한 경우에 주로 소송을 통하여 분쟁을 해결하거나 실력행사를 통한 해결에서 의료분쟁 조정법에 의해 조정이나 중재와 같은 자주적인 방법에 의해 분쟁을 해결하는 방향으로 분쟁 해결방법이 변화됨으로서 분쟁당사자 간에 자율적으로 문제를 해결할 수 있도록 전환할 수 있다는 것을 의미한다. 이처럼 소송에 의한 분쟁해결과 달리 조정이나 중재를 통하여 자주적으로 분쟁을 해결하는 경우에는 당사자 사이의 갈등관계를 완전하게 해소함으로써 장래에도 지속적인 관계를 유지할 수 있다는 점에서 분쟁해결에 있어서 큰 변화를 가져 올 수 있을 것이다. 그러므로 의료분쟁조정법이 의사와 환자 사이에 분쟁을 적절히 해결함으로써 환자에게는 적절한 피해구제가 이루어질 수 있고 의사에게는 최선의 진료서비스를 제공할 수 있는 안정적인 진료환경이 구축될 수 있도록 하는데 기여할 수 있어야 한다. 조정을 통해 분쟁을 해결하는 경우에는 단순히 법률문제만을 다루는 것이 아니라 당사자의 그 밖의 관심사까지 고려하여 문제를 해결하기 때문에 서로에 대한 불편한 감정까지 해소할 수 있다. 따라서 조정이나 중재를 통하여 의료분쟁을 해결할 수 있도록 제정한 의료분쟁 조정법이 조정과 중재제도를 마련하고 감정단을 설치하여 적극적으로 사안을 규명하여 의료 분쟁을 해결하고자 한 것은 바람직하고 향후 이 법의 역할에 대한 많은 기대를 가지게 한다. On March, 2011, the Act of Medical Malpractice Damage's Relief and Mediation for Medical Dispute Resolutuin was enacted. The purpose of the Act is to relieve damages due to medical malpractice quickly and fairly. Thus, it pursues to create stable circumstances in medical service. The enactment of the Act means to change how people resolve dispute for medical malpractice. Because the Act seeks to resolve the dispute of medical malpractice through mediation or arbitration as alternation of lawsuits. So the disputants have more initiative in the course of dipute resolution by this Act. But mediation or arbitration in this act is not controlled the process by the disputants, because the act provides how and who deals with this process. However, the way of dipute resolution in medical malpractice by this Act is useful for the disputants. It establish a department of estimation and let it identify negligence of medical personnel and causation. The proof of negligence and causation is done by that department. So patient doesn't prove the negligence and causation on medical malpractice any more. In this sense, patient can overcome difficulties in proof. In addition to that, the committee of mediation give some proposition to the disputants. The dipute is ended if they accept the proposition. Therefore, the dispute through mediation or arbitration can resolve simpler and quicker than a lawsuit. The disputants in medical malpractice can resolve not only legal issues but also interests related the dispute, though. Accordingly, this alterantive way of dispute resolution is disirable. In conclusion, we look forward to resolve the dipute of medical malpractice through mediation or arbitration in the Act.

의료과오에 대한 형사과실과 그 판단기준 ― 일본의 판례분석과 그 시사점 ―

최대호 서울시립대학교 서울시립대학교 법학연구소 2020 서울법학 Vol.28 No.2

This paper analyzes the criminal case of Japan, which has a criminal system of negligence with our country in relation to the case of criminal medical malpractice, and also seeks criteria for determining criminal malpractice for medical malpractice. the contents are as follows. First, Japanese’ judicial precedent, In judging the obligation to foresee results and evasion of results, are judged by the doctor's negligence based on the medical level at that time. in addition, medical and surgical errors require medical judgment, and only if the degree of deviation from the medical level at that time is considered large or a serious negligence, the criminal responsibility for the doctor is recognized. however, criminal liability for medical personnel, in the case of medical errors regarding “technical matters” that do not require medical judgment, is relatively easily recognized. Second, even if the doctor was aware of the risk of the outcome, he neglected the doctor's negligence because it was difficult to avoid the outcome at the medical level at the time. therefore, due to the nature of medical practice, doctors often recognize the risk of outcome, and it is necessary to consider the possibility of evading results in that it is easy to recognize the predictability. however, it is advisable to acknowledge the negligence when a medical practitioner negligently takes into account the reckless attitude and lack of skill in recognizing the specific risk of the outcome. Finally, a simple medical mistake is a rudimentary and serious mistake. in this case, since the degree of neglect of the duty of attention is remarkable, the tendency to recognize criminal responsibility as a serious negligence is increasing. on the other hand, in the case of diagnosis and surgery, it can be recognized as a serious negligence if it is evaluated as ‘significantly deviating’ from the action (medical level) to be taken by the average doctor who is in the same position as the doctor at the time of the act. however, the court's judgment may be divided even in the same medical case, and if you consider the anxiety felt by medical personnel, in setting individual and specific foreseeability for each medical case, it is desirable to judge the negligence based on the average doctors belonging to the field of expertise by presenting ‘objective attention obligation’. 본 논문은 형사의료과오사건과 관련하여 우리나라와 과실의 범죄체계를 같이하고 있는 일본의 의료과오에 대한 형사판례를 분석함으로써 형사과실의 판단기준에 관한 시사점을 얻고자 하였다. 그 내용을 정리하면 다음과 같다. 첫째, 일본판례에서는 결과예견의무 및 결과회피의무를 판단함에 있어 당시 의료수준을 바탕으로 하여 의사의 과실을 판단하고 있다. 또한 진료 및 수술상 과오는 의학상 판단을 요구하고, 이에 당시 의료수준으로부터 일탈한 정도가 크거나 중대한 과실로 인정되는 경우에 한하여 의사에 대한 형사책임을 인정하고 있다. 다만 의학상 판단이 요구되지 않는 ‘기술적 사항’에 대한 의료과오의 경우 의료관계자에 대한 형사책임이 비교적 쉽게 인정되고 있다. 둘째, 의사가 결과발생의 위험을 인식하고 있었다고 하더라도, 당시 의료수준에서 볼 때 그 결과를 회피하는 것이 곤란하다는 이유로 의사의 과실을 부정하고 있다. 따라서 의료행위의 특성상 의사는 결과발생의 위험을 인식하고 있는 경우가 많으며, 또 그 예견가능성을 인정하는 것이 용이하다는 점에서 결과회피가능성도 고려할 필요가 있다. 다만 의료인이 결과발생의 구체적 위험을 인식함에 있어 무모한 태도 및 자기의 기술부족을 고려하지 않고 과신한 경우에는 과실을 인정하는 것이 타당하다. 마지막으로, 단순한 의료과오는 초보적이고 중대한 과실에 해당한다. 이 경우 주의의무에 대한 태만의 정도가 현저하기 때문에 중대한 과실로 인정하여 형사책임을 인정하는 경향이 높아지고 있다. 이에 비해, 진단 및 수술의 경우에는 행위 당시 당해 의사와 동등한 입장에 놓인 평균적인 의사가 취해야할 행동(의료수준)에서 ‘현저히 일탈한 행위’로 평가되면 중대한 과실로 인정할 수 있다. 다만, 동종(同種)의 의료사안에서도 법원의 판단이 나뉘는 경우도 있고, 또 의료관계자가 느끼는 불안감을 배려한다면 의료사안마다 개별적・구체적인 예견가능성을 설정함에 있어 ‘객관적인 주의의무’를 제시함으로서 당해 전문분야에 속하는 평균적 의사를 기준으로 하여 과실을 판단하는 것이 바람직하다.

損害賠償 訴訟上의 醫療過失 -論點의 分析과 提言에 중점 두어-

손용근 한양법학회 2009 漢陽法學 Vol.25 No.-

This thesis seeks to provide a brief account of several problems associated with medical negligence in medical malpractice actions to recover damages and suggest some new ideas from the critical point of view. The summary of the thesis is as follows. First, more refined definition and analysis is due on medical negligence as one of medical treatmentrelated terms. So far, it is not yet well distinguished in its concept and coverage from treatment negligence and medical malpractice. Second, medical negligence is part of civil negligence approached from the medical perspective. Thus, the legal application of the notion of negligence should be studied with the secret, discretionary, and a prompt judgmental nature of medical acts in mind. Third, medical negligence poses a central issue in the medical malpractice actions to recover damages, regardless of whether claims arise under tort or in contract law. Although civil medical negligence to be established in the medical malpractice actions for damages is a so-called “abstract negligence,” the duty of care owed by average or customary practitioners is that of the highest attention duty of care. Nonetheless, the term “highest attention duty” has been understood as an abstract standard, which is a mere combination of several elements at the most. It is hoped that more studies should be devoted to the refinement of its meaning. Fourth, the precedents of the Supreme Court of Korea attributes the highest attention duty of care to medical practitioners, and negligence is practically presumed in the proof of medical negligence. However, such an approach has been a matter of dispute because it is ambiguous which duty of care is violated, and medical negligence is merely inferred from the totality of circumstantial facts such as a close proximity in time in the occurrence of events or the absence of intervening causes, etc. A refinement and further development is in demand. A continued use of some legal expressions, which have been established by the Supreme Court precedents since the 1990s, constitutes another problematic area. Some scholars, who are probably confused because of ambiguous expressions in the precedents, argued that the presumption of negligence is based on the so-called theory of probability. As an example, one of the hardened expressions “the burden of proof is alleviated … under the presumption of causal relation between medical negligence and damage” should be modified to the more accurate statement that “the burden of proof is alleviated … under the presumption of both medical negligence and the causal relation between medical negligence and damage.” The Court in its precedents has maintained its position requiring that negligence be established in the areas of both common knowledge and specialized medical knowledge. Such problematic position should be settled to the direction in which medical negligence is established by practically presuming negligence in the specialized medical knowledge. The highest attention duty of care is required to a medical practitioner, i.e., an average or customary practitioner. The highest attention duty, although it has only an abstract meaning, remains as a constant in its relation to medical negligence; whereas the level of best medical knowledge and clinical medical practice constitutes variables measured in the framework of relevant time period and local environment. Negligence shall be established by considering the functional relation between the above constant and variables, uninterruptedly examining whether the balance between them has remained intact, and searching for a new factor triggering a shift in the balancing point. As an example of one novel variable, we might want to consider adding a normative standard level to the standard of care, as it had been already adopted in Japan, not limiting relevant factors to merely social and environmental elements in clinical medical practice. It is high time for us...