비의료인 문신시술행위 규제에 비판적 검토 - 헌법재판소 2022. 3. 31. 2017헌마1343 결정례에 대한 검토를 중심으로 -

소병완,박종현 국민대학교 법학연구소 2023 법학논총 Vol.36 No.1

This study examines the legal status of tattooing in the context of Korean law, particularly in light of the 2017Hun-ma1343 decision by the Constitutional Court of Korea, which reaffirmed that only medical professionals are qualified to perform tattooing. Consequently, tattooing performed by non-medical professionals is deemed illegal and subject to criminal prosecution. This situation presents an ironic paradox considering the renowned skills of Korean tattoo artists who are worldwide famous. While historically Japan, like Korea, regarded tattooing as a medical procedure that has to be performed exclusively by medical professionals, the Supreme Court of Japan ruled on September 16, 2020, that tattooing does not fall within the scope of medical procedures and the implications of this Japanese ruling are of importance to us. Given that instances of getting tattoos from medical professionals are exceedingly rare and the majority of tattooing procedures are performed by non-medical professionals(tattooists), the application of an overly broad interpretation of medical procedures to tattooing, and the consequent imposition of the most severe sanction, namely criminal punishment, is inconsistent with reality. The insistence on a system that does not match with reality has resulted in the invalidation of current regulation toward tattoo. Even if the enforcement of the provision protecting public health, which falls under the jurisdiction of the criminal punishment clause, leads to harm to the health rights of citizens, because they paradoxically conceal even when they get harm by getting tattoo, resulting in the detrimental impact on the lives, bodies, and public hygiene of the people, contrary to the intended purpose of the provision. Despite the lack of effective protection for the public interest, the provision that excessively restricts the fundamental rights of individuals' freedom of occupation and freedom of expression is in violation of the principles of clarity and prohibition of excessive measures. Furthermore, this study explores alternative approaches based on legislative examples from countries such as the United States, France, and the United Kingdom, aiming to bridge the gap between law and reality while maintaining a balance between public interest and private interests. It is deemed desirable to establish a separate qualification system for non-medical tattooists, supported by regulations such as a separate examination that does not require the same level of expertise as a medical licensing examination, mandatory education for a specified period, obligatory renewal of certification at regular intervals, adherence to hygienic procedures for sterilization, disinfection, and disposal of materials before and after each procedure. Implementing such regulations could minimize the societal costs and the gap between reality and the current system, while ensuring the appropriate harmony between public interest and private interests in the long run. Moreover, it would facilitate the development of the tattoo industry, which now reaches a market size of approximately 2 trillion won and continues to grow, as a national cultural and artistic industry. Furthermore, it would naturally lead to an increase in effective tax revenue through legitimate taxation in that boundary of legal industry. 헌법재판소가 2022년 3월 31일에 선고한 2017헌마1343 결정에서 의료인만이 문신시술 자격을 가짐을 다시금 확인함에 따라, 비의료인에 의한 문신시술행위는 불법으로서 형사처벌의 대상이 되고 있다. 과거의 일본 역시 우리나라와 같이 문신시술행위를 의료인이 행해야 하는 의료행위의 범주에 속하는 것으로 보았으나, 이후 2020년 9월 16일 일본 최고재판소에서 문신시술행위는 의료행위에 해당하지 않는다고 판결을 내렸다는 점은 우리에게 시사하는 바가 크다. 의사로부터 문신시술을 받는 경우는 극히 희소하며, 대부분의 시술이 비의료인인 문신시술자(타투이스트)에 의하여 이루어진다는 사회적 현실을 고려할 때, 종래 판례들에 의해 지나치게 확장된 의료행위의 개념을 문신시술행위에도 적용하여 그 위반을 가장 강력한 제재수단인 형벌로서 다스리는 심판대상조항은 현실에 부합하지 않는 제도를 고수하는 것이다. 현실에 맞지 않는 제도를 고수한 결과는 문신시술행위의 음성화라는 결과로 이어졌으며, 비의료인에 의한 문신시술행위 자체가 불법이기에 심판대상조항이 보호하고자 하는 국민의 건강권에 위해가 생기더라도 이를 감추게 되어 결과적으로는 심판대상조항으로 인해 국민의 생명, 신체 및 공중위생에 대한 위해가 발생하는 역설적인 결과가 초래되고 있다. 위와 같이 공익에 대한 효과적인 보호가 전혀 이루어지지 못함에도 개인의 직업선택의 자유 및 표현의 자유라는 중대한 기본권을 필요 이상으로 제한하는 심판대상조항은 구체적으로는 명확성의 원칙과 과잉금지의 원칙에 위배된다고 볼 수 있다. 나아가 비의료인 문신시술자들을 위한 별도의 자격 제도를 마련한 뒤, 이를 의사자격시험에서만큼의 전문 지식은 요구하지 않는 별도의 시험, 특정 시간 이상의 의무 이수 교육, 특정 주기마다의 자격증 갱신 의무, 작업 장비 및 매 시술 전후 물품과 기구의 멸균 및 소독, 폐기물 처리와 같은 위생적인 절차에 대한 규율로 뒷받침한다면 사회적 비용과 현실과 제도 사이의 공백을 최소화하면서도 장기적으로는 공익과 사익의 적절한 조화를 지킬 수 있는 대안으로 기능할 수 있을 것이다.

문신시술의 비범죄화에 대한 연구

도규엽 ( Do Gyuyoup ) 한국외국어대학교 법학연구소 2021 외법논집 Vol.45 No.2

현행 법제에 따를 때 문신시술은 의료법 제27조 제1항에서 금지하고 있는 ‘무면허 의료행위’로서 취급되어 의사면허를 소지하지 않는 자의 문신시술은 엄격히 금지되고 있고, 이를 위반한 경우에는 동법 제87조에 의거하여 5년 이하의 징역이나 2천만 원 이하의 벌금에 처해질 수 있다. 과거 일탈의 상징으로 인식되었던 문신에 대한 부정적 편견은 사라졌고, 문신은 보편적 사회현상 및 문화적 트렌드로 자리잡게 되었음에도 우리의 법 시스템은 여전히 이를 받아들이지 못하고 있다. 사람들은 원하는 디자인과 스타일의 문신을 몸에 새기기 위하여 홍대 타투골목 등의 트렌디한 문신시술소 등을 찾아가 문신사들로부터 문신시술을 받고 있음에도 불구하고, 현행법에서는 병원에서 의사로부터 문신시술을 받을 것을 요구하고 있다는 점이 이를 보여준다. 이 글은 문신 관련 현실에 부합하는 적절한 해결방안을 모색할 필요가 있다는 생각으로 접근을 하고는 있지만, 궁극적 해결방안인 문신사 자격제도의 입법적 도입 이전에 해석론으로서 문신시술의 과잉처벌, 그리고 이로 인하여 초래되는 법과 현실의 괴리의 문제를 임시적으로나마 해결하고자 하는 데 주된 목적이 있다. 이러한 관점에서 문신시술의 무면허 의료 행위죄 구성요건해당성과 사회상규에 위배되지 아니하는 행위를 중심으로 한 문신시술에 대한 정당화 문제를 검토하도록 한다. In the past, tattoos used to be a symbol of deviance, but now tattoos have become a fairly common cultural trend. Meanwhile, the Medical Service Act article 27 (1) states that “Any non-medical personnel shall not perform medical practices; and even medical personnel shall not perform any medical practice other than those licensed” under the title of ‘Prohibition against Unlicensed Medical Practices.’ According to the Supreme Court’s interpretation of the current legislation, tattooing is prohibited by the Medical Service Act article 27 (1) and the Article 87 provides that a person who violates the article 27 (1) shall be punished by imprisonment for not more than five years, or by a fine not exceeding twelve million won. In the point of that the tattooing involves penetrating the skin and injecting ink pigment, there would be no denying the invasiveness of the tattooing. The tattooing requires certain expertise that without which it may be difficult to control the risk of tattoos. In this respect, a lot of countries have regulations and legislations related to tattooing. It is necessary to create new regulations about licensing tattooists in Republic of Korea. As a matter of the unlicensed medical practice, to begin with, tattooing should be seen as a ‘medical practice’ under the article 27 (1) of the Medical Service Act, despite some claims that tattooing is not a medical practice. Next, tattooing with certain conditions must be considered an ‘Action which does not violate the social rules’ of the Criminal Act article 20.

일본에서의 문신시술행위 규제에 관한 법적 고찰 –문신시술행위의 의료행위성과 직업의 자유에 대한 침해를 중심으로–

박용숙 강원대학교 비교법학연구소 2019 江原法學 Vol.56 No.-

In contemporary society, tattooing is regarded as part of art or fashion, away from the antisocial and negative images of the past. However, despite the changes in society's perception of these tattoos, our current laws regulate tattooing practices as “Medical Service Act” and “Act on Special Measures for the Control of Public Health Crimes”. Of course, it can not be denied that the legislature's freedom of legislation is broadly recognized in order to ensure that the people receive a high level of medical care and to protect and promote the health of the people. However, there are constitutional problems such as freedoms of occupation and freedom of expression, which are prohibited uniformly without consideration of changes in social awareness of tattooing practices, risks to health and hygiene, substantial regulatory possibilities and preventable possibilities. In Japan, as in the case of ours, the act of tattooing was regarded as a medical act and the violation of Article 17 of the “Medical Practitioners’ Act” was the case. However, on November 14, 2018, the Osaka High Court ruled for the first time that the practice of tattooing was not a violation of the “Medical Practitioners’ Act”. The final judgment of the Supreme Court remains, but we have a great deal to suggest. The purpose of this study was to examine the history of tattooing in Japan (Ⅱ) and its regulations (Ⅲ), and then to examine the medical behavior of tattooing(Ⅳ). In addition, I examined the validity of the Supreme Court 's regulatory purpose established to limit the freedom of the profession, and examined the infringement of job freedom (Ⅴ) due to the prohibition of tattooing. 현대사회에서 문신은 과거의 반사회적 부정적 이미지로부터 탈피하여, 예술 또는 패션의 일부로서 여겨지고 있다. 그러나 이러한 문신에 대한 사회적 인식의 변화에도 불구하고 우리 현행법에서는 문신시술행위를 「의료법」 및 「보건범죄 단속에 관한 특별조치법」 등으로 규제하고 있다. 물론 국민이 수준 높은 의료 해택을 받을 수 있도록 그리고 국민의 건강을 보호하고 증진하기 위한 목적으로 행하는 이와 같은 규제에는, 입법부의 입법형성의 자유가 넓게 인정되는 것을 부인할 수는 없다. 그러나 문신시술행위에 대한 사회적 인식의 변화, 보건위생상의 위험성, 실질적 규제가능성 및 예방 가능성 등의 구체적 고려 없이 획일적으로 금지하고 있는 것은 직업의 자유 및 표현의 자유 등 헌법적 문제가 발생한다. 일본에서도 우리와 마찬가지로 문신시술행위를 의료행위라 판단하고, 「의사법」제17조 위반이라 여기는 것이 판례의 경향이었다. 그런데, 2018년 11월 14일 오사카 고등법원에서 처음으로 문신시술행위를 「의사법」위반이 아니라고 판시했다. 최고재판소의 최종적 판단은 아직 남아 있지만, 우리에게 시사하는 바가 크다. 이에, 본고에서는 일본에서의 문신시술의 역사(Ⅱ)와 그에 대한 규제(Ⅲ)를 살펴 본 다음, 일본의 판례와 학설에서의 의료행위에 대한 정의를 바탕으로 문신시술행위의 의료행위성(Ⅳ)을 검토하였다. 나아가 직업의 자유를 제한하기 위해 확립한 최고재판소의 규제목적 이분론의 타당성을 검토하여, 문신시술행위의 금지로 인한 직업의 자유의 침해(Ⅴ)에 대해 살펴보았다.

문신시술 규제와 관련하여 ‘의료행위성’에 대한 법적 고찰 - 일본 최고재판소 2020년 9월 16일 결정을 중심으로 -

박용숙(Park, Yong-Sook) 한국비교공법학회 2021 공법학연구 Vol.22 No.4

최근 우리사회는 소위 ‘MZ세대’의 등장으로 문화와 분위기의 많은 변화가 나타났으며, 대표적으로 문신을 과거의 반사회적 부정적 이미지가 아닌 예술 또는 패션의 일부로서 받아들이고 있는 경향이 있다. 우리 현행법에서는 이러한 문신시술행위를 「의료법」 및 「보건범죄 단속에 관한 특별조치법」 등으로 규제하고 있는데, 의사면허를 소지한 자만이 문신시술행위를 행할 수 있도록 하고 있다. 즉, 우리가 주변에서 쉽게 마주하는 문신시술소의 경우 대부분 불법영업을 하고 있는 것이다. 2007년 우리 헌법재판소는 재판관 전원일치 의견으로 ‘의료인이 아닌 자가 문신시술을 하는 행위를 처벌하는 현행 보건범죄단속법 관련조항이 헌법에 위배되지 않고, 문신시술이 “의료행위”에 해당하는지 여부를 판단하는 것은 법원의 고유권한’이라고 밝힌 바 있다. 하지만 전술한 바와 같이 문신에 대한 사회인식의 변화와 더불어 국민 보건에 대한 인식에도 많은 변화가 있었다. 그렇다면 2021년 현재에도 2007년 헌법재판소의 결정을 그대로 유지하는 것이 타당한지 다시 살펴볼 필요가 있다. 나아가 이처럼 문신시술을 의료행위라 판단하여 의사면허를 소지한 자에게만 시술을 허가하고 있는 것은 우리나라뿐이다. 일본에서도 문신시술행위를 「의사법」 제17조 위반이라 판단하며 처벌하는 것이 그동안 판례의 경향이었다. 그런데, 2020년 9월 16일 최고 재판소에서 문신시술행위가 의료행위에 해당하지 않아, 의사법 위반이 아니라 판단했다. 따라서 본고에서는 일본의 최고재판소의 결정문의 분석을 통해 문신시술행위의 의료행위성에 대해 고찰해 보았다. Recently, many changes in culture and atmosphere have occurred in our society due to the emergence of the so-called ‘MZ generation’, and there is a tendency to accept tattoos as a part of art or fashion, not as an anti-social negative image of the past. In our current law, such tattoos are regulated by the “Medical Service Act” and the “The Act on Special Measures for the Control of Public Health Crimes,” and only those with a doctor’s license are allowed to perform tattooing. In other words, most of the tattoo parlors we see around us are operating illegally. In 2007, in the unanimous opinion of the judges, the Constitutional Court decided that the provision of the current Health Crimes Enforcement Act, which punishes non-medical individuals for performing tattooing, does not violate the Constitution and determines whether or not tattooing is a “medical practice”. It is the prerogative of the courts to do so.” However, as mentioned above, along with the change in the social perception of tattoos, there have been many changes in the perception of public health. If so, it is necessary to re-examine whether it is appropriate to maintain the 2007 Constitutional Courts decision as it is in 2021. Furthermore, it is the only country in Korea that judges tattooing as a medical practice and permits it only to those who have a medical license. In Japan, it has been the trend of precedent to judge tattooing as a violation of Article 17 of the “Doctors Act” and punish it. However, on September 16, 2020, the Supreme Court ruled that tattooing was not a medical practice and was not a violation of the Doctors Act. Therefore, in this paper, the medical practice of tattooing is considered through the analysis of the decision of the Supreme Court of Japan.

대학생의 유행선도력에 따른 타투인식과 타투행동

이영주 한국지역사회생활과학회 2020 한국지역사회생활과학회지 Vol.31 No.2

This study provides the basic data required for actively responding to tattoo customers’ needs by analyzing the tattoo perception and tattooing behavior by fashion leadership among college students in their 20s. For this, a questionnaire survey was conducted among college students in Busan in June and September 2019. A total of 317 questionnaires were used for the analysis, and the following results were obtained. First, fashion leadership was comprised of fashion innovation, fashion opinion leadership, and fashion information search, while the perception of tattoos consisted of interest, personality, safety, and image. Depending on the fashion leadership, the subjects were classified as a fashion-dual leader, fashion follower, and fashion laggard. In contrast, the interest in tattoos, focus on tattoo images, and non-interest in tattoos were obtained depending on the perception of tattoos. Second, the perception of tattoos revealed differences depending on fashion leadership. Interest in tattoos was highest among fashion-dual leaders with positive thinking. In contrast, it was lowest among fashion-late adopters. In other words, interest in tattoos was mostly high among trendsetting college students. In terms of personality, fashion dual leaders and followers believe that having a tattoo makes them look different, stylish, and conspicuous. Concerning tattoo images, fashion followers concluded that tattoos influence a person’s image while fashion-late adopters did not agree with this perception.

Preoperative Tattooing Using Indocyanine Green in Laparoscopic Colorectal Surgery

이상재,손대경,한경수,김병창,홍창원,박성찬,김민정,박병관,오재환 대한대장항문학회 2018 Annals of Coloproctolgy Vol.34 No.4

Purpose: The aim of the present study was to evaluate the usefulness of indocyanine green (ICG) as a preoperative marking dye for laparoscopic colorectal surgery. Methods: Between March 2013 and March 2015, 174 patients underwent preoperative colonoscopic tattooing using 1.0 to 1.5 mL of ICG and saline solution before laparoscopic colorectal surgery. Patients’ medical records and operation videos were retrospectively assessed to evaluate the visibility, duration, and adverse effects of tattooing. Results: The mean age of the patients was 65 years (range, 34–82 years), and 63.2% of the patients were male. The median interval between tattooing and operation was 1.0 day (range, 0–14 days). Tattoos placed within 2 days of surgery were visualized intraoperatively more frequently than those placed at an earlier date (95% vs. 40%, respectively, P < 0.001). For tattoos placed within 2 days before surgery, the visualization rates by tattoo site were 98.6% (134 of 136) from the ascending colon to the sigmoid colon. The visualization rates at the rectosigmoid colon and rectum were 84% (21 of 25) and 81.3% (13 of 16), respectively (P < 0.001). No complications related to preoperative ICG tattooing occurred. Conclusion: Endoscopic ICG tattooing is more useful for the preoperative localization of colonic lesions than it is for rectal lesions and should be performed within 2 days before laparoscopic surgery.

인디아잉크 타투(Tattoo)로 유발된 대장 농양

방창석 ( Chang Seok Bang ),김연수 ( Yeon Soo Kim ),백광호 ( Gwang Ho Baik ),한상학 ( Sang Hak Han ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.1

Endoscopic tattooing with India ink is generally regarded as a safe procedure that enables ready identification of endoluminal cancer from the serosal surface. However, significant complications have been reported, including local inflammatory pseudotumor formation, peritonitis, rectus muscle abscess, small bowel infarction, and phlegmonous gastritis. Although the mechanism of complication is not completely understood, it may be related to the chemical compounds contained in the ink solution and enteric or extraenteric bacterial inoculation by injection needle or the ink itself. Authors encountered a case of a 60-year-old man with a resectable sigmoid colon cancer which was tattooed with India ink for subsequent localization in the intraoperative setting. During the laparoscopic operation, the proximal and distal margin of the lesion appeared edematous with bluish color. The distal resection margin was extended approximately 5 cm more than expected because of long extent of edematous mucosa. Histologic examination of the edematous tattooing area revealed an ink abscess spreading laterally above the muscularis propria. Although tattooing is widely used and relatively safe, the presented case indicates the risk of infection or inflammation by tattooing. (Korean J Gastroenterol 2014;64:45-48)

문신술을 이용한 각막혼탁의 미용적 치료

김신우,한영근,위원량,이진학,권지원.Cinoo Kim. M.D.. Young-Keun Han. M.D.. Won-Ryang Wee. M.D.. Jin-Hak Lee. M.D.. Ji-Won Kwon. M.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.12

Purpose: To evaluate the efficacy of tattooing with tissue marking dye for cosmetic repair of corneal opacity. Methods: Tattooing by the injection of tissue marking dye into the corneal stroma was performed in 67 eyes of 67 patients in whom there were no changes in visual acuity or size of corneal opacity for at least 5 years. Conjunctivalized corneal opacities and calcium deposits were removed before tattooing. All patients were followed up for a period of at least 3 months. Results: The most common causes of corneal opacity were trauma (56.6%) and infectious disease (19.4%). Combined ocular diseases included sensory exotropia (43.3%) and band keratopathy (31.3%). In this study, 98.5% of patients showed satisfactory results with cosmetic staining. Remaining opacity was observed in 1 eye (1.5%). Intraoperative complications occurred in 6 eyes (9.0%) and were resolved completely during surgery. Foreign body sensations (38.8%) and conjunctival injection (32.8%) disappeared within 2 months after surgery. Conclusions: Cosmetic repair by tattooing using tissue marking dye is an effective treatment for corneal opacity and is not associated with any significant complications.

양측 전진피판과 문신을 이용한 부분 눈썹 결손의 치험례

윤정호,홍종원,김영석,노태석,나동균 대한두개안면성형외과학회 2010 Archives of Craniofacial Surgery Vol.11 No.1

Purpose: Reconstruction of eyebrow defects after wide excision of the benign and malignant tumors present a cosmetic challenge to the plastic surgeon. There were several methods for reconstruction of partial eyebrow defect with local flaps except hair bearing composite graft. We introduce simple eyebrow reconstruction with bilateral advancement flap and tattooing on the idea that eyebrow tattooing is popular permanent eyebrow makeup among elderly Korean women. Methods: The flaps were designed on both ends of the eyebrow defect along the upper and lower margin of the eyebrow. Both flaps were cut, undermined and were moved centrally to cover the defect. Both flaps were attached along the vertical suturing line. The rest of each flap was sown with dog-ears revised minimally. Scar lines would be hidden along the natural borders of the eyebrow if possible. The resulting vertical scar finally was covered with hair. After 8 months, eyebrow tattooing would be done to camouflage eyebrow shortening and scar. Results: Partial eyebrow defect was reconstructed successfully with bilateral advancement flap and tattooing. The postoperative scar was inconspicuous and eyebrow looked symmetric. Conclusion: We recommend partial eyebrow reconstruction with bilateral advancement flap and tattooing for the elderly Korean female patients after excision of small tumor in and around eyebrow region.(J Korean Cleft Palate Craniofac Assoc 11: 37, 2010)

착색양막을 이용한 띠각막병증의 미용적 치료

김신우,한영근,현준영,위원량,이진학,권지원 대한안과학회 2007 대한안과학회지 Vol.48 No.11

Purpose: To evaluate the efficacy of stained amniotic membrane transplantation (AMT) for cosmetic repair of band keratopathy. Methods: Eight eyes from 8 patients with band keratopathy without the possibility of visual improvement were treated with corneal tattooing and stained AMT. Calcific plaques were removed with EDTA and a blade prior to the tattooing. Tattooing by the injection of tissue marking dye into the corneal stroma was performed in corneal opacities. The remaining opacity, which could not be treated with corneal tattooing, was treated with black dye-stained AMT. Results: The most common cause of band keratopathy was trauma (50%) and the mean time to epithelial healing was 11.3 days. All patients showed satisfactory results with cosmetic staining. Recurring cases and significant complications were not observed during the mean follow-up period of 7.4 months. Conclusions: Cosmetic repair by corneal tattooing and stained AMT is an effective treatment for band keratopathy and is not associated with any significant complications.