수의사의 애완동물에 대한 의료행위에 있어 동물소유자의 자기결정권에 관한 고찰 ― 서울중앙지법 2022. 2. 20. 선고 2020가단5281353 판결을 중심으로 환자의 자기결정권과 비교 ―

임지성 ( Lim Jisung ) 연세대학교 법학연구원 2022 法學硏究 Vol.32 No.3

As a growing number of people have pet animals and veterinarians undergo consequent medical treatment for pet animals, so legal disputes are on the rise. In judging the duty of explanation as well as the duty of care by a veterinarian’s medical practice in legal action, the court analogically applies legal principles of doctor’s duty of explanation to pet owners on the grounds that veterinary practice is similar to medical practice one with its high profession and that such practice is aimed to enhance an animal’s health. The recent amendment to the Veterinarians Act has stipulated that when a veterinarian performs a treatment which he/she deems likely to cause serious harm to an animal’s life or its body and he/she fails to fulfill the duty of explanation, it can constitute a breach of law. However, there is controversy as to whether infringement of a pet owner’s self-determination right might be recognized as the same legal principles as a patient’s autonomy right like the judgment. First of all, this paper explored relevant theoretical grounds and legal interests of the doctor’s and veterinarian’s duty of explanation and then looked into the similarities and differences between the patent’s autonomy and the pet owner’s self-determination right. The fulfillment of the veterinarian’s duty of explanation is premised on the fact that pet owners are entitled to have a self-determination right as to whether an animal gets veterinary treatment or not. Unlikely, the fulfillment of the doctor’s duty of explanation is a precondition that can enable patients to have the right of self-determination as a patient, closely associated with human dignity regarding intrusion upon one’s own body, except the patient’s autonomy right of medical contracts. Although there are discrepancies in legal nature and protection scope between a patient’s autonomy and a pet owner’s self-determination right, pet owners are entitled to have the same self-determination right as a patient regarding intrusion upon a body, citing that a veterinarian’s medical treatment is similar to a doctor’s medical practice, according to such judgment. However, veterinary treatment has something to do with one’s possession; in other words, intrusion upon an animal’s body rather than a pet owner. Therefore, if a veterinarian violates the duty of explanation for its treatment, it is then appropriate that infringement is properly considered to be on the self-determination right as a consumer, not on the self-determination right as a patient. In judging the veterinarian’s duty of explanation, this paper suggests that a pet owner will be entitled to have a self-determination right as a consumer who is related to a contract made for an animal’s treatment with a veterinarian within the legal interests of protection, rather than a self-determination right as a patient regarding intrusion upon a body, by the court considering the causes and backgrounds for new regulations of duty of explanation for serious treatment, including operation, under the Veterinarians Act and discrepancies in legal nature and protection scope between a constitutional patient’s autonomy and a pet owner’s self-determination right.

환자의 알권리와 자기결정

안선화 ( Seon Hwa Ahn ),김용순 ( Yong Soon Kim ),유문숙 ( Moon Sook Yoo ),방경숙 ( Kyung Sook Bang ) 한국의료윤리학회 2009 한국의료윤리학회지 Vol.12 No.2

Purpose: The purposes of this study were a) to examine the level of awareness among patients of their right to know and their right to self-determination, and b) to determine the relationship between patients` awareness of these two rights. Method: For this descriptive-correlational study, participants were recruited at the endoscopic examination rooms of two university hospitals. Responses to self-report questionnaires were collected from 236 participants from 20 December 2007 to 10 November 2008. Results: On the basis of a five-point scale, the average scores were 3.67 for patients` awareness of their right to know and 2.81 for their awareness of their right to self-determination. The relationship between their awareness of these two rights was not significant. The recognition of a patient`s right to know was higher among those with a college education. Awareness of a patient`s right to self-determination varied according to age, education level, and economic status. Conclusion: There is an insufficient awareness among patients of their rights to know and to selfdetermination, especially for those with a lower education. Nurses should consider a patient`s right to know when providing medical treatment and to assist their right to self-determination. Systematic educational programs on patients` rights need to be developed for both patients and medical personnel.

연명의료결정에 있어서 사전의료지시에 관한 연구

정화성 중앙대학교 법학연구원 문화.미디어.엔터테인먼트법연구소 2022 문화.미디어.엔터테인먼트 법 Vol.16 No.2

Humans exercise their right to make their own decisions and act accordingly on matters related to their lives in various areas such as life, freedom, and property, which the state guarantees as a law. In this sense, the Life-sustaining Treatment Decision Act institutionalizes the life-sustaining treatment decision of patients on their deathbed so that all citizens can respect the patient's self-determination, guarantee the patient's dignity and value, and finish their lives comfortably. In particular, the patient's right to self-determination is the right to make self-determination without interference from others, and the patient's right to self-determination is the patient's right widely recognized in most medical practices. These patients' right to self-determination is recognized as an important criterion for life-sustaining treatment decisions, and advance directives are the best system to protect patients' right to self-determination. On the other hand, the principle of respecting autonomy should be respected in advance directives, and since it is an important way to confirm the patient's intention, the legal basis for "informed consent" should be prepared and guaranteed. However, advance directives exist in various types, and there is a limit to the method of confirming the patient's intention, so advance directives that meet the procedures and requirements for life-sustaining treatment decisions should be supplemented with a system suitable for reality. 인간은 생명, 자유, 재산 등 다양한 영역에서 자신의 인생과 관련된 문제들에 관하여 스스로 결정하고 그에 따라 행동할 권리를 행사하고, 이는 국가가 법으로써 보장하고 있다. 이러한 의미에서 「연명의료결정법」은 환자의 자기결정을 존중하고 환자의 존엄과 가치를 보장함과 동시에 국민 모두가 인간적인 품위를 지키며 편안하게 삶을 마무리할 수 있도록 임종과정에 있는 환자의 연명의료결정을 제도화한 것이다. 특히, 환자가 다른 사람으로부터 간섭을 받지 아니하며, 스스로 결정할 수 있는 권리가 자기결정권이며, 환자의 자기결정권은 대부분의 의료행위에서 폭넓게 인정되는 환자의 권리이다. 이러한 환자의 자기결정권이 연명의료결정의 중요한 판단기준으로 인정되고 있으며, 이에 사전의료지시는 환자의 자기결정권을 보호할 수 있는 가장 좋은 제도이다. 한편, 사전의료지시는 자율성 존중의 원리가 존중되어야 하며, 환자의 의사를 확인할 수 있는 중요한 방법이기 때문에 ‘충분한 설명을 듣고 난 후의 동의’의 법적 근거를 마련하여 이를 보장하여야 한다. 하지만, 사전의료지시는 다양한 유형으로 존재하면서, 환자의 의사를 확인하는 방식에 한계가 있어 ‘환자의 최선의 이익’을 위해 연명의료결정에 관한 절차와 요건에 맞는 사전의료지시를 현실에 적합한 제도로 보완하여야 한다.

의사 설명의무의 법적 성질과 그 위반의 효과

석희태 대한의료법학회 2017 의료법학 Vol.18 No.2

Physician’s Duty of Information is classified into three categories by legal function: ‘Duty of Information to Report’ to fulfill the patient’s right to know; ‘Duty of Information to Guide’ patient’s convalescing and staying healthy; ‘Duty of Information to Contribute’ to patient’s self-determination. We classify the physician’s duty of information because the legal effect from the breach of duty varies accordingly. The legal effect is focused on damage compensation responsibility for breach of duty. When a physician violates ‘Duty of Information to Report’, he subjects himself to liability of compensation for infringing on the patient’s ‘Right to Know’. When a physician violates ‘Duty of Information to Guide’, she subjects herself to liability for general medical malpractice. Finally, when a physician violates ‘Duty of Information to Contribute’, the physician is basically liable for violation of the patient’s ‘Right to Self- Determination’ which refers to infringement on freedom of choice. However, in the case of situation that patient's refusal to the medical treatment would be presumed, the physician bears all liability for the patient's damage which includes both of property and mental damage. 의사의 설명의무는 의사가 환자에게 이미 시행한 의료행위, 시행 중인 의료행위 및 장래에 시행할 의료행위와 환자의 요양상 수칙에 관하여 적극적·체계적으로 진술함으로써 환자가 그 내용을 인식하게 할 법적 의무를 총칭한다. 이 의무는 환자의 알 권리에 대응하는 보고성 설명의무, 환자의 동의권·거절권에 대응하는 기여성 설명의무, 요양지도성 설명의무로 나뉜다. 설명의무를 분류하는 것은 각각의 기능과 법적 성질이 다르고, 법적 성질이 다름에 따라 그 위반 시의 효과, 특히 손해배상책임의 대상과 범위가 달라지기 때문이다. 이 주제에 관하여 우리나라에서는 지난 40년 가까운 기간 동안 많은 이론의 발전이 있었고, 그를 토대로 대법원 판결의 논리도 상당히 정치하게 전개되어 왔다. 그러나 여전히 학계와 실무계 일각에서는 용어와 개념의 혼동, 학설과 판례 논리에 대한 이해 부족을 목격하게 되고, 심지어 대법원 판결문 내의 전후 문맥에서 그리고 관련 있는 복수의 판례 사이에서 논리와 이론의 불일치를 발견하게 되는 것이 사실이다(이것은 합리적 근거와 설득력을 지닌 견해의 분립을 지적하는 것이 아니다). 위와 같은 견해와 문제의식을 기초로 해서, 의사가 부담하는 설명의무의 기능별 분류와 법적 성질 및 그 위반 시의 효과를 우리나라 학설과 판례를 중심으로 분석 정리한다.

의사의 설명의무와 미성년 환자의 자기결정권 - 대법원 2023. 3. 9. 선고 2020다218925 판결을 중심으로 -

김상헌 한국재산법학회 2023 재산법연구 Vol.40 No.3

의사는 응급환자의 경우나 그 밖에 특별한 사정이 없는 한 환자에게 수술 등 인체에 위험을 가하는 의료행위를 할 경우 그에 대한 승낙을 얻기 위한 전제로서 환자에게 질병의 증상, 치료방법의 내용 및 필요성, 발생이 예상되는 생명, 신체에 대한 위험과 부작용 등에 관하여 당시의 의료수준에 비추어 환자가 의사결정을 함에 있어 중요하다고 생각되는 사항을 구체적으로 설명하여 환자로 하여금 수술 등의 의료행위에 응할 것인지 스스로 결정할 기회를 가지도록 할 의무가 있다. 이러한 의사의 설명의무 이행상대방으로서의 환자의 지위는 자기결정권을 요체로 한 동의능력 구비 여부로 인정되었는데, 미성년 환자가 설명의무의 이행상대방이 될 수 있는지에 관하여도 많은 논의가 있었다. 이러한 사정 하에 최근 대법원은, 대법원 2023. 3. 9. 선고 2020다218925 판결(이하 ‘대상판결’이라고 한다)을 통하여, 의사의 설명의무 당사자는 미성년 환자도 될 수 있음을 명확히 판시하였고 미성년 환자에 대한 의사의 설명의무 준수에 대한 방법론적 기준 또한 제시하였다. 대상판결은, 미성년 환자 또한 의사의 설명의무에 따른 설명을 듣고 결정할 이행상대방이 될 수 있음을 밝힌 점에서 의의가 있지만, 미성년 환자에 대한 그 설명의무의 이행은 미성년 환자의 복리를 이유로 미성년 환자에게 전달될 가능성이 큰 친권자 등에 대한 의사의 설명만으로 족할 수 있다는 설명의무 이행충족에 대한 방법론적인 판시를 하였는데, 이는 설명의무의 취지 등에 비추어 다소 의문이 있다. 대상판결이 의료관행과 복리를 고려한 점은 일부 이해되지만, 미성년 환자가 친권자 등과 동행한 상태에서 미성년 환자에게 직접 설명하는 것이 설명의무가 원칙적 이행방법이고 미성년 환자에게 직접 설명하기 어려운 사유가 있는 경우, 전달될 것에 대한 담보 하에 간접 설명만으로 의사의 설명의무는 이행되었다고 보는 것이 설명의무 취지 및 기능에 보다 들어맞는 해석일 것이다. 설명의무가 의료영역의 시대적 변화와 더불어 환자의 지위 및 그 권리, 그중 자기결정권 행사의 이해와 연관된 영역이 확장된 만큼, 현재 시점에서 설명의무가 어떠한 독자적인 기능 또는 역할을 할 것인지에 대하여 한층 더 진전된 논의가 필요할 것이다. Unless there are special circumstances, when a doctor performs a medical procedure that poses a risk to the patient's body, the doctor must inform the patient in detail about the symptoms of the disease, the content and necessity of the treatment method, risks to the body, and side effects, etc. This is the doctor's duty to ensure that patients have the opportunity to make their own decisions. The patient's status as a party to the doctor's obligation to explain was determined by acknowledging the patient's ability to consent, focusing on the right to self-determination. For this reason, there has been much discussion as to whether minor patients can be the parties to the obligation to explain. Under these circumstances, the Supreme Court recently clearly ruled through Supreme Court Decision 2020Da218925 Decided March 9, 2023(hereinafter referred as ‘the Judgment’) that a minor patient can also be a party to a doctor's obligation to provide explanation. However, the Judgment that the fulfillment of the obligation to explain to a minor patient is satisfied solely by the doctor's explanation to the person with parental authority on the grounds of the minor patient's welfare is somewhat questionable in light of the purpose of the obligation to explain. In conclusion, the principle way to fulfill the duty of explanation should be to directly explain to the minor patient while the minor patient is accompanied by a person with parental authority. In exceptional cases where it is difficult to explain directly to a minor patient, the doctor can be considered to have fulfilled his duty of explanation by providing an indirect explanation to the person with parental authority.

연구 : 의료행위 자기결정권과 그 한계

노상엽 ( Sang Yup Roh ) 가톨릭대학교 법학연구소 2010 법학연구 Vol.5 No.1

Conventional medical practice is done by the medical contract. recently, the problem of self-determination has emerged in medical practice. A medical doctor about his decision from the actors themselves sufficient explanations, make decisions about medical practice to medical care for these patients is. However, the exercise of his or her discretion will be permitted unlimited. Is not necessarily so. If you suspect that genuine self-determination, is not permitted by law, not my decision if 3rd party, in violation of good customs and other social order, even if you exercise self-determination is the existence of certain limits. Recently in Korea, various issues related to self- determination is taking place. Regarding his or her decision, but events and according to specific criteria regulations is not available, only the court`s interpretation and practice of medicine, said the charge is not an exaggeration. Analysis of the specific statutory criteria or standards does not raise problems in doing this is always difficult to follow. As a matter of conclusion, his or her decision to exercise his / her doctor, according to the good or the reality if permit of such self-determination. As a result, the unfortunate events can happen, it significantly better. Before that can prevent these post-conflict or the system will require a legal basis, particularly as the ultimate exercise of self-determination, starting with various forms of the subject prepared by the will be. In this regard, advance health care directive in Germany or Austria, the national law-related information systems will be is very suggestive.

시도할 권리(the Right to Try)의 이론적 근거 및 법제화에 관한 시론적 연구

박희수 한국생명윤리학회 2024 생명윤리 Vol.25 No.1

미국에서 제정·시행되고 있는 「시도할 권리법」은 사용 가능한 치료 옵션을 소진하고 임상시험 자격이 없는 말기 질환 환자를 위하여 임상시험용 약물에 보다 직접적으로 접근할 수 있도록 한다. 시도할 권리는 환자의 자기결정권 행사의 일환으로써, 생명의료윤리의 영역에서 자율성 존중의 원칙과 의사의 선행의 원칙 사이의 충돌을 야기할 수 있다. 환자가 충분한 정보에 의하여 자율적으로 소위 ‘위험한’ 선택을 할 경우, 의사는 그에게 발생할 해를 막거나 완화하고자 의도적으로 개입할 수 있을까?(강한 온정적 간섭주의의 문제) 일반적인 생명의료 분야의 개념적 이해에 따르면 시도할 권리에 대한 의사의 강한 온정주의적 개입은 정당화되는 것처럼 보인다. 그러나 시도할 권리에 있어서는 사용가능한 치료 옵션을 소진하고, 임상시험 자격이 없는 말기 질환 환자의 특수성을 고려하여야 한다. 말기 질환 환자가 충분한 정보에 근거하여 자율적으로 시도할 권리를 행사하고자 하는 경우, 의사는 환자의 자율성을 포함한 환자의 총체적 이익을 고려하여 온정적 간섭을 행하여야 하며, 그러한 경우 환자의 시도할 권리 행사와 의사의 온정적 간섭은 서로 배치되거나 충돌하지 않고 규범조화적으로 행사될 수 있다. 종래 확대된 접근/동정적 사용 프로그램이 있기 때문에 별도로 시도할 권리를 둘 필요가 없다는 등 반대의 목소리도 높지만, 확대된 접근/동정적 사용 프로그램의 절차적 한계를 고려할 때, 「시도할 권리법」은 환자들에게 보다 신속한 기회와 절차를 제공한다는 점에서 어느 정도 차별화된 특징을 갖는다. 특히 「시도할 권리법」은 환자의 접근권을 종래의 확대된 접근/동정적 사용 프로그램에서의 시혜적 성격에서 나아가 환자의 ‘권리’로서 보장하려 한다는 점에서 큰 의의가 있다. 서구에 비하여 상대적으로 개인의 권리 주장에 소극적인 동아시아 문화권에 속하는 대한민국의 경우, 취약한 권리주체인 환자에게 이론적·법적 근거에 기반하여 시도할 권리를 법적 권리로서 보장하는 것이 더욱 더 필요할 것으로 생각된다. With the enactment of ‘the Right to Try Act’ in the United States, debates over the right to try are rising. There are also many voices of opposition, such as that there is no need to have the right to try separately because there is already an expanded access/sympathetic use program. However, ‘the Right to Try Act’ is differentiated in that it provides patients with faster opportunities and procedures. In particular, it is meaningful in that it actively seeks to guarantee the patient's access rights as the patient's 'right' beyond the nature of giving. The right to try can cause a conflict between the principle of autonomy and the principle of beneficence. If a patient makes a so-called ‘risky’ choice autonomously with sufficient information, can the doctor deliberately intervene to prevent or mitigate the harm that may occur to him?(the problem of strong pateralism) However, the specificity of eligible patients should be considered when it comes to the right to try. If the patient wants to exercise his right to try autonomously based on sufficient information, the doctor should conduct compassionate intervention in consideration of the patient's overall interests, including the patient's autonomy. In this case, the exercise of the patient's right to try and the compassionate interference of the doctor can be exercised in harmony without contradicting or colliding with each other. Considering the procedural limitations of the EA program, the "Right to Try Act" is differentiated in that it provides patients with faster opportunities and procedures. In particular, the "Right to Try Act" is of great significance in that it tries to guarantee the patient's approach as the patient's "right" beyond the conventional beneficial feature. In the case of Korea, which belongs to East Asian cultures that are relatively passive in claiming individual rights compared to the West, it is considered even more necessary to guarantee the right to attempt based on theoretical and legal grounds to patients who are vulnerable.

환자의 자기결정권의 한계에 관한 연구 -여호와 증인의 수혈거부사건을 둘러싸고-

박태신 ( Tae Shin Park ) 연세법학회 2015 연세법학 Vol.26 No.-

When it comes to the subject judgement issues to be discussed, followings should be considered. What is the patients`` self determination between doctors and patients, how doctors have to make a decision in case of conflict occurring between patients`` self-determination and the physicians`` discretion right (ex, obligation of life saving), specifically, how doctors respect patients`` right if patients are able to judge clearly and ask for no blood transfusion due to the religious reason. According to a lot of discussions about these issues, we are able to see that the Supreme Court``s opinions have progressively been changed than in the past. Especially, the article 15 paragraph 1 of the Medical Law shows that medical personnel should not deny patients`` request for medical care or premature birth. Due to this law, there must have been trouble to judge this case. In other words, this judgement established the limitation or principles of the right of self determination in a certain range comparing to the existing judgement or judgement of the first instance, which have acknowledged the patients`` right superior. In this case, even though the patients apparently wanted no blood transfusion and agreed not to be transfused, and signed the liability waiver, this judgement declared that patients`` lives should be more prioritized than any other matters. We just think that the judgement above should be have considered the problem in relationship between patients and doctors and long term perspectives, if so , it would be logically clear.

채혈 및 수혈 시 주의의무와 설명의무

김재국(Jae-Guck Kim) 한국비교사법학회 2006 비교사법 Vol.13 No.4

  Medical treatment does not always make a good result. but occasionally makes the bad result because medical personnel relaxes his attention to it or the patient does not obey doctor"s directions. To avoid bad result, the doctor must devote his attention to the patient in medical care. The blood transfusion gives direct effect on the patient"s life and health like the case of medical service. Therefore the doctor should pay attention in transfusion service and so does the blood-gathering agency in blood-collecting work. In blood-collecting work, the blood-gathering agency ought to identify the blood type and ought to grasp whether the blood donor get infected with fatal disease through investigation into his job, living circumstances, and health conditions. In transfusion service, the doctor should decide the accurate time and quantity for transfusion, should confirm the security of blood for transfusion and should devote his attention to the change of blood recipient"s situation during transfusion. If they are negligent of above duties and the recipient get infected with fatal disease by the infected blood, they will compensate the patient for the damages.<BR>  Medical treatment brings the infringement to patient"s life and health. So the patient decide by himself the acceptance and rejection of treatment, the time of treatment, and the method of treatment. We call it the patient"s right of self-determination. To guarantee the patient"s right of self-determination, the doctor must explain to the patient the name of a disease, the condition of a disease, the method of treatment, the ill and harmful effect of a treatment method, and so on. In blood transfusion service, the doctor should also explain the infection possibility with fatal disease by transfusion to the patient or his family. On the contrary the blood-gathering agency has no obligation to explain them to the patient, because blood transfusion is not its business. If the doctor is negligent of this duty and the recipient get infected with fatal disease by the transfusion, he will compensate the patient for the damages.

의료과오소송에 있어서 설명・동의에 관한 소고

박민제 한국민사소송법학회 2012 민사소송 Vol.16 No.1

In recent times, it is generally recognized that patients must ensure right of self–determination, right to know, consent competency in medical practice. However, in reality, the doctor is expert who has professional knowledge on the medicine field, whereas patients are layperson about medicine. Under these circumstances, it is natural that patients should be in a disadvantageous position in comparison with doctor. In this situation, it is required for the patients to ask various questions about disease, to advocate patient’s right to know. Also, doctor must make sufficient explanations to guarantee patients’right. Doctor should not manage to escape liability by formal and insincere questions. By setting up a good and trustful doctor–patient relationship, we can prohibit defensive medicine executed by a doctor. At the same time,we can foster more desirable treatment milieu between them. Informed consent is derived from to secure patient’s or participant’s right to self–determination substantially in the field of medical practice and medical research. On the other point of view, some opinions show that it is desirable to restrict informed consent to attenuate psychological burden, in case of participating medical treatment and medical research for the sake of securing patient’s or participant’s self–determination effectively. But this is superficial viewpoint. This is dimensionally different problem. Henceforth, That problem can practically be deduced a conclusion, vice versa, in real medical practice. In conclusion,it should be desirable to acquire informed consent from patients, except for the inevitable circumstances. To this point of view, we should solve this difficult problem rationally.