개정민법에 있어서 성년후견과 의료행위 동의권

장석천(Jang, Seok-Cheon) 한국재산법학회 2011 재산법연구 Vol.28 No.3

개정 민법은 고령화 사회로의 진입 속도가 다른 선진국에 비해서 급속도로 빠른 현재의 우리 실정에서 어느 정도 노령 인구의 복지라는 측면에서는 바람직한 입법이라고 할 수 있을 것이다. 그러나 의료행위에는 정기적으로 행하는 건강검진, 인플루엔자 예방접종, 감기약의 복용, 각종의 수술, 장기의 적출까지 꽤 폭넓고 다양한 형태로 존재한다. 이러한 의료행위 중에서 신체의 침해를 수반하는 경우를 제외한 그 외의 의료행위에서 피성년후견인이 동의할 수 없는 경우에 누가 동의권을 행사 할 것인가에 대하여 개정 민법은 침묵하고 있다. 또한 동의능력을 상실한 피성년후견인에 대한 의료행위를 하기 전에 의료계약이라는 것을 체결하여야 하는데 누가 의료계약을 체결할 것인가의 문제도 발생하게 된다. 본 논문은 이러한 문제에 대해서 살펴보려고 한다. 의료계약의 체결과 관련하여 성년후견은 피성년후견인이 질병, 노령, 장애, 그 밖의 사유로 인하여 정신적 제약으로 사무를 처리할 능력이 지속적으로 결여된 경우에 개시된다. 따라서 대부분의 피성년후견인은 사리를 분별할 의사능력이 떨어진다고 볼 수 있으며, 이들이 본인의 의료계약을 정상적으로 체결할 것을 기대하는 것은 무리라고 생각된다. 이 경우 피성년후견인을 위한 의료계약은 성년후견인에 의하여 체결되어야 하며, 피성년후견인의 건강의 유지라는 신상보호의 측면에서 성년후견인의 의료계약 체결의 법적근거를 성년후견계약에 의한 선관주의의무 등에서 찾는 것이 합당하리라고 생각된다. 피성년후견인이 치료를 받는 경우에 의료적 침습이 수반되며 이러한 침습을 정당화하기 위해서 의료행위에 대해서 환자의 동의를 받게 된다. 동의가 없이 한 의료행위는 정당화 될 수 없기 때문에 피성년후견인이 동의능력을 상실하여 동의할 수 없는 경우에는 의사가 의료행위에 대한 동의가 없다는 이유로 환자를 방치하는 상황이 발생한다. 반대로 의료행위에 대한 동의 없이도 의료처치를 인정한다면 환자의 인권이 침해되는 경우 발생할 수도 있다. 따라서 피성년후견인의 복리를 증진한다는 측면을 고려한다면 누구가가 의료행위에 대한 동의권을 행사 할 수 있도록 해야 한다. 후견인 제도는 피후견인의 재산관리와 신상보호를 위하여 인정하는 것이다. 따라서 동의능력이 상실된 피성년후견인에 대해서 성년후견인이 있는 때에는 성년후견인의 신상보호의무로부터 일정한 권한이 수반되는 것이라고 볼 수 있고, 이로부터 피성년후견인에 대한 의료에도 권한을 가질 수 있다고 할 수 있을 것이며, 이로부터 성년후견인에게 통상의 의료행위에 대한 동의권을 부여할 수 있다고 생각한다. In Korea, current revised version of Civil Law may be viewed as desirable legislation to a certain degree in the aspect of welfare for senior population, because Korea now faces more rapid pace of entry to aged society than other advanced countries. The current revised Civil Law of Korea confines adult guardian’s right of consent on medical treatment to any medical treatment in violation of ward’s body, and also permits the right to the extent that ward cannot give any consent to such medical treatment. However, medical treatment are available in considerably wide and various forms including regular health examinations, influenza vaccination, cold remedy administration, various operations and evisceration. If a ward cannot give consent to any other medical treatment except all cases of physical violation in the above list of treatment, there is a question about who can exert the right of consent on the medical treatment. Moreover, it is medical contract that is required to be signed by relevant parties before any medical treatment for a ward who lost any capacity to give consent to the treatment. Here, there is also a question about who shall sign on the medical contract. This way, there are a lot of legal issues in terms of any medical treatment for ward. In regard to the conclusion of medical contract, adult guardianship is introduced to wards who show ongoing deficiency of capacity to deal with any affair under the influence of mental restrictions due to illness, old age, disability and other causes. Thus, most of wards virtually lack in any mental capacity to discriminate right from wrong, so it is unreasonable to expect that they will be able to sign on medical contracts on their own normally. In this case, it is required that adult guardian should sign on any medical contract for his or her ward, and it is reasonable that any legal ground of adult guardian’s signing on medical contract for ward should be found in prudent person rule or guardian’s duty of care under adult guardianship contract in the aspect of physical custody like maintenance of ward’s health. Ward’s reliance on medical care involves medical intrusion, and any justification of this intrusion requires informed consent from patients on medical treatment for them. None of medical treatment can be justified without any consent from patients, so if a ward who lost any capacity of consent fails to give consent to medical treatment, there may be a situation where his or her physicians neglect him or her for the cause of no consent on medical treatment. On the contrary, there may be any case of violation against human rights of patients, if medical treatment is just recognized even without their consent on medical treatment. Thus, in view of better welfare for wards, it is important to permit any competent one to exert the right of consent on medical treatment on behalf of the wards. Guardianship system is recognized in order that any adult guardian can manage ward’s property and take care of him or her. Hence, it is concluded that when there is an adult guardian for a ward who lost any capacity of consent, adult guardian’s duty of physical care involves certain rights and the adult guardian can have the right to give medical care for wards, so that adult guardian can be given the right of consent on general medical treatment on behalf of ward.

피성년후견인의 의료행위에 대한 동의

이영규 ( Lee¸ Younggyu ) 한양대학교 법학연구소 2020 법학논총 Vol.37 No.4

오늘날 의사가 행하는 의료행위는 의사의 충분한 설명과 이에 대한 환자의 승낙이 있을 때 정당화된다. 의료계약에 근거하여 행하여지는 의료행위가 적법한 의료행위가 되기 위해서는 의사는 환자에게 해당 의료행위에 대해 충분한 정보제공을 한 후 동의를 받아야 한다. 즉, 의료행위에서 환자의 동의는 원칙적으로 환자 본인에 의해 이루어져야 한다. 이것은 의료행위에 대한 신체의 자기결정권이라는 측면에서 당연한 것이다. 그런데 환자 본인이 동의를 하기 위해서는 판단능력이 있어야 하는데, 문제는 판단능력이 없거나 판단할 수 없는 경우(예, 식물인간) 다른 누군가가 환자 본인을 대신하여 동의하는 것이 필요하게 된다. 우리 민법은 성년후견제도를 입법화하면서 이에 대한 규정을 두었다. 즉, 의료에 관한 사항은 전형적인 신상에 관한 것으로서 피성년후견인은 자신의 신상에 관하여 그의 상태가 허락하는 범위에서 단독으로 결정한다(민법 제947조의2 제1항). 피성년후견인의 신체를 침습 하는 의료행위에 대하여 피성년후견인이 동의할 수 없을 때 성년후견인이 대신하여 동의할 수 있다(동조 제3항). 성년후견인이 대신 동의하여야 하는 의료행위의 직접적인 결과로 사망하거나 상당한 장애를 입을 위험이 있을 때에는 가정법원의 허가를 받아야 한다. 다만, 허가 절차로 의료행위가 지체되어 피성년후견인의 생명에 위험을 초래하거나 심신상의 중대한 장애를 초래할 때에는 사후에 허가를 청구할 수 있다(동조 제4항). 성년후견인이 피성년후견인을 치료 등의 목적으로 정신병원이나 그 밖의 다른 장소에 격리하려는 경우에는 가정법원의 허가를 받아야 한다(동조 제2항). 본 논문에서는 피성년후견인이 의료행위를 받을 때 동의문제와 관련된 내용을 다뤘다. 먼저 의료행위와 동의에 관한 법적 문제를 살펴보고, 우리 민법규정이 독일법의 입법례를 많이 참고하였고, 우리나라에서는 아직 이에 관한 판례가 나오지 않고 있는 실정이므로 독일에서의 논의와 쟁점을 살펴보았는데, 이는 앞으로 우리나라 해석론에서 많은 참고가 될 것으로 판단된다. 우리나라 민법의 규정내용을 살펴보고 성년후견인의 동의, 가정법원의 허가와 관련된 내용을 살펴보았다. 그리고 의료행위에 대한 동의, 설명의무와 관련된 쟁점들을 포함하고 있는 몇몇 개별법률들을 살펴보았다. 연명의료중단, 장기이식의 경우, 사전의료지시서가 있는 경우의 처리문제, 응급의료와 관련된 문제, 그리고, 그동안 보호의무자에 의한 입원을 둘러싸고 각종 인권침해 문제 등 문제가 많았던 정신보건법을 폐지하고 새로이 제정된 정신건강증진 및 정신질환자 복지서비스 지원에 관한 법률에서 보호의무자에 의한 입원시 보호의무자로 성년후견인이 될 수 있게 해석이 가능하므로 민법에서 가정법원의 하가를 받도록 하여 환자의 인권보호를 위한 입법취지를 살릴 수 있게 되었다. 개정된 민법취지, 각종 개별법의 취지에 맞게 자기결정을 할 수 없는 의사능력이 없거나 부족한 사람의 인권보장에 도움이 되도록 자그마한 도움이 되었으면 한다. The medical treatment performed by doctors today is justified when there is sufficient explanation by the doctor and the consent of the patient. In order for a medical practice performed under a medical contract to become a legitimate medical practice, a doctor must provide sufficient information to the patient and obtain consent. In other words, the consent of the patient in medical practice must be made by the patient himself in principle. This is natural in terms of the body's right to self-determination over medical treatment. However, in order for the patient to give consent, he must have the ability to judge, but if the problem is inability to judge or judge (eg, plant humans), someone else needs to give consent on behalf of the patient himself. The Korean Civil Law established regulations on this while legislating the adult guardianship system. In other words, matters related to medical care are related to typical personal information, and the adult guardian decides on his or her personal information to the extent permitted by his or her condition (Article 947-2 (1) of the Civil Act). If the adult guardian cannot consent to medical practices that invade the body of the adult guardian, the adult guardian may consent on behalf of the adult guardian (paragraph 3 of the same article). If there is a risk of death or significant disability as a direct result of medical treatment that the adult guardian must consent on behalf of, permission from the Family Court must be obtained. However, if medical treatment is delayed due to the approval procedure, which causes a danger to the life of the adult guardian or serious disability in the mind and body, permission may be requested after the death (paragraph 4 of the same article). If an adult guardian intends to isolate the adult guardian for the purpose of treatment, etc. in a mental hospital or other place, he/she must obtain permission from the Family Court (paragraph 2 of the same article). In this paper, we dealt with the matters related to the consent issue when an adult guardian receives medical treatment. First of all, we looked at legal issues related to medical practice and consent, and we looked at the discussions and issues in Germany because Korean civil law regulations referenced many legislative laws of German law. It is considered to be a great reference in interpretive theory. The contents of the provisions of the civil law of Korea were reviewed, and the contents related to the consent of adult guardians and the permission of the family court were reviewed In addition, we looked at several individual laws that included issues related to consent to medical practice and obligation to explain. Mental health law was abolished and re-enacted in the case of life-sustaining medical interruption, organ transplantation, and handling problems in the case of prior medical instructions, problems related to emergency medical care, and various human rights violations related to hospitalization by a protective person In the Act on the Promotion of Mental Health and Welfare Service Support for Mental Diseases, it is possible to be interpreted to be an adult guardian as an adult guardian when hospitalized by a guardian. I hope that it will be of little help to protect the human rights of those who do not have the ability to make self-determination or who are unable to make self-determination according to the purpose of the revised civil law and various individual laws

성년후견인의 의료행위 동의권

장석천 충북대학교 법학연구소 2017 과학기술과 법 Vol.8 No.2

It is time to think about the welfare of the aged population in the rapidly aging society, which is rapidly accelerating compared to other developed economies. In this regard, it is believed that adopting a civil service system in the Civil Service has significant implications. The system of civil rights in civil law is designed in the framework of the basic framework of self-determination of ward. However, the initiation of adult guardianship is not a situation that can make a reasonable decision on its own, so it can be said that it is necessary for the adult guardian to help. But the Civil Code is asking those who are in this situation to decide the doctor's decision, and it is not really for the benefit of those who are not physically capable. Especially, medical treatment that accompanies physical invasion is serious. Such medical treatment are available in considerably wide and various forms including regular health examinations, influenza vaccination, cold remedy administration, various operations and evisceration. If a ward cannot give consent to any other medical treatment except all cases of physical violation in the above list of treatment, there is a question about who can exert the right of consent on the medical treatment. Moreover, it is medical contract that is required to be signed by relevant parties before any medical treatment for a ward who lost any capacity to give consent to the treatment. Here, there is also a question about who shall sign on the medical contract. In the case of medical care for the ward, the consent of the ward shall be obtained. This can be said to justify the medical practice of a doctor. Doing so without consent constitutes an infringement of the body of a ward, constitutes an infringement of the body of a guardian year, and a problem of compensation or criminal problems. If you allow medical practice without consent, you may encounter a violation of the basic rights of the ward. Therefore, if the caregiver considers the benefit of the ward to promote the benefit of the ward, the person in question shall be allowed to consent to the consent of the person in question. The guardian system is to acknowledge the property management and personal protection of the ward. Therefore, if there is an adult guardian for a ward who has lost his / her ability to consent, he / she may be entitled to certain authority from the guardian's duty to protect the adult guardian. From this, it can be said that the medical care for the ward is also authorized. Therefore, I think that adult guardians can be granted consent for normal medical treatment.

미성년자의 최선의 이익의 평가방법

송영민(Song, Young-Min) 원광대학교 법학연구소 2017 圓光法學 Vol.33 No.3

Gillick Rule of UK is summarized as follows. ① The problems are about whether the will of adult is equal to the will of competent minor or not, and whether minor s most interest benefits is to respect the will of medical treatment or conduct the best medical treatment. In terms of the former, theoretically the competence of minor is basically accepted, but it is only to limit things at a certain time. Therefore, the competence of minor would be recovered in case that the minor is mature. The latter is about the relation between the most interest benefits and the legal principles of substitute decision, that is to say, in case of the adult who has the competence, the adult has the self-determination for medical treatment, and the will of medical treatment would be priority. On the other hand, in case of minor, if the minor has the competence equal to adult, the will of medical treatment would be respected, but if the will is not clear, the minor s most interest benefits should be priority. ② The problem is about whether the competence to consent the medical treatment is equal to the competence to refuse the medical treatment or not. In case that the minor has the competence and gives consent to medical treatment, the consent is valid, and the minor s self-determination would be guaranteed. However, in case that the minor refuses to give consent to necessary medical treatment even if the minor has the competence, the minor s competence should be questioned and judged not to have the competence, or self-determination should be limited even if the minor has the competence. The next is about Informed Assent Rule of USA. ① Informed Assent Rule is useful to protect the minor from disadvantage related to parents, doctor and patient caused by raising the problem of Informed Consent Rule. Informed Assent Rule is interpreted to share the responsibility of medical decision with doctor and parents together. Informed Assent Rule includes the factor responsibility , and it is different from minor s rights or providing proper treatment. ② If it is judged that the person over 15 years of age(adolescent) has the decision-making ability for health and legal rights to admit or refuse the medical intervention like adult, Parental Permission is not requirements, and according to circumstances, involvement of parents is advised and Informed Consent Rule are recommended. In addition, the person aged 8 to 14(school age) is recommended to apply Parental Permission and Patient Assent, and the person under 7 years of age(infant) is recommended only to apply Parental Permission. According to Gillick Rule, the minor can give consent to medical practice in case that underage patient has the competence, the grounds of this logic is minor s most interest benefits. On the other hand, Informed Assent Rule should be explained in details by doctor for the minor to consent, nevertheless, if it is judged not to be competent, the medical practice should be done by the family s consent after detailed explanations by doctor. On this occasion, the minor s most interest benefits should be the standard, in addition, the doctor and the parents should share the responsibility together for the medical decision. Although there are a little different factors, these debates basically desire for protecting the minor s most interest benefits in medical practice. 영국의 Gillick Rule 을 요약 정리하면 아래와 같다 . ① 성년자의 동의능력과 동의능력이 있는 미성년자의 意思는 동등한가 , 또는 자의 최선의 이익은 자의 치료행위에 대한 의사를 최대한 존중해야 한다는 것인가 아니면 의료상의 최선의 시술을 해야 한다는 것인가에 대한 문제이다 . 전자에 대해서는 이론적으로 자의 동의능력은 기본적으로 인정되는 것이지만 자의 일정한 사정 ( 판단능력 등 ) 에 따라 일정한 시기에 일정한 제한을 받는 것에 불과하다 . 그러므로 미성년자라도 성숙한 경우에는 당연히 본래의 동의능력을 회복하게 된다 . 후자는 최선의 이익과 대행판단의 법리와의 관계에 대한 것이다 . 즉 동의능력이 있는 성년자의 경우에는 스스로의 치료의 대한 자기결정권을 가지며 본인이 의도하는 치료행위에 대한 意思가 우선된다 . 반면에 미성년자의 경우에는 본인에게 성년과 동일한 판단능력이 있다고 인정되는 경우에는 본인의 치료에 대한 진정한 의사가 존중되지만 , 본인의 의사가 분명하지 않는 경우에는 미성년자의 최선의 이익이 우선되어야 한다. ② 미성년자의 치료에 동의하는 동의능력과 치료를 거부하는 능력은 동일한가 하는 문제이다. 동의능력이 있다고 판단된 자가 의료행위에 단순히 동의하는 경우에는 그러한 동의는 유효하며 자의 자기결정권은 보장된다. 그러나 치료상 필요한 의료행위에 동의할 수 있음에도 동의하지 않는 경우에는 자의 동의능력이 의문시되어 동의능력이 없다고 판단되거나 혹은 동의능력이 있다고 판단되더라도 자의 자기결정권은 제한된다. 다음으로 미국의 Informed Assent 법리에 대한 것이다 . ① Informed Assent 법리는 Informed Consent 법리에 따른 문제제기를 계기로 부모와 의사 그리고 환자의 관계에서 자의 불이익으로부터 자를 보호하는 점에서 유용하다 . Informed Assent 법리는 의료의 결정에 따른 책임을 의사와 부모가 분담한다고 해석되고 있다 . 자의 권리나 적절한 치료의 제공과는 이질 적인 모습인 “ 책임 ” 이라는 요소가 포함되어 있다 . ② 15 세 이상 (청소년)은 성인과 동일하게 건강에 대한 의사결정능력과 의료개입을 수용하거나 거부할 법적인 권한이 있다고 판단된 경우에는 Parental Permission( 부모의 승낙 ) 이 필요요건은 아니며 경우에 따라서는 부모의 관여를 권고하면서도 Informed Consent 법리의 적용을 권장한다. 또한 8 세~14세 (취학연령)는 Parental Permission(부모의 승낙) 과 Patient Assent(환자의 贊同)의 적용을 권장한다. 그리고 7세 이하 (영유아)는 Parental Permission (부모의 승낙) 만을 권장하고 있다. Gillick Rule 은 미성년 환자가 본인에게 동의능력이 있는 경우에는 미성년자 본인이 의료행위에 동의할 수 있다 . 이러한 논리의 근거가 본인의 최선의 이익이다. 반면에 Informed Assent 법리는 미성년자가 스스로 동의할 수 있도록 의사에 의한 상세한 설명이 이루어지고 그럼에도 불구하고 동의능력이 없다고 판단된다면 의사에 의한 상세한 설명이 이루어진 후 가 족의 동의에 의해 의료행위가 이루어지는 것이다. 이 때 자의 최선의 이익이 기준이 된다는 것이다 . 그리고 의료의 결정에 따른 책임은 의사와 부모가 분담한다는 것이다 . 이들 논의는 다소 이질적인 요소를 포함하고 있다고 할지라도 근본적으로는 의료행위에서의 미성년자의 최선의 이익을 보호하고자 함에 있는 것이다.

刑法の観点からみた医療行為の代理承諾とその許容可能性 ー 日本の議論を参考に ー

洪 太 錫(Hong, Tae-Seok) 원광대학교 법학연구소(의생명과학법센터) 2017 의생명과학과 법 Vol.17 No.-

Patient s consent is required for medical action on the patient s body. In other words, what is the disease, surgery is required and don t have access to any patient to make a decision to hear his doctor s explanation of the so-called ‘Informed Consent’ should be made. The required consent of the patient treatment procedure here for consent for patients with the ability should be made by you. But the real health care at the scene is minor or severe the patient s consent do not have the ability, including a mentally handicapped person, if not fewer. As such, patient consent for the act of medical treatment capability can not obtain patient consent if not. However, in the spot of the real medical care, a patient is a pupil and is the person who suffered a severe mental disorder and there are a lot of at all scenes to be the person who does not have ability for agreement. With the case which the patient does not have ability for agreement for the treatment act in this way, I cannot obtain a patient s consent. In addition, it is a patient, and the one which cannot afford to obtain consent before it is usual likewise in the scene where it is necessary to urgently put an operation to save the life of the patient who has been carried in an unconscious state. In this case should I deny the justification of the treatment act for the reason of not being able to obtain consent of the patient who is one of the justification requirements of insulting it of the medicine such a conclusion will too lack in validity. Should the aggression of the specialist to the patient who does not have ability for agreement not accept justification in the range of uniformity A problem is theory constitution to lead justification of insulting it of the specialist of this case. About the aggression of the normal medicine, an agreement of a patient is required by a thought to respect the self-decision right of the patient, but a patient cannot fill up in the justification requirements of the aggression of the medicine without an agreement of a patient being provided with the case which does not possess the agreement ability for the treatment act. Therefore it is necessary to consider the justification of the treatment act in the scene where an agreement of a patient is not provided some other time. In the spot of the medical care treatment act seems to be performed with the approval of a family or the relatives of the patient when the patient is the person who does not have ability for agreement for the treatment act. It is a point whether is the thing which the agreement by others has any significance on leading justification of insulting it of the medicine that what you must examine here does not obtain a patient s consent. Like an agreement of a patient is it the thing which can arrest you as one of the justification requirements of insulting it of the medicine that can correspond to the constitution requirements of the charge of inflicting bodily injury from such a critical mind. I want to add consideration about the substitute consent for the treatment act in this paper. 환자의 신체에 대한 의료행위를 위해서는 원칙적으로 환자 본인의 동의가 요구된다. 즉, 병명은 무엇인가, 정도는 어떠한가, 수술은 필요한가 등 환자 자신이 의사의 설명을 듣고 판단을 내려야 하는 이른바 ‘인폼드 컨센트(Informed consent)’가 이루어져야 한다. 여기서 요구되는 환자의 동의는 치료행위에 대한 동의능력을 구비하고 있는 환자본인에 의해서 이루어져야 한다. 하지만 실제 의료현장에 있어서는 환자가 미성년자이거나 중증의 정신장애를 가진 사람 등 동의 능력을 갖고 있지 않는 경우가 적지 않다. 이와 같이 환자 자신이 치료행위에 대한 동의능력을 가지지 않은 경우에는 환자 본인의 동의를 얻을 수 없다. 또한 의식불명 상태로 옮겨져 온 환자의 생명을 구하기 위해서 긴급하게 수술이 필요한 경우에도 환자본인의 사전동의를 얻을 여유가 없는 것이 일반적이다. 이러한 경우 의료행위의 정당화 요건의 하나인 환자 본인의 동의를 얻을 수 없다는 이유로 치료행위의 정당화를 부정해야 할 것인가가 문제된다. 즉, 동의능력을 갖지 않는 환자에 대한 의료행위도 일정한 범위에서 정당화를 인정할 수 있는가의 문제인 것이다. 통상의 의료행위에 대해서는 환자의 자기 결정권을 존중한다는 견지에서 환자 본인의 동의가 요구되지만 환자가 치료행위에 대한 동의 능력을 구비하고 있지 않는 경우에는 환자 본인의 동의를 얻지 못하고 의료행위의 정당화 요건을 충족 할 수 없다. 따라서 환자 본인의 동의를 얻을 수 없는 경우 치료행위의 정당화에 대하여 검토할 필요가 있다. 우리 민법 제947조의2제3항은 “피성년후견인의 신체를 침해하는 의료행위에 대하여 피성년후견인이 동의할 수 없는 경우에는 성년후견인이 그를 대신하여 동의할 수 있다.”고 규정하여 성년후견인이 대리로 동의할 수 있음을 명시하고 있다. 또한 실제 의료현장에서도 환자 자신이 치료행위에 대한 동의능력을 가지고 있지 않는 경우 환자의 가족이나 친인척 등의 동의를 받아 치료행위를 하고 있다. 하지만 여기서 검토하여야 할 것이 환자 본인의 동의를 얻지 않은 의료행위의 정당성을 근거지움에 있어 다른 사람에 의한 동의가 어떠한 의의를 가지는 것인가 라는 점이다. 치료행위에 대한 환자의 동의능력의 의의 및 그 유무를 판단하기 위한 기준과 관련하여 최근까지의 연구에 대한 검토를 기반으로 의료행위에 대한 동의능력의 의미를 보면 ①치료행위에 관한 정보를 이해하는 능력, ②이해한 정보를 기억하고 결론을 이끄는 능력, ③얻은 정보를 구사하고 스스로 결정을 내리는 능력을 말하고 그 내용은 민법상의 행위능력과는 반드시 동일한 것은 아니며, 동의능력의 유무 또한 환자가 일정한 연령에 이르고 있는지에 의해서 일률적으로 판단되는 것이 아니고 환자가 정신질환을 앓고 있다는 객관적인 사정에 의해서 구별 수 있는 것도 아니다. 이러한 동의능력의 유무는 그 내용과 연동하여 판단해야 하는 것이기 때문에 ①환자가 의사로부터 받은 설명의 내용을 이해하고 기억에 남겨 둘 수 있을지, ②의사로부터 제공된 정보를 진정한 것이라고 믿고 자기의 가치관에 따라서 판단을 내릴 수 있을지, ③정보를 비교·형량하여 논리적으로 검토하여 스스로 결론을 이끌어 낼 수 있는지 등 다양한 기준에 따라 판단하여야 할 것이다. 본 논문은 이러한 내용을 중심으로 형법적 관점에서 대리승낙 허용의 가능성에 대하여 검토 하여 보았다.

의료행위 동의권자의 결정 -성년후견제 시행에 대비하여-

현소혜 ( So Hye Hyun ) 홍익대학교 법학연구소 2012 홍익법학 Vol.13 No.2

Every person has the right to determine whether he consents to the specific medical treatment or not, even though he cannot make a rational decision. The new adult guardianship system in Korean revised Civil Law guarantees such a right of self-determination of the mentally incapacitated adult. Furthermore, it provides adult-guardians and limited-guardians can make decisions about medical affairs for the mentally incapacitated adult in case of judicial declaration and his being unable to make decision by himself. But who can consent to the medical treatment for the mentally incapacitated adult without adult-guardians or limited-guardians? If the mentally incapacitated adult has appointed a personal guardian for medical affairs, he can be informed of and decide whether to consent to the medical treatment, Besides adult-guardians and limited-guardians, specific guardians has the power of decision-making for the mentally incapacitated person too, when there is no personal guardian, Supervisor of guardianship can consent as a accompanying deputy just in circumstances of emergency. In case of not being any kind of guardians at all, it seems the legislator deems for the court to appoint new guardian for medical affairs, but it demands too much of patient`s family considering its high cost and severe effort, Therefore we should design alternate system of adult guardianship, which enables other person to substitutes guardian`s decision, Otherwise, medics will not give proper medical treatment as a warning for medical malpractice suit. It would be appropriate close relatives of patient, such as spouses, children or parents, to be the legal representatives for the mentally incapacitated person in common sense and medical practice. We should pay attention the power of decision-making for the mentally incapacitated person not to be misused. The interests of patient and those of guardians or relatives are sometimes imcompatible, so Korean revised Civil Law demands the permission of family court when there is a risk of death or considerable disability as a immediate result of medical treatement. Such a provision must be applied to the substitute consent of relatives, and furthermore, when there is a risk of death or considerable disability as a immediate result of denial of medical treatement, too. Finally, advance directives for medical affairs should be introduced in new guardianship system. It will help a right of self-determination of the mentally incapacitated adult be realized in full range. It would be better to make the advance directives for medical affairs a formal act (for example, in writing and with autograph) for securing true intention of patients. But it seems advance directives for medical affairs cannot restrict medics because it is no informed-consent. Advance directives cannot be used for the denial or termination of life-sustaining treatment or organ transplant, either.

成年後見과 醫療行爲의 決定

김천수(Kim Cheon Soo) 한국가족법학회 2007 가족법연구 Vol.21 No.1

  In this paper, the writer analysed the system of a guardianship for the mentally handicapped adults, especially a guardian’s authority to consent to or refuse a medical treatment for his ward. The medical treatment, analysed here, includes ‘the artificial abortion,’ ‘the donation of human organ,’ ‘the medical experiment on human body’ and ‘the suspension of medical treatment’. In order to analyse these issues, the writer consulted Prof. M?ller’s paper commenting Section 1904 of German Civil Code(§1904 BGB), which is contained in the Kommentar BGB(2003) edited by Bamberger/Roth. The writer introduced the German argument about the general and special issues relating with the guardian’s medical decision for his ward who is a mentally handicapped adult. And then he presented his opinion about each issue.<BR>  The writer manifested his opinion different with German predominant opinion relating with some of the general issues.<BR>  The writer supported the German Law’s legislative attitude and purpose that the guardianship court’s permission is necessary before the guardian consents to the medical treatment serious or dangerous to his ward.<BR>  The writer’s attitude against the artificial abortion is very firm, so that he did not agree with the suggestion introduced or supported by Prof. M?ller.<BR>  As far as the donation of human organ is concerned, the Korean legislation is superior to that of Germany. The writer suggested only that it is necessary to introduce into the relating Korean act a new clause prohibiting the guardian from consenting to an operation for tearing off any organ from his ward’s body.<BR>  The consent to the medical experiment on human body needs more detailed and circumstantial information for the consent to be valid. It should be noted that the consent to the medical experiment on the ward’s body could not be executed vicariously by the guardian without any therapeutic effect for the ward’s disease.<BR>  It is the writer’s opinion that any medical treatment on a patient could be suspended only according to his own consent or intent. His consent or intent could be manifested in advanced or inferred subjectively or objectively even after he falls in to a coma. However anyone including his guardian can not consent the suspension vicariously, but can only help a physician infer the patient’s consent or intent.<BR>  According to §1904 BGB, the guardianship court’s permission is not necessary in such a case that the process of obtaining the permission delays the urgent treatment and therefore endangers unreasonably the patient, even for the guardian’s consent to the medical treatment serious or dangerous to his ward. When such a process of the court’s permission is enacted in any Korean act, such an exemption clause should be included. It would be necessary for prevention against any defensive medicine.<BR>  On the whole, the writer supported the legislative attitude of the rest clauses relating with the process of the court’s decision for the permission.

醫師의 說明義務에 관한 硏究

昌新娟 원광대학교 법학연구소 2011 의생명과학과 법 Vol.5 No.-

Patients have the right to understand the purpose and risks of an invasive medical procedure, before they give consent for that invasive medical treatment. Doctors must offer full explanations of the treatment, risks, and the reasons for said treatment to all patients before any invasive medical procedure is performed. Doctors should also obtain a signed consent form from the patient before the invasive medical procedure in the event of any complications during the invasive medical procedure that leaves the patient in worst health after the invasive medical procedure. The consent form should describe allowed compensation in the event of any medical complication during the invasive medical procedure. If the doctor takes time to help the patient understand invasive treatments and the associated risks, patients can make informed decisions before signing any consent forms that may limit their ability to win monetary compensation in a medical malpractice suit in the event of a complication during the invasive procedure. The doctors can concentrate on healing the patient during invasive medical procedures when the doctor and patient have a mutual understanding of the invasive procedure and a signed, comprehensive consent form to cover the allowed compensation, should there be any complications during the invasive procedure. With communication and a comprehensive consent form, patients can make an informed decision to allow doctors to perform an invasive medical treatment and doctors can make an informed decision to treat a patient without the worries of any medical or legal repercussions after the said invasive treatment. A German court in 1894 determined that invasive medical procedures without patient consent were a criminal act of inflicting bodily injury. Later Anglo-American and Japanese laws require doctors to provide an explanation of the invasive medical procedure in conjunction with the consent form. In a case of an invasive medical procedure resulting in complications, a patient can seek damages if the patient can prove a lack of sufficient explanation of the procedure and/or a signed consent form prior to the invasive medical procedure. Korean laws currently consider physical damages to infringing on a person’s body and mental damages to infringing on a person’s rights in cases of insufficient explanation by the doctor in cases of complications during an invasive medical procedure. Laws requiring doctors to provide prior explanations of invasive medical procedures and patient consent forms need revision to reduce generalities. Doctors need clear legal guidelines on invasive medical procedure explanation documentation in addition to outlines for standard consent forms to assure all patients and doctors in Korea have sufficient information, before an invasive medical procedure, to make an informed decision.

醫師의 說明義務에 관한 硏究

昌新娟 원광대학교 법학연구소 2011 의생명과학과 법 Vol.5 No.-

Patients have the right to understand the purpose and risks of an invasive medical procedure, before they give consent for that invasive medical treatment. Doctors must offer full explanations of the treatment, risks, and the reasons for said treatment to all patients before any invasive medical procedure is performed. Doctors should also obtain a signed consent form from the patient before the invasive medical procedure in the event of any complications during the invasive medical procedure that leaves the patient in worst health after the invasive medical procedure. The consent form should describe allowed compensation in the event of any medical complication during the invasive medical procedure. If the doctor takes time to help the patient understand invasive treatments and the associated risks, patients can make informed decisions before signing any consent forms that may limit their ability to win monetary compensation in a medical malpractice suit in the event of a complication during the invasive procedure. The doctors can concentrate on healing the patient during invasive medical procedures when the doctor and patient have a mutual understanding of the invasive procedure and a signed, comprehensive consent form to cover the allowed compensation, should there be any complications during the invasive procedure. With communication and a comprehensive consent form, patients can make an informed decision to allow doctors to perform an invasive medical treatment and doctors can make an informed decision to treat a patient without the worries of any medical or legal repercussions after the said invasive treatment. A German court in 1894 determined that invasive medical procedures without patient consent were a criminal act of inflicting bodily injury. Later Anglo-American and Japanese laws require doctors to provide an explanation of the invasive medical procedure in conjunction with the consent form. In a case of an invasive medical procedure resulting in complications, a patient can seek damages if the patient can prove a lack of sufficient explanation of the procedure and/or a signed consent form prior to the invasive medical procedure. Korean laws currently consider physical damages to infringing on a person’s body and mental damages to infringing on a person’s rights in cases of insufficient explanation by the doctor in cases of complications during an invasive medical procedure. Laws requiring doctors to provide prior explanations of invasive medical procedures and patient consent forms need revision to reduce generalities. Doctors need clear legal guidelines on invasive medical procedure explanation documentation in addition to outlines for standard consent forms to assure all patients and doctors in Korea have sufficient information, before an invasive medical procedure, to make an informed decision.

성충동 약물치료의 선행연구에 관한 독창적 비판 – 동의론을 중심으로 -

천정환 한국교정복지학회 2018 교정복지연구 Vol.0 No.52

Korean sex-drive medication treatment system(law) for correcting sex-offenders against female and children as redundant security measure was established very rapidly without due discussion with complex surrounding of korean commercial journalism, public indignation about koreans rigid sex-offenses which has steadily increasing, korean authoritarianism regime, public blind faith in professionalism due to Bacon’s theater idol, complex interests of korean political groups. Therefore, Korean sex-drive medication treatment system has in its pocket fascistic anti-human rights factors and various existing studies to improve its anti-human rights factors has been published. But, many existing studies which has based on revision pointed out human problems of sex-drive medication treatment system which goes into effect without sex-offenders consent and have insisted on “sex-drive medication treatment system on condition of consent” But, their sex-drive medication treatment system theory on condition of consent is within the basic limit in view of the form of consent only. Therefore, in this paper, I presented ingeniously a qualitative aspects of consent including consent’s authenticity, consent’s understanding, consent’s maturity and consent’s powerlessness, consent’s stratification, consent’s inequality, consent’s welfare. consent’s welfare ideology which many existing studies have looked out. In conclusion, I insisted on my original view with a subjective point of view about existing “sex-drive medication treatment theory on condition of consent.” 한국에서 성범죄자에 대한 보안처분인 성충동약물치료제도는 잔인한 성범죄에 대한 자본화된 저널리즘과 권위주의 역사, 전문성에 대한 맹종, 정치집단의 이해관계 등이 복합적이고 역동적으로 작용해 충분한 숙려 없이 너무나 급속히 제정되었다. 성충동 약물치료제도는 파시즘적인 반인권성이 은밀히 작용하고 있는 관계로 이에 따라 인권적 측면에서 이 제도의 개선을 위한 다양한 선행연구들이 나왔다. 그러나 제도의 보완론에 기반한 대다수의 선행연구들은 현재 성범죄자의 동의 없이 이루어지는 성충동 약물치료의 인권적 문제점을 지적하고 “동의부 성충동 약물치료론”을 주장한다. 그러나 그러한 “동의부 성충동 약물치료론”은 동의를 성범죄자가 했느냐의 동의의 형식성만 본 점에서 근본적 한계를 가진다. 따라서 본 논문에서는 선행연구들이 전혀 알지 못한 동의의 진정성, 이해성, 성숙성 등을 포함한 동의의 질적 측면과 동의 메카니즘에 내재된 동의의 권력성, 계층성, 자본성, 불평등성, 선택성, 복지성 등을 독창적으로 제시하여 “동의부 성충동 약물치료론”을 주체적 관점에서 새롭게 비판하였다.