건강보험에 있어 임의비급여 규제에 대한 헌법적 평가

박지용 ( Ji Yong Park ) 경상대학교 법학연구소 2013 法學硏究 Vol.21 No.3

임의비급여 규제에 대한 국민건강보험법의 명시적 규정이 없음에도 실무에서는 이를 당연 위법으로 판단하였다. 그리고 대법원이 이를 승인함으로써 이러한 해석론은 정당화되어 왔다. 그러나 의료현실에서는 이러한 임의비급여에 대한 일률적 금지에 대하여 꾸준한 문제제기가 있어왔다. 최근 대법원은 전원합의체 판결로써 임의비급여는 원칙적으로 위법이지만, 예외적으로 허용될 수 있다고 판시하면서, 그 허용요건으로서 임의비급여의 급여항목 또는 법정비급여로의 전환 절차의 부존재, 의료행위의 안전성과 유효성, 의학적 필요성의 존재, 환자의 충분한 설명에 근거한 동의 등을 제시하고 있다. 그리고 이러한 허용요건은 이를 주장하는 요양기관에서 입증하여야 한다고 판시하였다. 이와 같은 대법원의 입장은 비록 임의비급여의 예외적 허용가는성과 그 허용요건을 구체적으로 설시하고 있다는 점에서 진일보한 것이기는 하지만, 임의비급여가 원칙적으로 불법이라는 종래의 대법원 판결과 그 궤를 같이 하고 있다는 점에서 근분적인 분제점을 탈피하지는 못했다. 물론 사회보험 형식으로서 공적 의료보장을 도모하고자 하는 건강보험제도 하에서 의료행위는 적정하게 관리되어야 하고, 그로 인하여 일정 부분 의사 또는 환자의 자율권 및 선택권이 제한되는 것은 불가피하다. 그러나 임의비급여원칙적인 위법으로 해석하고 있는 대법원의 태도는 지나친 국가 권력의 개입을 통한 의료에 대한 전면적 통제를 가능하게 한다는 문제점을 가지고 있다. 이 글에서는 의료행위의 본질이나 의료윤리의 원칙, 의료계약의 법률관계론으로부터 도출되는 의사 및 환자의 자율성 그리고 건강보험제도의 본질과 한계 등을 논증함으로써 임의비급여를 원칙적으로 위법으로 보는 해석론을 극복할 수 있는 근거를 제시하고자 한다. Although there is no explicit provision for regulation about unauthorized non-benefit medical care in National Health Insurance Act, the National Health Insurance Service and the Supreme Court determined that the unauthorized medical care is per se illegal. The Superme Court, however, recently has changed the conventional position. The Supreme Court decided that the unauthorized medical care is illegal in principle, but it can exceptionally be allowed. These requirements are as follows: First, there is no legal procedure to change from unauthorized non-benefit medical care to benefit medical care. Second, the medical safety, efficacy and need should be recognized. Third, there is informed consent from the patients based on sufficient explanation of the doctor. This Supreme Court decision has proposed the exceptional approval and its requirements about unauthorized non-benefit medical care in National Health Insurance System, but it may have the fundamental problem, This is because it still recognized the unauthorized medical care is illegal in principle. Medical care, of course, should be managed appropriately by the government as a public insurer under the National Health Insurance System, and the autonomy and the free to choose of physician and patient could be limited. However, the view, which the non-benefit medical care is illegal in principle, has a constitutional problem that the fundamental rights of physicians and patients might be violated through excessive state`s interventions. This article aims to analyze the nature of medical care, autonomy of physician and patient from principles of medical ethics and medical contract and limitations of public health insurance, and suggest a constitutional approach about unauthorized medical care.

국민건강보호법의 최근 이슈들 ; 국민건강보험법상 상대가치점수 직권 조정의 합법성에 대한 법이론적 분석

이상돈 ( Sang Don Yi ) 고려대학교 법학연구원 2012 고려법학 Vol.0 No.65

현행 국민건강보험법상 요양급여비용은 공단 이사장과 유형별 요양기관의 대표자 사이의 계약으로 정하게 되어 있으나, 계약이 결렬되면 보건복지부 장관이 고시에 의해 정한다. 계약은 장관이 고시로 정하는 의료행위별상대가치점수의 단가만을 대상으로 한다. 이와 같이 반의 반쪽의 계약제는 보건복지부 장관이 점수 당 단가에 대한 계약이 체결된 이후, 그 계약의 기간 이내에 직권으로 상대가치점수를 인하할 경우에는 그 실질이 심각하게 훼손될 수 있다. 그러므로 상대가치점수의 직권인하(고시처분)의 위법여부가 문제될 수 있다. 이 문제는 헌법이 보장하는 두 이념, 즉, 사적 자치와 (의료보험의) 사회보장성이 실제적으로 조화를 이루도록 하는 방향으로 요양급여비용계약법제를 해석함으로써 판단되어야 한다. 그런 해석의 핵심적인 내용을 요약하면 다음과 같다. 첫째, 고시에 의한 상대가치점수의 직권조정 제도 자체는 허용될 수 있다. 둘째, 상대가치점수의 직권인하가 그 직전의 요양급여비용계약의 체결로 기대되었던 수가인상분을 ``현저하게`` 상쇄시키는 정도여서는 안 된다. 왜냐하면 계약체결 후에 장관이 상대가치점수를 그런정도로 인하할 것을 알았다면 계약을 체결하지 않았을 것이기 때문이다. 셋째, 상대가치점수의 직권 조정은 의료행위에 포함된 업무량 또는 자원의 량·가격 등이 ``상당히`` 변화되었을 경우에만 허용된다. 넷째, 상대가치점수의 직권 조정은 전문평가위원회의 평가절차를 반드시 거친 후에만 허용된다. Current National Health Insurance Act of Korea states that medical care benefit cost shall be determined by contract between the President of National Health Insurance Corporation and the representative of each medical and pharmaceutical communities. However, in the case of non-conclusion of contract due to rupture of negotiations, Minister of Ministry of Health and Welfare has the authority to determine such expense via public notice. The aforementioned contract only deals with unit cost derived from relative value of each medical procedure which is determined by the Minister through public notice. Such contract can only perform as a half of a already half contract. Also, this contract`s substantiality can be severely damaged if the Minister compulsorily markdowns the relative value point after the contract has been concluded. This is where the ex officio markdown`s illegality becomes a problem. This problem should be solved by balancing two constitutional principles, principle of private autonomy and social security of health insurance, when interpreting the System of Contract on Medical Care Benefit Costs. The key points of such interpretation is as follows: First, ex officio adjustment system by public notice itself is allowable. Second, decrease in relative value point by ex officio markdown of relative value point should not be noticeable from the expected medical care benefit cost derived from Contract on Medical Care Benefit Costs. For if one had known that relative value point would decrease in distinguishable amount from what he expected from a conclusion of contract, no one would participate in a contracting process. Third, ex officio adjustment can only be allowed in case where amount of physician work, amount of resource, or practice expense needed for a medical act have changed significantly. Lastly, ex officio adjustment of relative value point must be preceded by reviewing process of Reviewing Committee of Specialists.

국민건강보험법상 상대가치점수 직권 조정의 합법성에 대한 법이론적 분석

이상돈 고려대학교 법학연구원 2012 고려법학 Vol.0 No.65

Current National Health Insurance Act of Korea states that medical care benefit cost shall be determined by contract between the President of National Health Insurance Corporation and the representative of each medical and pharmaceutical communities. However, in the case of non-conclusion of contract due to rupture of negotiations, Minister of Ministry of Health and Welfare has the authority to determine such expense via public notice. The aforementioned contract only deals with unit cost derived from relative value of each medical procedure which is determined by the Minister through public notice. Such contract can only perform as a half of a already half contract. Also, this contract’s substantiality can be severely damaged if the Minister compulsorily markdowns the relative value point after the contract has been concluded. This is where the ex officio markdown’s illegality becomes a problem. This problem should be solved by balancing two constitutional principles, principle of private autonomy and social security of health insurance, when interpreting the System of Contract on Medical Care Benefit Costs. The key points of such interpretation is as follows: First, ex officio adjustment system by public notice itself is allowable. Second, decrease in relative value point by ex officio markdown of relative value point should not be noticeable from the expected medical care benefit cost derived from Contract on Medical Care Benefit Costs. For if one had known that relative value point would decrease in distinguishable amount from what he expected from a conclusion of contract, no one would participate in a contracting process. Third, ex officio adjustment can only be allowed in case where amount of physician work, amount of resource, or practice expense needed for a medical act have changed significantly. Lastly, ex officio adjustment of relative value point must be preceded by reviewing process of Reviewing Committee of Specialists. 현행 국민건강보험법상 요양급여비용은 공단 이사장과 유형별 요양기관의 대표자 사이의 계약으로 정하게 되어 있으나, 계약이 결렬되면 보건복지부 장관이 고시에 의해 정한다. 계약은 장관이 고시로 정하는 의료행위별 상대가치점수의 단가만을 대상으로 한다. 이와 같이 반의 반쪽의 계약제는 보건복지부 장관이 점수 당 단가에 대한 계약이 체결된 이후, 그 계약의 기간 이내에 직권으로 상대가치점수를 인하할 경우에는 그 실질이 심각하게 훼손될 수 있다. 그러므로 상대가치점수의 직권인하(고시처분)의 위법여부가 문제될 수 있다. 이 문제는 헌법이 보장하는 두 이념, 즉, 사적 자치와 (의료보험의) 사회보장성이 실제적으로 조화를 이루도록 하는 방향으로 요양급여비용계약법제를 해석함으로써 판단되어야 한다. 그런 해석의 핵심적인 내용을 요약하면 다음과 같다. 첫째, 고시에 의한 상대가치점수의 직권조정 제도 자체는 허용될 수 있다. 둘째, 상대가치점수의 직권인하가 그 직전의 요양급여비용계약의 체결로 기대되었던 수가인상분을 ‘현저하게’ 상쇄시키는 정도여서는 안 된다. 왜냐하면 계약체결 후에 장관이 상대가치점수를 그런 정도로 인하할 것을 알았다면 계약을 체결하지 않았을 것이기 때문이다. 셋째, 상대가치점수의 직권 조정은 의료행위에 포함된 업무량 또는 자원의 량․가격 등이 ‘상당히’ 변화되었을 경우에만 허용된다. 넷째, 상대가치점수의 직권 조정은 전문평가위원회의 평가절차를 반드시 거친 후에만 허용된다.

의사의 설명의무에 대한 연구

장창민 아주대학교 법학연구소 2019 아주법학 Vol.13 No.2

The relationship between a doctor and a patient can be regarded as a contractual relationship of a legal relationship, called a "medical contract," between a doctor providing the medical service and the patient receiving the medical service. In this way, in the process of concluding a medical contract or in the execution of a contract, the patient has a right to self-determination to make decisions and decide on the medical actions to be performed on his / her life and body. The physician shall bear the obligation of explanation in addition to the obligation to care for the medical act under the medical contract. Therefore, even if a patient violates his / her right to self-determination in violation of explanation obligation, the doctor will be liable for damages due to the breach of duty. Compensation for breach of explanation duty is a common feature of malpractice lawsuits that are handled in conjunction with medical malpractice. In the case of patients who are responsible for damages due to medical malpractice, almost all of them allege violations of explanation duties as follows: i) medical treatment of patients, including 'silent conspiracy', 'medical patriarchy' Ⅱ) Unlike in Germany, which is strict in recognition of alimony, torture is easy to be recognized if liability for illegal acts is recognized. Ⅲ) In the case of a medical suit, I am afraid that I will not keep my rights. The explanation of self-determination and the explanation of the purpose of treatment may be different from the content and purpose, but it will be the same in order to prevent the patient's physical or health-related damage and property damage. Therefore, there seems to be no reason to treat the requirements and effects of liability for damages due to breach of explanatory duty differently from the attitude of judicial precedents. In this way, it is doubtful whether or not the explanation obligation is an easy way to escape from the difficulty of proving a malpractice or causal relationship in the event of a medical accident. In order to solve these questions, this paper examines the basis, type, method and degree of explaining obligations, and examines the problems of related precedents. 의사와 환자와의 관계는 의료서비스를 제공하는 의사와 그 의료서비스를 받는 환자와의 ‘의료계약’이라고 하는 법률관계의 대등한 계약당사자 관계로 볼 수 있다. 이와 같이 의료계약의 체결과정 또는 계약의 이행과정에서 환자는 자신의 생명과 신체에 행해질 의료행위에 대하여 스스로 판단하고, 결정할 수 있는 자기결정권을 갖는다. 의사는 의료계약에 의하여 의료행위에 대한 주의의무와 더불어 설명의무를 부담한다. 따라서 설명의무를 위반하여 환자의 자기결정권을 침해한 경우에도 의사는 의무위반에 따른 손해배상책임을 지게 된다. 설명의무위반에 따른 손해배상은 의료과실과 더불어 다루어지는 것이 의료과오소송의 일반적인 모습이다. 환자가 의료과실에 따른 손해배상 책임을 묻는 경우에 거의 대부분이 설명의무 위반을 함께 주장하는데 그 이유는 ⅰ) 의료계의 일부가 지니고 있는 ‘침묵의 공모', ‘의료 가부장주의’를 비롯한 환자의 의학적 전문성의 결여로 인한 입증곤란, ⅱ) 위자료 인정에 엄격한 독일과는 달리 불법행위책임이 인정되면 위자료배상이 쉽게 인정되는 경향, ⅲ) 의료소송에서 의사의 과실을 청구원인으로 하여 소를 제기하는 것이 자신의 권리를 지키지 못할 것이라는 불안감을 들 수 있다. 자기결정 설명과 진료목적 설명은 그 내용과 취지는 다를 수 있겠지만, 결국 환자의 신체상 또는 건강상 나아가 재산상의 손해를 입지 않도록 하기 위한 점에서는 같다고 할 것이다. 따라서 설명의무 위반에 따른 손해배상책임요건과 효과에 있어서 이를 판례의 태도처럼 달리 구별해서 다루어야 할 근거가 없어 보인다. 이와 같이 설명의무에 대한 입장은 의료사고가 발생한 경우, 과실이나 인과관계에 관한 입증의 곤란함을 피하는 일종의 탈출구로 위자료라는 손쉬운 방법을 택하고 있는 것은 아닌지 하는 의문이 든다. 이와 같은 의문점을 해소하기 위하여 본 논문에서는 설명의무의 근거, 유형, 방법과 그 정도 등에 대한 내용을 살펴보고, 이와 관련된 판례의 문제점을 살펴보고자 한다.

의료계약과 치료중단에 있어서의 의사의 보증인적 지위 - 보라매병원 사건을 중심으로 -

김성룡,백자민 경북대학교 법학연구원 2008 법학논고 Vol.0 No.29

The so-called Boramae hospital case is that patient's conservator claimed discharge against medical advice, and doctors who accepted that demand were indicted for murder. In this case, there are many issues of criminal law(like judgement of act and omission, legal property of treatment ceasing, duty to act of the doctor in treatment ceasing in case of confirming omission, and so on). This paper begins with the examination of legal property of the medical contract and we discuss it mainly on an existing related law and a domestic discussion with Boramae Hospital case how the property of such a medical contract can be applied to the confirmation of the duty to act of the doctor when a treatment ceasing is accepted in omission. Doctor has legal, contractual, social-conventional duty to give medical treatment continuously in spite of the demand of the discharge of patient or patient's conservator. It is also from the voluntary undertaking of the doctor. The confirmation of doctor's duty to act is clear by a law of the emergency medical care Article 10 above all. As we have discussed it with the property of the medical contract, the medical contract is non typical contract which is similar for mandate so that the provision of this article with respect to mandate shall apply in conclusion and cancellation of the contract. If it is so, demand of the discharge of patient's conservator despite possibility of survive is high when treatment was maintained not stand because self-determination can't be represented. In addition, doctor's duty to give medical treatment continuously is not thought only to be the moral obligation by all means, so it can be accepted as the duty according to social-conventional rules following the restrictive view of it. 소위 보라매병원 사건은 의학적 권고에 반하여 환자의 보호자가 퇴원을 요구하고, 이 요구에 응해 치료를 계속할 경우에 생존가능성이 높았던 환자를 퇴원시킨 담당의사가 살인죄로 기소된 사건이었다. 이 사건에는 작위와 부작위의 판단, 치료중단의 법적인 성격, 치료중단이 부작위로 판단내려질 경우의 의사의 보증인 지위와 의무의 근거 등 많은 형법적 쟁점을 내포하고 있다. 본 논문에서는 의료계약의 계약법적 성격에 대한 논의부터 시작하여, 의사의 치료중단이 부작위로 인정될 경우의 의사의 보증인적 지위와 의무와 관련하여 의료계약의 특성은 어떻게 이해될 수 있는지를 특히 보라매 병원사건과 관련하여 살펴본다. 의사에게는 환자 또는 환자 보호자의 퇴원요구에도 불구하고 계속적 치료에 대한 법적, 계약적, 조리 상의 의무가 인정된다고 할 수 있고, 그것은 의사의 자발적 인수에서도 마찬가지이다. 의사에게 보증인 지위와 의무를 인정하는 법적 근거는 무엇보다 응급의료에 관한 법 제10조에서 찾을 수 있다. 의료계약은 위임계약에 유사한 비전형계약이다. 따라서 계약의 성립과 해지에 관해 위임계약에 관한 규정이 준용된다고 할 수 있다. 그런데, 치료가 계속해서 이루어질 경우에 생존가능성이 높은 환자 보호자의 퇴원요구는 계약 일반에 있어서 대리가 가능한 성질의 것이 아니므로 그러한 보호자의 대리행위는 무효라고 할 수 있으며, 따라서 보호자의 퇴원요구가 있다고 하더라도 의사는 계속적 치료의무를 진다고 할 것이다. 또한 의사의 치료계속의무는 반드시 도덕적 의무라고만 볼 수는 없으므로 조리를 제한적으로 인정하는 견해에 따른다면 조리 상의 작위의무도 인정될 수 있다고 본다.

의료행위에 대한 미성년자의 의사결정권- 캐나다의 법률을 중심으로 -

송재우 부산대학교 법학연구소 2022 법학연구 Vol.63 No.2

A minor may consent or reject to medical care, regardless of his/her age, if he/she has the capacity to understand the information that is relevant to making a decision about the medical care and to appreciate the reasonably foreseeable consequence of a decision or a lack of such decision. However, problem may arise if the parent/guardian disagrees with the minor’s decision to consent or reject medical care. The parent/guardian’s right should reasonably be exercised in accordance with the nature of the medical care, whether it is related to his/her health and causes the grave and serious affection, to the decision of consent or refusal made by the minor. Additionally, it should be considered to make a third-party institution judge the legal matter regarding the minor’s capacity for medical care and the medical care providers’ release from any potential liability with respect to the minor’s decision making, as far as he/she provides the medical care to the minor upon the reasonable judgment for the minor’s capacity, even without the consent from a parent/guardian. Under the Canadian legal system, the minor’s rght to decide upon the medical care for himself is protected by law, so that the additional consent from parent/guardian or withdrawal by such is prohibited. Furthermore, a third party specialized institution has the authority to dissolve any related matter in an efficient and timely manner. In this regard, the Canadian legislation may be considered helpful for future Korean legislation.

2013년 주요 의료 판결 분석

이동필,정혜승,이정선,유현정 대한의료법학회 2014 의료법학 Vol.15 No.1

The court handed down meaningful rulings related to medical sectors in 2013. This paper presents the ruling that the care workers could be the performance assistants of the care-giving service although the duties of care worker are not included in the liability stipulated in the medical contract signed with the hospital for reason of clear distinction of duties between care workers and nurses within the hospital in connection with the contract which was entered into between the hospital and patients. In relation to negligence and causal relationship, the court recognized medical negligence associated with the failure to detect the brain tumor due to the negligent interpretation of MRI findings while rejecting the causal relationship with consequential cerebral hemorrhage. The court also recognized negligence based on the observation on the grounds of inadequate medical records in a case involving the hypoxic brain damage caused during the cosmetic surgery. In terms of the scope of compensation for damages, this paper presents the ruling that the compensation should be estimated based on causal relationship only in case the breach of the 'obligation of explanation' is recognized, however rejecting the reparation for de factor property damages in the form of compensation, and the ruling that the lawsuit could be instituted in case that the damages exceeded the agreed scope despite the agreement that the hospital would not be held responsible for any aftereffects of surgery from the standpoint of lawsuit, along with the ruling that recognized the daily net income by reflecting the unique circumstances faced by individual students of Korean National Police University and artists of Western painting. Many rulings were handed down with respect to medical certificate, prescription, etc., in 2013. This paper introduced the ruling which mentioned the scope of medical certificate, the ruling that related to whether the diagnosis over the phone at the issuance of prescription could constitute the direct diagnosis of patient, along with the ruling that required the medical certificate to be generated in the name of doctor who diagnosed the patients, and the ruling which proclaimed that it would constitute the breach of Medical Act if the prescription was issued to the patients who were not diagnosed. Moreover, this paper also introduced the ruling that related to whether the National Health Insurance Service could make claim to the hospitals for the reimbursement of the health insurance money paid to pharmacies based on the prescription in the event that the hospitals provided prescription of drugs to outpatients in violation of the laws and regulations.

우리나라 공공의료의 쟁점과 해결책

이은혜 연세대학교 의과대학 2022 의학교육논단 Vol.24 No.1

South Korea is not a wasteland of publicly funded health care—instead, it has a good medical social security system known as the national health insurance (NHI). The NHI of Korea has three unique features; (1) low premiums, low insurance fees, and low coverage; (2) obligatory designation of medical institutions; (3) and allowance of non-benefit services. These features have made hospitals and doctors interested in profit-seeking. However, the commercialization of medical institutions has taken place in both private- and public-established sectors. A basic problem of commercialization is the co-existence of the obligatory designation of medical institutions and non-benefit services. The problem became worse in the Kim Dae-Jung government because it officially permitted non-benefit services. Since 2000, the Korean government has consistently pursued benefit extension policies, but the coverage rates of the NHI have stagnated. In addition, premiums and current medical expenses have markedly increased because policy-makers have emphasized accessibility to the NHI, while ignoring important principles of medical social security such as a needs-based approach and patient-referral system. In order to resolve the commercialization problem, the obligatory designation of medical institutions to the NHI should be changed to a contract system, and non-benefit services should be prohibited at NHI institutions. We must re-establish the patient-referral system via a needs-based approach. We also need to build a primary healthcare system and public health policies. We should make a long-term plan for healthcare reform.

병원 위탁급식 품질관리를 위한 품질평가도구 개발

양일선,김현아,이영은,박문경,박수연 대한지역사회영양학회 2003 대한지역사회영양학회지 Vol.8 No.3

The purposes of this study were: a) to develop the a quality measurement tool for the contract-managed hospital foodservice, and b) to evaluate their performance with the developed quality measurement tool, and c) to verify the reliability and validity of the quality measurement tool. The developed quality measurement tool comprised two parts, which were foodservice management and medical nutrition care service. The foodservice management part was classified into six functional categories which were Menu, Procurement and Storage, Production and Distribution, Facility and Utility, Sanitation and Safety, and Management and Evaluation. The medical nutrition care service part indicated the medical nutrition care provided. Quality measurement tool had 91 standards and 324 indicators. The quality measurement tools were distributed to the hospital foodservice manager employed by the foodservice company. The 324 indicators were measured by foodservice manager on the 5-Likert-type scales, and then adapted to a 100 point scale. The SPSS Ver. 11.0 was used for statistical analysis. The categories whose scores were evaluated as being high were Procurement', General Sanitation', Personal sanitation' and Waste' and the categories whose scores were evaluated as being low were Diet Order Manual', Standard Recipe', Appropriateness (Facility and Utility)', Check (Facility and Utility)' and Information Management'. All the categories of medical nutrition service were evaluated as having seriously low scores. Therefore, it was necessary for the contract-managed hospital foodservice to improve its performance in the area of medical nutrition care service. For the verification of the developed quality measurement tool, the reliability obtained by calculating Cronbach's α was 0.8747, and the content validity was also proved by scrutiny of the modification of the professional group's techniques.

로봇수술로 인한 의료과오 민사책임에 있어 과실 판단의 문제

김재완 아주대학교 법학연구소 2020 아주법학 Vol.14 No.1

Modern medical technology has been remarkably developed and new surgical methods using robots are being used in clinical surgery. Although surgical robots currently in use do not have the autonomy of artificial intelligence, they are precision and automated medical robots that work together with physicians in all or part of the operation process. The ultimate actor of robot surgery is a doctor of surgery, while the robot of surgery is a medical device under the Medical Devices Act of the Republic of Korea. The core of the determination of legal liability for medical accidents caused by robot surgery is to judge negligence in relation to the actor. However, there is a realistic problem that doctor's liability is not recognized in the case of medical malpractice litigation caused by robot surgery. The new medical practice of robotic surgery belongs to a more advanced field of expertise, and requires a high degree of attention from doctors. On the other hand, the highly specialized expertise in the medical and medical fields is also a characteristic that makes it difficult for the patient to prove the negligence of the doctor. Since robot surgery is a new treatment method different from existing surgical methods, there is a problem that is more difficult to judge medical malpractice. In the conventional medical practice, the legal standard of judicial precedent on the doctor's duty of medical treatment, the duty of care and the violation of the duty of explanation is also applied to the determination of negligence in civil liability due to robot surgery. In particular, it is a matter of reviewing and judging the negligence of this in relation to the part where the new treatment method and technology called robotic surgery are implemented. In this paper, we examine the legal criteria for the negligence presented by the precedents in the past medical malpractice lawsuits, clarify the problems and limitations thereof, and suggest the normative criteria for the negligence in the civil liability for the medical malpractice due to robot surgery, a new treatment method. In addition, it is possible to predict the occurrence of medical accidents due to the implementation of more advanced medical technologies, especially robot doctors equipped with artificial intelligence systems. It emphasizes that it should lead to research and practical tasks that recognize the problems and limitations of the realistic liability law, and constantly consider and present normative criteria for negligence. 현대 의료기술은 눈부신 발전을 거듭하여 임상 수술에서 로봇을 이용한 새로운 수술방법이 사용되고 있다. 현재 사용되고 있는 수술로봇은 인공지능의 자율성을 갖추지는 않았지만, 수술의 모든 과정 또는 일부를 의사와 함께 작업하는 정밀하고 자동화된 의료로봇이다. 로봇수술에 있어 궁극적인 행위 주체는 외과의사이고, 수술로봇은 우리나라 「의료기기법」상 의료기기에 해당한다. 로봇수술로 발생한 의료사고에 대한 법적 책임 판단의 핵심도 행위자와 관련하여 과실을 판단하는 것이다. 그런데 로봇수술로 인한 의료과오소송의 판례에서는 의사 측의 과실책임이 인정되지 않고 있는 현실적인 문제가 있다. 로봇수술이라는 새로운 의료행위는 더욱더 고도의 전문분야에 속하는 것으로, 의사에게 고도의 주의의무를 요구한다. 한편, 의학 및 의료영역의 고도로 특화된 전문성은 환자 측에서 의사 측의 과실 입증을 어렵게 만드는 특성이기도 하다. 로봇수술은 기존의 수술방법과는 다른 새로운 치료방법이라는 점에서 의료과실에 관한 판단에 더욱 어려운 문제가 있게 된다. 종래의 의료행위에 있어 의사의 진료의무와 주의의무 및 설명의무위반에 대한 판례의 법리적 판단기준은 로봇수술로 인한 의료과오 민사책임에서의 과실을 판단할 때에도 적용된다. 이때, 특히 로봇수술이라는 새로운 진료방법 및 기술이 시행된다는 부분과 관련하여 이에 대한 과실의 검토와 판단이 문제 된다. 본 논문은 종래의 의료행위 및 로봇수술로 인한 의료과오소송에서 판례가 제시하고 있는 과실에 대한 법적 판단기준을 검토하여 그 문제점과 한계를 밝히고, 새로운 치료방법인 로봇수술로 인한 의료과오 민사책임에 있어 과실에 대한 규범적 판단기준을 제시해 보기로 한다. 또한, 향후 더욱 새롭게 발전된 의료기술, 특히 인공지능시스템을 갖춘 로봇의사 등의 시행에 따른 의료사고 발생도 예상할 수 있으므로 이에 대한 현실적인 책임법의 문제 및 한계를 인식하고, 과실에 대한 규범적 판단기준을 끊임없이 고민하고 제시하는 연구 및 실무적 과제로 이어져야 한다는 점을 강조한다.