損害賠償 訴訟上의 醫療過失 -論點의 分析과 提言에 중점 두어-

손용근 한양법학회 2009 漢陽法學 Vol.25 No.-

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

의료과오 사건에서 인과관계 증명에 관한 최신 대법원 판결 - 대법원 2023. 8. 31. 선고 2022다219427 판결 및 대법원 2023. 8. 31. 선고 2021도1833 판결을 중심으로 -

문현호 대한의료법학회 2023 의료법학 Vol.24 No.4

의료과오 민사소송의 주된 쟁점은, 과실, 과실과 손해 사이의 인과관계이다. 진료 상 과실이 증명된 경우 인과관계 추정과 관련하여 종래 대법원 1995. 2. 10. 선고 93다52402 판결이 있으나, 위 판결 문언 상 요건을 충족하는 사안은 찾기 어렵고, 그럼에도 실무는 위 판결을 인용하면서 인과관계를 추정하는 경우가 많아 위 판결 문언과 정합성이 없다는 비판이 꾸준히 제기되었다. 대법원은 대상 민사판결에서, 민사소송에서 진료 상 과실이 증명된 경우 인과관계 추정에 관한 법리를 정비하여 새롭게 제시하였다. 이에 의하면, 환자 측이 의료행위 당시 임상의학 분야에서 실천되고 있는 의료수준에서 통상의 의료인에게 요구되는 주의의무의 위반 즉 진료 상 과실로 평가되는 행위의 존재를 증명하고, 그 과실이 환자 측의 손해를 발생시킬 개연성이 있다는 점을 증명한 경우에는, 진료 상 과실과 손해 사이의 인과관계를 추정하여 인과관계 증명책임을 완화한다. 여기서 손해 발생의 개연성은 자연과학적, 의학적 측면에서 의심이 없을 정도로 증명될 필요는 없으나, 해당 과실과 손해 사이의 인과관계를 인정하는 것이 의학적 원리 등에 부합하지 않거나 해당 과실이 손해를 발생시킬 막연한 가능성이 있는 정도에 그치는 경우에는 증명되었다고 볼 수 없다. 한편 진료 상 과실과 손해 사이의 인과관계가 추정되는 경우에도 의료행위를 한 측에서는 환자 측의 손해가 진료 상 과실로 인하여 발생한 것이 아니라는 것을 증명하여 추정을 번복시킬 수 있다. 한편 민사사건과 달리 형사사건에서는 ‘합리적 의심이 없을 정도의 증명’이 기준이고, 인과관계 추정 법리가 적용되지 않는다. 이에 따라 동일한 의료사고에 관하여 같은 날 동일한 재판부에서 선고된 업무상과실치사 형사사건에서는 진료 상 과실과 사망 사이 인과관계에 대한 증명 부족을 이유로 무죄 취지로 파기환송하였다. 대상 형사판결은, 의료과오 관련 형사 사건에서 ‘업무상 과실’이 인정되더라도 ‘인과관계’에 대한 확실한 증명이 부족하면 유죄로 판단하지 말라는 취지의 판결이다. The main issue in medical malpractice civil litigation is medical negligence and the causal relationship between medical negligence and damages. Regarding the presumption of causality in cases where medical negligence is proven, there is a previous Supreme Court decision 93da52402 on February 10, 1995, but it is difficult to find a case that satisfies the textual requirements of the above decision, and yet, in practice, the above decision is cited. In many cases, causal relationships were assumed, and criticism was consistently raised that it was inconsistent with the text of the above judgment. In its ruling, the Supreme Court reorganized and presented a new legal principle regarding the presumption of causality when medical negligence is proven in a civil lawsuit. According to this, If the patient proves ① the existence of an act that is assessed as a medical negligence, that is, a violation of the duty of care required of an ordinary medical professional at the level of medical care practiced in the field of clinical medicine at the time of medical practice, and ② that the negligence is likely to cause damages to the patient, the burden of proving the causal relationship is alleviated by presuming a causal relationship between medical negligence and damage. Here, the probability of occurrence of damage does not need to be proven beyond doubt from a natural scientific or medical perspective, but if recognizing the causal relationship between the negligence and the damage does not comply with medical principles or if there is a vague possibility that the negligence will cause damage, causality cannot be considered proven. Meanwhile, even if a causal relationship between medical negligence and damage is presumed, the party that performed the medical treatment can overturn the presumption by proving that the patient's damage was not caused by medical negligence. Meanwhile, unlike civil cases, the standard is ‘proof beyond reasonable doubt’ in criminal cases, and the legal principle of presuming causality does not apply. Accordingly, in a criminal case of professional negligence manslaughter that was decided on the same day regarding the same medical accident, the case was overturned and remanded for not guilty due to lack of proof of a causal relationship between medical negligence and death. The above criminal ruling is a ruling that states that even if ‘professional negligence’ is recognized in a criminal case related to medical malpractice, the person should not be judged guilty if there is a lack of clear proof of ‘causal relationship’.

미국에서의 의료과오에 대한 형사과실과 그 판단기준

최대호(Choi, Dae-Ho) 중앙대학교 법학연구원 2020 法學論文集 Vol.44 No.2

본 논문은 최근 의료과오에 대한 형사소추 사건이 증가하고 있는 추세를 보이고 있는 미국의 형사판례를 분석하고, 이를 통해 우리나라에서의 의료과오에 관한 형사과실을 판단기준을 모색하였다. 그 내용을 정리하면 다음과 같다. 첫째, 미국에서는 의료과오사건이 주로 면허취소 등 행정처분이나 민사상 손해배상의 문제로 추급되고 있는 점을 고려한다면 미국에서의 의료과오사건에 대한 형사판례를 우리나라와 단순히 비교할 수는 없다. 특히 미국은 주(州)마다 차이를 보이고 있으므로 일률적으로 비교하기도 곤란하다. 그렇다고 하더라도 미국에서는 의료과오가 통상의 위험을 초과하는 중대한 위험이라고 평가되는 경우, 즉 ‘주의기준으로부터의 중대한 일탈’ 또는 ‘중대한 비난가능성’에 해당하는 경우 등을 형사과실의 판단기준으로 삼고 있다. 둘째, 미국판례에서는 의료인의 ‘주관적 사정’이 형사과실을 판단하는 데 큰 역할을 하고 있다. 의료과오는 복잡한 의학적 쟁점이 얽혀 있는 경우가 많고, 또 인과관계 및 주의의무의 기준을 평가하는 데 상당한 어려움이 있다. 이로 인하여 형사과실을 판단함에 있어 타인의 안전을 ‘완전히 무시’하거나 실질적으로 ‘정당화할 수 없는 위험을 의식적으로 경시’하는 경우 등 의료인의 주관적 측면을 많이 고려하게 된다. 이에 비해, 우리나라에서는 의사가 결과발생에 대한 예견가능성이 인정되더라도 당시 의료수준에 입각하여 그 결과에 대한 회피가능성을 인정할 수 없는 경우에는 형사과실을 부정하게 된다. 셋째, 우리나라에서는 의료과오에 대한 의료관계자의 형사과실에 대하여 형법 제268조의 ‘업무상과실·중과실치사상죄’가 적용된다. 중과실치사상죄의 경우에서 ‘중대한 과실’이란 일반적으로 주의의무위반의 정도가 현저한 경우 즉 사소한 주의를 기울임으로써 주의의무를 다할 수 있었음에도 이를 태만히 하여 범죄결과를 발생시켰기 때문에 중한 법적 비난을 가하여야 할 경우를 의미한다. 그런데 미국에서의 중대한 과실 또는 중대한 일탈이란 단순한 민사상 과실과 구별되는 ‘중대한’이며, 그 중대한은 형사과실의 하한으로서 기능하고 있을 뿐이다. 마지막으로 단순한 실수의 경우 우리나라에서는 형사과실로 인정되는 경향이 높지만, 미국에서는 누구나 범할 수 있는 실수로서 형사과실로 인정되지 않는다. 단순한 조작적 실수처럼 보이는 경우에도 구체적인 상황에 따라서는 회피하기 곤란한 경우도 있기 때문에 ‘초보적인 실수’라는 이유만으로 과실을 쉽게 인정하는 것은 위험하다. 이에 비해, 진단 및 수술의 경우에는 의사의 전문적인 지식 및 기술, 경험에 좌우되고 광범위한 재량도 인정되고 있기 때문에 과실이 중대한지 여부를 판단하는 데에는 의학적 지식이 필요하게 되는 경우가 있다. This paper analyzes criminal precedents in the United States, which show a trend of increasing criminal prosecutions against medical malpractice in recent years, and by doing so, sought criteria for judging criminal negligence in medical malpractice in Korea. the contents are as follows. First, in the United States, considering the fact that medical malpractice cases are mainly promoted due to administrative dispositions such as license cancellation or civil damages, the criminal case for medical malpractice cases in the United States cannot be simply compared with Korea. In particular, the United States is different from state to state, so it is difficult to compare uniformly. even so, in the United States, medical errors are assessed as serious risks that exceed normal risks. in other words, cases that fall under “critical deviation from state standards” or “significant criticism” are used as criteria for criminal negligence. Second, in the US case, the “subjective assessment” of medical personnel plays a large role in judging criminal negligence. the medical mistakes are often complicated by medical issues, and there are significant difficulties in evaluating causality and standards of care. as a result, in judging criminal negligence, the subjective aspects of the healthcare practitioner, such as “completely ignoring” the safety of others or actually “consciously neglecting risks that cannot be justified,” are considered. on the other hand, in Korea, even if the doctor predicts the possibility of the occurrence of the outcome, the criminal negligence will be denied if the possibility of avoidance of the outcome cannot be recognized based on the medical level at the time. Third, in Korea, the “offenses for business negligence and gross negligence” of Article 268 of the Criminal Code are applied to the criminal negligence of medical personnel for medical malpractice. “the gross negligence” generally refers to a case where the degree of violation of the duty of duty is remarkable, that is, even though it is possible to fulfill the duty of caution by paying little attention, the neglect of this has resulted in a crime, and serious legal criticism is to be applied. however, serious negligence or serious deviation in the United States is “significant” that is distinguished from simple civil negligence, and its significance only serves as the lower limit of criminal negligence. Lastly, in the case of simple mistakes, the tendency to be recognized as criminal negligence in Korea is high, but in the United States, it is not recognized as criminal error as a mistake that anyone can commit. even if it seems like a simple operational mistake, it may be difficult to avoid the error simply because it is a “elementary mistake” because it may be difficult to avoid depending on the specific situation. on the other hand, in the case of diagnosis and surgery, medical knowledge is sometimes required to determine whether negligence is serious or not, because it Depends on the doctor s professional knowledge, skills and experience, and also extensive discretion is recognized.

中国刑法中的医疗事故罪

赵辉 원광대학교 법학연구소 2015 의생명과학과 법 Vol.13 No.-

의사의 범죄에 대해서 형법에 특별히 규정하고 있는 나라는 그리 많지 않다. 그러나 인신범죄로 규정한 업무상 과실로 크게 다치거나 죽는다는 법률 조항은 의사도 예외가 될 수 없다. 예를 들어, 1871년 독일 형법전 제222조에 규정: 과실로 사람이 죽게 되는 경우, 3년 이하의 금고에 처한다. 직업, 영업상의 부주의로 사람이 죽게 된 경우는 형법을 가중 적용하여 5년 이하의 금고에 처해야 한다. 일본 현행 형법전 제211조 규정: 필요한 주의를 태만해서 사람이 죽게 되면 5년 이하의 노역, 또는 100만원 이하의 벌금에 처한다. 중과실로 사람이 죽게 되는 것도 이와 같이 처리한다. 한국 현행 형법전 제268조 규정: 업무상 과실이나 중과실로 사람이 죽게 되면 5년 이하의 금고나 2000만원 이하의 벌금에 처한다. 위 국가와 달리, 중국 형법은 의사의 의료과실로 인한 의료사고죄에 대해 직접적이면서도 명확하게 규정했다. 중국 형법 제335조 규정: 의무요원이 주의를 다하지 않아서 환자를 사망하게 하거나 심각하게 환자의 인신 건강에 손해를 주면 3년 이하의 유기 징역이나 노역에 처한다. 이 법률 조항에 따라 중국 형법 이론과 실무계에서는 일반적으로 의료사고죄는 의무요원이 주의를 다하지 않아서 진찰하고 있는 환자가 사망하거나 환자의 인신 건강에 심각한 손해를 주는 행위에 한계를 정한다. 의료과정의 복잡성, 침입성은 의료행위의 위험성과 관련된다. 과학기술의 발전에 따라 많은 신 의료 설비, 의료기술, 의료수단은 의료진단 중에 사용된다. 사람들의 건강수요를 만족시키면서 의료행위의 위험 요소가 많아지고 있고, 그로 인한 의료손해도 자주 나타난다. 환자의 생명과 건강을 보호하기 위해 법률에 의무요원의 행위규범을 규제하는 규정과 요구가 필요하다. 중국 형법이 의료사고죄를 설치한 이유가 바로 여기에 있다. 그러나 의료과실 범죄의 형법규범은 장점과 단점의 양면성을 가지고 있다. 그것은 의무요원의 책임심이 강화되고 환자의 이익을 보호하는 반면에 무거운 처벌규정으로 인해 때문에 의무요원의 열의를 손상 시킬 수도 있다. 그래서 중국 형법은 일본, 한국과 달리 단독적으로 의료사고죄를 규정하고 가벼운 형벌을 설치한 방식은 당연히 의미가 있다고 할 수 있다. 그러나 법률 조항에는 부족한 점도 있는데, 그 예로 범죄 구성 요건의 규정, 법정형(法定刑)의 설치 등 문제는 아직도 재검토를 필요로 한다. Different from the criminal law of Japan and Korea, Chinese criminal law directly and clearly specifies the crime of medical accident caused by physician’s negligent act. According to the article of 335thin Chinese criminal law, the crime of medical accident is defined as the behavior which caused the death or serious injury to the victim due to the severe irresponsibility of the physician. Firstly, analysis of constitution of medical malpractice crime Specific provisions of Chinese criminal law demands the establishment of every specific crime meets subjective elements and objective elements which contains four basic elements: criminal object, objective aspect of crime, subject of a crime and subjective aspect of a crime. So does the crime of medical accident. The first, the object of the crime Chinese criminal law commonly believe that criminal object means the social relationships which protected by criminal law is assaulted and threatened by commission of offence. Although Chinese scholars still hold arguments for criminal object of medical accident, the current view that believes the object of this crime is the nation’s management order towards the medical practice and the rights of client’s life and health. The mange and managed legal relationship of medical management between nation and physician, the serve and served legal relationship of medical service between physician and clients. This two aspects constitutes the nation’s manage order towards medical practice. The second, objective aspect of the crime Objective aspect of crime means the criminal law stipulates and explains the feature of objectively external facts that the social relationship protected by criminal law causes damage by behavior. Objective aspect of the crime of medical accident, for the sever irresponsibility of doer which caused clients die or serious damage the health of clients. One, the identification of serious irresponsibility Serious irresponsibility means the physician violates medical regulations or routine of nursing care in every medical link, they default or incorrect perform the responsibility of the nursing care. The medical regulation and routine of nursing care are not only can be written but also convention which is conventional and obeyed by physician in practice. For how to understand the “serious” of “serious irresponsibility”, it’s usually judge the quality of the behavior from the result and subjective state of mind in practice. Two, the criterion for judgment of serious damage the health of clients The constitutional essential element of the crime is the harmful results that the physician causes the death or serious damage to the health of clients. As for what is serious damage to the health of the clients, the criminal law doesn’t give clear explanation and the educational circles have different viewpoints. The scholars start a series of discussions and form the different views of medical criteria, criminal criteria and standard of administrative law. There is no unified view so far. Three, the identification of causal relationship Establishment of the crime of medical accident, there must have casual relationships between violation of medical regulation and death or health serious damage. For the definition of the casual relationship of medical malpractice crime, Chinese scholars have lots of arguments. Some determine the causal relationship should be positive causal relationship in medical malpractice crime. That is the internal, inevitable and in conformity with the law’s casual relationship between medical behavior and clients. For the specialty of medical malpractice crime, some scholars believe we should make a concrete analysis of each specific question and support the application of causal relationship of epidemiology. Also many other scholars advocate we can analyze the responsibility of the physician with the help of the degree of medical fault participation. They propose to draw on the experience of five grade method in medical damage compensation cases to judge the participation of medical fault in medical damage case. Therefore, we can definite the causal relationship between medical fault and damage result. The third, subject of the crime The subject of crime means the implement behavior of damaging the society and the nature man and unit which should responsible for the action. According to the article of 335th, the subject of medical malpractice crime is the special subject, which is physician. The medical institution can’t be the subject of this crime. The so-called physician is the person, who is trained by medical colleges or departments at various levels, passes the examination and approved by public health administration, qualified as a doctor and engages in medical service work in practice. As for the medical support crew and medical administration staff belong to the physicians of this crime or not, most scholars don’t agree to put them into the scope of the subject of the crime. With regard to trainee of the physician can be the subject of the medical malpractice crime or not, the law has no clear explanation. Chinese scholars have different views, the strongest view is the trainee different from the formal physician and trainee can’t do the medical behavior or assistant work of diagnosis independently. They must guide by the qualified physician and engage with their medical behavior suitable for their major. Usually, the physician should fully responsible for the trainee. The fourth, subjective aspect of the crime The subjective aspect of a crime means the state of mind the subject of the crime hold for their own behavior and harmful social result. It concludes offence (intentionally or negligence), criminal purpose, criminal motive and so on. According to the rule of criminal law, the subjective fault of doer in medical malpractice crime is negligence, which contains careless and inadvertent negligence and negligence with undue assumption. Duty of care is the premise of the establishment of negligence. Attention ability is the condition of foundation of negligence. Combinations of them make the duty of care become possible. The basis of the duty of care in medical negligence concludes three aspects: First, the duty of care of health law and regulations; second, the duty of care of routine of nursing care; third, the duty of care of medical literature. The judgment criteria of doer have duty of care or not in medical malpractice crime, there exists three different opinions: first is subjectivism, second is objectivism, and third is unified subjective and objective theory. Currently most of the scholars support the third theory. Secondly, the differences among crime of medical accident, crime of negligent homicide and crime of negligent serious injury First, the content of the subjective negligence is different. The negligence in medical malpractice crime is professional negligence; it violates the duty of care in the process of medical diagnosis. While the fault of crime of negligent homicide and crime of negligent serious injury should only be ordinary negligence. Most are general negligence in daily life. Second, the pattern of manifestation is different in objective aspects. Objective aspects of medical malpractice crime shows serious irresponsibility, violates rules and regulations or the routine of nursing care in the diagnosis work. The objective aspect of crime of negligent homicide and crime of negligent serious injury shows lacking of focus to other’s health and life in daily life. Making others die or damage seriously due to action or forbearance. Third, subject of the crime is different. The subject of medical malpractice crime should be physician while the subject of fault of crime of negligent homicide and crime of negligent serious injury can be the nature person who own criminal liability and reach the age of 16. Fourth, the legal interest assaulted is different. The medical malpractice crime not only assault other people’s life or health, but also the management order of nations towards medical practice. However, crime of negligent homicide and crime of negligent serious injury only injure the rights of other’s life and health. In addition, compares with Japanese and Korean criminal law, put the medical malpractice crime into professional negligence, Chinese criminal law sets the legislative mode of medical malpractice crime independently is relatively rational. First of all, the legislative mode of Chinese criminal law is direct and clear. Next, the medical behavior belongs to the highly specialized technical field, which is unusual. It’s not proper to apply medical negligence the same statutory sentence as others negligence. Thirdly, the problems in legislation of crime of medical accident The first, essence of crime regulation is not clear What is serious irresponsibility and what is serious damage the health of clients are both lack of clear definition. This makes the constitution of the crime lost its constancy and range of function which cause the disputes in theoretical research, even the chaos of medical malpractice crime in juridical practice. The second, the category of punishment of statutory sentence is singleness Chinese current criminal law stipulates the statutory sentence of medical malpractice crime fixed-term imprisonment of not more than three years or detention. They both belong to the short-term freedom penalty. The statutory sentence’s category of punishment is singleness which will lead the selective choice of penalty of specific case is less and difficult to deal with the complex medical malpractice crime. The third, the extent of statutory sentence is too narrow; the setting of tallest penalty is too low The maximum statutory penalty of crime of negligent homicide has reached seven years fixed-term imprisonment in Chinese criminal law. The extent of the statutory sentence is three to seven years fixed-term imprisonment. When the circumstances of the crime are rather lighter, the sentence won’t more than three year’s fixed-term imprisonment. However, the same as offense of vocational negligence like the traffic accident crime, crime of negligently causing a serious accident, their extent of statutory sentence and maximum statutory penalty are both higher than medical malpractice crime.

損害賠償 訴訟上의 醫療過失(1)

손용근(Sohn, Yong-Keun) 한양법학회 2009 漢陽法學 Vol.25 No.-

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

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.

의료과실 없이 발생한 의료처치 부작용의 상해보험 보험사고 해당성

전상용 서울대학교 법학연구소 2022 서울대학교 法學 Vol.63 No.1

Whether the side effects of medical treatment for diseases is an ‘accident’ under accident insurance is difficult to answer. Adverse events of medical treatment can be classified into cases where side effects or complications occurred without medical negligence and cases where medical negligence was engaged. With regards to non-negligent medical events, lower court judgments are inconsistent, causing serious confusion. Standard Terms and Conditions of Accident Insurance contained ‘medical treatment exemption clause’ before, exempting insurers regardless of the existence or absence of medical negligence. Now that the amended Standard Terms and Conditions do not have such a clause, the problem of whether non-negligant medical events is an accident needs to be identified. This paper argues that the general trend of lower court judgments which focuses on whether the duty to explain side effects was fulfilled is unjust, and that typical side effects of medical treatment should not be considered an accident. This view is consistent with the existing court rulings on medical treatment exemption clause, which stated that only highly invasive medical treatments are subject to exemption clause. Various U.S. rulings, including Senkier v. Hartford Life & Accident Insurance Co., are in support of this view. ‘질병’에 대한 의료처치의 결과로 발생한 ‘상해’의 부작용이 상해보험의 보험사고에 해당하는지는 어려운 문제다. 크게 의료과실 없이 부작용이나 합병증이 발생한 경우와 의료과실이 개재된 경우로 나누어 볼 수 있는데, 이 중 전자에서 엇갈린 하급심 판결례가 선고되며 법적인 혼란이 초래되고 있다. 기존에는 의료과실의 존부에 관계없이 보험자를 면책하는 ‘의료처치 면책조항’이 표준약관에 존재하였다. 그러나 표준약관 개정으로 의료처치 면책조항이 사라진 지금에는 보험사고 해당성의 문제가 정면으로 규명될 필요가 크다. 본고에서는 부작용 설명의무의 이행 여부를 우연성 판단의 핵심 기준으로 삼는 하급심 판결례의 대체적인 경향은 부당하며, 의료처치에 통상적⋅전형적으로 발생하는 부작용은 우연성과 외래성이 각 부정되어 상해보험사고에 해당하지 않음을 주장한다. 이는 위험성이 큰 의료처치에 한정해서 의료처치 면책조항을 적용해 온 기존의 판결례에 부합할 뿐만 아니라, Senkier v. Hartford Life & Accident Insurance Co. 판결을 위시한 미국의 여러 판결례와도 일관된다.

의료사고처리특례법의 과제 ― 잉글랜드 Gross Negligence Manslaughter와 스코틀랜드 Culpable Homicide의 비교를 중심으로 ―

정소영 연세대학교 법학연구원 2024 法學硏究 Vol.34 No.1

우리나라에서 의사의 의료과실에 대한 형사 기소가 적은 나라의 예시로 항상 언급되는 잉글랜드는 의사의 의료과실로 환자가 사망한 사건에 대하여 중과실치사죄를 적용하고 있다. 물론 형사 기소 건수가 연간 1건 정도로 우리나라와 비교할 때 거의 형사 기소가 되지 않는다고 보아야 하지만, 이런 잉글랜드에서조차도 2011년에 시작되어 2018년에 최종 판결이 난 Bawa-Garba 사건을 계기로 의사의 형사 기소에 대한 불안감이 매우 팽배해있으며 따라서 현행 중과실치사죄의 법리를 바꾸어야 한다는 논의가 활발히 이루어지고 있다. 잉글랜드에서 중과실치사죄에 대한 변화를 촉구할 때 항상 등장하는 것이 스코틀랜드 과실치사죄와의 비교이다. 의료과실의 맥락에서 스코틀랜드의 과실치사죄는 고의가 아닌 과실로 환자의 사망을 초래한 경우에 적용된다는 점은 유사하지만, 어느 정도의 과실이 있어야 범죄가 성립하느냐에 대한 판단에서 비난가능성에 초점을 맞추어 중과실보다 더 비난가능성이 큰 무모함, 무관심함을 나타내는 과실이 있을 때에서야 비로소 구성요건에 해당한다고 보고 있다. 또한 이러한 무모함이나 무관심함은 나쁨, 사악함 등의 주관적 상태와 결합할 때 비로소 구성요건을 만족시키게 된다. 이에 잉글랜드에서도 중과실치사죄에서 요구되는 과실의 정도를 한 단계 높여 무모함이 드러나는 경우에 처벌하여야 하고, 무모함이나 무관심함을 보여 주관적으로 비난 가능한 경우가 아닌 ‘위험한 상황을 인식한 상태에서 환자를 살리려고 최선을 다했으나 결과가 좋지 못해 환자가 사망한’ 의사에 대해서는 주관적인 비난가능성이 없으므로 처벌해서는 안 된다는 주장들이 나타나고 있다. 그리고 과실이 있었는지를 판단할 때 평균적인 의사라면 기울였을 주의의무와 비교하는 것이 아니라(객관적 과실) 자신이 가진 역량 내에서 기울일 수 있었던 주의의무에 기초하여(주관적 과실) 판단해야 한다는 주장도 있다. 만약 이러한 주장들을 우리나라에 도입하여 의료사고처리특례법에 반영한다면, 업무상 과실치사죄가 적용되는 범위가 중과실 또는 더 나아가 무모함이 있었던 경우로 훨씬 좁아질 것이고, 수련의나 전공의 신분인 의사의 경우에는 형사 책임이 한결 경감될 수 있을 것이다. 이에 더하여 잉글랜드에서는 의사가 의료 행위를 하였던 맥락을 양형 단계가 아니라 중과실치사죄의 성립 단계에서 반영하여, 특히 수련의・전공의가 의료 시스템에 내재된 문제로 인해 자신이 가진 역량을 다 발휘하지 못하거나 자신의 역량을 뛰어넘는 업무를 맡아 처리하다 사망 사건이 발생한 경우에는 형사책임을 물어서는 안 된다는 주장도 제기되고 있다. 이러한 고려를 우리나라의 의료사고처리특례법에 반영한다면, 우리나라의 맥락에서도 수련의・전공의 보호에 큰 의미를 가질 수 있을 것이다. England is frequently mentioned as an example country where criminal prosecutions for medical errors of doctors are extremely rare. England is applying a gross negligence manslaughter to case in which a patient died due to the medical negligence of a doctor. Compared to our situation, the number of criminal prosecution in England is about one per year. However, even in England, anxieties about the criminal punishment of doctors are very prevalent in the wake of the Bawa-Garba case, which began in 2011 and was finally ruled in 2018. Therefore, there are active discussions that the current gross negligence manslaughter law should be reformed. What always appears at this point is the comparison with Scotland's culpable homicide law. In the context of medical errors, Scotland's culpable homicide has similarity in that it applies to cases where a patient's death is caused by unintentional medical negligence. The difference between the England law and Scotland law is that the focus to determine the criminality is on the culpability. It is believed that the objective constituent requirements are satisfied only when a negligence indicates recklessness and indifference. In addition, this recklessness or indifference becomes a crime only when combined with badness and wickedness, the subjective constituent elements. Accordingly, it is argued that in England, punishment should be given in cases where recklessness is revealed by tightened requirement for gross negligence manslaughter. Moreover, there are demands that doctors who ‘tried their best to save the patient's life, even in recognizing the fatal risk, but eventually caused unintentional death’ should not be punished. Also it is required to reflect the medical practice context at the stage of establishment of a crime of gross negligence manslaughter, not at the sentencing stage. Criminal responsibility should be reduced if a death occurs while taking charge of a task that exceeds doctor's capacity due to a problem inherent in the medical system. Finally, regarding England and Scotland's efforts to protect patient safety, it was impressive that both places communicate honestly with patient carers when deaths occur and intervene from the initial stage of investigation to prevent them from being left out. In England and Scotland, the NHS (National Health Service) is responsible for injuries and deaths in the medical process and provides financial compensation, and doctors are all insured for preparing for such cases. Plus, because patient's relatives could hear a detailed explanation of the situation from a doctor or receive an apology of doctor through arbitration, it was managed not to create a situation like us, where injustice and frustration accumulate and lead to criminal court. This system is based on the premise that ‘everyone makes mistakes’. In England and Scotland, criminal punishment for a doctor who made a mistake in the course of medical practice is not the best solution. Rather, it focuses more on the reasons such mistakes have occurred and what needs to be fixed and improved in order for them not to occur in the future. This approach protects patient safety and lays the foundation for doctors to further improve their healthcare system in a future-oriented way.

일본에서의 의료과오에 대한 형사책임 - 과실공동정범의 성립범위를 중심으로 -

배상균 한국외국어대학교 법학연구소 2017 외법논집 Vol.41 No.1

This report discusses Japan's criminal law regarding ‘medical malpractice’ and points out problems that need to addressed. Allegations of medical malpractice have been relatively rare in Japan, in part perhaps because of an imbalance of power in the doctor/patient relationship. Awareness of such problems, however, has been growing, and the law has started to respond. For example, the recognition of victim's rights has been increasing in Japan along with the punishment of offenses that arise from negligence. Even so, society needs to be attentive to any tendency to overreach in subjecting medical personnel to criminal law. About the criminal responsibility, ‘medical malpractice’ by multiple participants such as team medical care is a problem, especially ‘the co-principals of crime by negligence’ are the main problem. The legal formation of a crime of involuntary wounding and manslaughter through negligence is indefinite, and the characterization of a doctor's responsibility is problematic. So In cases where ‘recklessness’ and ‘levity’ are recognized as obvious faults of doctor's medical practices, exceptional ‘criminal responsibility’ should be pursued, and only in such case, errors of multiple participants are accepted as the co-principals of crime by negligence. Specifically, in complex cases such as defects of company products, large-scale disasters, medical malpractice due to team medical care, the presence or absence of recognition of collective error by such co-principals is significant. 일본에서는 1990년대부터 의료과오소송이 사회문제로서 제기된 이후 주요사회문제로서 논의되고 있다. 과거, 의료행위가 갖는 고도의 전문성 및 사회적 영향력으로 인해 의료과오의 문제로 인하여 의사 등에게 책임을 묻는 것은 많지 않았다. 그러나 이와 같던 상황이 크게 변하여 피해자에 대한 여론의 관심이 높아짐에 따라 의료사고에 대한 적극적인 형사개입이 점차적으로 증가하고 있다. 이로 인해 의료과오의 인정에 있어서 주의의무위반 및 인과관계 등의 논의가 많았고 그 중 복수관여자의 과실경합 등의 문제로서 과실공동정범론이 주목받고 있다. 물론 의사의 의료과오와 형사책임의 인정여부에 있어서 의료행위, 그 자체가 결과를 완전히 예측할 수 없는 것이라고도 볼 수 있는 것이기 때문에 “주의의무위반에 따른 과실”, “결과가 예견됨에도 불구하고 이를 회피하지 않은 것”을 이유로 업무상 과실치사상죄를 적용할 경우에는 제한적으로 해석될 필요가 있다. 그럼에도 불구하고, 의사의 의료행위에 대하여 명백한 과실로서 무모(recklessness)와, 경솔성(Leichtfertigkeit)이 인정되는 경우라면 예외적으로 형사책임이 추궁(追窮)되어야 할 것이며, 이러한 경우에 한하여 공동주체에 의한 집단과오에 따른 과실공동정범도 인정될 수 있다고 생각한다. 즉 과실범에 있어서도 복수의 행위자들이 의사연락을 통해서 일정한 결과발생방지를 위한 일체가 되어 활동하는 공동주체로서 인적으로 결합되면, 해당 행위자들의 주의의무위반행위가 공동주체에 의한 전체행위로서 불가분의 형태로 일체화된 것으로 볼 수 있다는 점에서 과실범의 공동정범이 의미를 갖는다. 구체적으로는 기업제조물의 결함책임, 대형참사, 팀의료에 의한 의료과오 등의 복잡한 사안에서 이러한 공동주체에 의한 집단과오행위의 인정여부가 큰 의미를 갖게 된다.

2019년 주요 의료판결 분석

유현정,박노민,정혜승,이동필,이정선,박태신 대한의료법학회 2020 의료법학 Vol.21 No.1

During the main ruling in 2019, a number of rulings that were of interest or meaningful were handed down, such as just because the complication of medical practice has occurred, there is no presumption of negligence, a case involving a fall accident in which a lot of culpability has recently been made. the death of a well-known singer that caused a sensation, a case about damages caused by MERS in 2015, which is more meaningful in connection with damages caused by COVID-19, an infectious disease that has recently hit the world, including Korea. In preaching the principles of the law, just because there has been a complication caused by medical practice, there is no presumption of negligence, 'The scope of the complication without presumption of negligence' was determined differently by the court, the court was not able to specify the criteria. Specific circumstances were presented to limit the responsibility of the medical institution while acknowledging the malpractice of the medical institution in relation to the fall accident. In relation to the scope of damages, judgment was made on issues related to the calculation of lost profits of medical malpractice; criteria for determining celebrities' daily income, criteria for determining daily income in case of receiving survivor's pension due to medical accident, an incident in which the daily income is denied if the labor capacity is already lost at the time of a medical accident. But, it seems that judgments should be made based on clearer and more reasonable standards. Related to Medical Advertise, specific logic of judgment was presented as to whether it was interpreted as being in accordance with the specific prohibition listed in Article 27 paragraph 3 of the Medical Law, which is the criterion for violation of the Medical Law, or if it constitutes a significant harm to the order of the medical market. In response to the prohibition of operating the multiple medical institutions, the Constitutional Court decided that it was constitutional because it did not violate the regulations on excessive funding, and rationally limited the scope of the prohibited 'redundant operation'. The Supreme Court ruled for the first time that even a medical institution established and operated in violation of the Medical Service Act did not make it impossible to receive all medical care benefits implemented by a medical institution under the National Health Insurance Act. Significant rulings were finalized that recognized the existence of specific protection obligations for the people of the country in the management of infectious diseases. 2019년 선고된 의료판결 중에는 의료행위로 인한 합병증이 발생하였다는 것만으로 과실이 추정되지 않는다는 사건, 최근 소제기가 많이 되고 있는 낙상사고 관련 사건, 세간을 떠들썩하게 했던 유명 가수의 사망사건, 최근 국내를 포함하여 전 세계를 강타하고 있는 전염병인 COVID-19로 인한 피해와 관련되어 더욱 의미가 있는 2015년 메르스로 인한 손해배상사건 등 관심의 대상이 되었거나 의미 있는 판결들이 다수 선고되었다. 법원은 의료행위로 인한 합병증이 발생하였다는 것만으로 과실이 추정되지 않는다는 법리를 설시하면서 ‘과실이 추정되지 않는 합병증의 범위’를 재판부에 따라 달리 판단하였는바, 그 기준을 구체적으로 제시하지 못하고 있었다. 낙상사고와 관련하여 의료기관의 과실을 인정하면서 의료기관의 책임을 제한하는 구체적인 사정들이 제시되었다. 손해배상범위와 관련하여 연예인의 일실수입 판단기준, 의료사고로 유족연금을 받게 된 경우 일실수입 판단기준, 의료사고 발생 당시 이미 노동능력이 상실된 경우 일실수입을 부정한 사건 등 일실수입 산정과 관련된 쟁점에 관한 판단들이 이루어졌으나, 좀 더 명확하고 합리적인 기준에 따른 판단이 이루어져야 할 것으로 보인다. 의료광고와 관련하여 의료법 위반의 기준인 의료법 제27조 제3항에서 나열한 구체적 금지행위에 준하는 것으로 해석되거나 의료시장의 질서를 현저히 해친 것에 해당하는지 여부에 관한 구체적 판단논리가 제시되었다. 의료기관 중복운영 금지조항에 대하여 헌법재판소는 과잉금지원칙에 위배되지 아니하여 합헌이라고 판단하면서, 금지되는 ‘중복운영’의 범위를 합리적으로 제한하였고, 대법원은 의료법을 위반하여 개설 및 운영된 의료기관이라 하더라도 의료기관에서 시행한 모든 요양급여가 국민건강보험법에 따라 수령이 불가능한 것은 아니라고 최초로 판단하는 의미 있는 판결을 선고하였다. 감염병 관리에 있어서 국가의 국민에 대한 구체적 보호의무의 존재를 인정한 의미 있는 판결들이 확정되었다.