연명의료결정법안에 관한 문제점 및 개선방안 (Issues and Improvements on the Decision Bills of Life-sustaining Treatment Withdrawal)

서지정보

· 발행기관 : 강원대학교 비교법학연구소
· 수록지 정보 : 강원법학 / 43권 / 1 ~ 43페이지
· 저자명 : 고준기, 조현, 이강호

초록

대법원은 2009년 5월 21일 인공호흡기 제거청구사건 판결에서 “국가는 연명의료결정 등의 문제를 아무런 기준 없이 당해 의사나 환자본인, 가족들의 판단에만 맡겨두는 상황이 지속되는 것은 바람직하지 않으며, 개개의 사례들을 모두 소송사건화 하여 일일이 법원의 판단을 받게 하는 것도 비현실적”이라고 판시한 이후, 정부는 환자의 연명의료결정법안을 만들었다. 이 연구는 연명의료결정법(안)의 입법 타당성과 문제점을 도출하여 보완ㆍ개선방안을 마련하고자 하였다. 동 법안은 존엄한 죽음의 선택에 대한 환자의 요청을 문서화하는 제도나 관행이 성숙되어 있지 않고, 호스피스와 완화의료가 활성화되어 있지 않은 상태 등의 여건을 감안할 때 법제화해도 실효성 적은 것으로 분석되었다. 연명의료결정 여부의 불확실성을 제거하고, 의료현장에서의 혼란을 방지하기 위하여 특별법으로 제정은 필요하다. 다만, 동 법안은 다음과 같은 개선이 필요하다. 첫째, 동 법안에서 연명의료의 대상으로서 회복 불가능성 판단기준이나, 무의미한 연명의료 기준, 연명의료 중단 시 기본적인 의료서비스를 중단할 수 있는 특별한 사유 등을 명확히 규정할 필요가 있다. 둘째, 사전의료의향서의 경우 작성자의 능력, 의사의 진정성 ㆍ객관성 여부, 정보제공 유무, 타당성과 적절성 기타 제3자 확인이 가능하도록 하는 등 정당성이 확보될 수 있도록 보완하여야 한다. 의사추정과 대리결정의 경우 남용 내지 부작용을 방지할 수 있도록 제도적으로 보완하여야 한다. 셋째, 연명의료결정’의 법제화와 함께, 호스피스-완화의료에 대한 사회적 기반 구축을 위한 법적 근거를 마련하는 것이 필요하다.

영어초록

For the bill of removing ventilator, the supreme court ruled on May 21st 2009 that it is not right for the government to continue to allow doctors, patient self, or family to make a decision on the life-sustaining treatment without any standards. Yet it is also unrealistic to take individual cases to the court for case-by-case judgment. Afterwards, the government passed the legal of life-sustaining treatment. In this study, the building Act (draft) drawn to the issue of legislative validity and complementary features and improvement measures. Moreover, it is necessary to and systemize the law so that the abuse and misuse can be prevented when withdrawing life-sustaining treatment.
The meaning of life-sustaining treatment is a treatment to extend life. While debates of whether to withdraw the life-sustaining treatment or not are being raised, there are still so many problems with the legal withdraw of life-sustaining treatment.
Moreover, living will or advanced directives are barely being utilized and also hospice palliative care is insufficient to activate.
This portrays how our country is underdeveloped about the quality of death.
The greatest problem of the legal withdraw of life-sustaining treatment is, first, ambiguity in determination of the treatment. Life is a basic right to each person, and so is the will to want to receive the treatment. However, when a patient becomes incapable of executing such right, his life will be determined by his family or medical facility. This, then, creates ambiguity where a person's life is determined by someone else's decision.
The second problem in withdrawing life-sustaining treatment is within legal perspective. As described in the first problem, determining withdraw of life-sustaining treatment incorporates ambiguity, and consequently it cannot be solved merely by law. The withdraw of life-sustaining treatment is usually to be executed when a patient is in a condition of so-called ‘unrecoverable’, which then inevitably allows the third person, either the patient's family or medical facility, to make a decision in place of the patient. This eventually leaves a great possibility of the patient's right of determining his own life to be misused.
Last but not least is an insufficient application of living will or advanced directives as well as a lack of promotion and systemization of hospice. If a decision is to be made according to the law of withdrawing life-sustaining treatment, living will or advanced directives will be able to direct to the decision of which the patient pursued. Unfortunately, even though such system exist in our country, it is rarely being practiced. In addition, even though a hospice can provide an opportunity of natural death, it is not promoted or systemized enough to be actually utilized.
In conclusion, even though there exists a legal system for the life-sustaining treatment, still so many issues are to be improved and developed. Moreover, it is necessary to and systemize the law so that the abuse and misuse can be prevented when withdrawing life-sustaining treatment.

참고자료

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