Earticle

Based on foreign examples and past debates, the minimal conditions for passive euthanasia can be suggested as following; ① The patient is incurable by modern medical practice and his death is impending (less than 6 months), ② Euthanasia is practiced solely to relieve physical pain of the patient, ③ If the patient can express his will, there should be a clear and sincere request or consent, ④ More than 2 doctors including doctor in charge should consent, ⑤ Euthanasia should be practiced in ethical way, ⑥ Patient family should agree(when the patient will is assumed.) It is hard to resolve issues regarding euthanasia based on past rulings and cases without concrete law. As in United States and Germany, clear and objective provisions of euthanasia and definitive method for patient's advanced directive should be legislated to resolve medical conflict and to relieve patient and family from agony. And death with dignity debate will not be able to proceed if it is only substantively approached because of unclear definition of euthanasia and benefit comparison way of thinking. Thus it is important to establish definitive process to decided legislation of euthanasia act and resolving conflicts arising from each step of the process among interested parties exchanging medical/ethical opinions.

The end of life problem in the United States has been evolved from the development of concept of brain death over last 50 yr. The invention of ventilator and the development of emergency medicine also played a key role to elongate the end stage of life and which caused the American people to ask a question about the patients self determination and refusing the unwarranted medical treatment in the view of the death with dignity. With regard to the patient unable to self determination, surrogate decision was also considered. To guarantee the self determination, The patient self determination act also enacted on the level of Federal regulation in 1990s. But no law has effectively dealt with the situation when medical treatment became futile. Along with the significant debates on literature and court cases, The American Medical Association's Council on Medical and Judical Affairs presented formal opinion and the Texas was the first states to regulate the medical futile situation in 1999. Even though that definition was in controversy, the concept of medical futility mainly focused on the doctors' right to refuse the treatment.

In Republic of Chaina (Taiwan), Natural Death Act named “Anning Huanhe Yiliao Tiaoli” which means palliative and hospice care act was enacted in year of 2000. And enforced in the same year. Many scholars say that Taiwan's Act took Many U.S.A.'s acts such as ‘Federal Patient Self-Determination Act 1990’, ‘California Natural Death Act 1976’ and ‘Washington Natural Death Act 1979’ for a model. Taiwan's Act adopts a few outstanding systems - ‘advance declarations’ including ‘living will’ and ‘durable power of attorney for health care’, ‘family-determination system’ for a patient who is in a persistent unconscious state. This paper disusses this Act. The content is as follow : 1. A background of legislation. 6. Keeping documents. 2. The purpose of legislation. 7. Punitive provision. 3. The concept of terms. 8. The relationship with euthanasia. 4. Patient's self-determination. 9. Controversial issues. 5. Subrogated determination by family.

현대사회를 살아가는 누구에게나 응급의료를 제공받아야 할 상황이 발생할 수 있고, 응급의료제공에 있어 치료비 등 경제적 요인이 장애가 되어서는 안 된다. 이에 응급의료제공에 따른 권리와 의무를 규정하고 현실화하기 위한 제도가 마련되었다. 즉, 응급상황시에 국민의 생명과 건강을 보호하기 위한 응급의료가 경제적 사유로 인하여 적기에 응급의료를 제공받아야 할 응급환자에게 지연되거나 거부되지 않도록 하기 위해 마련된 제도가 ‘응급의료비미수금대불제도’이다. 하지만, 현행 응급의료대불기금제도는 그 운영 등 여러 가지 점에서 본래의 취지에 맞지 않게 운영되는 문제점을 나타나게 되었다. 이러한 문제점의 근본적인 부분을 법리적 해석을 통하여, 적용대상, 심사제도의 타당성, 구상권 범위, 권리구제상의 문제, 소멸시효, 처벌규정 및 위탁기관의 적합성 등에 대한 문제점과 개선방안을 알아보고자 한다.

This study was carried out to investigate the present conditions and discuss the issues of the Subrogation payment system in emergency medicine. Hitherto preceding study is focusing on controversial of management or efficient control of Subrogation payment system in emergency medicine. The object of this study is legalistic study of the Subrogation payment system in emergency medicine. The current legalistic issues of subrogation payment system in emergency medicine are the following aspects; Firstly, there are a claimant conformity to the standard limit. Secondly, the review system is not propriety of the promptitude. Thirdly, there is a lack of propriety claim for compensation of a support responsible person. Fourthly, there are objectivity and fairness of administrative appeal system. Fifthly, the point where one starts counting of extinctive prescription. Sixthly, the administrative punishment is an illogical system. Lastly, equity and fairness of the Review Agency, as an insurance company and an review Agency are sameness In conclusion, we ought to improvement an unnecessary obstructions of promptitude in the Subrogation payment system in emergency medicine, and ensure a right of emergency medicine without delay.

With recent emphasis on evidence based medicine, clinical practice guidelines are seen as a potential mechanism by which unify various managerial and professional approaches to improving the quality of care. The development process of guidelines has been the subject of much research. and it is need translating the medical evidence of research into a clinical practice guidelines. the gathered evidence needs to be interpreted into a clinical, public health, policy, or payment context. The term 'clinical practice guidelines' can evoke a diverse range of responses from healthcare personnel. Clinical practice guidelines are increasingly used in patient management but some clinicians are not familiar with their origin or appropriate applications. Understanding the limitations as well as benefits of CPG could enable clinicians to have clearer view of the place of guidelines in every practice. In the context of increasing complaints and litigation in healthcare, the legal implications of clinical practice guidelines are of increasing importance. Clinical practice guidelines could, in theory, influence the manner in which the courts establish negligence by suggesting the doctor breached the duty of care by failing to provide the required standard of medical care. In several studies, the CPGs were relevent to and played a pivotal role in the proof of negligence. Much depends on the quality of guidelines and the tools developed and the authoritativeness of a guideline. Recently, there are several opinions the court also should review the validity and reliability of expert testimony including medical evidence. and widespread use of guidelines in malpractice lawsuit could lead the physicians to greater compliance with guidelines in the long term. In conclusion, Health care reformers, physicians as well as guidelines developers should understand that guidelines have both medical and legal aspects as a double-edges sword. so clinicians, legal representatives and decision-makers should not defer unduly to guidelines.

의료와 관련된 법률을 종합해 볼 때, 검체검사는 의료행위의 일종으로서, 채취된 검체를 가지고 해당의료기관의 의사 또는 치과의사의 지도에 의해 임상병리사가 체외진단용 기기와 진단용 의약품을 사용하여 분석을 수행하고, 검증 및 판독을 거쳐 보고하는 것으로 규정되어 있다. 그러나 실제 의료현장에서는 ‘의사의 지도’가 심히 불충분하거나, 심지어 임상병리사가 아닌 자가 수행하거나, 더 나아가 검증 혹은 허가를 받지 않은 기기나 시약을 사용하여 검사결과를 산출하는 일도 빈번히 발생하고 있다. 이와 같은 절차에 의해 산출된 검체검사 결과는 한 국가의 질병통제에 대한 중요한 자료가 될 수도 있고, 또한 환자의 질병에 대한 확진과 예후관찰에 결정적인 판단자료가 될 수도 있고, 의료소송에 있어 관계 전문가의 감정결과와 함께 거의 유일한 증거로 활용되는 중요한 의료행위임에도 불구하고 검체검사와 관련된 비용과 인력의 부족으로 정도관리가 되고 있지 않는 우리의 현실은 참으로 우려할만한 상황이다. 이제라도 정부는 검체검사의 중요성을 인식하고 보다 엄정한 행정적 관리와 함께 법률 정비도 아울러 하여야 할 것이다.

When we are totalizing the lawsrelated to the medical, as the Laboratory medical testing is a kind of the medical act, it is the regulation that the medical technologist can analyze the specimen using in vitro diagnostic devices and diagnosticdrugs under the guidance of doctor or dentist from a corresponding medical institution and can report through verification and interpretation. However, in real medical fields, ‘the guidance of doctor’ is seriously insufficient or even the person who is not the medical technologist is executing. Furthermore the cases that produce inspection results with devices or reagents which are not validated nor approved have been frequently occurred. The result of Laboratory medical testing derived from this procedure can become the important information for the disease control of a country, and also can be decisive to the definite diagnosis and the prognostic monitoring about the patient disease. In spite of its significant medical act to be applicable to an unique proof with the related expert appraisal result in the medical malpractice lawsuit, our reality in which the quality control is not properly working due by the costs and the labor shortage related to the Laboratory medical testing is quietly in bad condition. Even from now, the government should recognize the significance of the Laboratory medical testing and must achieve more strict administrative management as well as the law maintenance.

Tobacco has become the world's leading cause of deaths and diseases. And the tobacco use and dependence itself is a kind of diseases, so-called "mental and behavioural disorders due to use of tobacco" in 「International Statistical Classification of Diseases and Related Health Problems(ICD-10)」 and 「Korean Standard Classification of Diseases」. The tobacco use and dependence is a chronic disease that requires repeated clinical interventions and multiple attempts to quit. But effective treatments to the tobacco use and dependence are developed and exist that can significantly increase the rate of long-term smoking abstinence. So the physicians should warn smoking patients about the dangers of smoking to the health and the life, and the clinicians ought to provide one of more of the treatments which have been proven effective in helping smokers quit to smoke. It has been concluded that if a doctor failed to provide effective treatment for smokers, and the smokers subsequently died of the smoking- related conditions(tobaccosis) or became incapacitated by the tobaccosis, the smokers were considered in the medical malpractice. Thus the smokers could sue the physician for medical malpractice, claiming that the doctor's legal responsibility of appropriate treatments including smoking-cessation which the physician deliberately or negligently breached.

The contemporary age is a period of PR for the self. Regardless of how good the quality of goods or services offered is, if it is not made known to the buyers, a sell is impossible. As a result, the contemporary man is flooded with advertisements and is living in a time of over-saturated information. This is not much different in the medical services sector, as it too is experiencing an overflow of information due to the expansion of advertisement approaches to include not only the previous positive-method, but also the negative-method. In tandem, recent advancements in electronics and information technology has made possible a rapid increase in then number of internet advertisements. However, outmoded medical law, which was created to regulate newspapers and billboards, is still being applied to regulate today's modern medical advertisements. At the same time, collateral ordinances such as "corrective statutes for signs and advertisements" are not sufficient in providing the necessary regulatory countermeasures. In the midst of all this, as IPTV is scheduled to be broadcast nationwide starting next year, and with the market for search advertisements and internet advertisements annually growing at a rapid pace, it has become evermore urgent to come up with an adequate regulatory measure. Consequently, it is necessary to look into the possibility of restricting the medium and content of internet medical advertisements as well as realistic schemes for its realization. In particular, regulatory measures that take into consideration the special characteristics of internet advertisements should be found, and the necessity of an prior deliberation procedure and the likelihood of introducing a certification system should be examined.

This paper aims to introduce an overview of the regime of expert witness in the medical malpractice litigation, and to provide a plan of how to make it improved. In regard with medical expert witness, several problems, such as time-consuming procedure, non-neural and unclear opinion without reasons provided, have been pointed out for several years. Lack of skill of the court and plaintiff/defender to question the expert is one of many cause to lead to the above problems. What is questioned to the expert? Because expert witness is used in determining probability of negligence, questions to the expert should be selected on the grounds of whether or not to obtain opinions or facts sufficient to let the judge infer negligence in view of the theory of proof burden established by the Supreme Court. In addition, to avoid non-neutral and unclear opinion, it is necessary to question the expert clearly, specifically and scientifically

Medical information is one of significant private information that includes individual's own diverse information. Once opened, it exposes one's health condition and medical history to a third party, which could bring about serious troubles. On this account, the third parties are of much concerns about the information. If medical information collected through various routes is used with another purpose, other than the initial intention, it might cause serious results beyond one's control. Thus, it is essential to keep the information confidential. Also, the discrimination based on the medical information ought to be banned because it is likely to happen that exposed information socially stigmatizes a person, being discriminated in a work place or a school when he/she is employed or gets an insurance. In the current system, only medical institutions are responsible for protecting or securing medical records. Despite the information technology development and the increased interests in medical information, there are quite a few limitations in legal, technical, and administrative aspects. All kinds of organizations, involved in collecting and using the information, as well as medical institutions primarily producing and managing it should share the responsibilities.

Considering above, It might be efficient that medical disputes would be settled by the intervention, the agreement, and the administrative relief that reflect mediators' opinion, who have rich social experience as well as specialized knowledge. Therefore, KCA needs to strengthen its function of mediation and improve relevant systems to become an effective settlement institution. And although Oriental medicine disputes have mainly given ex post facto explanations so far, administrative efforts such as policy development or legislation should be made for the high quality of Oriental medical services offered because an efficient way saving social or economic costs caused by the dispute would be precautionary measures. The traditional Oriental medicine is featured with the lack of baseline examination, the uncertainty of medical mistakes, the difficulty in clarifying and proving facts, the hardship of injury confirmation and causality because of the characteristics of Oriental medicine, and the relative lightness of physical damages. Actually, there has been few legal settlements in Oriental medical disputes since the compensation, itself, compared to the lawsuit cost, is relatively much lower without practical benefits.