Earticle

“Bioethics” may have various meanings depending on its roles. It may mean professional ethics for scientists and physicians, etc. It may also mean an academic discipline using interdisciplinary approach as well as a philosophical or a legal approach. “Bioethics” as an interdisciplinary study should often deal with public policy on bioethical issues. I call this role bioethics as a study of bioethics policy, which has to be developed as a new discipline. From this perspective, I deal with bioethical issues relevant to a human life before birth. There are various and often conflicting arguments about the moral status of a human life before birth such as the fertilization argument, the argument of genetic identity, so-called the “14 days” argument focusing on the formation of primitive streak, the argument of sentient being, and Michael Sandle's argument of an embryo as a being between a thing and a person. I argue that each of them is reasonable. Thus we are faced with reasonable disagreement on the views over whether a human life before birth has the same right to life as that of a person or whether right to life may be considered to be a matter of degree. If we acknowledge reasonable disagreement, as John Rawls pointed out, we should tolerate the views from ours in a plural society. Therefore, we cannot help making a policy that allows abortion and embryonic research with some limitations. When we say a certain act is morally permissible, “moral permissibility” does not mean that the act is morally right for all. Rather it means that the act cannot help being morally allowed for some persons although the others do not believe its moral rightness because they cannot right now rationally persuade others to accept their view.

생명의료과학기술의 급속한 발전과 이용의 확대는 출생 전 생명의 헌법적 지위 및 보호에 대한 논의의 대상 범주를 태아로부터 배아는 물론 생식세포로까지 확장시켜야 할 필요성을 제기하고 있다. 이러한 헌법적 논의의 핵심은 헌법에 의해 보장되는 인간의 존엄과 가치 및 생명권에 대해 출생 전 생명의 주체성 인정 여부를 어떠한 근거를 바탕으로 판단할 수 있을 것인지, 특히 생명권이 인정되는 경우라면 어떠한 이유로 이를 제한할 수 있을 것인지에 있다. 이에 대해 생명권을 인간의 존엄과 가치와 결합되는 것으로 보고 양자 모두 그 본질적 특성상 절대적 보장을 받아야 한다고 주장하는 입장이 있지만, 헌법적 권리에 대한 법적 평가의 현실적인 불가피성은 이미 헌법상 권리 제한을 가능하게 할 수 있는 규정에 반영되어 있다. 태아와 배아는 각각 인간으로의 탄생 가능성과 태아로의 발생 가능성이라는 특별한 가치를 지니면서 출생후 인간과 인과적 연속성상에 있기는 하지만, 출생후 인간과 달리 인간이 되어가는 과정 중에 있는 존재이므로 인간으로서의 생명권은 아니되 그 존재 가치를 기반으로 하여 그 발생 과정에 따라 단계적으로 다른 생명권을 특별히 인정받아야 한다. 그리고 이러한 출생 전 생명의 생명권 역시 인간으로서의 생명권처럼 다른 헌법적 권리들과의 비교형량에 따라 제한이 가능하여야 한다. 하지만 출생 전 생명의 존중과 보호의 당위성은 부정할 수 없는 것인 바, 생명권의 과도한 침해가 발생하지 않도록 하기 위해 출생 전 생명의 지위 및 보호에 대한 헌법적 측면에서의 근본적인 논의를 바탕으로 이들의 생명권 존중에 대한 인식과 자율적 보호 의지를 확산시켜야 할 것이다. 지금이야말로 다양한 이해관계가 고려되는 공론의 장을 통해 출생 전 생명의 생명권 보장에 관한 합의를 도출해내고, 이를 기반으로 법과 제도를 수정․보완함으로써 출생 전 생명의 존중과 보호를 위한 새로운 패러다임을 구축해야하는 시점이어야 한다.

The development of the biomedical science and technology has extended an argument about a status in constitutional law of unborn human life and a protection of the potential human life to that of an embryo and a gamete beyond a fetus. This argument has been focused on whether we should provide unborn or potential human life with human dignity and the right to life that are guaranteed by the constitutional law altogether or separately. If the right to life is given to unborn or potential human life, on what grounds can we restrict this right. Those who argue for the unity of the right to life with human dignity and the inseparability of those two claims that the right to life in itself should be guaranteed absolutely. According to the constitutional law, however, any constitutional right of the human person within the protection of essential part of the right can be compared with each other and restricted with some valid reasons from the legal perspective. This measure is unavoidable in reality because one right can come into conflict with another right frequently. Since fetus and embryo are in a process of developing into the human person, it is difficult to think that they are the same with the human person. For that reason, it is hard to consider that the right to life of fetus or embryo is the same with that of the human person. However, since a fetus has a special status as a potential human person, and an embryo also has a special value as a potential fetus upon an implantation, the right to life of fetus or embryo should be judged differently according to the stage of their development. A study on a constitutional status and protection of a fetus and an embryo is essential because unborn or potential human life is the origin of human person. Therefore, we have to make much account of their right to life and seek the legal respect for their inherent value.

생식의료보조기술의 발전으로 출생까지의 생명이 발달과정에 인간의 개입정도가 더욱 커졌다. 이는 출생 전 생명의 보호에 대한 필요성이 더욱 커지게 되었다. 헌법상 기본원칙인 생명존중, 인간존중의 사상은 민법에서도 여전히 존중되어야 한다. 생명존중의 방법이 민사책임법적으로 어떻게 구현되는지에 대해서 검토한다. 특히 시간적 흐름의 관점에서 출생 전 생명의 보호에 대해서 설시한다. 결국 생식세포인 정자와 난자의 출발하여 그의 수정과 배아로의 발전, 그리고 착상을 통한 태아에 대한 민사책임법적 보호의 방법과 정도에 대해서 연구한다. 특히 권리의 주체는 언제부터 어떻게 변화하는가를 살펴본다. 나아가 태아의 경우 종래의 정지조건설적 관점에서 살아서 출생할 것을 조건으로 손해배상책임의 주체가 될 수 있다는 판례의 견해와 헌법재판소의 견해를 비판적으로 검토한다. 나아가 생명존중의 방법에 다른 대안적 해석론을 제시해 본다.

Owing to the development of Biotechnology, the involvement of humans in life before birth has been increasing. This means the need for the protection of unborn life takes on new importance. The respect for life and human beings which is based on fundamental constitutional principle should still be respected under civil law. This study examines how methods of respect for life are embodied in civil liability law. In particular, it enunciates the protection of unborn life within time-flow. Lastly, it studies the instruments of the civil liability law and the extent of protection for a fetus from the process of fertilization of an ovum by a sperm, development into an embryo and implantation. Especially, it looks into when and how the subject of the right changes. Besides, it critically scrutinizes the opinions of leading case lawyers and the Constitutional Court which conclude that, in order for a fetus to become the subject of Damage law, it is required to be born alive to comply with precedent. Furthermore, it suggests an alternative interpretation theory.

형법상 생명의 보호는 태어난 사람을 주된 대상으로 하며, 출생 이전의 존재인 태아의 생명을 침해하는 범죄는 살인죄가 아니라 낙태죄에 해당한다. 또 태아는 상해죄의 객체도 되지 아니한다. 그리고 태아와 사람을 구분하는 기준은 진통설 또는 분만개시설이라는 것이 지금까지의 통설과 판례이다. 그러나 최근에 제기되는 견해들은, 정상적인 자연분만을 전제로 한 종래의 기준이 인공출산의 경우에는 미흡하며, 따라서 규범적 판단을 고려할 것을 주장하고, 또 태아의 상해에 대해서도 처벌할 것을 요구한다. 이와 같이 출생 전 생명의 보호를 강화하는 것은 생명존중의 사상에 부합한다고 할 수 있다. 그러나 처벌의 공백을 메우기 위한 이러한 시도는 혼란을 초래할 우려와 함께, 특히 형벌의 과잉을 초래하는 면도 있다. 사람의 시기와 종기는 객관적으로 발생한 사실이라는 명확한 기준에 의해 판정되어야 하며, 예정된 시기 또는 사후에 규범적으로 판단되는 시점이 기준이 될 수는 없다. 또 출생 이전의 태아를 살인죄나 상해죄의 객체가 된다고 하는 것은 유추적용금지원칙에 위배된다. 낙태죄의 규정과 그 현실을 살펴볼 때, 출생 전 생명에 대한 형법의 입장은 출생 후의 생명과 현격한 차별을 하고 있음은 분명하다. 그러나 출생 전의 생명의 보호를 강화하려는 노력은 죄형법정주의, 보충성의 원칙과 같은 형법의 기본원칙들과 조화되는 범위 내에서 이루어져야 한다.

Generally, criminal law protect the human life after he/she has born. Before the birth, the life of fetus are protected by prohibition of abortion, not of murder. Also, the fetus is not considered as an object of infliction of injury. A popular opinion and case law say that the fetus becomes a person at the point of an outset labor pains. Recently, some theories allege that traditional opinions is not sufficient in the case of induced delivery, so it should be decided by norm, not by a simple fact, whether a unborn child is a fetus or a person, and that the fetus should be considered as an object of infliction of injury. These theories can be meaningful because these could protect human life more comprehensively. In the other side, however, these could harm the legal stability and bring the excessive punishment. Abortion of negligence is not punishable in criminal law, and there is little possibility of the fetus injury without the injury of the pregnant woman. And the Contergan Case, if it happened again, must be dealt with as crime about environment or public health more severely. These new approaches are in conflict with the principle of “nulla poena sine lege” and other fundamental rules of the criminal law, and should lead to the excessive punishment and criminal provisions. Accordingly, the decision of Supreme Court of Korea about the beginning point of human being should be maintained.

Because Korea has the excellent informational technology, it was expected to be able to improve the accessibility to healthcare and compete with other nations in excellence through u-Healthcare. But we can't complete the excellent u-Healthcare because of the law to be able to use only the tele-counselling between doctor to doctor or doctor to nurse. First of all, we must complete the law to be able to use the improved u-Health containing of telemedicine between doctor to patient. Though other factors, the procurement of safe IT, the credibility to healthcare service provider containing of nutritionist and occupational therapist etc. are prepared for erecting u-Healthcare, we can get the final and decisive u-Health policy only by means of Law for supporting u-Healthcare's Activation. The important sections of Law for supporting u-Healthcare's Activation are as follows. Sec. 4 The Minister for Health, Welfare and Family Affairs and the dean of associated administrative division have to erect the combined plan for u-Healthcare's Activation. Sec. 11 Government and local autonomous entity can support the facility and equipment to be necessitated for using u-Healthcare to improve the medical accessibility of person in the region with poor medicine. Sec. 13 Doctor can support other doctor's medical action through IT and if there are not medical risk, doctor can give medical act directly to the special patients. Sec. 21 If pharmaceuticals is necessitated in u-Healthcare, remote doctor has to send the patient the electronic prescription and the pharmaceutist to receive the electronic prescription has to delivery the pharmaceuticals in accordance with patient's demand.

While the medical supplies have positive functions such as extending lifespan, recovering health, and preventing diseases, they also cause unexpected tragic consequences due to their side effects, and the magnitude of such damage inevitably increases due to the mechanism of mass production, mass distribution, and mass consumption of those medical supplies. Therefore, needless to say, the optimal way to prevent or reduce such damage is rather through medical supply manufacturers' producing non-defective products, or through the government's controlling production and sales of medical supplies with more aggressive exercise of regulatory authority on medical supply manufacturers, than through a remedy by a legal relief after using medical supplies. In this case, although the victim died due to the defect of the cold medicine, 'Contac 600', the drug company's responsibility to cover damages was not recognized because a defect could not be found in the then-manufacturing process. Thus, while pharmaceutical companies are gaining economic profits by producing and selling a medical supplies, if they do not take any remedy measures for the victims of their products' side effects, the victims have to use medical supplies under their own responsibility of taking a risk, and they have to accept the full damage of the potential consequence. Therefore, to remove such absurdity and contradiction, and to practically remedy the victim of medical supplies' side effects, the pharmaceutical side effects remedy project pending in the pharmaceutical affairs law needs to be actively implemented.

Is it lawful to withhold or withdraw life-sustaining treatment applied to a patient in a terminal condition or permanent unconscious condition? In Korea, there are no such laws or regulations which control affairs related to the withholding or withdrawal life-support treatment and active euthanasia as the Natural Death Act or the Death with Dignity Act in the U. S. A. And in addition there has had no precedent of Supreme Court. Recently Supreme Court has pronounced a historical judgment on a terminal care case. The court allowed the withdrawal life-sustaining treatment from a patient in a permanent unconscious state. Fundamentally the court judged that the continuation of that medical treatment would infringe dignity and value of a patient as a human being. And the court required some legal grounds to consider such withdrawal or withholding of medical care lawful. The legal grounds are as follow. First, the patient is in a incurable and irreversible condition and already entered a stage of death. Second, the patient executed a directive in advance or at least the patient's will would be presumed through his/her character, view of value, philosophy, religious faith and career etc. I regard if a patient is in a incurable and irreversible condition or in a terminal condition, the medical contract between a patient and a doctor would be terminated because of the actual impossibility of achievement of it's purpose. So I think the discontinuation of life-sustaining care would be legally allowed without depending on the patient's own will.

일본에서는 임종은 자택에서 맞기를 희망하는 사람이 전체의 80%를 넘고 있지만, 실제로는 10% 정도밖에 실현되지 못하고 있다. 한편, 세계에서 가장 높은 평균수명에도 불구하고 차라리 죽는 것이 낫다고 생각하는 사람의 비율이 재택개호를 받는 65세 이상의 노인 중 30% 정도나 차지하고 있다. 이러한 상황에서 말기의료의 문제가 사회적으로 관심을 받고 있는데, 말기의료는 본인의 자유의사 및 존엄사 등과 같은 윤리적인 문제와 더불어, 의료비 문제에까지 걸친 경제적인 문제의 측면까지 고려하지 않을 수 없게 되었기 때문이다. 본 연구는 말기의료와 관련된 문제의 배경 및 선행연구를 고찰하는 동시에 일본에서의 현황을 알아보도록 한다. 특히, 말기의료에 의한 의료비를 추계하고 총의료비가 절감될 수 있도록 하는 방안을 모색해 보았다. 또한 말기의료의 문제를 의료윤리의 바탕 위에서 환자 본인의 의사 및 경제적 지불능력 및 지원을 통해 해결할 수 있도록 하는 방안을 제시한다.

More than 80% of Japanese still want to face death at home, but only 10% of them can have his/her last moments of life at home. On the other hand, the end-of-life care has been a big issue in both ethical and economic aspect because of euthanasia and healthcare costs. It is generally known that the end-of-life care spends much more than the care for nonterminal years. This study approaches the key for the end-of-life care and suggests a desirable solution.

In Korea, Abortion in the Criminal Law is an illegal act in exception of on which abortion may be carried out through the grounds are very limited and related such a emergency situation of women's physical health, rape, incest and genetic diseases. The Criminal Law regulates the mother's act of abortion and the doctor's surgical performance of abortion. The Mother and the Child Health Law prescribes the medical, ethical, and genetic grounds for the legal permission of abortion. Many people tend to abuse of abortion even though they are fully aware of its illegality. The law lead to be inconsistent with its enforcement. In this paper, I would like to suggest some proposals about the legal analysis of the Abortion Regulations th reform the existing regulation and increase th effectiveness of the regulations. Recently, in a case of the a maternity hospital where a midwife left alone a diabetes pregnancy women who had a baby, and the overweight baby(5.2Kg) died in the uterus due to hypoxic states. Supreme Court of Korea 2007.6.29. 2005do3832) had given a verdict of "not guilty". It looked like there were very fair with current crime law. But, we want this case to be investigated if there weren't any logical contradictions as well as concurrent translation within Constitution Law. Now the Mother and the Child Health Law prescribes the medical, ethical, and genetic grounds for the legal permission of abortion. But this law does not include social and economic grounds.

ⅰ) Das deutsche Arzneimittelgesetz(AMG) vom 24. 8. 1976 hat neben der Einführung des Zulassungsverfahren für Arzneimittel anstelle des bisherigen Registrieungsverfahrens vor allem auf dem Gebiet des Haftungsrechts eine bedeutende Neuerung gebracht: die Gefährdungshaftung für den pharmazeutischen Unternehmer. Gemäß §84 AMG ist der pharmazeutische Unternehmer zum Schadensersatz verpflichtet. wenn infolge der Anwndung eines Arzneimittels ein Mensch getötet oder Körper oder die Gesundheit eines Menschen nicht unerheblich verletzt wird. Pharmazeutischer Unternehmer ist, wer das Arzneimittel unter seinem Namen in Verkehr bringt. ⅱ) Die Ersatzpflicht des pharmazeutisches Unternehmers besteht jedoch nur in zwei Fällen: a) Das Arzneimittel hat bei bestimmungsgemmäßem Gebrauch schädliche Wirkungen, die über ein nach den Erkenntnissen der medizinischen Wissenschaft vertretbares Maß hinausgehen(§84 Abs. 1 Satz 2 Nr. 1 AMG). b) Der Schaden ist infolge einer nicht den Erkenntnissen der medizinischen Wissenschaft entsprechenden Kennzeichnung, Fachinformarion oder Gebrauchsinformation eingetreten(§84 Abs. 1 Satz 2 Nr. 2 AMG). ⅲ) Mit dem 2. Schadensersatzrechtsänderungsgesetz ist, dem Konzept von §6 Umwelthaftungsgesetz folgend, eine gesetzliche Kausalitätsvermutung eingeführt worden. Ist das angewendete Arzneimittel nach den Gegebenheiten des Einzelfalls geeignet, den entstandenen Schaden zu verursachen, so soll vermutet werden, daß das Arzneimittel auch den konkreten Schaden beim Anwender verursacht hat(§84 Ⅱ AMG). Der pharmazeutische Unternehmer hat dann diese Vermutung zu wiederlegen. ⅳ) Gemäß §94 AMG hat der pharmazeutische Unternehmer für seine Haftpflicht Deckungsvorsorge entweder durch eine Hafpflichtversicherung oder eine Freistellungs- oder Gewährleistungsverpflichtung eines lnländischen Kreditinstituts zu treffen. ⅴ) Aber koreanisches Arzneimittelgesetz hat keine Gefährdungshaftung für Arzneimittelschäden. Es gibt nur Gefährdungshaftung des Hersteller aufgrund des Produkthaftungsgesetzes, das auf das Arzneimittel Anwendung findet. Ich glaube, in Zukuft soll koreanisches AMG die Gefährdungshaftung für den pharmazeutischen Unternehmer regeln.

대법원 2005. 6. 24. 선고 2005다16713 판결 및 그 하급심 판결은 응급환자의 전원에 있어서 전원하는 의료기관의 의사와 전원받는 의료기관의 의사의 주의의무에 대하여 판시하고 있다. 판결이 설시하고 있는 전원시 고려사항은 다음과 같다. 먼저 환자를 전원하는 경우 불안정한 환자를 의학적인 필요성 이외의 이유로 전원하여서는 안 되고, 수용하는 의료기관의 가용성을 확인하여야 하며, 환자와 관련된 정보를 신속히 전달하여야 한다. 다음으로 환자를 전원하는 의사는 전원을 받은 의료기관의 의사와 직접적인 연락을 통하여 환자의 신원, 환자의 사고력, 응급실에서의 환자의 초기상황과 시행된 처치에 대한 환자의 반응 등에 관한 정보를 제공하고, 해당 의료기관의 의료능력과 수준, 즉각 조치의 가능성 등을 타진하여 전원받을 의료기관을 결정하며, 환자를 전원받는 의사는 전원된 환자의 수용․치료가능 여부를 확인한 후 전원에 대하여 동의하고, 예상되는 치료내용에 대한 사전준비를 하여야 한다. 원심판결은 전원받는 의료기관에게 전원하는 의료기관이 제공한 정보를 확인하여야 하는 의무를 부담시켰으나, 대법원은 전원받는 의료기관이, 전원하는 의료기관이 제공하는 정보를 확인하여야 하는 의무까지 부담하는 것은 아니라고 판단하였다. 그러나 전원받는 병원이 전원에 동의함에 있어서 의사는 전문가의 입장에서 독립적으로 판단하여야 하며, 제공받은 정보가 불충분한 경우 구체적이고 추가적인 질문을 통하여 정보를 요청하여야 한다고 생각한다.

Main Issue of Supreme Court Decision 2005Da16713 Delivered on June 24, 2005 is about the duty of medical care in the interhospital transfer of patients. According to the above Supreme Court Decision, in the interhospital transfer of patients, the decision to transfer should make from the aspect of medical treatment. The hospitals and doctors keep the duty of medical care. In addition to the duty for hospitals/doctors to check the capacity and availability of the hospital to which the patient is transferred, there are also duties to inform about emergency medical service and to sufficiently explain the need for the transfer, the medical conditions of the patient to be transferred and the hospital from which the patient is transferred. The hospital to which the patient is transferred must be thoroughly informed about matters such as the patient's conditions, the treatment the patient was given and reasons for transfer. including information upon referral, completeness of medical records, patient monitoring and so on. The interhospital transfer requires the consent of doctor belonging to the hospital to which the patient is transferred after the consideration of capacity and availability of the hospital and the informed consent of patients or legal representatives.