Earticle

Nowadays we have a lot of interest in dissociative identity disorder(DID) which was officially registered in DSM-Ⅳ-TR.. In the interest of continuity, This complex forensic case illustrates the creative interface between clinical and legal thinking because it challenges both fields to think about issues of volition and responsibility that we might not otherwise have considered. The general legal standard for criminal responsibility is determining defendants’ state of mind and capacity to control their behavior at the time of the offense. Application of this rule to a disorder that, by definition, is characterized by limited self- knowledge and self control is not likely to be an easy task. DID is the mental disorder most strongly associated with child abuse, especially sexual abuse, and the issue is very controversial. However, the value of controversial evidence should not be ignored. Sometimes use of the more controversial evidence is the only way to establish a DID diagnosis. So enhanced admissibility of expert witness and evidence in DID cases would support concepts of fundamental fairness.

Because medical malpractice suits are about human's life and body, they can affect medical personnel in financial bankruptcy as obligation to compensate is admitted. For example, if serious encephalopathy or persistent vegetative state happen to patients because of medical malpractice, hospital conducts medical judging body to comprehend loss of disability. through medcal jdging body, rate of loss of labor capacity, life expectancy, and additional expense to medical treatment will be caculated because disability of patients remains uncomplete condition. Therefore, doctor takes more lage range of charge, in such case court orders a lump sum allowance compensation and financially situation can be worse. In addition, becacuse life expectancy is not definite in modern medical science level, the average of judging body is determined by contemporary life expectancy on settling money. So, if contemporary life expectancy is over and the patient continuously lives, expanded damage matters. Way to give punitive damages is two. The one is a lump sum allowance compensation as mostly admitted, the other is installment compensation as exceptionally. But, korean court's tendency in civil liability of mdern medical malpractice to reckon compensation for damages hesitates definite installment because of lack of ensuring performance. Just merely, as mdical expense and nusing expense caused by illegal act of body invasion, it is possible to receive regularly for another use of money. In civil liability of medical malpactice, when late loss appears because result of judging body or averge on settling money is changed, previous jugement or settlement matter. And on chargeing excessive compensation, it matters to give installment compensation. Thus, in view of patient how desirably court makes up for disability, and in view of doctor how to distribute for compensation of medical pers onnel needs. So, in this manuscript, firstly when unpredictable late loss is ordered, admirable grounds about that late loss will be considered. Also, such ad mission in medical malpractice brings expansion of compensation, becaus e through later suits judging body is not always same condition. for this reason, adaptable necessity will be discussed in that installment compens ation can be alternative.

Human tissue differs from other things in that it derives from human being. Its donation is made without compensation. Hence, the management of human tissue requires strong morality and necessitates a fair and prompt system of distribution based on the principle of fair distribution. Public management of human tissue is important. The state should prepare the public management system of human tissue and intervene in the channeling and distribution of human tissues more actively. To wit, the state should uphold the donors' spirit of donation without compensation and provide and manage the public management system of human tissue that can encourage the spread of the culture of human tissue donation and enable the beneficiary to receive fairly at low cost. The establishment and management of public tissue bank that publicly implements pursuant to the non-profit principle the collection and processing of tissues obtained by tissue donation support organizations becomes important with regard to the reinforcement of public management of human tissue. In the long run, the current management that separates the donations into organs, marrows, human tissues, cord blood, and other human resources needs to be replaced by the separate management of human resources for transplant and human resources for research and development. In the case of human resources for transplant, commissioning one comprehensive organization to establish the integrated data base system and conduct integrated public management is desirable.

A drug can be defined as a substance other than food which may affect the constitution or function of a living thing through its chemical properties. In this sense, it may be possible to place organic solvents like bond, gas or thinner and narcotics like marijuana, methamphetamine, cocaine or heroine under the category of drugs. These drugs are characteristic of having positive medicinal as well as side effects upon human being including but not limited to excitement, hallucinatory image, auditory hallucination, relaxation, sleeping, anorexia, nerve stability, schizophrenia, anaesthesia, brain damage, narcissism, etc. Abuse of drugs, however, would result in direct and indirect impact upon the society, family and industry as a whole by ruining of families, unemployment, loss of manpower, and catastrophic damage of physical and mental health of all people. Strong cling to drugs could also cause devastation of personality by abandoning relationship with family members and friends and even jobs, hobbies and culture and would eventually make addicts unsociable. Furthermore, abuse of drugs could be a cause for more serious phenomenon of social pathology such as drastic increase of inhuman violent crimes, crimes without specific motives, frequent burglary and theft to raise the money to buy drugs with. In contrast with the global trend to enforce the regulations for drug-related crimes, the Korean judiciary authorities keep on dealing leniently with offenders, especially when they are first timers, by only charging the fine not exceeding 50 million Won. To put use of drugs under control, it seems more effective to install and operate facilities which are dedicated to providing supports for drug addicts to get free from the cycle of crimes and return to the society. In sum, it would be extremely important to study the measures needed to prevent occurrence of drug-related crimes because the issue of addiction can not　rely on legal punishments alone. The legal system that imposes heavy penalty upon drug-related crimes may be effective to a certain extent in terms of crime prevention but has limit in itself. It is therefore most imperative to respond in a more active way to prevention of drug-related crimes by introducing the educational programs for drug addiction, by training experts who can treat drug addicts, not to speak of working out preventive measures from the perspective of criminal legislation and socio-cultural aspects as well.

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.

PTSD라는 개념이 본격적으로 의학회에 정착하는 계기가 된 것은 1980년에 미국 정신의학회가 ‘정신 질환의 진단 및 통계 메뉴얼 제3판’에서 PTSD를 정의한 것이다. 미국에서는 1960-70년대에 베트남 전쟁 귀환병들이 고국으로 돌아온 후에도 일상생활에 복귀하기가 쉽지 않았고, 불면과 우울 상태에 빠지거나 자살을 하는 등 큰 사회문제가 되기도 하였다. 한편에서는 미국 페미니즘 운동의 고양은 강간 등 성폭력 피해자가 입은 심신에 미치는 깊은 상처를 어떻게 치유해야 하느냐를 물어왔으며 그런 가운데 마음의 상처라는 문제로서 PTSD개념이 발전해 왔다. 미국에서 발전해 온 PTSD 개념이 일본에서 사회적으로 인지된 것은 1995년에 일본 고베시를 중심으로 사망자 5000명 이상의 피해를 낸 한신-아와지 대지진이 큰 계기가 되었다. PTSD개념이 손해배상 청구 소송에서 하는 기능은 크게 두 가지로 첫째는 불법행위책임 성립의 문제이며 둘째는 손해 배상액 산정과 관련된 문제이다. 일본에서 PTSD피해를 처음으로 재판에서 인정하고 그것을 일실이익이나 위자료액 산정에 반영시킨 최초의 판결은 요코하마 지방법원에서 1998년 판결이다. 현재는 PTSD를 인정한 판결도 축적되어 가고 있는 반면에 PTSD인지 아닌지가 중요한 게 아니라 원고에게 얼마나 무거운 정신적 손해가 있었는지가 더 중요하다고 보고 굳이 PTSD발증 유무에 대한 판단을 명확히 하지 않는 판결도 나오고 있다. PTSD 중에는 점차 회복되어가는 경우도 있는가 하면 좀처럼 PTSD 증상이 사라지지 않는 만성형인 경우도 있다. 심각한 증상이 계속되고 있지만 그 원인이 본인이 과거에 받은 불법행위와 구체적인 연관성을 찾지 못한 채 오랜 시간이 지나고 이PTSD 원인이 과거 불법행위에 기인하고 있다는 것을 의사의 진단에 의해 밝혀진 때에는 이미 손해배상청구권의 시효기간이 지나 버린 경우도 발생한다. 특히 아동기의 성적학대피해는 좀처럼 드러나지 않는다는 잠재성을 가지고 있으며, 또한 장기간에 걸쳐 피해자의 심신에 심각한 영향을 준다. 아동기의 성적학대피해에 대해서는 피해의 특성에 입각한 시효론이 필요하다. 현재 일본에서는 채권법을 중심으로 한 민법개정안이 발표되었지만, 이 문제에 대해서는 특별히 고려하지 않고 있다. 독일에서는 고의에 의한 성적 자기결정권의 침해피해에 대해 피해자가 만51세가 될 때까지 손해배상청구권의 소멸시효는 완성되지 않는다는 획기적인 시효법 개혁을 2013년 민법개정을 통해 실현하였다. 아동기의 성적학대피해에 대한 손해배상청구권은 피해자가 성인이 될 때까지 시효는 정지한다는 독일처럼 손해∙가해자를 안 날로 부터 3년이라는 단기소멸시효의 적용을 배제하는 특별입법이 필요하다.

소아암환자의 생식가능성의 온존과 관련하여 소아암 환자는 육체적∙정신적으로 미숙하여 자기판단과 자기결정을 함에 있어서 어려움이 있기 때문에 의학적∙심리적∙윤리적∙법적인 문제가 있으며 신중한 대응을 필요로 한다. 소아암 경험자가 치유 후에 파트너를 만나 자신의 아이를 갖을 가능성을 보장하는 것은 그들의 생활의 선택지를 보장하는 것과 같다. 일본산부인과학회회고는 정자의 동결보존과 해동 후의 이용, 인간배아및 난자의 동결보존과 이식을 법률혼 및 사실혼 커플에게 인정하고 있다. 따라서 소아암 환자가 정자 혹은 난자를 동결보존하여 암 치유 후에 파트너를 만나 가정생활을 영위할 때에 자신의 정자를 파트너에게 인공수정하고 또는 자신의 난자와 파트너의 정자를 이용하여 체외수정을 하거나 그 배아를 자신의 자궁에 착상시켜 출산하는 것은 회고상 가능하다. 생식 가능성 온존에 관한 정보 제공 및 설명은 어려운 국면에 놓여 있다. 즉 암 통고로 인해 불안하고 우울 증상이 있는 상황에서 생식기능의 상실에 대해서 설명을 받는 것은 상당한 스트레스가 될 것으로 예상된다. 게다가 암 통고를 받은 환자, 또는 그 부모와 가족이 암 치료가 시작되기 전에 제한된 시간 내에 앞으로의 임신에 대비한 동결 보존에 관한 정보를 충분히 이해하기가 어렵다는 점, 시간적 또는 기술적인 문제로 인해 온존요법의 선택지가 적어질 가능성도 지적되고 있다. 이런 상황에서 암 치료로 인해 생식 기능을 잃게 될 가능성을 고려하면서 그것을 온존하기 위한 의료수단을 받을지 말지를 결정하게 된다. 확실히 구명이 최우선이긴 하지만 동시에 치료 후 사회생활의 질 향상도 시야에 넣은 치료전략이 요구된다. 그러기 위해서는 암 치료가 시작되기 전에 한정된 시간 안에서 환자와 부모, 가족에 대해 어떻게 정확한 정보를 전달하느냐가 중요하다. 암 치료 전문의, 간호사, 임상심리사, 약사, 소셜워커 등으로 구성된 의료팀 결성이 필수불가결하며 이 문제에 대한 의사, 간호사, 심리사 등 다직종 간에 상호이해와 연계와 함께 의료계에 대한 광범위한 계몽이 필요하다. 소아암 경우 장기적인 팔로우업이 필요하다. 이런 팔로우업의 하나로서 생식 기능 회복을 자리매김하고 그 전제로서 암 치료가 시작되기 전에 생식 가능성 온존에 대한 설명을 생식의료 전문의 및 임상심리사가 참여해서 아이의 증상, 연령, 이해력에 맞게 그리고 동시에 부모 등 양육자가 자리를 같이 하는 가운데서 실시할 것이 요구된다. 장기적으로 관련이 있는 문제이기 때문에 생식 가능 연령에 이르지 않은 아이라고 해도 이해력에 맞는 설명을 받고 그 내용을 알고 의료행위에 대해 자기 희망이나 의견을 말할 기회가 보장되어야 한다.