• The Korean Society of Law and Medicine
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• v.17 no.2
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• pp.145-173
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• 2016

A patient's Right to Self-Determination or his/her Right of Autonomy in the Republic of Korea has traditionally been understood as being composed of two elements. The first, is the patient's Right to Know as it pertains to the physician's Duty to Report [the Medical Situation] to the patient; the second, is the patient's Right to Consent and Right of Refusal as it pertains to the physician's Duty to Inform [for Patient's Consent]. The legal and ethical positions pertaining to the patient's autonomous decision, particularly those in the interest of the patient's not wanting to know about his/her own body or medical condition, were therefore acknowledged as passively expressed entities borne from the patient's forfeiture of the Right to Know and Right to Consent, and exempting the physician from the Duty to Inform. The potential risk of adverse effects rising as a result of applying the Informed Consent Dogma to situations described above were only passively recognized, seen merely as a preclusion of the Informed Consent Dogma or a denial of liability on part of the physician. In short, the legal measures that guarantee a patient's 'Wish for Ignorance' are not currently being understood and acknowledged under the active positions of the patient's 'Right Not to Know' and the physician's 'Duty to Consideration' (such as the duty not to inform). Practical and theoretical issues arise absent the recognition of these active positions of the involved parties. The question of normative evaluation of cases where a sizable amount of harm has come up on the patient as a result of the physician explaining to or informing the patient of his/her medical condition despite the patient previously waiving the Right to Consent or exempting the physician from the Duty to Inform, is one that is yet to be addressed; that of ascertaining direct evidence/legal basis that can cement legality to situations where the physician foregoes the informing process under consideration that doing so may cause harm to the patient, is another. Therefore it is the position of this paper that the Right [Not to Know] and the Duty [to Consideration] play critical roles both in meeting the legal normative requirements pertaining to the enrichment of the patient's Right to Self-Determination and the prevention of adverse effects as it pertains to the provision of [unwanted] medical information.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.149-159
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• 2006

과거 정신지체는 사회의 불가사의한 것이었으나 현재는 이들의 원인과 병리현상의 이해로 예방과 의학적 관리에 괄목할 만한 발전이 이루어져 왔다. 그러나 이들 정신지체인의 치과관리는 과거와 별다른 변화를 이루지 못한 것이 우리의 현실이다 이들에 관심을 갖고 치료하기 원하는 치과의사들도 아직 진단이나 치료방법에 이용이 제한되어있다 정신지체인 들에게도 정상화 개념을 도입해 보다 나은 건강관리 환경을 이루도록 시대가 바뀌어 가고 있다. 환자의 권리를 보장키 위해 수용시설 입소화. 물리적인 강제치료 등 기존의 일반적인 행위에서 탈피하여 이제는 행동조절의 차원에서 약물이용과 치과적용에 필요한 모든 지식의 습득이 필수적인 것으로 변화되고 있다.

• Journal of Korean Academy of Nursing
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• v.5 no.1
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• pp.48-58
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• 1975

대부분의 정신과적 위기 (자살시도.도주 공격적 파괴적행동.싸움 등)는 노여움이 원인이 되는데 심한 불안. 초초나 또는 규칙등을 위반하였을 때에. 고지식한 병원직원들의 마구 다툼에 의해서 자신의 권리나 존엄성을 모욕 받았다고 생각될 때 그것에 대한 반응으로 일어나게 된다. 이러한 환자들의 흥분및 공격적 파괴적 행동들에 대해서 우리 간호원들은 과연 겁내야 하며 곧 진정제를 투여하거나 강박의를 입혀야 하는가 하는 것이 이 연구의 촛점이다. 본인은 이러한 환자들의 위기상황에 성급한 행동들이 주어지기에 앞서 과학적이고 체계적인 간호적 이해가 따른다면 환자들의 태도는 휠씬 달라질 수 있을 것이라는 가정하에 국립정신 병원에서 1973년 6월 1일부터 9월30일까지 실험군 10명. 통제군 10명의 환자에게 관찰기 (5일). 간호기(5일). 후반기 (5일)로 나누어 실험군에는 간호기에 유효적절한 과학적 체계적 간호를 실시하고. 통제군에는 실시하지 않음으로써 그 효과도를 검증하였다. 환자의 치료에는 간호적 치료이외에도 약물요법, 정신치료. 충격요법 등 관계 요인이 많으므로. 이러한 기간동안의 환자의 행동변화가 간호적 치료 (Nursing Therapy)에 의해 변화된 것인가를 확인하기 위해 검증하였다. 그 결과는 다음과 같다. (P<.01) 표6. 7에서 관찰기. 간호기. 후반기 동안의 정신과 응급 행동의 빈도는, 실험군에서는 15.4. 7.0. 2.9 로 감소되어 p <.01의 수준에서 의미 있는 변화임이 밝혀졌고, 통제군에서는 10.6. 6.9. 6.6으로 행동빈도가 감소되었으나 p >.05의 수준에서 의미 있는 변화가 아님을 보이고 있다. 위의 결과들로 미루어 본 연구는 다음과 같은 결론을 내릴 수 있을 것이라고 생각한다. \circled1환자의 위기 행동에 관한 사전의 이해없이 무조건의 안정제 투여와 강박의 사용은 금해야 할 것이다. \circled2유효 적절한 자학적 체계적 간호치료 (Scientific & Systematic Nursing Therapy 로서 정신과적 위기는 해 결될 수 있을 것이다. \circled3간호원은 치료적 요원의 역할을 담당할 수 있을 것이다. 본 논문을 시종 지도하여 주신 이부영선생님과 조언을 주신 이은옥 선생님. 이귀향 선생님. 그리고 국립정신병원의 김종해선생님, 보건대학원의 이영환 선생님께 진심으로 감사를 드리며. 아울러, 실험에 협력하여 주신 모든 분들께도 감사를 드립니다.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.27-53
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• 2015

Recently, a plastic surgery hospital in Seoul, has been raided following suspicions that ghost surgery was performed by an unauthorized substitute surgeon on a chinese woman who lapsed into a death. Following the incident, an organization to eradicate ghost surgery was created in March by Consumers Korea, founded to protect consumer rights, and the Korea Alliance of Patients Organization. The organization has received reports of illegal medical practices. To substitute another physician without the patient's consent and without his knowledge of the substitution is fraud and deceit and a violation of a basic ethical concept. The patient as a human being is entitled to choose his own physician and he should be permitted to acquiesce in or refuse to accept the substitution. It should be noted that it is the operating surgeon to whom the patient grants his consent to perform the operation. The patient is entitled to the services of the particular surgeon with whom he contracts. The surgeon, in accepting the patient, obligates himself to utilize his personal talents in the performance of the operation to the extent required by the agreement creating the physician-patient relationship. He cannot properly delegate to another the duties which the patient authorizes him to perform personally. 'Ghost surgery' comes under Article 257(Inflicting Bodily Injury on Other or on Lineal Ascendant) of the Criminal Code. Substitution another physician without the patient's consent and without his knowledge of the substitution shall be performed Inflicting Bodily Injury. This is a controversial issue that'ghost surgery' comes under Article 347(Fraud) of the Criminal Code. It maybe controversial that operation substituted by another physician without the patient's consent and without his knowledge of the substitution becomes the component of Fraud. Also, Ghost surgery' comes under Article 27 (Prohibition of Unlicensed Medical Practice, etc.), Article 22 (Medical Records, etc.), Article 33 (Establishment) of the Medical Service Act. The surgeon's obligation to the patient requires him to perform the surgical operation: (1) within the scope of authority granted him by the consent to the operation; (2) in accordance with the terms of the contractual relationship; (3) with complete disclosure of all facts relevant to the need and the performance of the operation; and (4) to utilize his best skill in performing the operation.

• The Korean Nurse
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• v.19 no.1 s.104
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• pp.68-84
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• 1980

간호사업은 1970년대 후반부터 이제까지의 병원중심-환자중심의 간호사업을 수행해 오다가 지역사회에 기반을 둔 간호사업인 건강간호사업으로 전환되기 시작하였다. 세계보건기구에서도 지역사회에 기반을 둔 간호사업인 일차건강관리사업을 중점적으로 지원하기 시작한 것이다. 이러한 역사적 전환의 배경과 실태에 관하여 문헌고찰을 하여 앞으로 국민건강사업 체계에 대한 논의에 참고자료가 되게 하고자 본 논문을 시도하였다. 본 논문에서 얻어진 결과를 다음과 같이 요약한다. 고도의 과학문명의 발달과 물질적 풍요로 특징짓는 현대사회속에서도 인류의 건강문제는 영원히 충족되지 못한 상태로 대두되고 있는 실정이다. 전통적으로 60년대 중반까지는 의료지식 및 기계공업의 발달과 이를 뒷받침할 재정적 지원속에 세계적으로 치료의학분야에 획기적인 발전을 가져왔다. 다른 한편으로는 건강을 태생의 권리라고 규정하여 여러나라에서 사회보장제대로써 의료시해의 균점을 위한 각가지 방도를 마련하기에 이르렀다. 그리하여 60년대말기부터 70년대로 넘어오면서 치료의학의 발달만으로는 의료수가가 앙등되어 모든 국민이 이용할 수 없을 뿐만 아니라 나아가서는 모든 국민의 건강문제를 해결하기는 어렵다는 사실을 발견하기 시작하였다. 또한 지역사회의 건강문제를 요인별로 따져보면 복잡하여 사회경제적, 문화적, 환경적, 유전적 제요인과도 밀접한 관계를 맺고 있기 때문에 신체적인 질병의 치료만이 지역사회 건강문제를 해결하는 길이 아님을 알게 되었다 그리고 지역사회의 건강문제를 해결하기 위해서는 일차보건의료사업에 중점을 두어 노력하는 것이 가장 합리적인 개선방안이라는 의견이 경험적으로 이론적으로 뒷받침되기 시작하였다. 이러한 사조는 지역사회 건강문제가 복잡한 것과 같이 그 접근방법에 있어서도 여러보건요원이 팀이 되어 임해야만 하며 그중에서도 간호팀의 활동이 중추적인 역할을 담당해야 한다고 여러 전문가들은 주장하고 있다. 따라서 앞으로의 간호사업의 방향은 지역 사회에 기반을 둔 간호사업이 실시되어야만 국민건강문제 해결에 기여하게 될 것으로 고찰되었다.

• The Korean Society of Law and Medicine
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• v.20 no.1
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• pp.109-132
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• 2019

Recently, medical accidents related to surgical procedures have increased. In addition, the media reported that some of these accidents were involved in health crimes. Patient-advocate groups have called for mandatory establishment and management of CCTV in operating rooms. There is a lot of discussion among the interested parties, so it is necessary to review the relevant laws and regulations. The purpose of this study is to identify the characteristics of CCTV in operating rooms and to review legislations related to establishment and management of the CCTV in operating rooms. Medical institutions use CCTV for management of facilities and patient safety and install it in operating rooms optionally. The Constitution guarantees the privacy and the privacy of correspondence of every citizen, but it can be limited by the law for public welfare. Currently, however, there is no existing law about establishment and management of the CCTV in operating rooms and it can be defect of legal system. Under the current legislations, it is likely that the Self-determination can be violated due to the characteristic of healthcare provider when CCTV is mandatorily installed in operating room. In addition, the regulations on access and leakage of confidential information known by operator are insufficient. So that, the safety of the visual data might be threatened. Furthermore, unless the period and the place of storage of the visual data are clearly defined, it is highly unlikely to meet the original purpose of patient safety and prevention of medical accidents. This study is meaningful as there is few previous study on this topic although the need for legal review about this is growing and several bills are being proposed. It is expected that the results of this study can be utilized as basic data for enactment or amendment of the laws and regulations about establishment and management of CCTV in operating rooms.

• Journal of the Korean Society of Radiology
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• v.6 no.4
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• pp.281-290
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• 2012

The difference of radiation dose of MDCT due to different protocols between hospitals was analyzed by CTDI, DLP, the number of Slice and the number of DLP/Slice in 30 cases of the head, the abdomen and the chest that have 10 cases each from MDCT examination of the department of diagnostic imaging of three general hospitals in Gyeongsangbuk-do. The difference of image quality, CTDI, DLP, radiation dose in the eye and radiation dose in thyroid was analyzed after both helical scan and normal scan for head CT were performed because a protocol of head CT is relatively simple and head CT is the most frequent case. Head CT was significantly higher in two-thirds of hospitals compared to A hospital that does not exceed a CTDI diagnostic reference level (IAEA 50mGy, Korea 60mGy) (p<0.001). DLP was higher in one-third of hospitals than a diagnostic reference level of IAEA 1,050mGy.cm and Korea 1,000mGy.cm and two-thirds exceeded the recommendation of Korea and those were significantly higher than A hospital that does not exceed a diagnostic reference level (p<0.001). Abdomen CT showed 119mGy that was higher than a diagnostic reference level of IAEA 25mGy and Korea 20mGy in one-third. DLP in all hospitals was higher that Korea recommendation of 700mGy.cm. Among target hospitals, C hospital showed high radiation dose in all tests because MPR and 3D were of great importance due to low pitch and high Tube Curren. To analyze the difference of radiation dose by scan methods, normal scan and helical scan for head CT of the same patient were performed. In the result, CTDI and DLP of helical CT were higher 63.4% and 93.7% than normal scan (p<0.05, p<0.01). However, normal scan of radiation dose in thyroid was higher 87.26% (p<0.01). Beam of helical CT looked like a bell in the deep part and the marginal part so thyroid was exposed with low radiation dose deviated from central beam. In addition, helical scan used Gantry angle perpendicularly and normal scan used it parallel to the orbitomeatal line. Therefore, radiation dose in thyroid decreased in helical scan. However, a protocol in this study showed higher radiation dose than diagnostic reference level of KFDA. To obey the recommendation of KFDA, low Tube Curren and high pitch were demanded. In this study, the difference of image quality between normal scan and helical scan was not significant. Therefore, a standardized protocol of normal scan was generally used and protective gear for thyroid was needed except a special case. We studied a part of CT cases in the local area. Therefore, the result could not represent the entire cases. However, we confirmed that patient's radiation dose in some cases exceeded the recommendation and the deviation between hospitals was observed. To improve this issue, doctors of diagnostic imaging or technologists of radiology should perform CT by the optimized protocol to decrease a level of CT radiation and also reveal radiation dose for the right to know of patients. However, they had little understanding of the situation. Therefore, the effort of relevant agencies with education program for CT radiation dose, release of radiation dose from CT examination and addition of radiation dose control and open CT contents into evaluation for hospital services and certification, and also the effort of health professionals with the best protocol to realize optimized CT examination.

• Journal of Hospice and Palliative Care
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• v.2 no.1
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• pp.16-22
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• 1999

Purpose : Today, people usually die in hospitals and institution-sterile and strange, and equipped with a complex range of technology capable of supporting and prolonging life, frequently only biological one, when a return to health and vitality is no longer possible. Consequently, 'dying with dignity' has become a slogan of opposition to useless and degrading prolongation of life when a patient's organ, though still minimally functional, can no longer support or permit the exercise of self-fulfilling personal control over life's events. Dying with dignity, however, means entirely different things to different people. This study is to investigate the college students' attitude on terminal care and passive euthanasia. Methods : During June 1997, 337 college students participated in this study by responding to the pre-made questionnaire. It deft with the attitude to passive euthanasia, hospice, the most suffering fear facing the death, the preferred place and person to be with if dying. Results : 63.2% of subjects agreed to passive euthanasia. Only 14.2.% of college students can explain the concept of hospice, exactly They got the information about hospice by TV(43%), book(33.5%), religious group(12%) in order. The preferred death place was home(76.6%) and hospital(11.9%) in order. The Most suffering fear facing the death were about unknown(41.5%), loosing colleague(13.6%), pain(11%), isolation(6.5%) in order. Conclusion : About two-thirds of college students agreed to passive euthanasia. But euthanasia is dangerous and unnecessary. We should vigorously promote programmes of education in hospice and palliative medicine and care.

• The Korean Society of Law and Medicine
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• v.20 no.1
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• pp.133-162
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• 2019

Due to the nature of medical malpractice lawsuits, it is difficult for medical consumers, who are weak in getting information when it comes to health care problem, to secure all information inside the hospital. Even if you are confident about the hospital infection, it is true that people have difficult to obtain medical testimony by expert. It is seen as no easy task to testify to the malpractice of colleagues who work in the same field not only in our country but also abroad, when a doctor gives negative testimony to another doctor in a medical malpractice lawsuit. Although few health care providers will be motivated to take medical care from the outset, testimony or statements from a medical practitioner can have a significant impact on the outcome of a lawsuit, as it is impossible for the patient to control or be aware of the whole process of medical conduct, especially in the event of a hospital infection and the victim. If the hospital can prove the causality of damages caused by negligence of the employees or supervision of the hospital itself in a medical suit caused by the infection, the level of protection of the victim could be raised further. We sought to find a solution to these problems by looking at the provisions of other laws related to hospital infection. In particular, as the comparative legal review regarding hospital infection, Germany's legislative precedent sets a medical contract as a typical civil law contract, so it is thought that looking at German civil law regulations also has implications for Korean law. We also tried to improve the French Special Act 'rights of patients' and we can look at the consequent changes in court cases. Finally, the content of the U.S. case's and the theory of 'the doctrine of res ipsa loquitur' in relation to it show that doctors and hospitals have been forced to shift the burden of proof through this theory. This paper tried to find out the implications of mitigating the burden of proof by reviewing various issues that might be related to medical litigation of hospital infection from a comparative point of view.