• 제목/요약/키워드: Matter of care

검색결과 165건 처리시간 0.029초

중국의 최근 대기오염 규제 및 관리 정책에 대한 고찰 (An Overview on China's Recent Air Pollution Regulation and Management Policy)

  • 최민욱
    • 자원ㆍ환경경제연구
    • /
    • 제27권3호
    • /
    • pp.569-611
    • /
    • 2018
  • 중국의 고속 경제성장과 도시화 산업화는 생활환경 전반을 급격히 악화시키고 있으며, 특히 대기오염물질은 중국 국내 뿐 아니라 인접국가인 한국의 대기환경 악화의 주요 외부요인으로 작용하고 있다. 최근 중국 정부는 석탄연소로 인한 대기오염에 대한 방지 관리와 대기환경 개선 정책을 대대적으로 시행해 왔다. 본 연구에서는 석탄연소에 따른 대기오염과 석탄화력 발전 대기오염물질 배출에 대한 중국정부의 규제관리 동향을 살펴봄으로써 중국 대기환경 정책의 주요 제도적 배열의 흐름과 상세 현황을 파악하였다. 그 결과, 석탄화력발전 대기오염물질 배출에 대한 중국 정부당국의 규제는 권역별 규제와 발전설비 유형별 규제 실시 등을 통해 이전보다 세분화된 것을 확인하였고, 대기오염물질 배출허용 기준 역시 강화되고 있으며, 13차 5개년 계획 기간의 목표년도인 2020년에 맞춰 직접적인 규제 및 방지 관리 등이 정책제도 측면에서 더욱 강화될 것으로 파악되었다. 하지만, 중국 대기질 개선 정책의 실질적인 효과와 실행 가능성 여부는 과학적 근거에 기반을 두고 신중하게 평가되어야 하며, 한국 등 인접국가에 미치는 영향이 충분히 고려되지 않은 한계점에는 개선이 요구된다. 이를 위해서는 지속가능한 한 중 환경협력 네트워크를 구축하고 강화시켜 나가는 것이 필수적으로 전제되어야 하며, 비단 중국의 대기오염뿐만 아니라 에너지정책, 산업 기술, 글로벌 환경거버넌스 등 다양한 요인을 고려한 통합적 접근과 중장기적인 연구가 필요하다.

암환자 인식에 관한 연구 - 간호사ㆍ의사를 중심으로

  • 조인향
    • 호스피스학술지
    • /
    • 제2권1호
    • /
    • pp.58-74
    • /
    • 2002
  • This paper constitutes a descriptive investigation and used a structured questionnaire to investigate nurses' and doctors' recognition of cancer patients. The subjects were extracted from the medical personnel working at the internal medicine, the surgery ward, the obstetrics and gynecology department, the pediatrics department, the cancer ward, and the emergency room of five general hospitals located in Seoul and Gyeonggi Province. The research lasted from August, 2001 to September 2001. Total 137 nurses and 65 doctors were included and made out the questionnaires directly distributed by the investigator. The study tool was also developed by the investigator and consisted of such items as the demographic and social characteristics, the medical personnel's recognition degree of cancer and cancer patients, their recognition of the management of cancer patients, and their participation in a hospice. The results were analyzed using the SPSS Window program in terms of technological statistics, ranks, t-test, and ANOVA. The reliability was represented in Cronbach' α=.75. The nurses' and doctors' recognition degree of cancer and cancer patients had an overall average of 3.86 at the 5 point-scale. The items that received an average of 4.0 or more included 'Medical personnel should explain about the cancer cure plans to the cancer patient and his or her family', 'A patient whose case has been diagnosed as a terminal cancer should be notified of it, 'If I were a cancer patient, I would want to get informed of it,' and 'Cancer shall be conquered whenever it is'. In the meantime, the items that received an average of 3.0 or less was 'My relationship with the cancer patient's family has gotten worse since I announced his or her impending death.' And according to the general characteristics and the difference test, the recognition degree of cancer and cancer patient was high among the subgroups of nurses, females, married persons, who were in their 30s, who had a family member that was a cancer patient, and who received a hospice education. The biggest number of the nurses and doctors saw 'a gradual approach over several days'(68.8%) as a method to tell a cancer patient about his or her cancer diagnosis or impending death. Those who usually tell tragic news were the physician in charge(62.8%), the family members or relatives(32.1%) and the clergymen(3.8%) in the order. The greatest number of them recommended a cancer patient's home as the place where he or she should face death because they thought 'it would stabilize his or her mentality'(91.9%) while a number of them recommended the hospital because they 'should give the psychological satisfaction to the patient'(40%) or 'should try their best until the last moment of the patient's death'(30%). A majority of the medical personnel regarded 'smoking or drinking' and 'diet' as the causes of cancer. The biggest symptom of a cancer patient was 'pain' and the pain management of a cancer patient was mostly impeded by the 'excessive fear of drug addiction, tolerance to drugs and side effects of drugs' by medical personnel, the patient, and his or her family. The most frequently adopted treatment plan of a terminal cancer patient was 'to do whatever the patient or his or her family wants' to resort to a hospice' and 'to continue active treatment efforts' in the order. The biggest reasons why a terminal cancer patient went to see a doctor were 'pain alleviation' 'control of symptoms other than pain(intravenous supply)' and 'incapability of the patient's family' in the order. Terminal cancer patients placed their major concern in 'spiritual(religious) matter' 'emotional matters' their family' 'existence' and 'physical matters' in the order. 113(58.5%) of the whole medical personnel answered they 'would recommend' an alternative treatment to a terminal cancer patient mostly because they assumed it would 'stabilize the patient's mentality.' Meanwhile, 80(41.5%) of them chose 'not to recommend it mostly due to the unverified effects and high cost of it(78.7%). A majority of them, I. e. 190(94.1%) subjects said they 'would recommend' a hospice to a terminal cancer patient mostly because they thought it would help the patient to 'mentally prepare'(66.6%) Only 17.3% of them, however, had received a hospice education, most of which was done through the hospital duty education(41.4%) and volunteer training(34.5%). The follows are results of this study: 1. The nurses and the doctors turned out to be still passive and experience confusion in dealing with a cancer patient despite their great sense of responsibility for him or her. 2.Nurses and Doctors realize the need of a hospice, but an extremely small number of them participate in a hospice education or performance. Thus, a whole recognition of a hospice should be changed, for which purpose a hospice education for nurses and doctors should be provided. 3.Terminal cancer patients preferred their home to a hospital as the place to face their impending death because they felt it would bring 'mental stability.' And most of nurses and doctors think it would be unnecessary for them to be hospitalized just for control of their symptoms. Accordingly a terminal cancer patient can be cared at home, and a home hospice care needs to be activated.

  • PDF

Indoor Exposure and Health Risk of Polycyclic Aromatic Hydrocarbons (PAHs) via Public Facilities PM2.5, Korea (II)

  • Kim, Ho-Hyun;Lee, Geon-Woo;Yang, Ji-Yeon;Jeon, Jun-Min;Lee, Woo-Seok;Lim, Jung-Yun;Lee, Han-Seul;Gwak, Yoon-Kyung;Shin, Dong-Chun;Lim, Young-Wook
    • Asian Journal of Atmospheric Environment
    • /
    • 제8권1호
    • /
    • pp.35-47
    • /
    • 2014
  • The purpose of the study is to evaluate the pollution level (gaseous and particle phase) in the public facilities for the PAHs, non-regulated materials, forecast the risk level by the health risk assessment (HRA) and propose the guideline level. PAH assessments through sampling of particulate matter of diameter < 2.5 ${\mu}m$ ($PM_{2.5}$). The user and worker exposure scenario for the PAHs consists of 24-hour exposure scenario (WIES) assuming the worst case and the normal exposure scenario (MIES) based on the survey. This study investigated 20 PAH substances selected out of 32 substances known to be carcinogenic or potentially carcinogenic. The risk assessment applies major toxic equivalency factor (TEF) proposed from existing studies and estaimates individual Excess Cancer Risk (ECR). The study assesses the fine dusts ($PM_{2.5}$) and the exposure levels of the gaseous and particle PAH materials for 6 spots in each 8 facility, e.g. underground subway stations, child-care facilities, elderly care facilities, super market, indoor parking lot, terminal waiting room, internet caf$\acute{e}$ (PC-rooms), movie theater. For internet caf$\acute{e}$ (PC-rooms) in particular, that marks the highest $PM_{2.5}$ concentration and the average concentration of 10 spots (2 spots for each cafe) is 73.3 ${\mu}g/m^3$ (range: 6.8-185.2 ${\mu}g/m^3$). The high level of $PM_{2.5}$ seen in internet cafes was likely due to indoor smoking in most cases. For the gaseous PAHs, the detection frequency for 4-5 rings shows high and the elements with 6 rings shows low frequency. For the particle PAHs, the detection frequency for 2-3 rings shows low and the elements with 6 rings show high frequency. As a result, it is investigated that the most important PAHs are the naphthalene, acenaphthene and phenanthrene from the study of Kim et al. (2013) and this annual study. The health risk assessment demonstrates that each facility shows the level of $10^{-6}-10^{-4}$. Considering standards and local source of pollution levels, it is judged that the management standard of the benzo (a)pyrene, one of the PAHs, shall be managed with the range of 0.5-1.2 $ng/m^3$. Smoking and ventilation were considered as the most important PAHs exposure associated with public facility $PM_{2.5}$. This study only estimated for inhalation health risk of PAHs and focused on the associated cancer risk, while multiple measurements would be necessary for public health and policy.

일체형 방어벽 제작을 통한 이동형 엑스선 발생기의 차폐능 평가 (Shielding Capability Evaluation of Mobile X-ray Generator through the Production assembled Shield)

  • 김승욱;안병주
    • 한국방사선학회논문지
    • /
    • 제12권7호
    • /
    • pp.895-908
    • /
    • 2018
  • 의료방사선의 관리에서 가장 중요한 사항은 진료의 적정성을 확보하면서 방사선위해를 최소화하는 것이다. 국제원자력기구는 진단방사선 분야의 선량 감소 방법에 대한 지침서를 만들어 환자피폭선량을 측정하여 각 국가에 사용하도록 권고하고 있다. 또한 국내에서도 우리나라의 실정에 맞게 각 촬영마다 환자 피폭 선량값을 연구하여 진단참고준위를 제시하였다.환자가 질병 때문에 방사선 진료를 받는 것은 방사선 때문에 일어날 수 있는 위해보다 그것으로 얻어지는 이익이 크기 때문이다. 병실 이동검사와 같이 자신의 질병과 무관하게 방사선에 노출되는 환자 및 보호자들의 피폭을 줄이기 위해서는 환자, 방사선사, 의사 및 의료기관의 노력이 가장 중요하다.이에 본 연구에서는 개선방안의 일환으로 MG로 병실의 이동 검사에 대한 문제점을 제시하고 이 문제점을 근거로 하여 산란선으로 예상되는 공간선량률을 분석하였다. MG에 자체 개발한 방어벽을 설치하여 방어벽 설치 전후의 공간선량률을 측정하여 그 감소율을 분석하였다. 최종적으로 이 자료들을 종합하여 MG에 방어벽을 부착하여 방사선사의 병실이동에 대한 부담감의 최소화, 병실 이동검사로 인한 방사선사, 환자 및 보호자를 방사선 노출로부터 보호하고, 검사로 인한 주위 환자 및 보호자의 불편을 최소화하는데 의의가 있다. 이와 같은 개선안에 대해 보다 효율적인 시행을 위하여 MG에 대한 새로운 법 제도가 마련되면, 향후 예상되는 비용, 인력, 고객만족도 및 더욱 더 안정적인 피폭감소방안이 정착될 것이라 사료된다.

안락사에 대한 일반인들의 인식도 (General Population's View on Euthanasia)

  • 김선현;이혜리
    • Journal of Hospice and Palliative Care
    • /
    • 제6권2호
    • /
    • pp.133-143
    • /
    • 2003
  • 목적 : 최근 의료 기술이 발달하면서 대두된 여러 생명 윤리의 문제점들 중 특히 안락사에 대한 관심이 높아지고 있고 이에 대해 점차 개방적으로 생각하는 것이 전체적인 흐름이다. 미국, 유럽, 호주 등에서는 이에 대한 연구 자료가 구체적으로 나와 있고 실제로 시행되고 있으나 국내에서는 아직 연구가 부족한 실정이며 현재까지 발표된 연구들도 주로 의료인을 대상으로 한 것들이 많아 일반인들의 인식도가 어느 정도인지에 대한 연구가 필요하다. 방법 : 2000년 5월에서 7월까지 서울의 일개 구와 경기도내 한 지역의 고등학생 이상 남녀 600명을 대상으로 설문 조사를 시행하였다. 회수된 설문지 중 기재가 미비 된 것을 제외한 435명이 최종분석에 사용되었다. 인구사회학적 변수와 안락사에 대한 인식도와의 관계를 통계 프로그램 SAS 6.12를 사용하여 Chi-square test로 분석하였다. 결과 : 안락사를 법제화해야 한다는 사람은 304명(73.6%)이었고 안락사의 범위를 능동적 안락사까지 허용한다는 사람이 156명(37.8%), 수동적 안락사를 허용한다는 사람이 234명(56.6%)이었다. 안락사의 대상이 본인인 경우 능동적 안락사는 35세 이상(P=0.001)에서 더 많이 시행한다고 하였고 수동적 안락사의 경우에는 학력이 낮을수록(P=0.046), 경제력이 낮을수록(P=0.040) 더 많이 시행하겠다고 하였고, 안락사의 대상이 타인일 때 능동적 안락사의 경우에는 남자(P=0.001), 35세 이상(P=0.001), 기혼(P=0.002)에서 더 많이 허용하였고 수동적 안락사의 경우에는 직업(P=0.016)에 따라 유의한 차이가 있었다. 안락사가 합법화되었을 경우 본인에게 능동적 안락사를 시행하겠다는 경우는 35세 이상(P=0.001), 기혼(P=0.022)에서 많았고 수동적 안락사를 시행하겠다는 경우도 나이(P=0.001), 결혼여부(P=0.001)와 관련이 있었다. 타인에게 능동적 안락사를 시행하겠다고 한 경우는 성별(P=0.004), 결혼여부(P=0.001)에서, 수동적 안락사를 시행하겠다고 한 경우는 나이(P=0.002), 결혼여부(P=0.017), 교육 정도(P=0.025), 경제력(P=0.001)에 따라 유의한 차이를 보였다. 결론 : 대다수의 일반인들은 안락사에 대한 법이 필요하다고 하였고 연령과 교육, 경제력이 안락사 시행 여부에 영향을 주는 것으로 보여진다.

  • PDF

학교도서관 발전의 저해요인에 관한 실증적 고찰 -일학교장의 학교도서관에대한 인식을 중심으로-

  • 김남석;김정소
    • 한국도서관정보학회지
    • /
    • 제7권
    • /
    • pp.1-55
    • /
    • 1980
  • It has been observed that the purpose of education is poorly coordinated with the school library. Consequently a healthy growth of the library has been very rare, and educational process has been rather inefficient. Therefore this study attempts to define the role of a school library and the necessasity of its growth, examine principals' concepts of the library, find out the adverse causes for its growth, and make some suggestions to rectify them. A questionnaire was designed to get information on the principals' conceptions about the nature and the role of a school library, a librarian, and adverse causes for the growth of the library. This study is largely based on the analysis of this questionnaire. The results of this study may be summarized as. follows: 1) The school library is not generally considered as the center of educational activities. It is rather variously regarded as a subsidiary organization for education, a place where reading materials are offered, a place where books are kept, or a reading room. 2) This was largely due to the misconceptions of the principals as to the true nature and the role of the school library. 3) The degrees of their misconceptions varied depending on the amount of their exposure to the library science. Those principals who studied library science more hours had better understanding of the library. 4) Although the principals showed rather much concern for the library, the school library was not up to the expectation largely due to their misconception of it. 5) Most of the principals felt that they needed more knowledge on library science to carry out their job. This feeling was stronger for those who spent more hours in a library science course. 6) Most of the principals wanted to offer a position for a dual function: a librarian and a teacher. This was largely due to their lack of knowledge as to the duties of a librarian-which were considered as secondary to the duties of a teacher. 7) The majority of the principals thought the librarians were not paid well enough, but some of the principals o n.0, pposed their pay raise. The former generally took more courses in library science than the latter. 8) Many principals agreed that the adverse causes for the growth of the school library originated from the regional or governmental school authorities. This seemed to indicate that the legal requirements for the library were inadequate and that there was no administrative organization to take care of the library. 9) Most of the principals considered the insufficient funds as the major reason for the present poor condition of the library. But considering the fact that some libraries are better equi n.0, pped that others, financial matter cannot be the deciding factor. It rather seemed that there is some serious problems in the current educational system. For further studies in this field and for the libraries to function properly, the following suggestions are made here: 1) The major adverse cause for the healthy growth of the school library was found in the misconceptions on the school library by the principals, and these misconceptions were largely due to their lack of knowledge. Therefore they should be given more o n.0, pportunities to take courses in library science. 2) The librarian should not be overburdened with other duties than what his job duly calls for, and they should be properly compensated for their own job. They should also be encouraged to grow as librarians. 3) Education itself should be improved so that the library becomes the center of learning. 4) An administrative department should be created to oversee the school libraries, and legal measures should be enacted for better school libraries. 5) Financial su n.0, pport should be provided for a period of time in order to upgrade the school library to a certain level. Finally it is strongly felt that more detailed and inclusive studies in this field should be carried on and further experimental studies should be done.

  • PDF

PET 이용 현황 및 전망 (Current Status and Future Perspective of PET)

  • 이명철
    • 대한핵의학회지
    • /
    • 제36권1호
    • /
    • pp.1-7
    • /
    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.

저작권법에 준한 도서관봉사에 관한 연구 -미국과 한국의 저자재산권의 제한규정을 중시으로- (Limitations on Exclusive Rights of Authors for Library Reprography : A Comparative Examination of the Draft Revision of Korean Copyright Law with the New American Copyright Act of 1976)

  • 김향신
    • 한국도서관정보학회지
    • /
    • 제11권
    • /
    • pp.69-99
    • /
    • 1984
  • A dramatic development in the new technology of copying materials has presented us with massive problems on reconciling the conflicts between copyright owners and potential users of copyrighted materials. The adaptation to this changing condition led some countries to revise their copyright laws such as in the U. S. in 1976 and in Korea in 1984 for merging with the international or universal copyright conventions in the future. Copyright defined as exclusive rights given to copyright owners aims to secure a fair return for an author's creative labor and to stimulate artistic creativity for the general public good. The exclusive rights on copyrightable matters, generally for reproduction, preparation of derivative works, public distribution, public performance, and public display, are limited by fair use for scholarship and criticism and by library reproduction for its preservation and interlibrary loan. These limitations on the exclusive rights are concerned with all aspects of library services and cause a great burden on librarian's daily duty to provide balance between the rights of creators and the needs of library patrons. The fair use as one of the limitations on it has been coupled with enormous growth of a new technology and extended from xerography to online database systems. The implementation of the fair use and library reprography in Korean law to the local practices is examined on the basis of the new American copyright act of 1976. Under the draft revision of Korean law, librarians will face many potential problems as summarized below. 1. Because the new provision of 'life time plus 50 years' will tie up substantial bodies of material longer than the old law, until that date librarians would need permissions from the owners and should pay attention to the author's death date. 2. Because the copyright can be sold, distributed, given to the heirs, donated, as a whole or a part, librarians should chase down the heirs and other second owners. In case of a derivative work, this is a real problem. 3. Since a work has its protection from the moment of its creation, the coverage of copyrightable matter would be extended to the published or the unpublished works and librarian's work load would be heavier. Without copyright registration, no one can be certain that a work is in the public domain. Therefore, librarians will need to check with an authority. 4. For implementation of limitations on exclusive rights, fair use and library reproduction for interlibrary loan, there can be no substantial aggregate use and there can be no systematic distribution of multicopies. Therefore, librarians should not substitute reproductions for subscriptions or purchases. 5. For the interlibrary loan by photocopying, librarians should understand the procedure of royalty payment. 6. Compulsory licenses should be understood by librarians. 7. Because the draft revision of Korean law is a reciprocal treaty, librarians should take care of other countries' copyright law to protect foreign authors from Korean law. In order to solve the above problems, some suggestions are presented below. 1. That copyright clearinghouse or central agency as a centralized royalty payment mechanism be established. 2. That the Korean Library Association establish a committee on copyright. 3. That the Korean Library Association propose guidelines for each occasion, e.g. for interlibrary loan, books and periodicals and music, etc. 4. That the Korean government establish a copyright office or an official organization for copyright control other than the copyright committee already organized by the government. 5. That the Korean Library Association establish educational programs on copyright for librarians through seminars or articles written in its magazines. 6. That individual libraries provide librarian's copyright kits. 7. That school libraries distribute subject bibliographies on copyright law to teachers. However, librarians should keep in mind that limitations on exclusive rights are not for an exemption from library reprography but as a convenient access to library resources.

  • PDF

두부 외상 후 섬망의 자문 정신 의학적 고찰 (Delirium after Head Trauma at Psychiatric Consultation)

  • 김현철;이상철;김도훈;이상규;홍승관;손봉기
    • 정신신체의학
    • /
    • 제12권1호
    • /
    • pp.15-22
    • /
    • 2004
  • 연구목적: 두부 외상은 신체적 후유 증상뿐 아니라 다양한 정신 증상을 야기한다. 본 연구에서는 두부 외상 후 섬망을 보이는 환자들을 대상으로 정신과 자문을 실시하고 과다행동 증상의 유무 등의 임상 양상과 회복 기간과의 관련성에 대해 평가하고자 하였다. 방 법: 1998년부터 2002년까지 두부 외상을 주소로 신경외과에 입원한 환자들 중 섬망이 발생하여 정신과에 자문 조정이 의뢰된 45명의 환자를 대상으로 하였다. 섬망 발생 4주 후 추적 자문에서 섬망의 회복 여부에 따라 완전 관해 된 군 및 잔류 증상이 남아 있는 군으로 나누고, 두 군간의 차이를 과다행동 유무와 사회 인구학적 변수, 두부 외상 부위의 빈도에 따라 살펴보았다. 결 과: 첫 자문 주소에서 과다 행동 유무에 따라 분류해 보았을 때 4주 후의 섬망의 관해와 유의미한 관계를 보였다(p<.01). 섬망의 잔류 증상이 남아 있는 군은 완전 관해 된 군에 비해 중환자실 입원 기간 및(p<.05), 전체 입원 기간이 길었다(p<.01). 섬망 발생 4주 후 잔류 증상이 남아 있는 군은 완전 관해된 군에 비해 사고보험과의 관련성이 많았으며(p<.05), 신경 영상학적 조사에서 피질 하 회백질의 손상의 여부와 유의미한 관계를 보였다(p<.05). 결 론: 본 연구를 통해 첫 자문 의뢰 시 과다행동 유무에 따라 섬망의 회복 기간에 유의한 차이가 있었다. 또한 섬망의 회복 기간이 지연될수록 재원기간이 길어짐을 알 수 있었다. 향후 두부 외상 후 섬망 환자의 정신과적 개입에 있어 과다행동의 유무를 비롯한 임상 변수들에 대한 다각적인 연구가 필요할 것으로 사료된다.

  • PDF

사랑과 정의, 양립 가능한가 - 폴 리쾨르 이론을 중심으로 - (Love and Justice are Compatible ? - In Theory of Paul Ricœur)

  • 이경래
    • 비교문화연구
    • /
    • 제52권
    • /
    • pp.53-78
    • /
    • 2018
  • 서구의 도덕 문화에서 사랑과 정의는 고대로부터 내려온 두드러진 두 개의 명령이다. 하나는 헤브라이즘의 유산이고, 다른 하나는 헤브라이즘과 헬레니즘의 전통에 속한다. 그만큼 두 개념은 인간 공동체 사회를 안정되게 유지하는 데 필요한 가장 중요한 덕목이자 개념이다. 그런데 서로 배타적 관계로 보이는 이 두 명령은 양립 가능할까? 그들의 화해를 궁극적으로 모색하기 위해서는 그 두 개념이 함의하고 있는 의미의 다층성으로 인해 그들 각각에 대한 정확한 개념 분석과 다각도의 이해가 전제되어야 할 것이다. 이를 위해 우리는 먼저 사전적 의미에서부터 출발하여 이 두 개념이 무얼 말하는지 개념 분석 작업을 했으며, 그리고 사랑과 정의의 담론이 어떻게 해석되고 있는지 폴 리쾨르를 중심으로 살펴보았으며, 끝으로 이 두 개념이 과연 문학 작품에서는 어떻게 이야기되고 있는지, 그 문학적 형상화의 사례들(스탕달, 알베르 카뮈, 도스토예프스키의 작품들)을 통해 허구적이나마 삶 속에 구현된 모습들을 살펴보았다. 이처럼 두 개념에 대한 개념 분석, 담론 분석, 이야기 분석을 차례로 살펴본 결과, 우리는 다음과 같은 결론을 도출해낼 수 있었다. 사랑과 정의는 어느 한쪽을 선택할 문제는 아니었다. 부정한 사랑의 문제점이나 사랑이 결여된 정의사회의 냉정함과 비현실성 등은 스탕달과 알베르 카뮈의 소설적 형상화나 그들의 실제 논쟁을 통해 충분히 확인할 수 있었다. 뿐만 아니라 부정한 온정주의에서는 사랑의 힘이 정의의 손길을 일정부분 차단할 수 있는 위험성 또한 확인할 수 있었다. 따라서 차라리 사랑과 정의, 그 양자를 함께 보듬어 양립의 가능성을 모색하는 것이 건강한 미래 사회를 위해 더 필요하다고 여겨졌다. 여기서 우리는 폴 리쾨르의 표현처럼 '상황에 맞는 도덕적 판단'이 요구되는 '사려 깊은 균형'에서 그 양립 가능성을 확인했다. 이러한 이상적인 상황은 차원 높은 시민의식이 발휘되는 연대의식과 상호 배려, 도스토예프스키처럼 고통을 함께 하는 연민 등이 개입된 사랑의 형태가 분배적 정의 원리와 결합되었을 때 실현될 수 있을 것이다. 알베르 카뮈가 정의만을 추구하다 결국 현실을 직시하고 자비의 필요성을 언급할 때 이미 그는 이러한 상황에 따른 도덕적 판단을 내렸다고 할 수 있겠다. 결국 사랑은 정의를 지켜주고, 정의는 사랑을 현실화하는 데 기여한다. 정의는 초윤리적 사랑을 도덕 범주로 환원하는 데 일조하며, 사랑은 정의가 한껏 힘을 발휘할 수 있도록 도와주는 역할을 한다.