• 제목/요약/키워드: Self-balancing

검색결과 110건 처리시간 0.032초

인터넷 환경에서 서버간 부하 분산을 위한 새로운 웹 클러스터 기법 (A New Web Cluster Scheme for Load Balancing among Internet Servers)

  • 김승영;이승호
    • 정보처리학회논문지C
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    • 제9C권1호
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    • pp.115-122
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    • 2002
  • 본 논문에서는 능동적으로 서버의 상태 파악이 가능하고 서버의 운영테제에 의존적이지 않은 디스패처 방식을 개선하여 인터넷 환경에서 서버간 부하 분산을 위한 새로운 웹 클러스터 기법을 제안한다. 제안한 새로운 웹 클러스터 기법은 자율적 부하 분산 기능과 트랜잭션 페일 세이프(Transaction Fail-safe) 기능을 갖는다. 자율적 부하 분산 기능은 기존의 균등 분배와 고성 분배 부하 분산 방식을 개선하여 웹 클러스터 기법이 동작되는 상황에서 서버 각각의 부하 정도에 따라 실시간으로 트래픽(Traffic) 분배율을 조정하는 기능이다. 트랜잭션(Transaction) 페일 세이프 기능은 트랜잭션 단위의 복구가 지원되지 않는 기존의 방식을 개선하여 연속된 일련의 트랜잭션이 처리되는 도중 발생된 서버측 장애를 복구하여 주는 기능이다. 본 논문에서 제안한 새로운 빌 클러스터 기법은 유닉스 운영체제 환경에서 C 언어로 구현하였고, 기존의 상용 웹 클러스터 솔루션과의 벤치마크 비교를 통해 성능을 비교 분석하였다. 브로드케스팅 방식과의 성능 비교에서는 트래픽 처리량이 많아질수록 제안한 새로운 웹 클러스터 기법의 성능이 우수하였다. 라운드 로빈 DNS 방식과의 성능 비교에서 트래픽 처리 성능은 비슷하였으나, 서버의 장애 상황에서는 제안한 새로운 웹 클러스터 기법이 트래픽을 보다 신뢰적으로 처리 하였다. 따라서 본 논문에서 제안한 새로운 빌 클러스터 기법을 인터넷 서비스에 적용할 경우 급격히 증가하는 서비스 요청과 이로 인한 서버의 과부하론 효율적으로 처리하여 보다 신뢰적인 서비스가 가능할 것으로 기대된다.

중독(中毒) 현상의 도가철학적 해석 (On the Taoist Interpretation of Addiction)

  • 김백희
    • 대순사상논총
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    • 제47집
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    • pp.39-63
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    • 2023
  • 현대사회의 병리현상 중에서 매우 심각하게 문제를 야기하는 "중독(中毒)" 현상에 대한 도가철학적 해석과 해결 방안을 모색하는 것이 본고의 의도이다. 이를 위해 철학적 사유의 지평에서 중독을 관조는 법을 구명하였다. 질병은 고정불변의 실체를 지니는 존재자가 아니라 균형과 조화를 상실한 일종의 현상으로서 파악해야 한다. 이에 대한 치료는 해독약으로서의 약(藥)을 처방할 수 있다. 약 자체가 독약과 양약의 구분이 모호한 물질적 존재로서, 조화와 균형의 시각에서 약을 다루어야만 중독 현상의 해결에 유효할 수 있다. 중독 현상을 보는 도가철학의 관점은 만물의 개별자가 지니는 욕망의 일탈 또는 욕망의 과잉으로 빚어진 병리 현상이다. 개별자는 우주자연의 변화과정 속에 일시적으로 존재하는 과정적 존재일 뿐이다. 이런 도가적 세계관을 계승하는 유파로서의 한의철학이 있다. 도가적 한의철학의 지평에서 중독 현상은 마음의 조화와 균형을 잃는 것에서 온다. 해결의 방법도 마음의 혼란 상태[마(魔)]를 안정시키는 것에서 시작한다. 병리현상으로서의 중독은 실제로는 실체적 본질이 없다. 질병 현상은 삶의 어떤 계기나 인연에 의하여 조금씩 쌓여 견고하게 굳어진 일종의 일시적 현상일 뿐, 영원한 본질이 있는 악의 표상이 아니다. 이런 이치를 자각하는 순간 그런 병리현상에서 벗어날 수 있는 길이 열린다. 도가철학의 진단과 처방은 단호하다. 욕망의 일탈이 바로 병리현상을 일으킨다. 과유불급(過猶不及)이다. 과(過)와 불급(不及) 사이의 조화와 균형을 찾는 일이 중요하다. 그리하면 병리적 중독과 같은 모든 시름은 우주변화의 풍랑에 씻기어 간다.

만성통증 환자의 통증 조절 (Chronic pain control in patients with rheumatoid arthritis)

  • 은영
    • 근관절건강학회지
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    • 제2권1호
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    • pp.17-40
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    • 1995
  • Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

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The Effect of Propofol on Hypoxic damaged-HaCaT Cells

  • Park, Chang-Hoon;Kwak, Jin-Won;Park, Bong-Soo;Kim, Yong-Ho;Kim, Yong-Deok;Yoon, Ji-Uk;Yoon, Ji-Young;Kim, Cheul-Hong
    • 대한치과마취과학회지
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    • 제14권1호
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    • pp.41-47
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    • 2014
  • Background: Autophagy is a self-eating process that is important for balancing sources of energy at critical times in development and in response stress. Autophagy also plays a protective role in removing clearing damaged intracellular organelles and aggregated proteins as well as eliminating intracellular pathogens. The purpose of the present study was to examine the protective effect of propofol against hypoxic damage using keratinocytes. Methods: Human keratinocytes (HaCaT cells) were obtained from the American Type Culture Collection. Propofol which were made by dissolving them in DMSO were kept frozen at $-4^{\circ}C$ until use. The stock was diluted to their concentration with DMEM when needed. Prior to propofol treatment cells were grown to about 80% confluence and then exposed to propofol at different concentrations (0, 25, 50, 75, $100{\mu}M$) for 2 h pretreatment. Cell viability was measured using a quantitative colorimetric assay with thiazolyl blue tetrazolium bromide (MTT assay), and fluorescence microscopy and western blot analysis were used for evaluation of autophagy processes. Results: The viability of propofol-treated HaCaT cells was increased in a dose-dependent manner. Propofol did not show any significant toxic effect on the HaCaT cells. The autophagy inhibitor, 3-methyladenine, reduced cell viability of hypoxia-injured HaCat cells. Fluorescence microscopy and western blot analysis showed propofol induce autophagy pathway signals. Conclusions: Propofol enhanced viability of hypoxia-injured HaCaT cells and we suggest propofol has cellular protective effects by autophagy signal pathway activation.

무용요법이 노인의 신체적.심리적 특성에 미치는 효과 (The Effect of Dance Therapy on Physical and Psychological Characteristics in The Elderly)

  • 이영란
    • 대한간호학회지
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    • 제29권2호
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    • pp.429-444
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    • 1999
  • This study was performed to explore the effects of a dance therapy on physical and psychological characteristics in the elderly. The design of this study was a non-equivalent pre-post test experiment. The subjects consisted of elderly persons living in a facility located in Suweon and Bucheon. Fifty eight subjects, aged between 65 and 93 years who had normal cognition, sensory function, balance, and resting blood pressure. They underwent tests of balance, flexibility, muscle strength, depression, and anxiety as baseline data before dance therapy, and at 6th week and at the end of the 12nd week after following dance therapy. Twenty seven elderly persons were assigned to the experimental group and participated with the dance therapy between April and July, 1998. The dance therapy was developed by the author with the help of a dance therapist and a physiatrist. This therapy was based on the Marian Chace's dance therapy and Korean traditional dance with music. The dance therapy consists of 50 minutes session, 3 times a week for 12 weeks. One session was consisted of warming-up, expression, catharsis, sharing, and closing stage. The intensity of the dance therapy was at the 40 % of age-adjusted maximum heart rates. Data were analysed with mead standard deviation, Chi-square test, unpaired t-test, repeated measures ANOVA, and Bonferroni multiple regression using SAS program. 1. The results related to the physical characteristics were as follows : 1) The balance (standing on one leg, walking on the balancing bar), flexibility and muscle strength (knee extensor, knee flexor, ankle plantarflexor and dorsiflexor) of the experimental subjects significantly increased over time mere than that of the control subjects. 2) The experimental group had significantly higher score for balance, flexibility, muscle strength of knee extensor, and knee flexor than the control group at the 12nd week after dance therapy. 3) The experimental group had significantly higher score for muscle strength of ankle dorsiflexor and plantarflexor than the control group at the 6th week and the 12nd week after dance therapy. 2. The results related to psychological characteristics were as follows : 1) Scores of Geriatric Depression Scale, Hamilton Depression Rating Scale, and Zung's Self-rating Anxiety Scale of the experimental group were significantly decreased over time more than that of the control group. 2) The experimental group had significantly lower score for depression than the control group at the 12nd week after dance therapy. 3) The experimental group had significantly lower score for anxiety than the control group at the 6th week and the 12nd week after dance therapy. The findings showed that the dance therapy could be effective in improving the balances, flexibility, and muscle strength of lower limb, and effective in decreasing the depression and anxiety of the elderly. Additional merits of the dance therapy would be inexpensiveness, easy accessibility, and increasing interpersonal relationship. It can be suggested that the dance therapy is effective in the health promotion of the elderly.

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WDM 메트로 링 망에서 다양한 입력 트래픽을 고려한 MAC 프로토콜의 성능분석 (Performance Evaluation of MAC Protocols Considering Various Input Traffic in WDM Metro Ring Networks)

  • 이규정;소원호
    • 한국정보과학회:학술대회논문집
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    • 한국정보과학회 2006년도 가을 학술발표논문집 Vol.33 No.2 (D)
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    • pp.24-29
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    • 2006
  • 본 논문에서는 광대역 통신 방송 융합 서비스 제공을 고려한 WDM 메트로 링 망을 위한 매체 접근 제어(Medium Access Control; MAC) 프로토콜의 성능을 분석한다. 현재 인터넷은 통신 방송 융합 망으로 진화하고 있으며 다양한 트래픽 특성을 갖는 서비스가 액세스 망에서 메트로 망으로 유입되고 있다. 그러나 기존 메트로 망의 MAC 프로토콜은 이러한 망 환경 변화를 고려하지 않고 단순하고 동일한 트래픽만을 고려하여 성능을 분석하였다. 따라서 본 논문에서는 메트로 링에 연결된 액세스 노드의 입력 트래픽을 Self-Similar와 Poisson 트래픽으로 분류하여 기존 MAC 프로토콜의 성능을 분석하고 평가한다. 메트로 링 망에 연결된 액세스 노드는 이 두 종류의 트래픽 중에서 하나를 망에 유입하며 채널을 공유하는 노드 수에 따라서 다양한 트래픽 환경이 고려된다. WDM 메트로 링망의 기본 MAC 프로토콜은 CSMA/CA(Carrier Sense Multiple Access with Collision Avoidance)이며, 패킷을 빈 슬롯에 전송하고 송신지에서 패킷을 제거하는 SS (Source-Stripping) 기반으로 운용된다. 본 논문에서는 SS 방식으로 생성된 빈 슬롯을 바로 패킷 전송에 이용하는 방식과 그렇지 않은 방식을 각각 1-Persistent와 non-Persistent로 분류하고 MAC 프로토콜을 분석하여 기존 방식의 장 단점을 비교한다. 또한 전송 공정성과 처리율을 같이 고려하여 적용할 수 있는 확률 기반 p-Persistent MAC 프로토콜도 분석하였으며 시뮬레이션을 통하여 각 프로토콜을 노드 처리율, 전송 지연, 패킷 손실률, 전송 공정성 관점에서 비교하고 평가한다.y 수행을 여러 서버로 분산처리하게 함으로써 성능에 대한 신뢰성을 향상 시킬 수 있는 Load Balancing System을 제안한다.할 때 가장 효과적인 라우팅 프로토콜이라고 할 수 있다.iRNA 상의 의존관계를 분석할 수 있었다.수안보 등 지역에서 나타난다 이러한 이상대 주변에는 대개 온천이 발달되어 있었거나 새로 개발되어 있는 곳이다. 온천에 이용하고 있는 시추공의 자료는 배제하였으나 온천이응으로 직접적으로 영향을 받지 않은 시추공의 자료는 사용하였다 이러한 온천 주변 지역이라 하더라도 실제는 온천의 pumping 으로 인한 대류현상으로 주변 일대의 온도를 올려놓았기 때문에 비교적 높은 지열류량 값을 보인다. 한편 한반도 남동부 일대는 이번 추가된 자료에 의해 새로운 지열류량 분포 변화가 나타났다 강원 북부 오색온천지역 부근에서 높은 지열류량 분포를 보이며 또한 우리나라 대단층 중의 하나인 양산단층과 같은 방향으로 발달한 밀양단층, 모량단층, 동래단층 등 주변부로 NNE-SSW 방향의 지열류량 이상대가 발달한다. 이것으로 볼 때 지열류량은 지질구조와 무관하지 않음을 파악할 수 있다. 특히 이러한 단층대 주변은 지열수의 순환이 깊은 심도까지 가능하므로 이러한 대류현상으로 지표부근까지 높은 지온 전달이 되어 나타나는 것으로 판단된다.의 안정된 방사성표지효율을 보였다. $^{99m}Tc$-transferrin을 이용한 감염영상을 성공적으로 얻을 수 있었으며, $^{67}Ga$-citrate 영상과 비교하여 더 빠른 시간 안에 우수한 영상을 얻을 수 있었다. 그러므로 $^{99m}Tc$-transierrin이 감염 병소의 영상진단에 사용될 수 있을 것으로 기대된

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한방물리요법에 대한 문헌적 고찰 (A Literatural Study on the Traditional Korean Medical Physiotherapy)

  • 최보미;홍서영
    • 한방재활의학과학회지
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    • 제21권2호
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    • pp.211-226
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    • 2011
  • Objectives : The purpose of this study is to establish literatural evidence about traditional Korean medical physiotherapy through literatural review. Methods : Applicable paragraphs which were related to the traditional Korean medical physiotherapy were phrased from in "Hwang-je-nae-gyung(黃帝內經)", "Yumun-sa-chin(儒門事親)", "Geum-guei-yo-ryack(金匱要略)", "Eui-hack-ip-mun(醫學入門)", "Gyung-ack-jeon-seo(景岳全書)", "Eui-hack-gang-mock(醫學綱目)", "Dong-eui-bo-gam(東醫寶鑑)" where were archiving of Oriental or Korean medicine literatures. Searched paragraphs were analysed for establishing historical and theoretical bases of Korean medical physiotherapy. Results : 1. Theromtherapy is originated from yu(熨), hot hand, warm, water bath, warm earth, fumigation, lamp, torchlight and brazier. Matching indications are various musculoskeletal pain and diseases, skin diseases such as chronic inflammation, frostbite, gynecological and urogenital diseases such as uterine myoma, lower abdominal pain, metrorrhagia, breast diseases, digestive tract diseases such as vomiting, diarrhea, stomachache and also it treats cardiovascular disease. Other matching indications are sunstroke, rhinorrhea, psycosis and anal pain. And it used helping acupuncture therapy. 2. Cryotherapy is originated from lengfu(冷敷), lengtie(冷貼), cold stone and cold water. Matching indications are various fever disease, skin diseases such as acute inflammation, wound, fever skin disease, otorhinolaryngological diseases such as acute sore throat, otitis, stomatitis, nasal bleeding and contusions, abrasions, burn and dysuria. In addition, it treats extremity coldness, chillness, stomachache caused to accumulate fever. 3. Physiotherapy by circulating meridian system is originated from manipulation such as pushing, massage and beating to therapy point. Matching indications are musculoskeletal diseases such as various muscular pain, heavy sensation, convulsion, urogenital diseases such as dysuria, lower abdomen pain, digestive tract diseases such as stomachache, and paralysis due to blocked meridian system. And other matching indications are psycosis, leprosy, hypoesthesia, acute stroke. In addition it helps other therapy methods. In addition, the power of manipulation classify to strengthen and reduce. 4. Physiotherapy by balancing meridian system is originated from sunshine, magnet, horn, bamboo and tube. Sunshine helps improving self's care and cure inflammatory skin disease. Magnet's matching indications are paralysis, various injuries, abscess, fever and eye disease. Cupping therapy treats to skin diseases and internal diseases such as tuberculosis. Conclusions : Traditional Korean medical physiotherapy was widely used in traditional Korean medicine since ancient time based on the traditional Korean medical principle and anatomical knowledge. With modern physiotherapy and traditional Korean medicine together, effects of treatment are enhanced. And traditional Korean medical physiotherapy is appropriated to world physiotherapy's expectation.

색채치료(色彩治療)와 한의학(漢醫學)에서의 색(色)의 적용(適用) (Color therapy and application of color to oriental medical science)

  • 박승림;강정수
    • 혜화의학회지
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    • 제12권1호
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    • pp.79-102
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    • 2003
  • It has been believed that the human body can be effected by color, sound, smell, and taste - each of them is based on the original character. Out of these elements, the color can be a mediation that absorbs energy into human body and adapts it to the creatures whose life are definitely based on the solar energy. This thesis makes a study of the possibility of applying the color to the oriental medical science by researching the color psychology and therapy which are studied in the west medical science, the recognition and application of color developed from orientalism, and the opinion of color in the oriental medical science. Color therapy is one of the psychological treatment techniques that are able to recover and maintain the health with the rays of the sun rays and the color. The light and the color have its energy that may relax, harmonize, encourage, or excite a human being. This is because the wavelength and the vibration of each color will take effects to human body. The core energy of absorbing and distributing the color vibration is made in the 7 "chakras" in the body, which are the pith and marrow of bio-energy directly connected with the center of the nervous system. There are several methods in the color therapy - the treatment of solar ray, the color-bath, the water-therapy using color energy, the inducement of the solar energy into the body, the acupuncture, the therapy of crystal and jewel, and the self-suggestion dependent upon the color. The color therapy can help us to keep our balance by changing the emotion into the positive energy that will cure the disease with color. As a result, this method not only must be useful to cure physical disease, or develop into good health but also will be used in conforming itself to the mental disease. The color therapy mainly uses the eight colors, which are made by mixing Red, Yellow and Blue basic colors in the field. They are never used in the treatment, but they will go along with complementary colors. This rule is closely connected with the theory of yin and yang which lies at the root of oriental philosophy, and with the treatment principle of oriental medical science whose field is focused on the balancing the body mentally as well as physically. In the East, it is the Obangsaek - the color of blue, red, yellow, white, and black in the theory of yin and yang and the five elements that have been used in helping people having trouble with their health for a long time. In the view of the oriental medical science, these five colors attached the theory of five-elements have been very useful to the physiology, the pathology, or the diagnosis, and been applied to the medical treatment, combining themselves with a five-taste in medicinal herbs. Since the study of color and human physiology has been made in some different interest and fields these days, it goes to prove that the different function of color we couldn't have got before becomes very useful to the medical science. The color must be worth researching the diversity for applying itself to the oriental medical science.

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헤도닉 정보시스템의 지속적인 사용에 관한 연구: UCC를 중심으로 (IS Continuance of Hedonic Information Systems)

  • 서호철;안중호;양지윤
    • Asia pacific journal of information systems
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    • 제17권3호
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    • pp.25-53
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    • 2007
  • The Expectation Confirmation Model (ECM) of information systems investigates the continued information systems usage behavior. This paper expands the original post-adoption beliefs and searches the applications in the emerging hedonic information systems. Previous IS researches focused on the organizational environments. However as the information technology (especially internet) evolves, information systems have not only emerged for the organizations but also for the individual users, such as internet portals, internet communities, on-line games etc. These information systems so called Hedonic Information Systems aims to provide self-fulfilling value rather than instrumental value to the users. Researches in other disciplines, including marketing and consumer behavior research, illustrate that the hedonic and utilitarian perspective of goods and services have different influence on the consumer behavior. Goods and services used to be classified into either hedonic or utilitarian aspect but now they may belong to both aspects simultaneously. Moreover consumer's goals or tasks have both hedonic utilitarian aspects. When a consumer makes a decision to purchase or repurchase goods or services, he/she compares the hedonic and utilitarian perspectives of goods to find most suitable ones to satisfy their goals/tasks. Finally, consumer's behavior is determined by the trade-off between what the goods can provide to the consumers and in what extent the goods fulfill consumer's purchase behavior. Consumer also shows that the salience of hedonic perspective is relatively greater when consumer decides which of several items to give up (forfeiture choices) than the time when they decide which item to acquire (acquisition choices). Some researches in MIS discipline have found out that the information systems also have both hedonic and utilitarian perspectives. The decision process of whether to use information systems or not is similar to that of a consumer's decision of purchasing or repurchasing goods or services. However most of researches in MIS tend to focus on the extrinsic motivation variables which only cover the utilitarian perspective of information systems. It is only recent that researches start to investigate the intrinsic motivation variable - Perceived Enjoyment - for the hedonic perspective. Considering the consumer's purchasing decision process, users of information systems evaluate the systems through balancing between intrinsic (hedonic) and extrinsic (utilitarian) variables according to their main tasks or tendencies. This paper proposes a model that is based on the ECM of IS Continuance model modified from Expectation Confirmation Model to fit into the continued usage of information system. It first started from the decision process regarding hedonic and utilitarian perspectives in the consumer behavior literatures. The model deals with continued usage of information systems beyond the mere technology adoption as in most of the previous MIS researches. This research is particularly important to the hedonic information systems, because their business model depends on the frequent usages rather simple adoption at the beginning. Because the basic model only considered the extrinsic motivations (perceived usefulness) to explain the users' behavior and as the information systems can have both hedonic and utilitarian dimensions, it should consider both perspectives. Therefore, this newly proposed model considers intrinsic variable (perceived enjoyment) as well. Since the individual user can have a preference on either aspects that is between the hedonic and utilitarian perspective depending on his/her main tasks or goals, some variables (Hedonic Orientation and Utilitarian Orientation) meaning the extents of users' pursuing from the information system were additionally studied.

응급의료에서의 설명·동의 원칙과 응급의료거부죄 (Informed Consent and Refusal of Treatment in Emergency Medical Situation)

  • 이정은
    • 의료법학
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    • 제23권1호
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    • pp.37-80
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    • 2022
  • 이 논문에서는 현행 응급의료에 관한 법률이 규정하고 있는 응급의료에서의 설명·동의의 원칙과 응급의료거부죄를 검토함으로써 응급의료종사자의 환자에 대한 생명보호 의무가 환자의 자기결정권 보장보다 중요한 경우에 한하여 응급의료거부죄가 성립함을 제시한다. 응급의료에서도 일반 의료상황과 마찬가지로 의료행위 시행 전 환자에게 응급의료의 필요성이나 방법 등에 관하여 설명하고 동의를 받아야 함이 원칙이다. 다만, 설명·동의 절차를 예외적 방법으로 이행하거나 생략할 수 있음에도 그 절차 준수를 이유로 응급의료를 거부·기피한 응급의료종사자는 응급의료거부금지에 따른 행정처분과 행정벌을 부담하게 된다. 즉, 설명·동의 절차 생략 가능성에 관한 판단에 따라 응급의료거부죄가 성립할 수도 있는 것이다. 환자가 미성년이거나 의사결정능력이 없는 경우 그 법정대리인이 환자의 의학적 이익에 반하는 결정을 하더라도 법정대리인의 의견이 무조건적으로 존중되는 것은 아니다. 미성년 환자도 원칙적으로 자신의 신체에 관하여 결정할 권리가 있고, 법정대리인의 결정 역시 환자의 최선의 이익을 위한 것일 때 유효하기 때문이다. 환자가 치료를 거부하는 상황에서도 원칙적으로 응급의료종사자의 생명보호의무가 더 우선한다. 그러나 현행법은 여러 예외 상황에 대해 명문의 규정을 두고 있지 않아 응급의료 현장에서 그 해석에 어려움이 있다. 한편, 우리 대법원 및 하급심 판례는 응급의료종사자의 응급의료의무와 설명의무 사이의 이익형량이 불가피한 상황에서 환자의 생명상실이 문제되는 경우 설명의무보다 응급의료를 시행하여 환자의 생명을 보호하여야 할 의무가 우선이고, 예외적으로 사전에 치료 여부·방법에 대해 환자의 진지한 숙고가 있었던 경우 환자의 자기결정권이 응급의료의무와 대등하게 고려될 수 있다는 취지로 설시하고 있으므로, 이를 체계적으로 정리하고자 한다. 나아가 현행법의 해석만으로 해결이 어려운 부분에 대하여는 1) 미성년자에 대한 응급의료의무 조항 신설, 2) 응급환자의 의사결정능력 판단 기준을 의학적 내용을 중심으로 수정·보완, 3) 응급처치시 의료인의 추가 동의가 불요함을 명시, 4) 복수의 의견 충돌이 있는 경우에 대한 제도적 보완, 5) 응급의료 중단시 벌칙조항 신설 등 입법 과제를 제시한다.