• The Korean Society of Law and Medicine
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• v.21 no.2
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• pp.105-162
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• 2020

In the pandemic of infectious disease, restrictions of individual liberty have been justified in the name of public health and public interest. In March 2020, the National Assembly of the Republic of Korea passed the revised bill of the 「Infectious Disease Control and Prevention Act.」 The revised bill newly established the legal basis for forced testing and disclosure of the information of confirmed cases, and also raised the penalties for violation of self-isolation and treatment refusal. This paper examines whether and how these individual liberty limiting clauses be justified, and if so on what ethical and philosophical grounds. The authors propose the theories of the philosophy of law related to the justifiability of liberty-limiting measures by the state and conceptualized the dual-aspect of applying the liberty-limiting principle to the infected patient. In COVID-19 pandemic crisis, the infected person became the 'Patient as Victim and Vector (PVV)' that posits itself on the overlapping area of 'harm to self' and 'harm to others.' In order to apply the liberty-limiting principle proposed by Joel Feinberg to a pandemic with uncertainties, it is necessary to extend the harm principle from 'harm' to 'risk'. Under the crisis with many uncertainties like COVID-19 pandemic, this shift from 'harm' to 'risk' justifies the state's preemptive limitation on individual liberty based on the precautionary principle. This, at the same time, raises concerns of overcriminalization, i.e., too much limitation of individual liberty without sufficient grounds. In this article, we aim to propose principles regarding how to balance between the precautionary principle for preemptive restrictions of liberty and the concerns of overcriminalization. Public health crisis such as the COVID-19 pandemic requires a population approach where the 'population' rather than an 'individual' works as a unit of analysis. We propose the second expansion of the harm principle to be applied to 'population' in order to deal with the public interest and public health. The new concept 'risk to population,' derived from the two arguments stated above, should be introduced to explain the public health crisis like COVID-19 pandemic. We theorize 'the extended harm principle' to include the 'risk to population' as a third liberty-limiting principle following 'harm to others' and 'harm to self.' Lastly, we examine whether the restriction of liberty of the revised 「Infectious Disease Control and Prevention Act」 can be justified under the extended harm principle. First, we conclude that forced isolation of the infected patient could be justified in a pandemic situation by satisfying the 'risk to the population.' Secondly, the forced examination of COVID-19 does not violate the extended harm principle either, based on the high infectivity of asymptomatic infected people to others. Thirdly, however, the provision of forced treatment can not be justified, not only under the traditional harm principle but also under the extended harm principle. Therefore it is necessary to include additional clauses in the provision in order to justify the punishment of treatment refusal even in a pandemic.

• Sleep Medicine and Psychophysiology
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• v.3 no.2
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• pp.32-42
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• 1996

Objectives : Upper airway resistance syndrome(UARS) is a sleep-related breathing disorder characterized by abnormal negative intrathoracic pressure during sleep. Abnormally increased negative intrathoracic pressure results in microarousal and sleep fragmentation which underlay UARS-associated complaints of daytime fatigue and sleepiness. Although daytime dysfunction in patients with UARS is comparable to that of sleep apnea syndrome, UARS has been relatively unnoticed in clinical setting. That is why UARS is apt to be excluded in diagnosing of sleep-related breathing disorders since its respiratory disturbance index and arterial oxygen saturation are within normal limits. The current study presents a summary of clinical and polysomnographic characteristics found in patients with UARS. The present study aims (1) to explore characteristics of patients diagnosed with UARS, (2) to characterize the polysomnographic findings of UARS patients, and (3) to enhance the understanding of UARS through those clinical and laboratory characteristics. Methods : This was a retrospective study of 20 UARS patients (male 15, female 5) and 30 obstructive sleep apnea (OSA) patients (male 21, female 9) at the Stanford Sleep Disorders Clinic. We diagnosed patients as having UARS when they met critenia, RDI < 5 characteristic findings of an elevated esophageal pressure($<-10\;cmH_2O$), frequent arousals secondary to an elevated esophageal pressure, and symptoms of daytime fatigue and sleepiness. We used polysomnographic value, which is standardized by Williams et al(1974), as normal control. Statiotical test were done with student t-tests. Results : (1) Mean age of UARS was $41.0\;{\pm}\;14.8$ years and OSA was $50.9\;{\pm}\;12.0$ years. UARS subject was significantly younger than OSA subject (p<0.05). (2) The total score of Epworth Sleepiness Scale (ESS) was UARS $9.7\;{\pm}\;6.3$ and OSAS $11.2\;{\pm}\;6.3$. There was no significant difference between two groups. (3) The mean body mass index was UARS $28.1\;{\pm}\;5.7\;kg/m^2$ and OSAS $32.9\;{\pm}\;7.0\;kg/m^2$. UARS had significantly lower meen body man index than OSAS subjects (p<0.05). (4) The polysomnographic parameters of UARS were not significantly different from those of OSA except RDI(p<0.001), $SaO_2$ (p<0.001) and slow wave sleep latency (p<0.05). (5) Compared with normal control, Total sleep time in UARS subjects was significantly shorter (p<0.001), sleep efficiency index was significantly lower (p<0.001), total awakening percentage was significantly higher (p<0.001), and sleep stage 1 (p<0.001) were significantly higher. (6) OSA patients showed poor sleep quality and distinct abnormal sleep architectures compared with normal control. Conclusions : Conclusions from the above results are as follows : (1) UARS patients were younger and had lower body mass index when umpared with OSA patients. (2) The quality of sleep and sleep architectures of the UARS and OSA patients are significantly different from those of normal control. (3) ESS scores and awakening frequencies of UARS are similar with those of OSA, suggesting that daytime dysfunction of UARS patients may be comparable to those of OSA patients. (4) The RDI and the $SaO_2$ which are important indicators in diagnosing sleep-related breathing disorders, of UARS subjects are close to normal value. (5) According to the the above results, we unclude that despite the absence of $SaO_2$ drops and the absence of an elevated number of apnea and hypopnea, subjects developed clinical complaints which were associated with laborious breathing, elevated Pes nadir, and frequently snoring. (6) Accordingly, we suggest including LIARS in the differential diagnosis list when sleep related breathing disorder is suspected clinically and overnight polysomnographic findings except snoring and frequent microarousal are within normal limits.

• Sim-seong Yeon-gu
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• v.29 no.1
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• pp.1-45
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• 2014

Mystic experience such as seeing an vision could be explained as experiencing elusive and mysterious unique existence in religious way. In depth psychology, which is based on unconsciousness like analytical psychology, this could be explained as a something that gives a meaning of life and purpose through discovering health and healing. The importance of primodial experience in depth psychology is that it can possibly discover the base of present acts. In Christian theology, symbolic mystery and truth of religious experience that appear in Christian tradition have interest on human situation. These two fields' approach methods are different, but both show common interest on unique experience which can be said properly as raw experience. Various visions appear in many parts of the Bible. Among many visions, the book of Zechariah, one of the 12 Prophets, describes rich and diverse 8 visions through chapter 1 to chapter 8. However, due to the Genre of revelation, it lacks historicity, and because of vagueness and symbolic meanings, its visions are hard to understand and interpret. Theologically, visions of Zechariah show communality of Israelites by reconstructing kingdom of Judah and church in a way of historical circumstances. Though, these visions could deliver the meaning of an ethnical aspect as reporting continuous conversation between the God and humans. Furthermore, it could mean a personal aspect of the Prophet Zechariah as reaching for a opportunity of new change. Moreover, those who read these visions could try to interpret the meanings of various images which represent meeting mysterious existences. Therefore, the Author would concentrate on the fact that 8 visions in the book of Zechariah, which has not been received much attention to neither Christians nor non-believers, develop in chiastic structure (stylistic contrast), so that tries to interpret the first, second, seventh, and the eighth visions in analytic psychology way. In visions of Zechariah, excepting the 4th vision which probably was inserted later, rest of 7 visions each shows the stage of the hours of darkness. 1st to 3rd visions represent evening, 5th vision represents deep in the night, and 6th to 8th visions represent dawn to morning. Moreover, since structure of visions arranged in chiastic way, horse appears in 1st and 8th vision, measuring rope and measure tools are used as main motif in 2nd and 7th vision. However, same motifs could have different symbolic meanings and roles as visions are formed in different situations and conditions. In the first vision, angels who ride horses look around the world and report it is calm and peaceful. Concerning the political situation back in the day, the world being calm and peaceful in the beginning of evening means that it is not ready to change to a whole new world. Psychologically, if there is no readiness to adopt new world, it means being hopeless. It is sending you a message to get out of those kinds of situation. Moreover, appearance of four angels who rode red, brown, and white horses to a myrtus tree in the valley means that it is time for individuation and it is right and good timing for changing. In second vision, you will be able to see that Israelites had long years being caught in the shadows by foreign country, and long years succumbed by the strength of four horns, which shows the progress of renewing strength and being oneness with oneself from overwhelmed situation by paternity. In seventh vision, meaning of two women bringing the godness of the sky, who were locked up in a rice basket, back to the temple in Babylon is going towards in a level of Self-actualization by separating one's ego captured excessively by matherhood and putting back to a place where it was before. In eighth vision, chariots pulled by horses are scattered far and wide, and horses which went to north had rest in the land of North. After horses and chariots are seen between two mountains of bronze with the image of Self and anima/animus. These images can be explained as the changing progress are almost completed and the God and human, in other words Self and ego are being united and is now time for rest. All of 8 visions contains the conversation between angel and Zechariah who willing to know the meaning of visions. Zechariah asks the angel actively about the meaning of visions because of his wish for Israelites to return home and rebuild church. Conversation among the God, Zechariah, who asks questions until he knows everything, an Angel, who gives answer to given questions, is conversation between ego and anima/animus. Eventually, it is a conversation between Self and ego.