This article analyzes legal meaning and definition of medical practice examining Korean Supreme Court cases. Until now, there is no right answer about the meaning of medical practice and it is also hard to define of it. Moreover, not only Acts and regulations containing medical practice but also many cases ruling a person who practice medicine, the concept of medical practice involves various meanings. So, it has caused confusion. In order to solve this problem, this article divides the medical practice's meaning into range and nature within prohibition article of the Medical Act about unlicensed personnel who practice medicine. After providing a explanation of the meaning of medical practice according to amendment of the Act, this article disputes the meanings of the several cases following the amendment. And then analyzing non-medical person's unlicensed medical practice and medical person's unlicensed medical practice. In order to provide more accurate legal concept of medical practice when Korean government amends the Medical Act or making policies in this field, this classifying analysis approach should be needed. Looking at the result, in general, Korean Supreme Court has interpreted unlicensed prohibition clause of the Medical Act widely; not only non-medical person's unlicensed medical practice but also medical person's unlicensed medical practice. Therefore, this article suggests that the prohibition clause needs to be careful applying to non-medical practice. Because, in fact, even though there are some necessity of non-medical practice, there are no qualificatory or license system of non-medical practitioner in the Medical Acts or regulations forbidding whole non-medical practices. Furthermore, the Supreme Court has decided medical person's unlicensed medical practice too narrowly, thus it does not keep up with rapid change of medical development and people's demands these days. Regarding this subject, in order to take advantage of medical practitioners effectively and cope with increasing people's medical demands, this article proposes that medical person's unlicensed medical practice only to be prohibited in case of endangering our public health.
Under the existing law, an act included in medical practice by medical personnel seems to be irrelevant to whether the act concerned in the "Life World" is in the category of medical practice. In spite of the act having been done according to the custom for a long time, and generally done by individuals in the "Life World", these kinds of acts have been banned by law, because if these acts were done by the general individuals, it would be considered as harmful behavior to human life and body. And it is not sure that individuals know such a ban or notification. This cause a "Mistake of Law". Also it is happened if someone knows the existence of law but believes that his/her act is not included. For treating the problem of "Mistake of Law" of unlicensed medical act, in this study I inquired thoroughly into the category and regulation of unlicensed medical act, uncertainty of the Medical Services Law the first Section of Article 27, the prohibition of unlicensed medical act. The "Composition Condition" of the first Section of Article 27 of the Medical Services Law is not certain, it doesn't meet the "Doctrine of Clearance", and it cause the "Mistake of Law". Also it doesn't meet standardization of constitutional state. An exceptional decision of Pusan District Court, the debate about unlicensed medical practice, constitutional decision on unlicensed medical practice of the Constitutional Court of Republic of Korea and point of view of support of regulation. Also I examined the problem of "Mistake of Law" that the regulation of unlicensed medical practice has. I tried to solve uncertainty of "Composition Condition" and proposed a direction of regulation for solving the "Mistake of Law" and the use of existing law.
Background and Aim : Health care and cosmetics as well as quality of life is now a matter of concern and many categories of complementary and alternative medicine fall into the territory of the medical practice of Korean medicine. Accordingly, penalties are being taken for unlicensed medical practices of Korean medicine in so called complementary and alternative medicine area. There is a possibility of violating the law for the public part because it is not clearly stipulated in the law as to what is a licensed medical practice. Materials and Method : The significance of the Medical Service Act and the Act on Special Measures for the Control of Public Health Crimes were reviewed, and the related supreme court cases were discussed upon the legal aspect of processing the unlicensed medical practice of Korean medicine. The legal information was provided from the National Law Information Center of the Ministry of Government Legislation, and the information websites of the Supreme Court and the Constitutional Court. Results : The concept of medical practice, which is essential in judging the case of unlicensed medical practice, is 'prevention and treatment of diseases through diagnosis, examination, prescribing, medication, or surgical procedures based on medical expertise', and the 'acts that may result in harm and injury of health unless performed by a medical person'. With respect to the medical practice of Korean medicine, the concept includes 'prevention and treatment of diseases using the principle of traditional Korean Medicine'. Conclusions : The concept of medical practice should be clearly stipulated in the law for the control over the unlicensed medical practices of Korean medicine. And it is important to move from the current concept of medical person-oriented medical practice emerging from the national system of healthcare control, to a concept that can accept the era of health managing-oriented medical environment and the co-governance of the healthcare providers and consumers for the future.
There is a system in Korea named "Advanced Practice Nurse System" qualified by the Minister of Health, Welfare and Family Affairs for Advanced Practice Nurse besides nurse licence. Medical practice is, in today's medical law, understood as a general concept colligating medical practice, nursing practice and midwife practice and so on, for it is defined as a deed of medical technique practiced by medical personnel. Referring to the fact that the Supreme Court recognizes medical personnel as people who have medical expert knowledge, nursing practice can be recognized as a region of medical business and therefore it is not necessary to prescribe nursing practice separately from the definition of medical practice on a precedent, because nurse belongs to medical personnel. According to the precedent regarding 'Unlicensed Medical Practice of Advanced Practice Nurse for Anesthesia' recently sentenced by the Supreme Court, the medical practice is only allowed a doctor because it is 'in need of special knowledge and experience because of high danger on human body' and it is judged to be an unlicensed medical practice prohibited in medical law if it is to be done by a nurse. When considering the actual situation that System for Advanced Practice Nurse for Anesthesia is established under the circumstance that an anesthetist is in want and therefore the operation has not been performed on time, and that it is being expected an anesthetist to be in need, it is necessary to legislate for the range of medical practice of Advanced Practice Nurse so that Advanced Practice Nurse System can be practically legalized, for the role of Advanced Practice Nurse has the great possibility of shrinking because the precedent has considered Advanced Practice Nurse for Anesthesia doing anesthetic operation in clinic today as a potential wrongdoer.
Today, the medical system is changing into a comprehensive health care system in which collaborative relationships between medical professionals and non-medical personnels in neighboring occupational areas. The current medical act brands such "collaboration" as unlicensed medical practice, and punishes non-medical personnel who acted in the risk management of doctors as well as doctors collaborated with non-medical personnel as unlicensed medical practice. In order to narrow the gap between the legal system that regulates unlicensed medical practices and the medical reality, it is necessary to overcome the structural limitations of dualistic, nationalistic, and identity-oriented regulation of unlicensed medical practices. The legal interests of unlicensed medical practice have a dual nature as a personal legal interest of "human life and body" as well as a national legal interest of "maintenance and protection of the nation's medical license system", and it should be noted that the criteria for judging the legal interests protected by the regulations of criminal punishment should be found in "personal legal interest theory." In addition, when determining which behavior is a medical practice and evaluating its risk, the dimension of behavior and measures should be considered in a fair manner without being biased against the subject (identity) of the action. In other words, judging unlicensed medical practice should depend on whether the risk of side effects that may result from the act is reasonably managed. Considering the prospect of therapeutic dialogue between medical professionals and patients, it would be desirable for medical law policies to move in a way that does not fundamentally block the possibility of collaboration among pluralistic medical personalities.
The Supreme Court's en banc decision on December 12, 2022 (docket number 2016Do21314) presented a new standard for determining whether the use of diagnostic medical devices by Korean medical doctors constitutes oriental medical doctors constitutes unlicensed medical practice. Based on this standard, it was determined that the use of ultrasound by Korean medical doctors was not an unlicensed medical practice. Supreme Court's Decision 2016Du51405 on August 18, 2023, is the first case in which a new standard was applied to determine that an Korean medical doctor's use of electroencephalography to diagnose Parkinson's disease and dementia was not an unlicensed medical practice. The Supreme Court abolished the previous standard that Western medical knowledge and technology should not be required for Korean medical doctors to use medical devices. However, it was unclear whether Western medical diagnosis of Korean medical doctors using diagnostic medical devices would be viewed as an an auxiliary method of diagnosis. Parkinson's disease and dementia are Western medical diagnoses. The Supreme Court judged that the Western medical diagnosis of Korean medical doctors was not an unlicensed medical practice. This clearly explains what an auxiliary method of diagnosis means. In addition, the Supreme Court excluded the principles of development and production of electroencephalography from its judgment criteria. Automatic extraction and automatic reading of test results were also excluded. The criminal court's view that the meaning of oriental medical practice should be clearly and strictly interpreted from the perspective of an oriental doctor, and it was clarified that diagnostic medical devices were excluded from criminal punishment unless it was clear that they were not related to the principle of oriental medical practice. As a result, the Supreme Court made it clear that the use of diagnostic medical devices is excluded from criminal punishment unless it is clear that they are not related to the principles of Korean medicine.
Medical act divides unlicensed medical practice into medical practice by non-medical practitioners and unlicensed practice by medical practitioners. In the past, it was a common approach to strictly distinguish between western and Korean medicine, but the Supreme Court's Decision of December 22, 2016, Do. 21314, provided a new direction regarding the criteria for determining whether a Korean medicine practitioner is acting outside license. This paper analyzes the new criteria in detail, examines the significance of the new criteria, and explores its impact on the dualistic medical system. The difference between the new criteria and the previous criteria in the precedents is that the judgment is not based on the connection between Korean medicine principles and Western medicine principles. It is an advanced standard that actively accepts the overlap and variability of medical practice, moving away from dichotomous thinking that exclusively distinguishes between Korean medicine and Western medicine.
Promulgation of the medical practice rule without specific definition in Medical Law has brought about many constitutional issues. The major issue is that the law has the government punish unlicensed medical practice without defining what it is. Instead, the law chooses a license-centered structure of criminal punishment for medical malpractice, saying "no one can practice medicine without the government-approved license." This regulation violates the rule of "void for vagueness" based on the principle of "nulla poena nullum crimen sine lege." Judicial interpretation should be required for a citizen to understand the Medical Law provision intuitively. In addition, the law infringes upon the freedom of occupation of the unlicensed and the licensed who wish to extend his or her practice area for "holistic medicine." The central issue of the law is that it was established under no ground of professionalism even though medical practice has been understood professional. The government has centrally controlled the medical field for its needs. Lastly, the current law violates the right of medical selection of the consumers of medicine. Because patients have the right of health and life, they have to hold the latitude of selection for medical treatments. Especially, they should have an opportunity for considering the Complementary and Alternative Medicine if they want. But under the current rules, this medicine is not permitted. To correct those problems, a new provision for the definition of medical practice should be adopted at once.
This study aims to review legal problems of similar medical practice and suggest methods of improvement. Similar medical practice refers to all medical practices conducted in the state that human qualification is not fulfilled. It may cause serious damages on health and lives of national people. Currently, similar medical practices are recognized as unlicensed medical practices and prohibited based on the Medical law and additionally punished by then special law in Korea. However, the current Medical Law does not provide clear and accurate concept of medical practices so that it is difficult to regulate similar medical practices. The issue of complementary and alternative therapy related to similar medical practices is also in special state different from other countries. In addition, since similar medical practices lack of evidences in terms of safety, the dangerousness of accidents is high and it may affect badly on health of national people and health care policies. Methods of improvement in order to resolve problems regarding similar medical practices are: first, concept and scope of medical practice should be clear, accurate and concrete. Second, complementary and alternative therapies related to similar medical practices need to be strictly examined and the supervisory right should be given to doctors should be given even though a part of it is allowed. Third, research institutes specialized in the field should be established for scientific examination of complementary and alternative therapy and objective research results should be open to the public. Finally, since damage cases caused by similar medical practices by non-medical personnel, national management and supervision for similar medical practices should be reinforced.
The Supreme Court en banc decision on December 12, 2022 (docket number 2016Do21314) ruled that the diagnosis of endometrial hyperplasia by an oriental medical doctor using a diagnostic ultrasound device was not an unlicensed medical practice for an oriental medical doctor, which shall be scrutinized by the article 27 (1) of the Korean Medical Service Act. This ruling did not determine that a specific medical practice, especially diagnosis, based on the radiology, which is a part of western medicine, was not an unlicensed medical practice for an oriental medical doctor. Rather, it intended to clarify that the prosecutor should specify and prove the way of diagnosis and he should not prosecute mere the use of a diagnostic ultrasound device itself. To that extent, the ruling is agreeable because, as the oriental medicine community has argued, there is no regulation prohibiting the use of certain devices. It is probable, however, that the way of diagnosis established in radiology, which is a part of western medicine, was actually used in the case. In that case, there is undeniably an unlicensed medical practice for an oriental medical doctor. While many of the cases where the demarcation between (western) medicine and oriental medicine have been problematized thus far have been experimental treatment in nature, the above practice of using ultrasound appears to be frequently done in many oriental clinics, and so it is necessary to cope with the possibility of a disguised unlicensed medical practice. Another problem is the prevention of unfair practice or the protection of medical consumers. In fact, many oriental medical clinics' practice appear to have a tendency of inducing medical consumers' misunderstanding that a diagnosis based on radiology, which is a part of western medicine, were provided. It is hard to respond to this problem with demarcation between (western) medicine and oriental medicine. A new regulation against unfair practice might be necessary to implement.
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