예방접종피해 구제를 위한 제도적 과제 - 일본 예방접종피해 소송에 대한 사례분석을 중심으로 The Exploration into Favorable Ways to Remedy Victims Caused by Inoculation : Based on Analysis about Precedent Cases of Inoculation Damage in Japan원문보기
최근 통계청에서 발표한 통계자료에 의하면 1998년 이후 10여 년 동안에 사망한 사람들의 주요 사망원인으로는 뇌혈관질환을 포함하여 고혈압성으로 인한 질환, 동맥경화증, 심장질환과 같은 순환기계 질환에 의하여 사망하는 경우가 가장 많았으며, 그 다음 원인으로는 각종 암, 교통사고로 인한사망, 자살 및 각종 사고 등의 순으로 나타났다. 이 같은 주요 3대 사망원인 가운데에서 응급의료가 요구되는 경우는 순환기계 질환 및 각종 사고를 생각할 수 있겠는데, 순환기계 질환은 현대인의 식생활과 생활방식 등의 변화로 인하여 앞으로 많이 증가할 것으로 예상할 수 있으며, 각종 사고의 경우도 산업의 고도발전에 편승하여 위험시설이 증가하고 있는 점을 고려할 때 향후 응급의료체계(EMSS: emergency medical service system)의 새로운 구축이 요구되고 있다.
응급의료체계는 특정 지역과 장소에서 응급환자가 발생할 경우 효과적이고 신속한 의료를 제공하기 위하여 인력, 시설, 장비 등을 유기적으로 운용할 수 있도록 재배치하는 것으로, 응급환자가 발생했을 때 현장에서 적절한 처치를 행한 다음에 신속하고 안전하게 응급환자의 치료에 적합한 응급의료기관으로 이송하게 되며, 응급의료기관에서는 응급의료진이 의료기술과 의료장비 등을 동원하여 환자를 치료하기 위한 지원체계를 말한다. 이 같은 목적을 달성하기 위하여 현장출동 및 처치팀(119구급대), 응급의료정보센터(1339), 응급의료센터와 병원의 응급의료종사자간에는 유기적 협력체계의 구축이 필요하다.
응급의료는 일반 의료와는 달리 특수성이 존재하며, 나아가 응급환자의 경우 병상의 중증성과 다양성, 병상의 불명확성, 병상의 예측 불가능성 등으로 진료의 내용도 단정할 수 없다는데 문제가 있다. 나아가 응급환자의 경우 발병에 대한 예견이 어렵다는 점에서 진료방법의 선택에 있어서의 어려움, 의료인의 배치 곤란성 등과 같은 문제 등도 나타나고 있다. 특히 병상의 긴급성과 병변의 급변성, 환자에 대한 정보의 불충분성 등은 응급환자의 치료에 있어 많은 어려움이 따르게 된다. 이 같은 문제의식을 가지고 본고는 일반의료에서 나타나는 법적인 문제들을 가능한 제외하고 응급의료에서의 의사의 주의의무와 책임을 중심으로 논하였다. 이를 위하여 우리나라 판결례에서 나타난 문제점들을 지적하고 내용을 분석하여 방향성을 제시하여야 하겠으나 아직 우리는 이와 관련한 판결례들이 많지 않으므로 이해의 편의를 위하여 일본에서의 판결례들을 소개하면서 논의를 전개하였다.
최근 통계청에서 발표한 통계자료에 의하면 1998년 이후 10여 년 동안에 사망한 사람들의 주요 사망원인으로는 뇌혈관질환을 포함하여 고혈압성으로 인한 질환, 동맥경화증, 심장질환과 같은 순환기계 질환에 의하여 사망하는 경우가 가장 많았으며, 그 다음 원인으로는 각종 암, 교통사고로 인한사망, 자살 및 각종 사고 등의 순으로 나타났다. 이 같은 주요 3대 사망원인 가운데에서 응급의료가 요구되는 경우는 순환기계 질환 및 각종 사고를 생각할 수 있겠는데, 순환기계 질환은 현대인의 식생활과 생활방식 등의 변화로 인하여 앞으로 많이 증가할 것으로 예상할 수 있으며, 각종 사고의 경우도 산업의 고도발전에 편승하여 위험시설이 증가하고 있는 점을 고려할 때 향후 응급의료체계(EMSS: emergency medical service system)의 새로운 구축이 요구되고 있다.
응급의료체계는 특정 지역과 장소에서 응급환자가 발생할 경우 효과적이고 신속한 의료를 제공하기 위하여 인력, 시설, 장비 등을 유기적으로 운용할 수 있도록 재배치하는 것으로, 응급환자가 발생했을 때 현장에서 적절한 처치를 행한 다음에 신속하고 안전하게 응급환자의 치료에 적합한 응급의료기관으로 이송하게 되며, 응급의료기관에서는 응급의료진이 의료기술과 의료장비 등을 동원하여 환자를 치료하기 위한 지원체계를 말한다. 이 같은 목적을 달성하기 위하여 현장출동 및 처치팀(119구급대), 응급의료정보센터(1339), 응급의료센터와 병원의 응급의료종사자간에는 유기적 협력체계의 구축이 필요하다.
응급의료는 일반 의료와는 달리 특수성이 존재하며, 나아가 응급환자의 경우 병상의 중증성과 다양성, 병상의 불명확성, 병상의 예측 불가능성 등으로 진료의 내용도 단정할 수 없다는데 문제가 있다. 나아가 응급환자의 경우 발병에 대한 예견이 어렵다는 점에서 진료방법의 선택에 있어서의 어려움, 의료인의 배치 곤란성 등과 같은 문제 등도 나타나고 있다. 특히 병상의 긴급성과 병변의 급변성, 환자에 대한 정보의 불충분성 등은 응급환자의 치료에 있어 많은 어려움이 따르게 된다. 이 같은 문제의식을 가지고 본고는 일반의료에서 나타나는 법적인 문제들을 가능한 제외하고 응급의료에서의 의사의 주의의무와 책임을 중심으로 논하였다. 이를 위하여 우리나라 판결례에서 나타난 문제점들을 지적하고 내용을 분석하여 방향성을 제시하여야 하겠으나 아직 우리는 이와 관련한 판결례들이 많지 않으므로 이해의 편의를 위하여 일본에서의 판결례들을 소개하면서 논의를 전개하였다.
Inoculation aims to protect ourselves from potential risk of communicable diseases and is also a means for us to perform our own duty of social defense to prevent pathogenic bacteria that attacked someone from any further propagation into community. Here, the matter is that preventive vaccines used ...
Inoculation aims to protect ourselves from potential risk of communicable diseases and is also a means for us to perform our own duty of social defense to prevent pathogenic bacteria that attacked someone from any further propagation into community. Here, the matter is that preventive vaccines used to meet these goals, like other medicines, may involve potential side effects, complications and sequelae associated with any adverse reaction to inoculation, although every safety precautions are fully observed. In this regard, it is necessary to prepare an institutional instrument to remedy victims for any damage from adverse reactions to inoculation. With a view to implement such an instrument, Korea has enforced a system of governmental compensations for victims damaged by inoculation, but the system is formal remedy system led by governmental authorities, so it is inevitably demanded to develop more concrete and realistic remedy system. In particular, the rate of compensation for victims damaged by inoculation still remains lower in Korea than advanced countries, because any damage from inoculation is subject one- sidedly to governmental compensation to the extent that it is recognized as justifiable damage by the Minister of Health and Welfare, regardless of defective inoculation medicine or inoculation practitioner"s fault. As a matter of fact, governmental assumption of responsibility for any damage from adverse reactions to inoculation is attributed primarily to a judicial consensus that it is not reasonable to shift entirely on victims any damage from administrative enforcement for the benefit of better national health, and it is rather appropriate that such damages should be remedied by loss sharing among all the people. However, when considering that governmental remedy doesn"t mean any realistic compensation for victims, it is important that victims damaged by adverse reactions to inoculation should have a capacity to claim any damage and loss from defective vaccine to vaccine manufacturer. Moreover, it is also necessary to carefully consider possible ways for victims to claim damages to actual offender, if the damages are caused by intentional or unintended fault of other third parties. In Japan, most of early damage claim cases on any adverse reaction to inoculation were also associated with vaccine manufacturers" product liability and governmental responsibility for risk controls in regard to safety of vaccine, but governmental remedy for victims was consistently subject to inactive measures simply because such damages were construed not to result from any governmental illegal act. However, actual wide gap between damage and remedy has led to increasing national consensus about needs to develop permanent measures for those victims in terms of increasing needs to protect individuals from any mortal risk or other physical damages due to government-enforced inoculation, ultimately ending up with increasing demands of individual victims for permanent measures through lawsuits as well as their requests for review of conventional inoculation system to government. Such a social change of Japan is very significant in comparison with Korean realities. Notably, Tokyo cases of Japan concerning claims for damages from inoculation have significant implications in one sense that all of their judgments accept claims made by plaintiffs (victim) and are also epoch-making judgments that allow judicial remedy for damages from adverse reactions to inoculation, and in the other sense that their judgments made a meaningful opportunity to implement remedy for victims resulting from adverse reactions to inoculation and realize conventional inoculation system. Conclusively, it is expected that this study will be a useful reference to develop a future Korean system of remedy for victims damaged by inoculation, because it prepares an institutional foundation to remedy victims for their damages as the result of ..
Inoculation aims to protect ourselves from potential risk of communicable diseases and is also a means for us to perform our own duty of social defense to prevent pathogenic bacteria that attacked someone from any further propagation into community. Here, the matter is that preventive vaccines used to meet these goals, like other medicines, may involve potential side effects, complications and sequelae associated with any adverse reaction to inoculation, although every safety precautions are fully observed. In this regard, it is necessary to prepare an institutional instrument to remedy victims for any damage from adverse reactions to inoculation. With a view to implement such an instrument, Korea has enforced a system of governmental compensations for victims damaged by inoculation, but the system is formal remedy system led by governmental authorities, so it is inevitably demanded to develop more concrete and realistic remedy system. In particular, the rate of compensation for victims damaged by inoculation still remains lower in Korea than advanced countries, because any damage from inoculation is subject one- sidedly to governmental compensation to the extent that it is recognized as justifiable damage by the Minister of Health and Welfare, regardless of defective inoculation medicine or inoculation practitioner"s fault. As a matter of fact, governmental assumption of responsibility for any damage from adverse reactions to inoculation is attributed primarily to a judicial consensus that it is not reasonable to shift entirely on victims any damage from administrative enforcement for the benefit of better national health, and it is rather appropriate that such damages should be remedied by loss sharing among all the people. However, when considering that governmental remedy doesn"t mean any realistic compensation for victims, it is important that victims damaged by adverse reactions to inoculation should have a capacity to claim any damage and loss from defective vaccine to vaccine manufacturer. Moreover, it is also necessary to carefully consider possible ways for victims to claim damages to actual offender, if the damages are caused by intentional or unintended fault of other third parties. In Japan, most of early damage claim cases on any adverse reaction to inoculation were also associated with vaccine manufacturers" product liability and governmental responsibility for risk controls in regard to safety of vaccine, but governmental remedy for victims was consistently subject to inactive measures simply because such damages were construed not to result from any governmental illegal act. However, actual wide gap between damage and remedy has led to increasing national consensus about needs to develop permanent measures for those victims in terms of increasing needs to protect individuals from any mortal risk or other physical damages due to government-enforced inoculation, ultimately ending up with increasing demands of individual victims for permanent measures through lawsuits as well as their requests for review of conventional inoculation system to government. Such a social change of Japan is very significant in comparison with Korean realities. Notably, Tokyo cases of Japan concerning claims for damages from inoculation have significant implications in one sense that all of their judgments accept claims made by plaintiffs (victim) and are also epoch-making judgments that allow judicial remedy for damages from adverse reactions to inoculation, and in the other sense that their judgments made a meaningful opportunity to implement remedy for victims resulting from adverse reactions to inoculation and realize conventional inoculation system. Conclusively, it is expected that this study will be a useful reference to develop a future Korean system of remedy for victims damaged by inoculation, because it prepares an institutional foundation to remedy victims for their damages as the result of ..
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