醫療事故의 被害者救濟에 관한 硏究

Abstract

醫療事故는 현대의학의 한계 속에서 不可抗力的으로 발생하기도 하지만 대다수가 醫療人의 過誤에 기인하고 있음은 周知의 사실이다. 최근에는 우리나라에서도 健康權에 대한 市民意識이 提高된 가운데 醫療事故로 인한 醫療紛爭의 發生率이 크게 증가하고 있다. 醫療事故는 대부분이 의료인의 診療過失·說明義務違反 등의 診療上의 過誤로 인하여 발생하고 있다. 그러나 때로는 醫療器機의 缺陷 등의 物的 要因이나 또는 公法上의 醫療에 의해서도 발생할 수 있다. 醫師의 醫療過誤에 의하여 환자에게 손해가 발생한 경우에는 피해자인 환자는 醫療過誤訴訟을 제기하여 損害賠償을 받을 수 있다. 그러나 醫療事故의 被害者 救濟에 관한 特別法이 없기 때문에 환자는 醫療過誤訴訟에서 民法上의 債務不履行責任과 不法行爲責任 중 어느 하나에 의하여 損害賠償請求를 할 수 밖에 없다. 환자가 의사의 診療過失을 이유로 訴訟을 제기하는 경우에는 訴因을 不法行爲責任으로 하든, 債務不履行責任으로 하든 결국은 환자측이 醫師의 過失 등의 立證責任을 지게 된다. 醫療過誤訴訟에서 立證責任은 訴訟의 勝敗를 좌우하는 매우 중요한 것이다. 그런데 診療過失訴訟에서는 모든 情報가 의사측에 偏在하여 있고 醫療施術의 내용이 고도의 專門的인 것이므로 환자측에서 醫師의 過失을 立證하기란 결코 쉽지 않은 일이다. 따라서 醫療過誤에 의하여 피해를 입은 환자를 보호하기 위하여서는 광범위한 立證輕減 내지 緩和를 위한 制度가 마련되어야 한다. 한편 의사의 說明義務違反은 自己決定權의 侵害인 동시에 결과적으로 위법한 身體侵害가 된다. 따라서 患者의 損害로 실현된 그 위험에 대하여 의사가 사전에 환자에게 충분하고도 구체적인 說明을 하여야 한다. 의사가 자신의 說明移行을 立證하지 못하면 說明義務違反으로 인한 損害賠償責任을 지게 된다. 이러한 의사에 대한 立證責任의 轉換으로 인하여 최근에는 의사의 診療過失과 說明義務違反이 경합될 때 환자가 대한 醫師의 說明義務違反을 이유로 損害賠償을 청구하는 사례가 늘고 있다. 이러한 현상은 시대의 조류이자 세계적인 추세이기도 하다. 우리나라에서 醫療事故의 被害者들을 보호하기 위하여서 독립된 醫療事故 被害救濟法 또는 醫療紛爭調停法이 절실한 실정이나 관련 利益集團들간의 利害對立으로 수년째 표류하고 있다. 일반국민의 健康權과 醫師의 醫業權이 함께 보장될 수 있도록 공정한 醫療事故 判定機構의 設置 및 醫師賠償責任保險制度의 活性化가 이루어질 수 있도록 法과 制度를 조속히 완비하여야 한다. 그리고 醫療消費者의 被害救濟라는 측면에서 醫師賠償責任保險과 아울러 無過失補償制度의 補充的 導入도 이루어져야 할 것이다. 이 補充的인 無過失補償制度는 의사와 환자 사이의 信賴關係를 유지하고 防禦診療를 예방할 수 있으므로 환자의 신속한 損害塡補는 물론 立證責任上의 不公平한 問題點을 극복할 수 있다. 위 세 가지 制度의 導入은 醫療事故가 발생했을 때 피해자측에 적정한 賠償 또는 補償을 해주기 위하여서 반드시 필요하다고 본다. 결론적으로 醫療紛爭 調停法 또는 醫療事故 被害者救濟法이 마련될 수 없으면, 交通事故被害者를 보호하기 위하여 自動車 損害賠償 保障法을 마련하여 모든 自動車 保有者들이 責任保險을 强制加入토록 한 것처럼 醫療事故 損害賠償 保障法을 만들어서 醫師賠償責任保險制度의 活性化를 이루어 一般國民의 健康權이 保障될 수 있도록 해야 할 것이다.; The increase of medical malpractice disputes is believed to be caused mainly by the lack of confidence in doctor-patient relationship. As with the development of medical technology, the increasing awareness of human rights, and the enlargement of National Health Insurance, the medical malpractice litigations are rapidly increasing in these decades. The sky-rocketing medical malpractice lawsuit is a remarkable problem in advanced countries of the world. The present state of those affairs is not insignificant in Korea any more. All of us know that the trend is obviously aggravating. This study aims to find out more effective ways of guaranteeing both health right of patients and medical profession right of doctors. Accordingly this study stands in a neutral position considering the views of the both sides objectively. This study deals with as many judicial precedents as possible in order to get a more substantial result. To say more specifically, the purpose of this dissertation is as the following. First, I try to analyse the reason why medical incidents frequently happen, and the mechanism by which a medical incident becomes a medical malpractice dispute. Second, I try to specifically define some terms related to medical malpractice including as medical practice, medical accident or medical incident, medical malpractice, and medical malpractice dispute. Third, I try to find out more effective ways of alleviating patients' liability of proving medical malpractice for the purpose of protecting medical practice consumers. Fourth, I try to analyse the present relief system of medical malpractice including medical malpractice insurance system in some foreign developed countries. Fifth, I try to develop the relief system of medical malpractice suitable for the circumstances in Korea on the basis of the analysis of law making procedures regarding the relief system of medical malpractice. For these purposes, this dissertation consists of 6 chapters. Chapter 1 is devoted to the introduction, purpose and scope of the study. In this chapter, the importance of prompt and reasonable settlement of medical malpractice disputes is indicated. Chapter 2 deals with general theories related to the medical liability of medical malpractice. The conception of medical malpractice and the present state of medical-disputes are explored, and the increasing reason of medical malpractice disputes is pointed out. And the obligation of physicians' special attention and study of various recent judicial cases are investigated. Chapter 3 deals with aspects of legal contracts between a doctor and a patient, the general theory of liability caused by medical malpractice, and the duty of explaining problems derivable from informed consent. Chapter 4 deals with the relief system of medical malpractice. The relief system of medical malpractice can be divided into two types. The one is reparation based on the liability of medical malpractice which could be mistakes, errors or negligence. In order to prepare a rational basis, we studied Patient Compensation Funds, Limits on Recovery, Attorney Fee Regulation, Mutual-insurance companies, Joint Underwriting Association, Joint and Several Liability Rule, Periodic Payment of Damages, Pretrial Screening Panels and so on. All of them in the USA are efficient for reducing the cost of medical liability. The other is no-fault compensation system such as that in Sweden. The present relief system of medical malpractice in Korea is discussed. Those schemes can be classified into three types. But all of those were not efficient for settling the medical malpractice disputes and for reducing the cost of medical liability in our country. In Chapter 5, the discussion of legislation about medical malpractice and relief system is considered and the legislation is suggested. It is suggested that we need to introduce the compulsory medical malpractice insurance. And we should make the physicians to contract with the insurer of medical malpractice in a party. The insurer can be an insurance company or physicians' mutual benefit association. The discussion is made to find out how to develop the medical malpractice insurance in Korea. And we should reform our medical malpractice or tort system by making the pre-judgement system constituted of medical-examiners or coroners. Additionally, I dare to say, no-fault compensation system isn't suitable for us. But, we must induce somewhat supplementary no-fault compensation system for the sake of patients' human rights. That system indemnifies the compensation in case of no-fault incident of medical practices. Finally, in Chapter 6, the summary and conclusion of this study is provided. Everyone knows there is no almighty panacea in the world. Jurisdictions couldn't take parts of both sides absolutely. I dare to say that no perfect regime about this sophisticated social problem exists. But we should establish a fair and persuasive norm of conduct and judicial judgement to protect maximum interests of patients on one hand, and to guarantee physicians' right or duty to carry on their works. The one is the introduction of a medical professional liability insurance system. This insurance system should be compulsory. The other is the establishment of a pre-judgement system about medical malpractice. The core of this system is the compulsory conciliation committee that is constituted representative of medical-examiners. All the medical malpractices have to pass through this committee. With this system we will be able to get prompt and reasonable solutions. Alternatives to the present trial should reduce litigation costs and bring quicker settlements than traditional court proceedings.