연명치료중단 법제화의 전제조건에 대한 검토 – 세브란스병원사건에 대한 법원 판결의 의미와 시사점 -

Abstract

Owing to the remarkable advances in medical science and technology, terminally ill patients can survive longer than ever expected before. But the patients can not regain consciousness in many cases. The Supreme Court of Korea decided that if a patient is in an irreversible condition with imminent death, the discontinuation of treatment can be approved as the patient's self-determination, in 2009. In this case, a 76-year-old patient was in a persistent vegetative state, with artificial ventilation treatment. The Court approved the request of the patient to remove the artificial ventilation treatment, and allowed the patient to die. Therefore the artificial ventilation treatment was removed, but the patient maintained spontaneous breathing for about seven months, and deceased. This decision presented the general criteria and process of withdrawal of life-sustaining management in Korea for the first time, the majority opinion of the decision ruled that in state of critically irreversible condition the patient can exercise the right to self-determination based on human dignity, value and the right to pursuit of happiness, the withdrawal can be allowed. However, the court defined the concept of ‘irreversible condition’ and ‘imminent death condition’ vaguely and there is enough ground for controversy. A generally accepted consensus of end-of-life care decision-making appeared in Korean medical society after that decision, and guidelines to withdrawing life-sustaining therapies were published in 2009. Still there is an opposition to the legalization of the withdrawal of life- sustaining management, the majority of people seem to assent to the withdrawal of life-sustaining management in a specific condition, but in particular there are conflicts of opinion. An advance directive is a measure to certify the determination of incompetent patients, but the persistent vegetative state is so rare and unexpected condition, and it may happened suddenly. If the patient have made out an advance directive, there are many difficulties with advance directives. And withdrawal of life-sustaining artificial nutrition and hydration is more serious and critical problem, especially in case of the persistent vegetative state patient. Therefore national consensus should be made before the legislation of the withdrawal of life-sustaining management, especially about the persistent vegetative state.