건강권의 법적 토대와 그 실현에 대한 국제인권법적 고찰
Legal Foundation of Right to Health and Issues for Realizing Right to Health
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초록
이 글은 세계인권선언(UDHR)과 경제‧사회‧문화적 권리에 관한 국제협약(ICESCR)을 중심으로 오늘날 건강권이 어떻게 적용되고 실현되며 이에 대한 국제인권법적‧보건학적인 함의는 무엇인지 논의하였다. UDHR은 건강권의 법적인 토대를 놓았고 이러한 권리의 사회적인 실현을 추동해왔다. 각 국가들이 가진 보건의료자원의 정도에 따라서 개인의 권리 실현 정도에는 차이가 있으나 UDHR과 ICESCR은 국가와 사회 기관이 건강권에 대한 책무성을 가지고 관련 제도를 마련하는데 기여를 하였다. 그리고 더 나아가 건강이라는 본질적 권리가 한 사회 안에서 법적으로 검토되고 평등과 비차별의 원칙 하에서 그 실현 범위가 확대되는데 도움을 주었다. 그러나 인권이 한 국가의 실정법 안에서 뿌리내리는데 국제법의 영향력이 미미했던 것처럼 UDHR과 ICESCR 역시 현실에 존재하는 건강권 침해의 구체적 사안들을 해결하는데 제약이 있었다. 이런 측면에서 건강권을 법률적 권리로 실현하는데 국제기구와 비정부기구들(NPOs)의 역할이 컸다. 특히 전지구적 NPOs는 국제보건의 관점에서 HIV 감염인을 위해 ARV(anti-retrovirus) 치료제에 대한 접근권을 요청하여 각국 정부의 책무성(accountability)을 이끌어냈다. 이들은 정부의 관리적 인권(managerial human rights)의 한계를 지속적으로 확대하고자 노력했으며 재판회부가능성을 높여서 건강권의 법적 실현에 도움을 주었다. 그러므로 오늘날 건강권의 근본적인 실현을 위해서는 UDHR과 ICESCR 등을 통하여 건강권의 법적 토대를 강화하는 것뿐 아니라 국제보건의 관점에서 다양한 NPOs의 역할을 모색하는 것이 요구된다. 아울러 환자의 자율성 문제와 같이 점증하는 보건의료 분야의 윤리적인 사안들을 검토하여 건강권 실현을 위한 절차화를 고민하는 것도 필요하다.
Abstract
This study investigated how the right to health is applied and realized nowadays and what it implies in the field of law and health science based on Universal Declaration of Human Rights (UDHR) and International Covenant on Economic, Social and Cultural Rights (ICESCR). UDHR built legal foundation of right to health, and played a central role in leading the social realization of the right. Even though the degree of the realization of individual’s right is different depending on the degree of healthcare resource of each nation, UDHR and ICESCR have contributed to encouraging nations and social institutions to provide the systems related to right to health with accountability. In addition, health as a fundamental right was able to be reviewed legally within society and its scope of realization was expanded under the principle of equality and non-discrimination due to UDHR and ICESCR. However, UDHR and ICESCR had certain limitations for solving concrete cases of the violation of right to health in reality as international law had little influence on building foundations for a human right within positive law. In this aspect, international organizations and non-profit organizations (NPOs) played an important role in realizing right to health as a legal right. Especially, global-scale NPOs requested for the access to ARV (anti-retrovirus) medicine for HIV infectee to draw accountability from governments as a matter of global health. They tried constantly to expand the limitations of managerial human rights of government, and contributed to legal realization of right to health by increasing justiciability. Therefore, we need to focus on not only strengthening the legal foundation for the right to health through UDHR and ICESCR, but also the roles of various NPOs from the aspect of global health for fundamental realization of right to health. Furthermore, it is important to explore the proceduralisation for the realization of right to health by reviewing ethical matters gradually increasing in the field of healthcare such as the autonomy of the patients.
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