미성년자 연명의료 결정에 관한 소고: 미국에서의 논의를 중심으로
Decision making of Withholding or Withdrawal of life-sustaining treatment for Minors in the U.S
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미성년자는 의사표시를 잘 하지 못하는 영유아, 어린이부터 성인에 근접한 14세부터 18세의 청소년까지가 모두 포섭이 되는데, 미성년자도 독립한 인격체로 성인과 동등한 법적 권리를 가지고 있고 존중받아야할 존재임에도 불구하고 본인의 의료 결정에 있어 부모가 미성년자를 대신할 수 있어 자칫 소외될 수 있는 존재이기도 하다. 본고는 미성년자의 연명의료 결정에 있어서 성인과는 다른 특징과 법리가 미국에서 어떻게 논의되고 있는지를 탐색해 보고자 하였다. 미성년자의 개념과 연명의료에 있어서의 법적 지위, 미성년자 의료 결정의 헌법적 근거와 법리를 살펴보고, 영아와 청소년의 연명의료 중단에 관한 판례를 검토하였다. 임상에서 적용되는 법적 윤리적 가이드라인과 대리결정 기준도 검토되었다. 그럼으로써 미성년자의 연명의료 결정에는 본인과 부모, 그리고 의료진의 상호적인 의사결정이 중심이 되고 이들 간에 조화가 이루어짐을 볼 수 있었다.
Abstract
Minors include an infant, child, and adolescent from age 14 to 18 who is close to an adult who is not able to express his or her intention and wishes. Even if a minor is an independent person and has the same legal rights as an adult and must be respected, it is also a human being that can be alienated because parents can usually do a substitute decision making by minor’s surrogate. The purpose of this study was to explore how different characteristics and legal principles for minors are discussed in the United States from those of the adult's decision making process on withholding or withdrawal of life-sustaining treatment. The concept of minors, the legal status in medical care, the constitutional grounds and the legal basis of minors' medical decisions, and case precedents for the termination of life-sustaining treatment for infants and minors were reviewed. legal and ethical guidelines which are applied in clinical practice are analyzed as well. As a result, the shared decision making within the patient, the parents (including guardian), and the medical professionals should be centered and harmonized in the health care decisions of minors.
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