정무장관(제2)실과 여성특별위원회를 중심으로

그동안 우리나라의 여성부문은 점진적인 발전을 해왔고 여성정책기구도 확대되어 왔다. 그러나 여성관련행정기구에 대한 논란이 계속되고 있다. 논란의 쟁점은 여성관련행정기구의 형태를 어떻게 할 것인가, 어떠한 기능을 가져야 할 것인가 등이다. 이러한 논란의 배경에는 많은 통념과 선입견이 존재한다고 보아 이러한 선입견들이 타당성이 있는가를 검증하고자 하였다. 이에 따라 일반조직이론으로부터 정부조직 형성에 적용되는 원리를 살펴보았다. 다음은 여성행정기구 개편도 정부조직개편의 과정을 따르고 있는지를 보기 위하여 정부조직개편에 관한 선행연구들을 검토하고 경험적 연구에 적용한 분석틀을 찾아보았다. 개편의 전 과정을 분석한 틀을 바탕으로, 제한적이나마 여성정책전담기구로서의 틀을 갖추고 있는 정무장관(제2)실과 여성특별위원회를 대상으로 환경적 요인만을 한정하여 보았다. 대상 시기는 정무장관(제2)실은 노태우 대통령이 당선되어 취임하기까지의 기간인 ‘87년 12월 16일부터 ’88년 2월 25일까지를, 여성특별위원회는 김대중 대통령 당선일인 ‘92년 12월 18일로부터 정부조직법 통과시점인 ’98년 5월 21일을 중심으로 하였다. 분석상의 접근방법은 문헌분석방법을 주 연구방법으로 한 사례연구로 하고 공식문서나 자료가 없는 경우에 부분적으로 인터뷰와 설문을 활용하였다. 대부분의 정부조직 개편에 관한 연구가 정부조직 전체에 관한 것들이고 분야별로 다루는 사례는 거의 없어 일반정부조직 개편에 과한 연구를 주로 참고하였다. 또한 최근의 것은 관련 연구가 아직 충분히 이루어지지 않아 신문, 국회속기록, 연감, 정부내부자료 등을 참고로 하였다. 여성행정기구에 관한 선행연구에서는 여권론적 시각에서의 정부역할, 여성정책의 특수성과 이에 따른 여성행정기구의 역할 등을 살펴보고 여성행정기구개편의 환경적 요인분석을 위한 이론적 준거를 제시하였다. 환경적요인은 외부적 환경과 내부적 환경으로 구분하였으며 일반정부조직의 환경적 요인과 여성행정기구의 특수성을 반영하여 변용하였다. 여성행정기구의 외부적 환경으로는 광범위한 여성문제와 정책과제의 존재를 들었고, 정부조직개편이 정치적 행ㄹ위임을 전제로 정치적 요인의 중요성을 강조하였다. 여성지위와 관련하여 부각되는 또 하나의 특징으로 국제적인 요인 특히 UN의 적극적인 활동을 포함하였다. 여성문제와 정책과제로는 여성억압의 원인으로 지목되는 가부장제와 자본주의체제와 관련되는 지표인 여성들의 가족관련 문제와 경제활동을, 정치·경제·사회·문화 등 다른 영역의 불평등으로 이어지는 원인지표인 교육, 다른 분야의 불평등 해소에 기여할 수 있는 수단으로서의 비중이 있는 정치참여 분야를 포함하였다. 내부적인 환경으로는 외부환경에 부응하는 내적역량에 초점을 두어 기존조직의 당시의 모습을 바탕으로 문제점을 기능과 업무수행 능력을 중심으로 보았다. 연구의 결과는 다음과 같다. 첫째, 정부조직형성의 원리는 여전히 귤릭의 부성화의 원리와 기능중심의 분류가 적용된다. 여성업무는 그동안 기능중심이 아닌 성별분류로 인식되어 집행권한이 있는 독립부서가 도지 못하고 임시조직의 형태를 띠어왔다. 이에 따라 여성관련행정기구의 핵심기능으로 부여된 조정기능조차 제대로 발휘되지 못하는 한계를 노출, 개편논의가 반복되고 있다. 따라서 여성관련 행정기구의 필요성에 대한, 여성정책과 행정대상에 대한 인식의 전환과 재정의가 필요하다. 둘째, 외부적 환경과 내부적 환경은 정부조직개편의 필요조건이다. 일반 정부조직의 경우 전체적으로 보면 정치·경제·사회 전반적인 환경이 문제가 되지만 개별행정기구는 특수성을 반영해야 하며 일반적인 환경보다는 특수 환경이 더 중요하였다. 여성관련행정기구 개편에 작용하는 환경적 요인으로는 외부적 환경으로 여성문제와 정채과제 등의 행정수요, 정치적 요인으로 대통령 직선제와 정부의 당면과제, 선거공약, 여성들의 요구와 정치세력화, 국제환경 등이었고 이러한 외부적 환경에 부응하지 못하는 내부적 환경이 기구개편을 촉발하는 요인이 되었다. 셋째, 여성문제는 그동안 실질적인 기능을 하는 여성행정기구의 부재로 여성문제가 수십 년 동안 해결되지 않고 반복되고 있었다. 이러한 현실자체가 역설적으로 제 기능을 발휘할 수 있는 여성관련행정기구의 필요성을 반증하는 외부적 환경요인의 하나가 되고 있다. 넷째, 여성정책은 종합성, 포괄성, 상징성, 이데올로기성 등의 특성을 갖고 있어 여성관련행정기구는 이러한 특성을 반영할 수 있는 기능을 갖춰야 한다. 여성행정기구에 부여되는 필요한 기능은 계획수립기능, 집행기능, 조정기능, 자문기능, 모니터링 기능 등이다. 여성행정기구는 형태보다는 기능이 중시되어야 하며 이를 융통성 있게 적용하여야 한다. 다섯째, 우리나라 여성행정기구 개편에는 정치적 요인이 중요하게 작용하였고 정치적 과정이라는 통념의 일부가 타당함이 인정된다. 그러나 일반 정부조직의 개편도 민주화로 갈수록 정치적 과정일 수밖에 없다. 참여자요인이 중요해지는 만큼 개편과정 자체가 정치적 과정으로 디고 있기 때문이다. 본 연구는 여성관련행정기구 개편의 환경적요인만을 대상으로 함으로써 전반적인 개편과정과 내용을 분수없는 한계를 지니고 있다. 또한 여성행정기구 개편의 객관성을 확보하기 위해서는 일반정부기구의 개편과 여성행정기구의 개편에 관한 비교 등의 연구가 필요하다고 하겠다.;Until these days, women parts in our country have been developed gradually and also policy organizations for women have been expended. However, administrative organizations related to women affairs have been criticized continuously. The key point of the criticism is how to form the administrative organizations related to women affairs and what kind of function should the organizations have. On the background of the criticism, there are lots of common ideas and prejudice. So, this research is to verify these proprieties. For this purpose, theory, which has been applied to formation of government organization, as well as theory of general organization has been reviewed. The next step is the examination on preceding researches, which have been done for government organization reformation, and the searching the analyzing frame applied to experimental research to hind whether the reorganization of womens administrative formation has followed the process of reorganization on government formation. On the basis of frame analyzing all processes of reorganization, the Ministers Office of State for Political Affairs (the Second office) and the Special Committee for Women, shich has a certain frame as an organization for womens policy, have been reviewed in the view of environmental factor. The period of subject for the Ministers Office of State for Politial Affairs is from December 16th 1987 to February 25th 1988, which is from former president Roh, Tae Woos being elected day to inauguration day, and the Special Committee for Women is from December 18th 1997 to may 21st 1988, which is from President Kim, Dae Jung being elected day to the date of passing the law of fovernment organization. Analytical access wa has been applied by a case study which has document analysis as a main research way, and in case of no official document or material, interviews and questions have been used parially. Researches on reorganization of general government formation and there are just few cases by fields. Also, newspapers, stenographic records of National Assembly, year books, and governments inside material have been referred because recent material does not fuuly made in related research. In the preceding researches on administrative organization for women, role of government in the view of ruling party, particularity of womens policy, and role of administrative organization for women according to the policy have been reviewed, and theoretical standard for circumstantial factors on reorganization of administrative organization for women has been suggested. Environmental factors have been divided nto outer and inner context and aplied them in reflection of circumstantial factors of general government organization and particularity of administrative organization for women. Outer context of administrative organization for women are extensive women issues and existence of policy questions, and, on the assumption that reorganization of government formation is political activity, importance of political factors have been stressed. International factor, especially positive activity of UN, has been included as another highlighted characteristics related to womens position. Followings are included as issues on women and policy questions; patriarchal system, indicated as a case of suppression on women/Womens family issues and economic activity, related to the capitalistic system/ education, which has been a cause of inequality in politics, economy, society, culture, etc./participation in politics, which could contribute to settle the inequality in other areas. As for Inner context, having focused on inner ability responding to outer context, function and achievement ability on works have been reviewed I nthe based on the then aspect of established organization. The result of the research is as follows : First, Gulicks departmental principle and classification of function have been still applied to principles of formation of government organization. Until now, womens affairs have been regarded as a classification of distinction of sex, not as a function-focused, and thus, it has formed as a temporary organization. As the result, it has revealed the limitation in showing ist own crucial function of administrative organization related womens affairs, and it has been discussed about its reform repeatedly. Consequently, change of perception and redefinition are necessary regarding on womens policy and subject of administration, and on necessity of administrative organization related women. Second, outer and inner context are necessary condition in reorganization of government formation. In case of general government formation, on the whole, politics, economy, society, and all circumstances are become issued, but individual administrative organization should reflect its particularity, and the particular circumstance is more important than the general one. Third, issues on women have not solved for years. This reality shows that administrative organization for women, which can demonstrate its own role, is needed. Forth, in the administrative organization for women, function should be regarded as more important thin than formation, and it should be applied efficiently. Fifth, in th reorganization of administrative formation for women, political factor has played key role. However, general reorganization of government formation is also political process in the way of demonocracy. This research has not escape from limitation for its subjects are extensive comparison research on reorganization of general government formation and reorganization of administrative formation for women.제1장 서론 1 1. 연구목적 1 2. 연구의 대상 및 방법 3 제2장 여성관련행정기구 개편에 관한 이론적 고찰 및 분석내용 5 1. 정부조직 형성 및 개편에 관한 이론적 고찰 5 가. 정부조직화의 원리 5 나. 정부조직개편에 관한 이론적 고찰 13 2. 여성관련행정기구에 관한 이론적 고찰 19 가. 여성관련행정기구의 정의 19 나. 여권론적 입장과 국가의 역할 19 다. 여성정책과 여성관련행정기구 22 3. 여성관련행정기구개편의 환경적요인에 관한 분석내용 28 가. 정부조직개편 분석 연구의 적용 28 나. 본 연구의 분석틀 30 제3장 여성관련행정기구개편과 환경적 요인 34 1. 정무장관(제2)실로의 개편 34 가. 외부적 환경 34 나. 내부적 환경 51 다. 정무장관(제2)실의 출범 54 2. 여성특별위원회로의 개편 57 가. 외부적 환경 57 나. 내부적 환경 74 다. 여성특별위원회의 출범 78 제4장 여성관련행정기구 개편의 환경적요인 비교분석 81 1. 기구개편의 주요환경요인 비교분석 81 가. 여성관련 주요지표와 정책과제요인 81 나. 정치적 요인 86 다. 여성단체활동과 여성들의 정치세력화 89 라. 내부적 환경요인 90 2. 여성관련행정기구 개편의 내용 및 성격비교 92 가. 정무장관(제2)실과 여성특별위원회의 성격 92 나. 여성관련 행정기구의 형태별 기능비교 94 다. 여성관련행정기구 개편에 관한 시사점 101 제5장 결론 104 1. 분석결과 요약 104 2. 본 연구의 한계 및 과제 106 참고문헌 107 ABSTRACT 11

Research on deliberative justice implementation of a national health insurance policy deliberation committee

의료법윤리학협동과정 보건학전공/석사[한글] 이 연구는 분배정의와 사회정의의 갈등을 다루기 위해 정책이 공식화되고 이행되는 제도와 절차에 초점을 두는 참여정의(deliberative justice)의 구현방안에 관한 것이다. 참여정의는 국민에게 참여기회를 확대하는 것만으로 참여정의 구현이라는 과제를 달성할 수 없으며, 참여의 확대와 더불어 이성에 의해 지지되는 주장을 함으로서 문제를 제기하고 의견의 불일치를 해결하며, 갈등을 극복할 수 있는 안정된 논의의 장을 마련하는 것이 중요하다. 따라서 이 연구에서는 참여정의의 실현 수단으로서의 위원회 제도의 검토를 통해 참여정의의 구현 방안을 모색하고자 하였다. 위원회 제도의 사례분석은 2006년까지 한시적으로 운영되는 건강보험정책심의위원회를 대상으로 하였으며, 위원회의 기능 및 구조적 측면과 절차적 측면으로 구분하여 분석한 결과는 다음과 같다. 1. 건강보험정책심의위원회는 기능적 측면에서 심의?의결기능이 중심이나, 조정 및 중재 기능이 미흡하였다. 조정 기능 및 중재 기능의 문제는 구조적, 절차적 문제로 이어지게 되므로 위원회의 기능에 조정 및 중재의 기능을 부과하여 위원회를 활성화하도록 해야 한다. 2. 구조적 측면에서 위원회 구성은 심의?의결을 위한 동수의 이해 당사자와 중립적 공익위원으로 되어 있다. 그러나, 공익위원의 수가 많아서 공익위원들 내에서의 의견조율이 힘들 수 있고, 공익위원의 추천권이 정부에 있어 정부의 의견대로 결정되고 있다는 비판이 있다. 또한 공익위원 구성에 이해 당사자가 되는 보험자 대표인 공단이 위원으로 구성되어 있어 중립적인 역할을 이행할 수 없다는 지적이 있다. 따라서 독일의 경우처럼 공익위원을 양 이해당사자의 추천과 각각의 동의에 의해 위원을 구성하여 이해 당사자간의 이해조정을 중립적인 위치에서 중재할 수 있도록 가입자와 의약계의 동의를 받고 위촉하는 절차와 규정을 마련해야 할 것이다. 3. 절차적 측면에서 위원회는 조정 및 중재 보다는 의결기구의 성격을 갖기 때문에 이해당사자의 의견을 제시하고, 이를 서로 충분히 논의할 수 있는 절차상의 참여가 생략되어 있다. 또한 공급자와 가입자 양 당사자 내에서도 서로 입장을 달리하는 위원들로 구성되어 있어 각각의 입장을 충분히 반영할 수 있는 절차상의 참여를 보장하지 못하고 있다. 따라서 절차상의 참여를 보장하기 위해 조정 및 중재 기능의 강화뿐만 아니라 각 단체의 의사를 고루 반영하기 위해 각각의 참여 집단과 이해 당사자인 공단이 협상안을 놓고 협의과정을 거칠 수 있도록 절차적 측면의 참여방안을 구체화할 필요가 있다. 4. 위원회 운영 기간과 관련하여, 국민건강보험재정건전화특별법상 요양급여비용계약 체결 시한이 11월 15일로 규정되어 있어서 충분한 논의를 통해 협의에 이를 수 있는 기간이 되고 있지 않다. 충분한 논의를 통해 조정과 중재가 이루어지기 위해서는 당사자간의 협의기간으로 2개월 내지 3개월, 위원회에 회부되어 결정되기까지의 기간으로 2개월 내지 3개월의 기간이 필요하다. 따라서 현재 11월 15일까지 계약을 만료하도록 한 규정의 개정이 필요하다. 5. 건강보험정책심의위원회는 2006년까지 한시적으로 운영되는 위원회로 태생적인 결함을 갖고 있다. 이로 인해 목적 달성 여부와 상관없이 2006년 이후에는 국민건강보험법상 수입부문과 지출부문이 이원화된 체계인 재정운영위원회와 건강보험심의조정위원회가 부활하게 된다. 그러므로 장기적으로 재정적자 문제를 해결해 나가기 위해 현재 위원회의 일원화된 체계를 보완ㆍ유지할 수 있는 방안을 모색해야 하며, 위원회의 운용경험을 새로이 제정되는 국민건강보험법에 이를 반영하여야 한다. [영문]In order to address inevitable conflicts between the justice of distribution and the social justice, this study refers to some reasonable methods to implement so called deliberative justice that focuses on the system and procedures of formulating and implementing corresponding policies. As long as the deliberative justice is concerned, only extension of deliberative opportunities into whole nation cannot assure the achievement of a critical nationwide assignment titled ''the implementation of deliberative justice.'' In addition to nationwide extension of such opportunities, it is also important to build up a stable ground for discussion in which we may pose some question, resolve any inconsistent opinions and overcome resulting conflicts by unrolling arguments supported with rationality. Thus, this study intended to seek some reasonable methods to implement deliberative justice through reviewing the legitimate committee system as a mean to realize the deliberative justice in terms of national health insurance policies. In this study, a case analysis about committee system was applied to National Health Insurance Policy Deliberation Committee(hereinafter called NHIPDC) that is supposed to sustain its administration temporarily till Year 2006. This study analyzed the functions of the said committee in the aspect of structure and procedure respectively: 1. From a functional angle, NHIPDC focuses on deliberation and resolution on policies relevant to national health insurance, but lacks conciliation and intervention side. Naturally, the functional issues of conciliation and intervention lead to the structural and procedural questions. That is why we need to add the complementary function of conciliation and intervention to existing functions of said committee for the sake of its better functional performance. 2. From a structural standpoint, NHIPDC comprises the parties concerned and other neutral public delegates respectively in the same number for deliberation and resolution. However, there are some criticisms about the following points, i.e. difficulty in tuning up various opinions from lots of public delegates and government-driven appointment of public delegates with regard to the right of recommendation. Besides, it is also often pointed out that National Health Insurance Corporation(NHIC) as the representative of insurers and one of parties concerned with the organization of public delegates may fail to play their inherent neutral roles in terms of national health insurance policies, because it comprise the committee membership of NHIPDC. Hence, as proven in the counterpart case of Germany, it is required to prepare the relevant procedures and regulations for commissioning public delegates according to the mutual consent between insurants and medical organizations, so that the delegates may be organized by the recommendation and mutual consent of said both parties concerned in order to coordinate and intermediate the different interests among the parties concerned from their own neutral standpoint. 3. In the procedural aspect, NHIPDC has a critical disadvantage of omitting any course of procedural deliberation in which each of parties concerned may propose different opinions and discuss them with each other in more depth, because the said committee is typically characterized by a resolution body rather than coordinator or intermediate. Moreover, the said committee comprises the members with different standpoints even within both parties concerned(i.e. insurers and insurants). That is why the committee fails to assure any procedural deliberation that may successfully reflect the diverse viewpoints of parties concerned. Therefore, it is essential that NHIPDC should have more complemented function of intervention and coordination to assure any procedural deliberation, while formulating the reasonable ways to promote such procedural deliberation so that each of deliberation groups and NHIC as a party concerned may discuss any policies for negotiation in order to fully reflect the opinions from each interested party in unbiased manner. 4. With regard to the duration of committee administration, the valid term of concluding the Agreement about Medical Care Allowances is specified till November 15, 2004 in accordance with the Special Act for Steady Financial Conditions of National Health Insurance. This duration doesn''t comply with the realistic requirement for coming to further deliberation through full discussion. For the sake of coordination and intervention through full discussion, it presumably takes about 2 or 3 months only to discuss among parties concerned, and also takes additional 2 or 3 months from committal reference to final resolution. Thus, it is inevitable to revise the current compulsory provision about the valid termination of said agreement dated on November 15, 2004. 5. NHIPDC has its own inherent disadvantage as a temporary committee under administration till Year 2006. Accordingly, whether it succeeds in accomplishing original goals or not, former Committee on Finance and Administration and National Health Insurance Deliberation & Conciliation Committee will be possibly revived after Year 2006, which is characterized by dualized system involving revenue and expenditure respectively in accordance with the Act of National Health Insurance. Hence, in order to solve the questions of financial deficit from a long-term standpoint, it is important to seek any promising way to complement and maintain current unified committee system in terms of national health insurance, and reflect the committee''s expertise in policy administration proactively on an incoming new legislation named ‘the Act of National Health Insurance.''ope

Study on strengthening hospital ethics committee

의료법윤리학협동과정 보건학전공/박사[한글]본 논문은 병원윤리위원회의 운영 및 활성화 전략을 제시함으로써 임상현장에서의 무의미한 연명치료 중단과 같은 딜레마 상황을 해결하는데 목적이 있다. 연구 내용은 병원윤리위원회의 적정기능을 위한 운영방안과 제도적 정착을 위한 활성화 전략을 제시하는데 중점을 두었으며, 연구결과는 다음과 같다. 첫째, 우리나라 병원윤리위원회는 자문기능이 강한 위원회로, 기존 자문·심의기능을 그대로 유지하는 경우, 위원회의 결정 사항에 구속력이 없어, 형식적으로 흐를 가능성이 많다. 그러므로 위원회의 결정사항에 대해 일정 정도의 구속력을 갖출 수 있도록 심의·의결 기능을 보강할 필요가 있다. 이 때 관련 당사자들이 병원윤리위원회의 결정과 견해를 달리하는 경우, 다른 의료기관 또는 의료인을 선택할 수 있도록 조치를 취할 기간과 이를 위해 노력할 의료기관의 의무를 함께 규정하는 것이 아울러 요구된다.둘째, 연명치료중단과 같은 안건을 심의·의결하기 위한 기능을 강화하는 경우, 병원윤리위원회의 형태는 다학제 방식이 적합하다. 다학제는 의학적 의사결정 시 새롭고 가치 있는 대화를 조장하는 것뿐만 아니라, 법적 관점에서 볼 때 책임을 공유하고 분담한다는 측면도 갖는다고 볼 수 있으므로 다학제를 원칙으로 한다. 그러나 실질적인 사례 분석은 위원회 형태보다 팀 접근 방식이 보다 효율적이므로, 전문성과 의사결정의 충실성을 기하기 위해 전체위원회 내에 전문위원으로 구성된 소위원회에서 이를 심사하고 이차적으로 전체위원회로 회부되는 방식으로 병원윤리위원회가 운영될 필요가 있다. 셋째, 병원윤리위원회의 운영내규는 향후 위원회의 운영에 관한 일정 요건을 충족시켜, 운영상 발생하는 의료기관간, 지역간 격차를 최소화 시킬 수 있으므로, 표준화된 운영내규가 마련되어야 한다.넷째, 병원윤리위원회의 결정과 관련하여 구속력 있는 결정을 이끌어내기 위해 위원회의 설치 및 운영절차에 관한 법적 근거가 마련되어야 한다. 병원윤리위원회 관련 법률에는 총칙에 위원회의 설치목적 및 용어의 정의, 기본원칙 및 국가 공공단체의 책임에 관한 사항을 포함시키며, 그 외에 위원회의 설치 및 설치형태, 위원회 구성, 책임면제에 관한 사항이 포함되어야 한다. 병원윤리위원회의 면책 규정은 병원윤리위원회가 효과적으로 기능하도록 하는데 본질적인 것이라 할 수 있으므로 위원들을 포함하여 병원윤리위원회와 연관된 의료 기관과 이러한 기전에 따라 행한 의사의 경우에도 민·형사상의 책임을 지지 않도록 규정하는 것이 필요하다.다섯째, 연명치료중단과 같은 가치중립적인 안건들은 심의·의결로만 끝나는 것이 아니라, 선순환을 거쳐 개별 병원내의 정책뿐만 아니라 국가적 정책 및 지침개발로 이어질 필요가 있다. 전체사회가 각종 임상윤리문제를 이해하고 해결해 나가기 위해 국가적 차원의 기금마련과 각 병원윤리위원회 및 지역사회를 대상으로 한 교육프로그램 개발 및 시행과 병원윤리위원회의 설치 및 운영을 보조할 필요가 있다.마지막으로, 환자의 의사결정능력이 없는 상황에서도 환자가 원하는 바를 가족과 의료인간의 의사소통을 통해 최대한 반영되도록 함으로써 환자의 자기결정권이 올바르게 행사되도록 해야 한다. 현재 우리나라의 말기환자의 자기결정권이 행사되도록 하는 법규정이 없는 상황에서 병원윤리위원회가 환자의 안전과 자기결정권의 행사를 가능케 하는 기제로 작용할 수 있으므로, 법제정 이전이라도 의료기관차원에서 지침을 마련하고 병원윤리위원회에서 이러한 기능이 실행될 수 있도록 하여야 한다. [영문]The purpose of this study lies in presenting strategies for the management and reinforcement of the Hospital Ethics Committee in order to resolve dilemmas, such as the cessation of insignificant life prolongation therapy, that occur in the clinical field. The contents of the study focus on reinforcement strategies for the appropriate operation and institutional establishment of the Hospital Ethics Committee. The followings are the results. Firstly, the Hospital Ethics Committee of Korea exists primarily for the function of consultation. Maintenance of the current capacity of consultation； deliberation without legal-binding would allow the conclusions the Hospital Ethics Committee to remain but a formality. Therefore, reinforcement of the capacity for deliberation；decision of conclusions of the Hospital Ethics Committee is in need for a certain amount of legally-binding force. If the people in concerned disagree with the conclusion and opinion of the Hospital Ethics Committee at this point, regulations regarding a period of time to search for other medical institution or personnel and obligations for the medical institute to assist this search are also in demand. Secondly, the appropriate form of Hospital Ethics Committee would be multidisciplinary when reinforcing the capacity for deliberation；decision on issues such as the cessation of life prolongation therapy. Multidisciplinary would be the rule because multidisciplinary allows fresh and valuable conversations in the medical decision making process and legally has the aspect of sharing and dividing responsibility. However, since a team-approach is more efficient than a board-approach in actual case analysis, there is need for operation of a specialty board within the Hospital Ethics Committee for evaluation of issues which are consecutively forwarded to the general board in order to promote professionalism and substantiality in the decision making process. Thirdly, internal regulations of Hospital Ethics Committee should satisfy certain requisites concerning prospective operation of the board. Standardized internal regulations should be established for minimization of prospective institutional and regional disparities. Fourthly, legal provisions in relation to the decisions of the board should be made for establishment and operation of the board in order to draw out decisions with binding force. Subjects such as the purpose of Hospital Ethics Committee, definitions of terminology, cardinal principles, and the duties of national public bodies should be included in the general provisions of the law regarding Hospital Ethics Committee. Other issues such as establishment and form of Hospital Ethics Committee, constitution of the board, and exemption from duty should also be included. Because rules of exemption fundamentally allow efficiency of function in Hospital Ethics Committee, regulations are needed to exempt board members of the Hospital Ethics Committee, the involved institute, and doctors who acted accordingly to the system from civil；penal responsibilities. Lastly, there is need for ethically value laden issues such as cessation of life prolongation therapy to not end at deliberation；decision but to be connected through a virtuous cycle to change the policy of each institute and develop national guidelines；policies. The whole society needs to help establishing a national fund for understanding and resolving diverse clinical-ethical issues including life prolongation therapy and the establishment；operation of Hospital Ethics Committee including the development；enforcement of educational programs for the Hospital Ethics Committee of each medical institute and each regional society. The function of patient's self-determination should be included in the program of Hospital Ethics Committee in addition to the function of cessating the life prolongation therapy.ope

上司의 리더십 特性이 部下의 內在的 모티베이션에 미치는 影響에 관한 硏究

학위논문 (석사)--서울大學校 大學院 :經營學科 經營學專攻,1996.Maste

Attitudes and Practices of Critical Care Physicians in End-of-life

Purpose: This study was performed to evaluate both the attitudes and practices of critical care physicians in Korean ICUs regarding end-of-life care decisions as well as the factors that influence those attitudes and practices. Methods: A questionnaire was developed and delivered to 100 members of the Korean Society of Critical Care Medicine in September 2007. The questionnaire was divided into six parts including personal information, decision-making processes, the withdrawing and withholding of life-sustaining treatment, informed consent, consultation with ethics committees, and guidelines. Results: Eighty eight responses from 53 different institutions were received. The results of the questionnaire include the following. There was a significant difference between the attitude and practices of respondents concerning family consent and patient’s consent. Attitudes toward patient and family consent differed significantly according to the clinical experiences of the respondents (p<.05). There was a significant difference between the attitudes and practices of respondents concerning how often caregivers effectively communicated with patients and family members. Attitudes toward family participation in decision-making processes differed significantly according to the respondents’ gender. There was also a significance difference between the attitudes and practices of respondents regarding the withdrawal of life-sustaining treatment. Attitudes and practices on this issue varied according to the type of ICU where the respondents worked and their medical specialty. Practices concerning informed consent for “do not resuscitate” orders varied significantly according to respondent’s age and type of ICU. Finally, attitudes on the participation of ethics committees in decision-making processes varied significantly according to respondent’s clinical experiences (p<.05). Conclusions: This study found significant differences in the attitudes and practices of critical care physicians in Korean ICUs concerning end-of-life care decisions and the withdrawing and withholding of life-sustaining treatment. The study also found that the factors influencing these attitudes and practices include age, specialty, clinical experiences, and the types of ICU in which physicians work. However, there are some limitations in generalizing these findings.ope

Association of serum hemoglobin level with the risk of carotid plaque beyond metabolic abnormalities among asymptomatic adults without major adverse clinical events: a cross-sectional cohort study

Background The serum hemoglobin (Hb) level is closely related to adverse clinical outcomes. However, data on the association of Hb levels with subclinical atherosclerosis beyond metabolic abnormalities are limited. Methods This study evaluated the association among serum Hb level, metabolic syndrome (MetS), and the risk of carotid plaque formation in asymptomatic adults without a history of major adverse clinical events. Results A total of 2560 participants (mean age: 60 +/- 8 years, 32.9% men) were stratified into four groups based on Hb quartiles, as follows: &lt;= 12.8 g/dL (group I), 12.9-13.6 g/dL (group II), 13.7-14.5 g/dL (group III), and &gt;= 14.6 g/dL (group IV). The overall prevalence of MetS and carotid plaque was 37.2% and 33.4%, respectively. The prevalence of MetS increased with increasing Hb level (group I: 27.4% vs. group II: 35.9% vs. group III: 42.6% vs. group IV: 44.1%, p &lt; 0.001). The prevalence of carotid plaque was 34.3%, 28.1%, 32.8%, and 39.5% in groups I, II, III, and IV, respectively. Univariate logistic regression analysis showed that MetS was associated with an increased risk of carotid plaque (odds ratio [OR] 1.568, 95% confidence interval [CI] 1.326-1.856, p &lt; 0.001). Only group II showed a lower risk of carotid plaque than group I (OR 0.750, 95% CI 0.596-0.943, p = 0.014). Multiple logistic regression models showed consistent results after adjusting for clinical factors, including MetS and its individual components. Conclusion Serum Hb level is associated with the risk of carotid plaque beyond MetS and its components in a relatively healthy adult population

A Korean perspective on developing a global policy for advance directives

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.ope

Amendment of the “Acceptable Limit for Abortion” in Article 14 of the Mother and Child Health Law

Since its enactment in 1973 the Mother and Child Health Law in Korea has not properly reflected the rapid social changes that have taken place in Korea and has been enforced without appropriate legislative amendments. According to Henshaw and Simon, Korea posted a 19.6% rate of abortion, which is the highest among OECD countries. In Chapter 27 of the Criminal Law, established in 1953, before the passage of the Mother and Child Health Law, abortion was designated as a crime and was subject to punishment without exception. Although the Mother and Child Health Law has been revised six times, including an extensive amendment in 1986, Article 14 of the Law has not been revised due to possible ethical and social controversies. Accordingly, the Ministry of Health & Welfare and the Medical Law and Ethics Research Center at Yonsei University began studying an amendment of Article 14 in September 2007. These groups prepared an amendment bill for Article 14 based on existing research into the policies on abortion in other countries and ensured that the bill fully reflects the opinions of different social groups in Korea. This article summarizes the problem with Article 14 of the Mother and Child Health Law and the proposed amendments to it.ope

Correctional Health Care Delivery System and Prisoners' Human Rights

In recent several decades, we have concentrated on the human rights, making every effort for improving them. Although inmates and prisoners" fundamental rights can be reserved by the laws following due processes, the human rights should be universally applicable to them. In many fields, Korea has competitive capacities with other nations included in OECD, but needs to do it"s best to protect the human rights for inmates and prisoners, as well as for minorities. In this paper, we review the international standards and guidelines for the correctional health care related to inmates and prisoners. According to many reports, the Korean correctional health care system is not enough to protect the human rights of inmates and prisoners and has a lot of problems in medical care. We approach, however, to this system with other different view of points. The established studies have focused on the correctional medicine, but we intend to review the inmates and prisoners" health not only in correctional medicine simply, but also the health care system for them. Therefore, we can understand the basic relations between the correction and the health more properly, provide the better solutions on the correctional health care, and improve it on the basis of the human rights. The guarantee of the better health care to inmates and prisoners seems to be irony and very strange, but these approaches and understandings can produce the cost-effective answers in national health care system. Finally, the improvement of correctional health care system can give the safety and the stability to national health care systemope