연명의료 결정 제도화에 대한 윤리적 성찰

Ethical Reflection on the Legislation of Decision Making regarding Life-sustaining Treatments

‘연명의료 결정’이란, 죽음을 맞이하는 시기에 환자에게 행하는 처치에 대해 어떠한 것을 행하고 어떤 것을 하지 않을 것인가를 결정하는 것을 가리킨다. ‘연명치료 중단’이라는 말이 많이 사용되고는 있으나, 치료를 중단한다는 말은 그 자체로 어떤 부당한 의미를 내포하고 있어 ‘연명의료 결정’이라는 말이 제안된 바 있다. 이것이 윤리적 으로 중요한 논제인 이유는 죽음이 임박한 시기에 생명의 의미와 가치, 그리고 의료행위와 돌봄의 문제가 철학적, 윤리적, 사회적으로 매우 중요한 함의를 갖기 때문이다. 이에, 본 논문에서는 연명의료 결 정의 의미가 무엇이며 윤리적으로 합당한 연명의료 결정이란 어떤 것인지를 생각해 보고, 현재 사회적으로 논란이 되고 있는 연명의료 결정의 제도화, 즉 법제화에 대하여 성찰해 보고자 한다.

Decision making regarding life-sustaining treatments occurs with regard to treatments for patients in terminal stage of life. Regarding this decision making, we need to bear in mind that human being is limited but has dignity. The dignity of human being should be respected in a special way in medical practices: to diagnose patient 's physical condition accurately and to provide him with appropriate treatments and care until his or her death. This is the way to realize the essence of medicine which is service for life. However, there are unacceptable mentalities according to which the life and sufferings of a patient are meaningless so it needs to decide his life and death by killing him. As it can not be justified to kill deliberately a man who is alive, euthanasia is unacceptable in any sense. The principles and limits on the desirable decision making regarding life-sustaining treatments are the following: ① excluding any action and omission in order to kill deliberately patients, ② doing medical practices which are proportionate, useful and necessary for patient ' s conditions, but not doing those which are disproportionate and futile, ③ consider the medical judgements which discern adequate treatments as basic criteria, ④ offering basic caring including nutrition and hydration, pain control,hygiene, and etc. until the death of the patient Based on this fundamental principles, the Catholic Church strongly opposes ① doing medical practices which are disproportionate and futile, ② any type of euthanasia, ③ the notion that we decide when to die;Furthermore it supports for ① the acceptance of natural death, ② planning future treatments to use in continuos dialogues between patient and doctor, ③ promoting hospice-palliative care, reflection and education regarding meaning of life, suffering, and death.