사회계약에 근거한 의료의 윤리적 의사결정:의료 전문직의 계약 책임의 형성과정을 통하여

The normative principles of medical ethics are classified into two categories: traditional ethical theories (utilitarianism and deontological ethics) and empirical principles like the Hippocratic Oath. Each of these two streams of medical ethics has strengths and limitations. This article presents social contract theory as a new approach to understanding medical ethics. On this view, medical professions are based on social contracts for protecting patients from therapists with no licenses. These social contracts consist of hyper-norms, general or whole social contracts, regulations, stewardships and personal contracts. Medical professionals and medical societies both must uphold all of the social responsibilities (including legal liability) of these contracts. In order to strengthen the observance of these social contracts, this article proposes a process of medical ethical decision-making based on social contracts. Additionally, to reduce patient-physician conflicts, this article identifies the appropriate decision-making participants and argues for the necessity of hierarchical clinical ethics committees.