예방접종 피해보상 인과관계 범위에 대한 법리적 검토 - 판례의 인과관계 추단 법리를 중심으로 -

The Supreme Court has established three requirements for establishing a causal link between vaccination and injury in compensation program for adverse immunization reactions: (1) temporal closeness, (2) inference from medical theories and rules of thumb, and (3) unknown or not caused by other causes. The requirement to prove causation in immunization compensation is very similar to the burden of proof for occupational diseases in industrial accidents in that it emphasizes the need to encourage immunization and the need for an immunization compensation system as a social security system for inevitable side effects, in addition to highlighting the difficulty of proof due to the limitations of science and medicine. In the discussion of causation in occupational diseases, it is necessary to recognize that when multiple causes are contested, causation should not be attributed only to one strong relative cause, but also to co-causal causes. Compensation for vaccine adverse events in the form of exacerbation of pre-existing diseases should be recognized, and it is not reasonable to mechanically deny causation to vaccines based on the existence of pre-existing diseases, predisposing factors, etc. The U.S. Vaccine Court’s requirements for establishing causation have greatly influenced the Korean court’s rulings on causation in immunization compensation, but it is problematic that, unlike the U.S., the burden of proof for the third prong is placed on the patient, not the government. The legal standards for establishing the reliability of expert opinions in the U.S. Vaccine Injury Compensation Program (VICP) hearing process may be helpful in Korea. The most problematic types of causal inference requirements are categories 4-1 and 4-2 of the Adverse Event Management Guideline’s causation determination categories. The Expert Committee on Compensation for Damages uniformly applies the natural scientific and medical causation standard for adverse event reports to the standard for compensation for damages, which should be determined normatively by applying case law on the inference of causation. This tendency to not apply case law on causal inference may be partly due to the fact that the members of the Expert Committee on Compensation are mostly medical professionals, not lawyers familiar with normative causation. To address this issue, consideration should be given to separating the standard of causation for adverse event reports from the standard of causation for compensation, and to filling at least half of the specialized compensation committee with lawyers and non-medical members nominated by civil society organizations. The scope of vaccine injury compensation is closely related to causation, and it is necessary to consider short-term improvements in the scope of compensation by establishing more detailed compensation standards that take into account age and disability level, increasing unrealistically low care and funeral expenses, and improving unclear standards for payment of medical services not covered by national health insurance. However, in the long term, it is also necessary to consider whether fundamental changes are needed, such as strengthening the nature of immunization compensation as a social security system and reorganizing it into a pension structure.