화학적 거세의 의료윤리적 관점 = The Perspectives of Medical Ethics with Chemical Castration

국문 초록 (Abstract)

성적가해자에 대한 대중적인 관심은 오래 전부터 있었으나 가해자의 윤리적 문제에 대한 관심과 연구는 매우 적었다. 그러나 최근에는 성적 가해자의 윤리에 대한 연구보고가 증가하고 있으며 가해자의 인권에 관한 문제제기도 이루어지고 있다. 성적 가해자에 대한 치료의 한 방법으로 외과적 거세 및 화학적 거세치료 즉 성충동조절 약물치료 등의 방법이 있지만 공공의 안전을 위해서 범법자에 대한 벌이 필요하다는 의견과 임상적으로 가장 효과적인 치료방법을 선택해야한다는 의견이 서로 상충하고 있다. 본 연구자는 화학적 거세치료가 점차적으로 증가되고 있는 현시점에서 첫째, 화학적 거세 즉 성폭력 범죄자의 성충동약물치료에 대한 의학적 효능과 부작용을 알아보고, 둘째, 의료 윤리적 관점에서 화학적 거세의 주된 문제점들을 문답형으로 고찰하고자 하였다.

다국어 초록 (Multilingual Abstract)

Although the topic of sexual offense has received increased public attention in recent years, there has been relatively little research on the ethical issues related to the medical treatment of sexual offenders. Treatment options for sexual offenders include surgical castration and chemical castration through the use of sexual impulse control drugs. Opinions vary on the most effective and appropriate methods for treating sexual offenders. In this article we examine the side-effects of the drugs used in chemical castration and discuss the main ethical issues involved in chemical castration.

참고문헌 (Reference)

• 1 한국의료윤리학회, "전공의를 위한 의료윤리: 사례와 해설" 군자출판사 2011
• 2 한국의료윤리학회, "의과대학 학습목표에 기초한 의료윤리학" 계축문화사 2001
• 3 이경환, "약물치료 프로그램의 인권적인 고려. 소위 화학적 거세 어떻게 할 것인가? 토론회자료집. 법무부 설명자료 및 국회법제사위원회검토보고서"
• 4 임명호, "성폭력 충동조절 주사제의 효과성 평가 및 관리 가이드라인 개발" 법무부 2015
• 5 강석훈, "성적 가해자 혹은 성도착증의 향정신성 약물치료" 대한정신약물학회 24 (24): 59-68, 2013
• 6 임명호, "성도착증 혹은 성적 가해자의 인지행동치료" 대한불안의학회 10 (10): 85-94, 2014
• 7 김현식, "성도착증 청소년의 GnRH 유사체(Goserelin) 치료 사례" 대한정신약물학회 22 (22): 230-236, 2011
• 8 차승현, "생명의료윤리 관점에서 소아기호증 상습성폭력범에 대한 성충동 약물치료의 정당성 논의 -『 성폭력범죄자의 성충동 약물치료에 관한 법률』주요 쟁점" 생명의료법연구소 4 (4): 99-120, 2010
• 9 박민식, "상습적 아동 성폭력범의 예방 및 치료에 관한 법률" 9 : 5-7, 2009
• 10 유상호, "“임상에서 정신건강의학과 의료윤리의 실제”에 대한 논평: 강박 처치의 윤리적 쟁점" 한국의료윤리학회 18 (18): 50-55, 2015
• 11 Rösler A, "Treatment of men with paraphilia with a long-acting analogue of gonadotropin-releasing hormone" 338 (338): 416-422, 1998
• 12 Lippke RL, "Toward a theory of prisoners’rights" 15 : 122-145, 2002
• 13 Marshall WL, "Therapist characteristics in the treatment of sexual offenders: tentative data on their relationship with indices of behaviour change" 9 : 25-30, 2003
• 14 Crowley WF Jr, "Therapeutic use of pituitary desensitization with a long-acting lhrh agonist: a potential new treatment for idiopathic precocious puberty" 52 : 370-372, 1981
• 15 Ward T, "The treatment of sex offenders: risk management and good lives" 34 : 353-360, 2003
• 16 Bailey JM, "The science and ethics of castration: lessons from the morse case" 92 (92): 1225-1245, 1998
• 17 McMillan J, "The kindest cut? Surgical castration, sex offenders and coercive offers" 40 (40): 583-590, 2014
• 18 Munetz M, "The ethics of mandatory community treatment" 31 : 173-183, 2003
• 19 Losel F, "The effectiveness of treatment for sexual offenders: a comprehensive meta-analysis" 1 : 117-146, 2005
• 20 Thibaut F, "The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias" 11 (11): 604-655, 2010
• 21 Andrews DA, "The Psychology of Criminal Conduct" Anderson 2003
• 22 Chadwick R, "The Philosophy of Psychiatry" Oxford University Press 282-295, 2004
• 23 Garland D, "The Culture of Control: Crime and Social Order in Contemporary Society" Oxford University Press 2001
• 24 Gilbert F, "Rethinking responsibility in offenders with acquired paedophilia:punishment or treatment?" 38 : 51-60, 2015
• 25 Csernus VJ, "Release of peptides from sustained delivery systems (microcapsules and microparticles) in vivo. A histological and immunohistochemical study" 35 : 557-565, 1990
• 26 Morse SJ, "Psychopathy and criminal responsibility" 1 : 205-212, 2008
• 27 Radden J, "Psychiatric ethics" 16 (16): 397-411, 2002
• 28 Raymond NC, "Psychiatric comorbidity in pedophilic sex offenders" 156 : 786-788, 1999
• 29 La Fond JQ, "Preventing Sexual Violence:How Society Should Cope with Sex Offenders" American Psychological Association 2005
• 30 Sifton D, "Physicians Desk Reference" Medical Economics Company 2001
• 31 Rösler A, "Pharmacotherapy of paraphilias in the next millennium" 18 : 43-56, 2000
• 32 Briken P, "Pharmacological treatments for paraphilic patients and sexual offenders" 20 : 609-613, 2007
• 33 Briken P, "Pharmacological treatments for paraphilic patients and sexual offenders" 20 : 609-613, 2007
• 34 Malin HM, "Paraphilias: clinical and forensic considerations" 24 : 1-4, 2007
• 35 McGuire J., "Offender rehabilitation and treatment: effective programmes and policies to reduce re-offending" Wiley 3-38, 2002
• 36 Barron JL, "Metabolic clearance and plasma half-disappearance time of D-TRP6 and exogenous luteinizing hormone-releasing hormone" 54 : 1169-1173, 1982
• 37 Schwaebe C, "Learning to pass: sex offenders’strategies for establishing a viable identity in the prison general population" 49 : 614-625, 2005
• 38 Chodoff P, "Involuntary hospitalization of the mentally ill as a moral issue" 141 : 384-389, 1984
• 39 Kamm FM, "Inviolability" 20 (20): 165-175, 1995
• 40 Hudson B., "Human rights, public safety, and the probation service: defending justice in the risk society" 40 : 103-113, 2001
• 41 Ward T, "Human rights and the treatment of sex offenders" 19 (19): 195-216, 2007
• 42 Ward T, "Human rights and the treatment of sex offenders" 19 (19): 195-216, 2007
• 43 Ward T, "Human rights and correctional clinical practice" 2007
• 44 Home Office, "Home Office statistical bulletin:statistics of mentally disordered offenders in England and Wales" Home Office 1998
• 45 Conn PM, "Gonadotropin-releasing hormone and its analogues" 324 : 93-103, 1991
• 46 Thibaut F, "Gonadotrophin hormone releasing hormone agonist in cases of severe paraphilia: a lifetime treatment?" 21 (21): 411-419, 1996
• 47 O’'Donnell I, "Fear in prison" 79 : 90-99, 1999
• 48 Isaac H, "Efficacy of a monthly compared to 3-monthly depot GnRH analogue (goserelin) in the treatment of children with central precocious puberty" 68 : 157-163, 2007
• 49 Paterson WF, "Efficacy of Zoladex LA (goserelin) in the treatment of girls with central precocious or early puberty" 79 : 323-327, 1998
• 50 Thibaut F, "Effect of a long-lasting gonadotrophin hormone-releasing hormone agonist in six cases of severe male paraphilia" 87 (87): 445-450, 1993
• 51 Coyle A, "Editorial: a human rights approach to prison management" 13 : 77-80, 2003
• 52 Wheeler MD, "Drug treatment in precocious puberty" 41 : 717-728, 1991
• 53 American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" American Psychiatric Association 2000
• 54 Warnock JK, "Depressive symptoms associated with gonadotropin-releasing hormone agonists" 7 : 171-177, 1998
• 55 Warnock JK, "Depressive symptoms associated with gonadotropin-releasing hormone agonists" 7 : 171-177, 1998
• 56 Krueger RB, "Depot-leuprolide acetate for treatment of paraphilias: a report of twelve cases" 30 : 409-422, 2001
• 57 Krueger RB, "Depot-leuprolide acetate for treatment of paraphilias: a report of twelve cases" 30 : 409-422, 2001
• 58 Goldray D, "Decreased bone density in elderly men treated with the gonadotropin-releasing hormone agonist decapeptyl (D-Trp6-GnRH)" 76 : 288-290, 1993
• 59 Garcia FD, "Current concepts in the pharmacotherapy of paraphilias" 71 : 771-790, 2011
• 60 Alexander M, "Controversies in treatment: should a sexual offender be allowed castration?" 307 (307): 790-793, 1993
• 61 Lazarus L, "Conceptions of liberty deprivation" 69 : 738-769, 2006
• 62 King M, "British psychiatry and homosexuality" 175 : 106-113, 1999
• 63 Kádár T, "Behavioral effects of centrally administered LH-RH agonist in rats" 51 : 601-605, 1992
• 64 Warnock JK, "Anxiety and mood disorders associated with gonadotropinreleasing hormone agonist therapy" 33 : 311-316, 1997
• 65 Valette D, "AIDS behind bars: prisoners rights guillotined" 41 : 107-122, 2002
• 66 박우성, "A Case of Mental Retardation with Paraphilia Treated with Depot Leuprorelin" 대한의학회 29 (29): 1320-1324, 2014