Open Decision Ledger · Criminal law
Doctor's duty of care, treatment discretion and the standard of proof
Supreme Court, July 16, 2026, 2023Do3217 (judgment)
Case name: 업무상과실치상
Official text on the National Law Information Center
Question
In a criminal case arising from a medical accident, what must be proved before a doctor is found to have caused bodily injury by negligence, how far does the doctor's discretion in choosing treatment extend, and what degree of proof applies to the negligence and the injury?
Holding
A doctor is at fault only where the result was foreseeable and avoidable and the doctor neither foresaw nor avoided it, judged by the ordinary duty of care of an average physician in the same field, with regard to the medical level of the day, the medical environment and the particularities of the act. The doctor has a wide discretion in choosing treatment, so unless that choice leaves the reasonable range, the outcome alone cannot show fault. The prosecution must prove both the negligence and the causal link to the injury beyond reasonable doubt; proven negligence does not presume causation, and the judgment may therefore differ from a civil judgment on the same facts.
Summary of the holding, verbatim
의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하려면 검사가 법관으로 하여금 의사의 업무상 과실이 존재한다는 것에 관하여 합리적 의심의 여지가 없이 확신할 수 있도록 증명해야 한다.
Unofficial English translation
In a criminal case arising from a medical accident, in order to find the defendant physician's negligence in the course of work, the prosecutor must prove to the extent that the judge may be convinced, without a reasonable doubt, that the physician's negligence in the course of work exists.
Disposition
Reversed and remanded Stated in the decision
원심판결을 파기하고, 사건을 의정부지방법원에 환송한다.
Unofficial English translation
The judgment of the court below is reversed, and the case is remanded to the Uijeongbu District Court.
Form of the test
Elements stated Stated in the decision
의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하려면 결과 발생을 예견할 수 있고 또 회피할 수 있었는데도 예견하거나 회피하지 못한 점을 인정할 수 있어야 한다.
Unofficial English translation
In a criminal case arising from a medical accident, in order to find the defendant physician's negligence in the course of work, it must be possible to find that the occurrence of the result could have been foreseen and avoided but was not foreseen or avoided.
Factors
- 결과 발생을 예견할 수 있고 또 회피할 수 있었는데도 예견하거나 회피하지 못한 점을 인정할 수 있어야 한다
- 의사의 과실이 있는지는 같은 업무 또는 분야에 종사하는 평균적인 의사가 보통 갖추어야 할 통상의 주의의무를 기준으로 판단해야 하고
- 사고 당시의 일반적인 의학 수준, 의료환경과 조건, 의료행위의 특수성 등을 고려해야 한다
- 의사는 진료를 행할 때에 환자의 상황과 당시의 의료수준 그리고 자기의 지식경험에 따라 적절하다고 판단되는 진료방법을 선택할 상당한 범위의 재량을 가진다
- 검사가 법관으로 하여금 의사의 업무상 과실이 존재한다는 것에 관하여 합리적 의심의 여지가 없이 확신할 수 있도록 증명해야 한다
Unofficial English translation
• it must be possible to find that the occurrence of the result could have been foreseen and avoided but was not foreseen or avoided
• whether the physician was negligent must be determined on the basis of the duty of care that an average physician engaged in the same work or field would ordinarily be required to exercise, and
• the general level of medicine at the time of the accident, the medical environment and conditions, the particular nature of medical practice, etc. must be taken into account
• a physician, when rendering medical treatment, has a considerable degree of discretion to choose a method of treatment that the physician deems appropriate according to the patient's circumstances, the level of medicine at the time, and the physician's own knowledge and experience
• the prosecutor must prove to the extent that the judge may be convinced, without a reasonable doubt, that the physician's negligence in the course of work exists
Relation to precedent
Follows earlier decisions Stated in the decision
대법원 2018. 5. 11. 선고 2018도2844 판결(공2018상, 1121)
Unofficial English translation
Supreme Court Decision 2018Do2844 decided May 11, 2018 (Gong 2018 Sang, 1121)
Decisions referred to
[1] 대법원 2018. 5. 11. 선고 2018도2844 판결(공2018상, 1121) / [2] 대법원 2008. 8. 21. 선고 2008도3090 판결 / [4] 대법원 2011. 4. 28. 선고 2010도14102 판결, 대법원 2023. 1. 12. 선고 2022도11163 판결(공2023상, 463), 대법원 2023. 8. 31. 선고 2021도1833 판결(공2023하, 1764)
Burden of proof
The prosecution Stated in the decision
의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하려면 검사가 법관으로 하여금 의사의 업무상 과실이 존재한다는 것에 관하여 합리적 의심의 여지가 없이 확신할 수 있도록 증명해야 한다.
Unofficial English translation
In a criminal case arising from a medical accident, in order to find the defendant physician's negligence in the course of work, the prosecutor must prove to the extent that the judge may be convinced, without a reasonable doubt, that the physician's negligence in the course of work exists.
Open question and revisit condition
When a bacterial or viral infection cannot be excluded, what clinical criteria decide that steroids must be given at once rather than left to the doctor's discretion?
The remand judgment of the Uijeongbu District Court will show how this standard applies to the same facts. A later decision fixing clinical criteria for immediate steroid treatment, or an amendment to Article 268 of the Criminal Act, would require a fresh reading.
Cross-family AI independent reading & axis check
7 of 8 axes matched GPT-6 Astra (OpenAI, codex CLI) · 2026-10-24
A reader from another model family (GPT-6 Astra), given the official text but not the primary reading, agreed on 7 of the 8 axes; the readings differed on axis 8 (open question and revisit condition).
Axis 8 (Open question and revisit condition): Primary “When a bacterial or viral infection cannot be excluded, what clinical criteria decide that steroids must be given at once rather than left to the doctor's discretion?” vs Independent “What evidence would establish beyond reasonable doubt that the alleged medical negligence caused the patient's injury or death in this case?”
The primary asks when immediate steroid treatment is clinically required, while the independent asks what evidence proves causation beyond reasonable doubt.
의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하려면 검사가 법관으로 하여금 의사의 업무상 과실이 존재한다는 것에 관하여 합리적 의심의 여지가 없이 확신할 수 있도록 증명해야 한다.Raw responses and comparison record: Protocol · Blind readings (JSONL) · Axis comparison (JSONL) · SHA-256 (JSON)
Lower-court contrast & scope of application
Lower-court reading vs. Supreme Court holding
Lower-court context: The Uijeongbu District Court, in its judgment of 14 February 2023 (2021No2884), convicted both doctors. It held that Defendant 2, a paediatrician, should have stopped dapsone and given steroids continuously once the hypersensitivity reaction appeared, so that not giving steroids from 6 to 9 August 2013 and giving them only intermittently from 11 August was negligence. It held that Defendant 1, a dermatologist, failed to order a blood count and liver function test after prescribing dapsone on about 12 July 2013 and gave no instruction or explanation about the risks. The court below acquitted Defendant 2 on the Lasix charge, and the first instance had excluded the charge of prescribing dapsone without an indication for pigmented purpuric dermatosis.
Supreme Court standard: The Supreme Court held that the judgment below misread the law on a physician's duty of care and on proof of causation in a criminal medical malpractice case, and that the error affected the result. For Defendant 2, the eosinophil count, a core indicator of the drug hypersensitivity syndrome, never left the normal range from 4 to 19 August 2013, fever, rash and deranged liver function were non-specific symptoms also found in infection, and infection tests were still being reported; on that record, deferring steroids and switching to immunoglobulin were choices within a paediatrician's reasonable discretion. For Defendant 1, even assuming the failures were negligence, the prosecution had not proved beyond reasonable doubt that the injury would have been avoided, since the emergency-room tests after 4 August still did not allow a diagnosis. The Court reversed the whole judgment and remanded to the Uijeongbu District Court, on the unanimous opinion of the participating Justices.
Distinguishing conditions
- A civil claim for damages on the same medical accident, since the criminal judgment may differ from the civil judgment on the same facts.
- A case in which the contemporaneous findings did not leave the diagnosis uncertain between a drug hypersensitivity reaction and a bacterial or viral infection, so that the Court's reasoning about an unconfirmed diagnosis would not carry over.
- A case in which the doctor's chosen treatment is shown to have left the reasonable range of discretion, since the Court protected only choices within that range.
Record verification notes
Check which duty of care the indictment charged and whether any part was already excluded, since the first instance here removed the charge of prescribing dapsone without an indication. Then set the contemporaneous laboratory findings, the eosinophil count, the white cell count, CRP, procalcitonin and the pending infection tests against the charged duty. Keep the civil claim to one side: the victim and the victim's parents sued the school foundation operating the hospital for damages; the Seoul High Court, in its judgment of 4 April 2019 (2016Na2045265), recognised the doctors' negligence and ordered damages against the operator, and it became final. The Court explained, however, that a criminal judgment may differ from the civil judgment on the same facts, because the criminal case requires proof beyond reasonable doubt.
From the official text
Points at issue
[1] 의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하기 위한 요건 / 의사의 과실이 있는지 판단하는 기준 및 고려할 사항 / 의사에게 진단상 과실이 있는지를 판단하는 방법 [2] 의사의 진료방법 선택에 관한 재량의 범위와 내용 [3] 의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하기 위한 ‘업무상 과실 존재’에 관한 증명의 정도 [4] 의사에게 의료행위로 인한 업무상과실치사상죄를 인정하기 위한 ‘업무상 과실과 상해·사망 등 결과 발생 사이의 인과관계’에 관한 증명의 정도 및 형사재판에서의 인과관계에 관한 판단이 동일 사안의 민사재판과 다를 수 있는지 여부(적극)
Unofficial English translation
[1] Requirements for finding the defendant physician's negligence in the course of work in a criminal case arising from a medical accident / criteria and matters to be considered in determining whether the physician was negligent / method of determining whether the physician was negligent in diagnosis [2] Scope and content of the discretion accorded to a physician in choosing a method of treatment [3] Degree of proof required for 'existence of negligence in the course of work' in order to find the defendant physician's negligence in the course of work in a criminal case arising from a medical accident [4] Degree of proof required for 'causation between the negligence in the course of work and the occurrence of a result such as injury or death' in order to hold a physician liable for the crime of negligent homicide and bodily injury in the course of work arising from a medical practice, and whether the determination of causation in a criminal trial may differ from that in a civil trial concerning the same matter (affirmative)
Summary of the holding
[1] 의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하려면 결과 발생을 예견할 수 있고 또 회피할 수 있었는데도 예견하거나 회피하지 못한 점을 인정할 수 있어야 한다. 의사의 과실이 있는지는 같은 업무 또는 분야에 종사하는 평균적인 의사가 보통 갖추어야 할 통상의 주의의무를 기준으로 판단해야 하고, 사고 당시의 일반적인 의학 수준, 의료환경과 조건, 의료행위의 특수성 등을 고려해야 한다. 의사가 진찰·치료 등의 의료행위를 할 때는 사람의 생명·신체·건강을 관리하는 업무의 성질에 비추어 환자의 구체적 증상이나 상황에 따라 위험을 방지하기 위하여 요구되는 최선의 조치를 해야 한다. 의사에게 진단상 과실이 있는지를 판단할 때는, 의사가 비록 완전무결하게 임상진단을 할 수는 없을지라도, 적어도 임상의학 분야에서 실천되고 있는 진단 수준의 범위에서 전문직업인으로서 요구되는 의료상의 윤리, 의학지식과 경험에 기초하여, 신중히 환자를 진찰하고 정확히 진단함으로써 위험한 결과 발생을 예견하고 이를 회피하는 데에 필요한 최선의 주의의무를 다하였는지를 따져 보아야 한다. [2] 의사는 진료를 행할 때에 환자의 상황과 당시의 의료수준 그리고 자기의 지식경험에 따라 적절하다고 판단되는 진료방법을 선택할 상당한 범위의 재량을 가진다. 그러므로 그러한 선택이 합리적인 범위를 벗어난 것이 아닌 한, 진료의 결과를 놓고 그중 어느 하나만이 정당하고 이와 다른 조치를 취한 것은 과실이 있다고 말할 수는 없다. [3] 의료사고로 인한 형사사건에서 피고인인 의사의 업무상 과실을 인정하려면 검사가 법관으로 하여금 의사의 업무상 과실이 존재한다는 것에 관하여 합리적 의심의 여지가 없이 확신할 수 있도록 증명해야 한다. 검사의 증명이 그에 이르지 못한 경우에는 설령 피고인인 의사에게 업무상 과실이 존재하는 것이 아닌지 의심이 들더라도 이를 인정하여 유죄로 판단할 수 없다. [4] 의사에게 의료행위로 인한 업무상과실치사상죄를 인정하기 위해서는 의료행위 과정에서 공소사실에 기재된 업무상 과실이 존재하였다는 점 외에 그러한 업무상 과실로 인하여 환자에게 상해·사망 등의 결과가 발생하였다는 점에 관하여도 엄격한 증거에 따라 합리적 의심의 여지가 없을 정도로 증명이 이루어져야 한다. 의사의 업무상 과실이 증명되었다는 사정만으로 인과관계가 추정되거나 증명 정도가 경감되는 것은 아니다. 이처럼 형사재판에서는 인과관계의 증명에 있어 ‘합리적인 의심이 없을 정도’의 증명을 요하므로 그에 관한 판단이 동일 사안의 민사재판과 달라질 수 있다.
Order
원심판결을 파기하고, 사건을 의정부지방법원에 환송한다.
Unofficial English translation
The judgment of the court below is reversed, and the case is remanded to the Uijeongbu District Court.
Provisions referred to
[1] 형법 제268조 / [2] 형법 제268조 / [3] 형법 제268조, 형사소송법 제307조 제2항, 제308조 / [4] 형법 제17조, 제268조
Read 2026-10-24 · Cross-read 2026-10-24. All quotes matched against the official text. The Chinese-character placeholders the court used for anonymised parties are given in their Korean readings, and parenthetical Chinese-character glosses are omitted.
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