[불교와 정신치료] 불교의 생사관에서 본 연명의료결정에 관한 연구

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불교의 생사관에서 본 연명의료결정에 관한 연구

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학위논문   ;  석사 -동국대학교 불교문화대학원 생사문화학과 2017

소장기관   ;  동국대학교 중앙도서관  위덕대학교 도서관 

주  제 어   ; 불교 ;  생사관 ;  죽음 ;  연명의료결정 ;  불교적 연명의료 교육 프로그램

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불교의 생사관에서 본 연명의료결정에 관한 연구.pdf

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불교는 생로병사(生老病死)를 포함한 모든 번뇌를 소멸시키기 위해, 2600여년 전 역사적으로 실존했던 고타마 붓다에 의해 제시된 가르침이다. 자연과학과 함께 눈부시게 발전한 현대의학은 기존에 다루지 못했던 다양한 윤리적 쟁점들을 만들어냈다. 그 중 하나가 연명의료결정이다. 연명의료결정은 인공호흡기의 탈․부착으로 인한 존엄사, 뇌사판정으로 인한 장기이식에 관한 문제 등을 포함하고 있다. 이러한 쟁점들은 생존이라는 것은 어떠한 것이며, 죽음은 과연 어디서부터인지를 현대적 관점에서 새롭게 생각해보게 만들고 있다.
우리나라에서는 연명의료중단 결정을 두고 의료계와의 입장차이로, 환자와 그의 가족이 겪는 경제적․정신적 부담이 매우 심각한 현실이다. 본 연구에서는 연명의료결정에 관한 현대불교의 입장을 알아보고 불자들의 인식조사 및 그에 따른 현실적인 방안에 대해 서술하였다. 설문기간은 2016년 10월에서 2017년 2월까지 총 5개월에 걸쳐 진행하였고 대구시 재가불자들 300명을 대상으로 오프라인 설문지를 활용하였다.
불교에서 보는 삶과 죽음을 불교의 이론적 배경을 근거로 언급하였고 원시불교, 부파불교, 티베트불교의 죽음관을 토대로 불교의 관점에서 본 삶과 죽음을 정리함으로서 연명의료결정에 접근하였다. 한편, 불교의 업과 생사문제의 연관성을 불교 뇌사관과 장기이식에 대한 불교적 견해로 살펴보면서 연명의료결정의 진정한 이해를 돕고자 시도하였다.
불자들의 연명의료결정에 대한 인식조사에서 나타난 결과로 생사관(76.7%)과 좋은 죽음(78.3%)에 대한 생각은 70%이상으로 대부분 생각해 본 것으로 나타났으며, 임종을 앞 둔 자신의 삶 회상에서는 “불법(佛法)을 만나게 된 것(41.0%)” 로 가장 큰 의미가 있었다고 응답하였으며, 연명의료에 대한 인식 조사로는 “자기결정권(67%)”에 대해 60%이상이 알고 있다고 응답하였으며, “연명의료결정법 내용 중 신장혈액투석(60.7%)”, “인공호흡기 착용(78.3%)”, “고단위 항생제투여(49.4%)”로 50% 가까이 알고 있는 것으로 통계가 나왔다.
불자들의 연명의료결정에 대한 생각으로는 87.6%가 찬성이라는 긍정적인 답을 하였으며, 말기 상황일 때 계속해서 치료에 대한 질문에는 90%가 “예”라고 응답한 것으로 보면 연명의료중단 결정에 긍정적인 생각을 하고 있다는 것으로 나타났다.
불교적 행복한 마무리를 위한 연명의료결정 방안으로는 죽음을 주제로 한 불교의 명상법인 부정관(asubha)과 죽음에 대한 마음챙김(maran-sati), 『청정도론』의 사념(死念), 사수념(死隨念)이 있다. 죽음을 앞둔 임종자에게 적극적으로 이들을 설명해주어 자신의 명상주제로 삼아 남은 삶을 충만하고 의미 있게 살도록 도와줄 필요가 있다.
불교적 연명의료교육을 통하여 자신의 선택에 따라 인간의 존엄성이 회복된 임종을 준비할 수 있도록 정서적으로 안정을 유지시켜 삶에서 행복한 마무리로 해야 할 선행을 최대한 하도록 도와주어야 한다.
이와 같이 본 연구는 불교가 어떻게 죽음을 바라보는지 다양한 불교이론을 통해 살펴보았고 현대사회에서 야기되는 여러 가지 문제 중 연명의료결정에 대해 불교적 입장을 알아봄으로써 그 의의가 있다고 생각한다.

목    차

목 차 Ⅰ. 서 론 ·······························································································1

1. 연구의 목적 및 필요성 ················································································ 2

2. 연구의 범위 및 방법 ···················································································· 3

Ⅱ. 이론적 배경 ·················································································· 5

1. 불교 측면의 삶과 죽음 ················································································ 5

1) 탄생(生)과 죽음(死) ················································································5

2) 불교에서 생명과 불살생계 ··································································10

3) 불교의 죽음 ····························································································15

2. 불교의 생사문제에서 본 연명의료결정 ·················································· 42

1) 불교의 죽음이해 ····················································································42

2) 장기이식에 대한 불교적 견해 ···························································· 47

3) 불교의 뇌사(腦死)관 ·············································································50

4) 연명의료결정의 정의 및 불교의 견해 ·············································· 55

Ⅲ. 불자들의 연명의료결정에 대한 인식조사 ··························61

1. 설문조사의 목적 ······················································································ 61

2. 설문 개요 ·································································································· 61

3. 설문조사 결과 ·························································································· 61

Ⅳ. 불교적 행복한 마무리를 위한 연명의료결정 방안 ········· 69

1. 불교의 죽음을 주제로 한 명상법 ························································ 69 

1) 부정관(asubha [bhāanā]) ································································ 69

2) 죽음에 대한 마음챙김(死念, maraṇ-sati) ···································· 71

3)『청정도론』의 사념(死念), 사수념(死隨念) ································· 73

2. 불교적 연명의료 교육을 통한 행복한 마무리 ······························ 75

1) 호스피스 완화의료에 대한 교육확대 ············································ 75

2) 불교적 연명의료 교육 프로그램 ···················································· 77

Ⅴ. 결론 및 제언 ············································································82

1. 결론 ·········································································································· 82

2. 제언 ·········································································································· 8

4 참 고 문 헌 ························································································87

부록 ······································································································96

Abstract ···························································································10