KJC Korea
Journal Central

Korean medical society has been in a big turmoil since the second part of the 1990s. The first impetus for this turmoil was given by a court rule against doctors who discharged critically injured patient and removed life-sustaining appliances following the request of the patient's wife. Other members of the family filed a law suit against the doctors and the wife, and they have become convicted murderers according to the criminal law. When the debate began to subside, another big trouble broke out. The government tried to implement the policy of division between prescription and preparation of drugs in the year 2000. Physicians regarded this policy as another attack on their professional autonomy and interest. To everyone's surprise they went on a strike. The third impact on the already confounded situation was the report that a team of Korean scientists has cloned human embryos by somatic cell nucleus transfer and extracted stem cells for the first time in the world. I argue that the three cases have been and will be the paradigm cases for the moral discourse in Korean health care field. Although the nature of the problems are not that different from the cases of the west, the way of discussion and the context of it is not be the same. Korean people have the tradition of emphasizing virtuous doctors embodying good human nature (德醫) rather than the specific medical virtues(醫德) they have. Virtuous doctors are the medical professionals who not only listen to the voices of patients but also deeply tune into the concrete situation of the people suffering from various problems. This kind of committment to the people coincides with the spirit of the medical professionalism and "thick" version of virtue ethics developed in the west. All these are the moral resources we can mobilize to make a moral contract of our own.

Purpose: This study was done to develop a guideline on legal, ethical and philosophical grounds for whole procedure of organ transplantation, which is a life-saving treatment and improvement of the quality of life. Methods: A survey questionnaire was sent to surgeons and nursing coordinators to get basic information about current situation of transplantation in 66 centers. 112 responded from 53 centers. The data were analyzed using SAS-program by descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. After this survey, series of discussion ethical and philosophical considerations were followed. Results: This study investigated the current situation of organ transplantation in Korea and discussed some problematic points in <Law of Transplantation of Human Organs>. We suggest organ transplantation from brain death donors should be more activated, but the rigor of current law has hindered it. The procedure of brain death determination, the role and construction of the brain death committee, and the procedure of "informed consent" should be improved. The case of Germany and U.S.A may be good example for the improvement. Human tissue transplantation has its own problems, and should be considered as a part of transplantation.

Most transplantation has been done by donation from living donors rather than dead in Korea. Lack of organs is also a big problem. It is said that the Human Organ Transplantation Law is an obstacle to harvest organs from dead people. The author tries to show limits and ethical considerations of the brain death decision committee of the Human Organ Transplantation Law. The limits are; 1. The roles of committee are overlapped as deciding brain death and assuring ethical affairs. 2. The committee causes a delay of harvesting organs from donors, so donors should endure unnecessary procedures such as medication keeping respiration and heart function. 3. In the law, family member and physician can request for the decision of brain death. Before this, it is important to confirm the will of donor. The author suggests for the above limits; 1. To devide roles of the committee into two. One is for physicians to decide brain death finally, the other is for ethic committee to examine ethical affairs such as assuring donor's will for donation. 2. To adjust the time of the committee meeting between the first and the second brain death examination. 3. To strengthen assuring the will of donor's for organ donation. For this, chances for expressing donation should be expended before losing competency.

Bioethics is to require Anthropology, which studies the human nature. According to Anthropology, human being is person and physical-spiritual totality. In related contemporary bioethics problems, the physical life is to have fundamental value. Viewpoint from bioethics founded on anthropology, 1. the doctor-patient relation is the situation on need and help. So, this relation is to ask for care rather than autonomy. 2. The human embryonic stem cell research is to be prohibited. Because, the human embryo is the human being and person. 3. The xenotransplantation is possible to be allowed, but is to take into account questions and issues connected with the defence of the dignity and identity of the recipient. In order to realize the human dignity, bioethics is to found anthropology.

There may be three different educational purposes in teaching a course of medical ethics. One is to teach knowledge or information such as regulation relevant to medical ethics, ethical principles, or arguments in ethical issues. Another is to internalize some values or morality. The other is to improve a student's abilities of thinking and communication. I argue for the last purpose because it is effective in cultivating a student's disposition to make his/her moral judgment for him/herself with the acquisition of relevant knowledge or information. This cultivation will serve the other purposes in the long run. As a method to improve abilities of thinking and communication, I emphasize critical thinking. Critical thinking is a mode of thinking in which one improves his/her thinking considering its elements and assessing them by standards. The elements of thinking are problem, conclusion, concepts, information, assumption, perspectives, implication, context, and purpose. The standards are clarity, precision, accuracy, importance, relevance, logicalness, sufficiency, depth, breadth, and fairness. I explain these elements and standards applying them to the issue of euthanasia. In addition, I emphasize a teaching method based on conversation between a teacher and students. I also suggest some requirements that students must satisfy in their papers. A student has to explain the importance of an issue he/she considers, express his/her conclusion, provide reasons explaining some concepts and using relevant information such as data, cases, or experience, and respond to the strongest objections to his/her claim.

EU policy on the research of the human embryo and stem cell is based on the 1997 Convention - Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine : Convention on Human Rights and Biomedicine. The purpose of this convention is to protect the dignity and identity of all human beings without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine. Applying this convention's view to the human embryo and stem cell research, 1) the human embryo research can only be permitted only if it protect the embryo for the purpose of the health and medicine. 2) Making human embryo is prohibited by any method-IVF or SCNT technique. 3) Other stem cell resources(adult stem cell, cord blood stem cell, etc) can be used under the condition of full informed consent without any financial interest of the donor. 4) In all cases, the privacy and human right as well as health of all related persons should be guaranteed. As a result, the research on the human embryo and stem cell has not been done actively except in few country. But now most member states permit stem cell research using spare embryo, but prohibit therapeutic cloning by SCNT. However EU itself has failed to agree with to fund the scientific research on stem cell using spare embryo. It is hardly to say the decision on stem cell research in the future by EU, but EU will continue to stress on the basic human right, social justice and human freedom in the field of biotechnology and its applications.