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2009, Vol.12, No.1

  • 1.

    The Process of Medical Decision-making for Cancer Patients

    SangMok Lee | Seongyeon Kim | Hyung-Sik Lee | 2009, 12(1) | pp.1~14 | number of Cited : 30
    Abstract PDF
    Purpose: This study was performed to evaluate the perception and attitudes of cancer patients regarding medical decision-making. Method: A clinical survey was conducted using questionnaires consisting of 8 items for cancer patients and 11 items for dependents. Both patients and dependents were interviewed. Two hundred and ninety-four people (147 pairs) participated in this survey. The results of the survey were evaluated to see how attitudes concerning medical decision-making differ. Results: The majority of both patients and dependents (more than 90% for each group) gave positive answers to the question of whether the doctor explained the patient’s condition. Also, the majority of both patients and dependents (approximately 90%) were informed about treatment options. Fifty eight percent of the patients and 73% of dependents think that the family is entitled to be informed about the course of treatment and treatment options. In response to the question of which person should decide the course of treatment in the case of disagreement, about 47% of patients and dependents think that the patient should decide, but 14% and 22%, respectively, think that the family should. When making decisions regarding treatment, both patients and dependents consider that improvement in health is the main consideration, followed by the alleviation or avoidance of pain. The lack of information and the pain of the patient are the source of most difficulties. Conclusion: The survey results show that the majority of both cancer patients and their family members think that family members are entitled to be informed of treatment options and have a right to make decisions regarding treatment. The survey also indicates that the majority of patients and family members believe that patients themselves should make treatment decisions in the event of disagreements between patients and family members.
  • 2.

    Attitudes and Practices of Critical Care Physicians in End-of-life Decisions in Korean Intensive Care Units

    SO YOON KIM | 강현희 | Younsuck Koh and 1other persons | 2009, 12(1) | pp.15~28 | number of Cited : 19
    Abstract PDF
    Purpose: This study was performed to evaluate both the attitudes and practices of critical care physicians in Korean ICUs regarding end-of-life care decisions as well as the factors that influence those attitudes and practices. Methods: A questionnaire was developed and delivered to 100 members of the Korean Society of Critical Care Medicine in September 2007. The questionnaire was divided into six parts including personal information, decision-making processes, the withdrawing and withholding of life-sustaining treatment, informed consent, consultation with ethics committees, and guidelines. Results: Eighty eight responses from 53 different institutions were received. The results of the questionnaire include the following. There was a significant difference between the attitude and practices of respondents concerning family consent and patient’s consent. Attitudes toward patient and family consent differed significantly according to the clinical experiences of the respondents (p<.05). There was a significant difference between the attitudes and practices of respondents concerning how often caregivers effectively communicated with patients and family members. Attitudes toward family participation in decision-making processes differed significantly according to the respondents’ gender. There was also a significance difference between the attitudes and practices of respondents regarding the withdrawal of life-sustaining treatment. Attitudes and practices on this issue varied according to the type of ICU where the respondents worked and their medical specialty. Practices concerning informed consent for “do not resuscitate” orders varied significantly according to respondent’s age and type of ICU. Finally, attitudes on the participation of ethics committees in decision-making processes varied significantly according to respondent’s clinical experiences (p<.05). Conclusions: This study found significant differences in the attitudes and practices of critical care physicians in Korean ICUs concerning end-of-life care decisions and the withdrawing and withholding of life-sustaining treatment. The study also found that the factors influencing these attitudes and practices include age, specialty, clinical experiences, and the types of ICU in which physicians work. However, there are some limitations in generalizing these findings.
  • 3.

    Validating the Korean Version of the Preferences for Care near the End of Life (PCEOL-K) Scale

    Yunjung Lee | 김신미 | 2009, 12(1) | pp.29~42 | number of Cited : 14
    Abstract PDF
    The purpose of this study was to validate the Korean version of the Preferences for Care near the End of Life (PCEOL-K) scale. Original items on the PCEOL scale were translated from English into Korean and polished by means of retranslation back into English with editorial supervision by experts. A convenience sample of 247 nursing students participated in the study. Content validity and test-retest reliability tests were performed and descriptive statistics, factor analysis, Cronbach’s alpha and Pearson Correlation Coefficient were utilized. Five factors from the original PCEOL were validated with minor variations. Reliability estimates (internal consistency) for the factors ranged from 0.42 to 0.89. Retest stability estimates for PCEOL-K showed correlations of p=.000 for factor scores over a 2-week interval. As a result, PCEOL-K is a reliable, valid, and useful instrument for evaluating preferences regarding care near the end of life.
  • 4.

    Reflections on the Ethics of Withdrawing Life-prolonging Medical Treatment: The Decision of the Seoul Western District Court

    Dongik Lee | 2009, 12(1) | pp.43~60 | number of Cited : 11
    Abstract PDF
    This article examines the ethical issues involved in a recent decision of the Seoul Western District Court stating that a hospital in Seoul has an obligation to comply with a request made by the family of a 76-year-old female patient to remove the patient from the respirator on which she is dependent. This article defends the following claims concerning this court decision: 1) that removing the respirator from this patient is not a form of euthanasia; 2) that the removal of the respirator does not infringe the patient’s right to treatment; 3) that the free will of the patient may have been respected, even though there was no written consent; and 4) that the court’s decision does not acknowledge the right to death of the patient. The article also examines the concept of death with dignity, since the removal of a respirator that meaninglessly prolongs a patient’s life has implications for a dignified death. When treatment merely delays the time of death, it is more of a source of pain for the patient than it is a form of medical treatment. Hence it is inhumane. However, even in these cases “ordinary treatment” should not be neglected.
  • 5.

    Death with Dignity and Voluntary Passive Euthanasia

    CHOI Kyungsuk | 2009, 12(1) | pp.61~76 | number of Cited : 13
    Abstract PDF
    The concept of “death with dignity” has received a great deal of attention in South Korea recently. While some believe that death with dignity is different from euthanasia, others maintain that it is a form of voluntary passive euthanasia. Medical futility and autonomy clearly play an important role in the moral justification of death with dignity. This article argues for the necessity of introducing a new criterion of medical futility into the classification of euthanasia, for there may be moral differences between medically futile treatment and basic treatment such as antibiotics, hydration, and nutrition. The patient’s views on what constitutes medical futility may also be relevant. One notion of death with dignity examined in this article is the idea of not interfering with “natural death.” This notion of death with dignity is distinct from any form of euthanasia defined as hastening a patient’s death for him/herself. However, as is shown in this article, this notion is impractical due to the vagueness of the concept of “natural death.” Thus, this article defends the claim that death with dignity is a form of euthanasia.
  • 6.

    The Right to Refuse Life-Sustaining Medical Treatment in South Korea: The Case of Ms. Kim

    John M. McGuire | 2009, 12(1) | pp.77~95 | number of Cited : 6
    Abstract PDF
    In North America and elsewhere there exists a legal and ethical consensus concerning the right of patients to refuse life-sustaining treatment and the right of families or other proxies to make such decisions for patients who are themselves unable to do so. This consensus emerged gradually and through several landmark legal rulings, such as those made in the cases of Karen Ann Quinlan and Nancy Cruzan. In South Korea, on the other hand, there is no consensus on the rights of families to make decisions concerning the refusal of life-sustaining treatment on behalf of incompetent patients and, until recently, there was no legal recognition of a patient’s right to refuse life-sustaining treatment. However, the situation in Korea seems to be changing with the recent court rulings in the case of Ms. Kim, a case which may do for medical practice in Korea what the case of Karen Ann Quinlan did for the practice of medicine in the US. This paper makes a contribution to the much-needed consensus-building process in Korea by reviewing some of the landmarks cases in the international right-to-die movement, identifying the key legal and ethical lessons from those cases, and then applying those lessons to the case of Ms. Kim in order to evaluate the decisions that have been made in her case so far and to make further recommendations on what else needs to be done.