Progress in biomedical technology has resulted in a number of patients experiencing painfully slow deaths by means of artificial ventilators or other inhumane treatments. Such experiences give rise to the question of whether it is right to provide these life-sustaining treatments when no effective or curative therapies are available. The purpose of this study is to examine respective views on this issue given by criminal law experts, the courts, medical professionals, and the public. In Korea, there is still disagreement on the definition of the terms “euthanasia” and “death with dignity.” The current criminal law prohibits euthanasia for a dying patient with incurable disease and the withdrawal of life-sustaining treatment for a patient in a persistent vegetative state (PVS). However, a group of judicial and bioethics experts and policy-makers think that euthanasia or the withdrawal of life-sustaining treatment can be permitted under certain conditions. A recent court decision, which permitted the withdrawal of life-sustaining treatment on a PVS patient based on the patient’s right to self-determination and medical futility has stimulated a nationwide discussion for developing a legal framework for dealing with this issue. However, this article argues that care is needed in drafting the appropriate legislation as many unsolved problems related to this issue remain.
The question of what is a “good” and “dignified” death for a terminally ill patient is difficult to answer. The Code of Medical Ethics of the Korean Medical Association forbids physicians from participating in euthanasia. The code also approves of the withholding or withdrawal of life-sustaining medical treatment in certain conditions. Most legal experts seem to believe that while active and direct euthanasia is not permissible, passive euthanasia or “death with dignity” is acceptable. Indirect euthanasia as an anticipated side-effect, in which the patient dies as a result of analgesic treatment administered to alleviate pain, is legally permitted. There are various considerations that help to justify indirect euthanasia, such as the absence of an intention to murder and its acceptance as a form of permitted risk. This article examines some of the legal and ethical issues associated with indirect euthanasia and intended acts of willful negligence.
Purpose: The purposes of this study were a) to examine the level of awareness among patients of their right to know and their right to self-determination, and b) to determine the relationship between patients’ awareness of these two rights. Method: For this descriptive-correlational study, participants were recruited at the endoscopic examination rooms of two university hospitals. Responses to self-report questionnaires were collected from 236 participants from 20 December 2007 to 10 November 2008. Results: On the basis of a five-point scale, the average scores were 3.67 for patients’ awareness of their right to know and 2.81 for their awareness of their right to self-determination. The relationship between their awareness of these two rights was not significant. The recognition of a patient’s right to know was higher among those with a college education. Awareness of a patient’s right to self-determination varied according to age, education level, and economic status. Conclusion: There is an insufficient awareness among patients of their rights to know and to self-determination, especially for those with a lower education. Nurses should consider a patient’s right to know when providing medical treatment and to assist their right to self-determination. Systematic educational programs on patients’ rights need to be developed for both patients and medical personnel.
This article examines some of the legal issues associated with consent and the competence of minors. A study was designed to evaluate the self-decisions of competent minors who are regarded as vulnerable subjects. The study begins with the Grimes Case (Grimes versus Kennedy Krieger Institute, Inc., 2001), which has established some special relationship between research institutes and human subjects. Since minors do not have the legal competence to complete a contract without the consent of their parents there is a conflict between the consent of parents as guardians and that of minors as self-decision makers. This article argues that the self-decisions of competent minors should take precedence over parental rights and that the authority of parents should be restricted. The article discusses the role of IRBs in protecting the consent of the competent minors.
This study was performed to evaluate the efficacy of ethics education on nursing students. The study used the Korean version of the Defining Issues Test (DIT) and a nonequivalent control group, pretest-posttest design. Sixty-one nursing students were assigned to either an experimental (n=35) or control (n=26) group. Students who scored higher than the mean were classified as high-level students, while those who scored lower than the mean were classified as low-level students. The efficacy of ethics education on nursing students was not identified in the experimental and control groups but was partially identified in the higher and the lower moral judgment subgroups. P scores turned out to be more suitable than 4 stage scores in evaluating the efficacy of ethics education on undergraduate nursing students. It is concluded that ethics education does have an effect on nursing students’ moral judgment. Further research is needed to explain why 4 stage scores were raised for members of the lower moral judgment subgroup and to determine the effect of the field practices of nursing students on their moral judgment.
The increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and medical institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. When CAM and conventional medical therapies intersect, there is the potential for serious physician–patient conflicts as well as harm to patients. Some CAM therapies in and of themselves can be hazardous, but harm can also occur indirectly when patients choose less effective CAM treatments instead of conventional methods that have demonstrated efficacy. Physician–patient conflicts arising from issues related to CAM therapies are common, but the physician-patient relationship is more likely to remain intact if physicians are willing to engage creatively with patients when problems seem unsolvable. Even in the absence of scientific evidence for CAM therapies, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to clarify the patient’s core values and beliefs when counseling about CAM therapies. The commitment to joint problem-solving over time, which is a central obligation of the physician–patient relationship, becomes even more important when considering the use of CAM therapies. A long-standing, carefully nurtured partnership between a physician and a patient that has grown over time may be strained or completely destroyed if common ground in such situations cannot be found. The way forward for physicians involves not only preventing negligence and fraud, but also facilitating therapeutic exchanges between various healthcare providers and their patients. The use of case-based reasoning in questions of CAM therapy allows a fuller appreciation of the way in which circumstances play an intrinsic role in moral judgments. This paper presents two prototypical cases that illustrate the challenges already discussed as well as other ethical challenges that will arise as CAM therapies gain popularity in Korea.