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pISSN : 2005-8284 / eISSN : 2234-3598

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2010, Vol.13, No.1

  • 1.

    A Study of the Attitudes of Patients, Family Members, and Physicians toward the Withdrawal of Medical Treatment for Terminal Patients in Korea

    KWON Ivo | Younsuck Koh | Yun, Young Ho and 6other persons | 2010, 13(1) | pp.1~16 | number of Cited : 50
    Abstract PDF
    A survey was conducted from September to December 2008 to examine the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients and other related issues. The subjects for the study were 91 cancer patients, 96 family members of cancer or other terminally ill patients, and 140 physicians. Most subjects acknowledge the need for an appropriate regulatory framework for the withdrawal of treatment for terminal patients. However, some discrepancies were found among the different groups (patients, family members, physicians) in this study. Patients showed a stronger preference for the withdrawal of treatment than did family members. Also, most patients claimed they wanted to receive the diagnosis of a terminal illness from their physician, while most family members seem to think it is their own duty to convey such a diagnosis to the patient. Both groups prefer co-decision-making about the withdrawal of treatment over individual decision-making by the patient. However, most family members admit that they do not know much about the patient’s wishes and lack the time for sufficient conversation with the patient. Physicians are skeptical of the authenticity of the decisions made by family members, and some physicians also regard hospital ethics committees as being ineffective for resolving these issues. The results of this study paint a unique picture of clinical culture in Korea, where family members still exert strong influence on clinical decision-making and little information is shared between patients, family members, and physicians. The study points to a need for greater public education in Korea on the practical and ethical issues surrounding the withdrawal of treatment for terminal patients.
  • 2.

    The Limits of Medical Care and the Termination of Life-Sustaining Treatment

    안용항 | 김혜정 | 2010, 13(1) | pp.17~28 | number of Cited : 11
    Abstract PDF
    On May 21, 2009, the Supreme Court of Korea ruled that patients have the right to terminate medically meaningless treatment upon confirmation that their terminal illness is indeed irreversible. The Supreme Court’s decision thus makes proof of the irreversibility of a patient’s condition an important process in legitimatizing a patient’s decision to terminate life-sustaining treatment. However, since medical practice rejects explanations in terms of “essences” and is affected by issues of subjectivity, we argue that physicians cannot give indisputable confirmation of the irreversibility of a patient’s terminal illness, as required by the Supreme Court’s ruling.
  • 3.

    Advance Directives and Proxy Decision-making

    KIM Shinmi | 2010, 13(1) | pp.29~42 | number of Cited : 4
    Abstract PDF
    The purpose of this study was to explore the main features of proxy decision-making in advance directives. Fifty-three advance directive documents from the US, New Zealand, and Korea were retrieved through database searches and then analyzed. The following eight distinctive categories concerning proxy decision-making were identified: 1) establishment of proxy authority; 2) certification of proxy authority; 3) extent of proxy authority; 4) qualifications for proxies; 5) legal validity of proxy documents; 6) period of proxy authority; 7) revocation of proxy authority; and 8) exceptional regulations. It is pointed out in this article that prior to the regulation of proxy decision-making in Korea, relevant experts should consider each of the eight elements listed above and articulate clear guidelines for proxy decision-making.
  • 4.

    Evaluating the Quality of Informed Consent in Clinical Research

    Jeong Ihnsook | 손지홍 | Jae-Gook Shin | 2010, 13(1) | pp.43~58 | number of Cited : 10
    Abstract PDF
    This study was designed to assess the quality of the informed consent process in clinical research by measuring subjects’ understanding of informed consent. A convenience sample of 188 subjects aged 20 and above participated in bioequivalence studies at the Inje regional clinical trial center in Busan (South Korea). The study instruments were self-reported questionnaires, which were modified versions of the Quality of IC (QuIC) questionnaire developed by Joffe et al. (2001) and the Informed Consent Questionnaire-4 items (ICQ-4) developed by Guarino et al. (2006). The data were collected from February to May, 2007 and analyzed with descriptive statistics to assess the quality of the informed consent process and also with a t-test, X2 test, and paired t-test to identify correlates of increased understanding of informed consent. Prior to the subjects’ participation in these clinical trials, the mean QuIC objective knowledge score (QuIC-A) was 68.7 points (maximum: 100 points) and the perceived (subjective) understanding score (QuIC-B) was 78.7; after the clinical trials were completed, the mean scores for (QuIC-A) and (QuIC-B) were 68.7 and 80.4 respectively. The general quality of informed consent (ICQ-4) was measured after the clinical trials were completed; the score was 78.3 points (maximum: 100 points). Higher objective knowledge (QuIC-A) scores were associated with age (25 years old and above, p=0.043), and education (college and above, p=0.001). Higher QuIC-B scores were associated with previous experience with clinical trials (p=0.028) and memorization of the date of the signed consent (p=0.037). The quality of informed consent measured in this study is significantly lower than that reported in similar studies conducted in the US and Australia. Thus, this study suggests that it is there is a need to develop strategies to improve subjects’ understanding of informed consent.
  • 5.

    Preconditions for the Development of Global Bioethics Policies: What Purpose, Attitude, Effort, and System are needed?

    CHOI Kyungsuk | 2010, 13(1) | pp.59~71 | number of Cited : 0
    Abstract PDF
    혹자는 <생물학 및 의학 적용에 있어 인권과 인간존엄 보호를 위한 EU 협약>의 한계를 지적하며, 생명윤리 쟁점들에 대한 지구촌 정책은 모호함과 비일관성을 지니고 있다고 주장한다. 그러나 의·생명과학 연구의 세계화와 그에 따른 생명윤리 쟁점의 세계화로 인해, 지구촌 차원의 생명윤리정책을 개발할 필요성이 대두되고 있다. 지구촌 생명윤리정책은 중첩적 합의에 기초하여 개발될 수 있다. 중첩적 합의는 모든 사회 구성원들 사이에서 의견의 일치를 보이는 견해로서 생명윤리문제를 다룸에 있어 최소한의 기준을 제공해 준다. 뿐만 아니라 지구촌 생명윤리정책은 생명윤리에서 우리가 추구하는 이상과 가치가 무엇인지 알게 해 준다. 이런 점에서 지구촌 생명윤리정책은 윤리적 관점에서 일종의 구속력을 행사한다. 이러한 지구촌 생명윤리정책을 개발하기 위해서는 관용과‘이성적임(reasonableness)’이란 태도를 요구한다. 이것들은 이성적 불일치가 종종 목격되는 다원주의 사회에서 우리들이 견지해야 할 덕으로 간주된다. 생명윤리정책의 개발에 있어 토론과 토의는 필수적이다. 왜냐하면 토론과 토의는 무엇이 이성적 불일치를 야기하는지 알려주고 이견을 지닌 사람들 서로를 이해하는 데 도움을 주기 때문이다. 또한 우리는 하나의 학제적 학문 분야로서‘생명윤리정책’을 연구하고, 문화적 차이를 고려하며 생명윤리문제를 연구하는 문화 생명윤리학 연구를 증진해야 한다. 새로운 학문분야로서의 생명윤리정책은 생명윤리의 쟁점에 대한 개인적 차원의 윤리적 해답을 얻는 데 그치지 않고, 사회적 차원의, 나아가 지구촌 차원의 해답으로서 무엇이 바람직한지 연구한다. 아울러 지구촌 생명윤리정책 개발을 위해 우리는 국제적 의사결정기구, 국가간 전문가들 사이의 네트워크, 토론을 위한 정기회의 개최 등의 협력 체계를 구축해야 한다.