In this article casuistical deliberation is explained and examined in regards to whether or not it is suitable for clinical ethics deliberation. Casuistry is the analysis of moral issues using reasoning based on paradigms and analogies. Such case-based reasoning leads to the formation of expert opinions about moral obligations that are general but not universal or invariable. Casuists try to give guidance in cases in which no clear ethical principles can be applied and to categorize cases into paradigms and maxims. This article provides a casuistical analysis of a clinical case and argues that casuistical deliberation is an effective means of giving guidance on clinical ethics to clients.
Personal relationships between doctors and patients are essential for effective treatment.
Optimal care is possible only when there is trust between the doctor and patient. In recent years, disputes between healthcare providers and patients have been increasing. In particular, there have been disputes related to the sexual harassment of patients during physical examinations, causing harm to doctor-patient relationships. Fundamental measures are needed to deal with these disputes. In some countries, such disputes are prevented by means of a chaperone system that helps to establish trust between the doctor and the patient. With the chaperone system, when a doctor conducts a physical examination of a patient, an assistant helps with the examination or is present during the examination. When the chaperone system is used, communication between the doctor and the patient is enhanced, thereby reducing the chances of legal disputes. This article argues that a chaperone system with detailed guidelines is needed in South Korea in order to ensure patient safety and effective treatment, especially for gynecological and other intrusive physical examinations.
Purpose: The purpose of this study was to identify the levels of the preferences for care near the end of life-korean version(PCEOL-K) and factors affecting the PCEOL-K among nurses and physicians.
Methods: A descriptive study was conducted with 407 nurses and physicians working in general hospital and university hospital, Daegu and Busan. Data were collected through selfreported questionnaires from June to September, 2010. Data were analyzed using the Pearson’s Correlation Coefficient, t-test, ANOVA, Turkey’s HSD, and multiple regression with SPSS/WIN 15.0.
Results: The mean score of PCEOL-K was 69.03±5.48 for nurses and 68.69±7.15 for physicians.Factors predicting subjects’ PCEOL-K were clinical experience, fear of death, and the personal meaning of death. These factors explained 40.0% of the PCEOL-K (F=21.00, p<.001).
Conclusion: The results of this study suggest that the construction of comprehensive framework for nurses and physicians in relation to end-of-life care may contribute to improved positive preferences for care near the end of life by encouraging their professional careers and spirituality.
The purpose of this descriptive study was to examine the moral sensitivity and moral distress among clinical nurses in South Korea. Data were collected from 361 nurses between March and April 2009 using the following self-reported questionnaire: the Moral Sensitivity Questionnaire(Han, et al., 2009) and the Nurses’ Moral Distress Measurement Tool(Yu, 2003). An SAS program(version 9.1) was used to analyze the data by means of a t-test, ANOVA, and Scheffé test. The mean score of moral sensitivity was 5.13, and the sub-domain of patient-oriented care had the highest score (5.69). The mean score of moral distress was 2.89, and the emotional subdomain had the highest score (3.65). Scores for other sub-domains of moral distress were as follows: recognizable distress (2.94), situational distress (2.86), and behavioral distress (2.67).
Moral distress was significantly higher among the nurses who had education beyond the postgraduate level, clinical practice of 3-5 years, working experience in the emergency room, ethics education at a clinic, or experience in moral dilemma. The positive relationship between nurses’ moral sensitivity and moral distress were relatively weak. Future research needs to explore the factors that could have an effect on between nurses’ moral sensitivity and distress.
Xenotransplantation research raises a number of ethical issues, such as a possible outbreak of new/zoonotic infection, violating an individual’s privacy, and harm to the animals (especially to onhuman primates) that are used in experiments. Since 2004, xenotransplantation researchers and doctors associated with the Xenotransplantation Research Center (XRC) have been receiving education related to the ethical issues involved in xenotransplantation research at least twice per year. Learners’ attitudes toward xenotransplantation have been investigated three times: in 2004, 2007, and 2010. The objective of this study was to discover the changes in learners’ attitudes toward xenotransplantation issues and to identify the best form of ethics education for xenotransplantation researchers. The Ethics Education for Researchers provided to XRC associates since 2005 has involved seven units on laws and regulations, nine units on general ethical issues, five units on the ethics of animal research, and ten units on laboratory management and ethics. To the question concerning the justifiability of xenotransplantation research, 100 percent of respondents answered “Yes, it is justifiable” in 2004. However, the proportion of positive responses decreased to 90.9% in 2007 and 86.2% in 2009. The proportion of respondents who considered “the risk of zoonosis” and “lack of established legal framework” as top-priority projects has increased. The preferred educational method was “case-based study.” After receiving the Ethics Education for Researchers, researchers tended to be more conscious of the ethical issues raised by xenotransplantation research. This study suggests a need for mandatory ethics education for xenotransplantation researchers using a variety of educational methods.