This study aimed to validate one of the tools for assessing decision-making capacity: the University of California at San Diego’s Brief Assessment of Capacity to Consent (UBACC), which is composed of a 10-item scale that includes questions focusing on the understanding and appreciation of information concerning research protocol. The subjects in the study were 30 inpatients and 30 outpatients with schizophrenia or schizoaffective disorder and, for comparison, 30 healthy subjects, all of whom received information about a simulated clinical drug trial. Using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR) as a gold standard, inter-rater reliability with intra-class correlation coefficient (ICC) was measured. The ICC for inter-rater reliability ranged from 0.987 to 0.994. The UBACC was found to be a useful and valid instrument for the screening of decision-making capacity before obtaining informed consent. We recommend that it be used not only for schizophrenia patients but also for various vulnerable groups including the elderly or cognitively impaired subjects.
In order to promote the dignity of terminal patients and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The goal of this study was to assess the level of awareness of the guideline among physicians working in intensive care units (ICUs) in Korea and to identify barriers to the application of the guidelines. We surveyed 81 physicians working in ICUs in Korea. 32.1% of respondents were unaware of the guideline and 65.4% of respondents thought that the guidelines were not practical in the context of their ICUs. This study found that the biggest obstacle to the application of the guidelines was the lack of legal support. Ethical reasoning does not often work to resolve issues surrounding EOL care in Korean culture. In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the national health care system, more practical guidelines, and further social consultation are needed.
This survey, which was conducted over the course of 3 months in 2009, was designed to investigate what the medical residents of one university hospital in Seoul think about DNAR orders. A total of 214 out of 468 residents (45.7%) answered the questionnaire. Participants were divided into two groups according to their experiences with taking DNAR order. There was no difference between the two groups on the definition of DNAR, its limitations, and when to issue DNAR orders. However, the two groups showed different opinions concerning who should be consulted in obtaining consent for DNAR and whether or not it was necessary to review DNAR orders. Residents who were experienced in giving DNAR orders felt more inclined to discuss the situation with the patient’s family members rather than the patient herself and thought that DNAR orders would not need to be reconsidered. These differences in opinion may result from the different experiences the two groups of residents had in actually ordering DNAR in the clinical setting. This study shows that more research and discussion is needed in order to establish the limitations and precise definition of DNAR orders.
Purpose: This study examined the knowledge, attitudes, experiences, and educational needs regarding stem cell therapy of nurses in a Korean hospital in order to develop an educational program for stem cell therapy ethics.
Method: A total of 277 nurses participated in this study. The instrument used was a self-reporting Likert-type questionnaire consisting of 35 assumptions related to knowledge and attitudes regarding stem cell therapy and 20 assumptions related to subjects’ characteristics.
Result: For the knowledge level of stem cell therapy, the average score of all subjects was 9.97±4.13. For the attitudes towards stem cell therapy, items receiving positive responses included ‘informed consent’ and ‘oversight and control of stem cell research’; items receiving negative responses included ‘xenotransplantation of hESC’ and ‘cloning of human life.’ Knowledge levels concerning stem cell therapy were influenced by several factors including the following: age, education level, working experience, and need for stem cell education. Nurses who ranked higher in any of these categories tended to have more strict views on the ethical issues associated with stem cell therapy.
Conclusion: Nurses should have the ability to make ethical decisions in clinical situations requiring stem cell therapy. There is a need for well-designed and integrative education programs regarding stem cell therapy for clinical nurses working in Korean hospitals.
This paper examines the current status of, and issues surrounding, stem cell research in Korea. It is noted that ordinary citizens in Korea are being misled into spending large sums of money on unverified claims regarding stem cell research and that procedures are being prepared to protect people from such unverified claims. It is argued that scientists have responsibilities to provide correct information to the public regarding their research results and professional societies should establish a verification system in which the efficacy and safety of stem cell therapy can be assessed accurately. In addition, it is claimed that governmental authorities have a role to play in developing this line research and delivering accurate information on it so that citizens can form more reasonable expectations concerning scientific progress in the area of stem cell research.
Object: The purpose of this study was to identify the attitudes of patients regarding medical error.
Methods: The questionnaires were administrated to 145 college students in Busan, one hundred twenty three usable 123 questionnaires were analyzed. The questionnaires consist of 4 major concepts; 1) knowledge, 2) attitudes toward disclosure of medical error, 3) expectations for doctors' behaviors, 4) barriers to the disclosure of the medical error.
Results: Approximately 92% of respondents supported the immediate disclosure of medical errors, and 62.6% supported full disclosure including near misses. Approximately 57% believed that it would be most effective if doctors themselves communicated errors to patients, while almost 93% said that it was a doctor’s obligation to do so. Regarding reasons for disclosure, 44.7% said that it would reduce doctors’ feelings of guilt, while 45.5% said that it would also increase patient trust for doctors. Respondents also thought that the barriers to the full disclosure of medical errors were (1) damaged reputations (30.9%), (2) worries about medical lawsuits (22.8%), and (3) professional discipline (22.0%).
Conclusion: Most of the participants in this survey support the immediate disclosure of medical errors regardless of the seriousness of the error. Furthermore the participants regarded disclosure of medical error as doctors' obligation. In order to meet the patients' high expectation regarding the medical error, this might be a good time for us to find a way to close the gap between patients' expectation and doctors' current practice.
Physicians have both an ethical obligation and a right to participate in continuing medical education (CME) programs to constantly maintain and upgrade their knowledge and skills after the completion of their formal education. CME is the pharmaceutical industry’s most important marketing tool. CME is increasingly being funded by the pharmaceutical industry; currently the financial support from drug and device companies accounts for up to 60% of the costs of all accredited CME programs in the U.S. CME requirements for Korean physicians are somewhat lax at the present time, but industry sponsored CME is on the rise in Korea. With the increase in industry funded CME, there is cause for concern about potential conflicts of interest, scientific biases, and the educational quality of industry-funded CME. Physicians’ reliance on industry-funded CME has the potential to influence negatively their clinical decisions and to increase spending on prescription drugs. For these reasons, a growing number of medical institutions in the U.S. have limited or phased-out industry sponsorship of CME at their institutions. This article argues that in order to ensure the professional integrity of physicians and the process of learning in CME, physicians and pharmaceutical industries need more explicit codes of conduct and guidelines. Individual doctors should recognize the potential for the industry to influence their prescribing habits and follow the ethical principles of physician-industry relationships. Also, in order to better balance learning needs and patient concerns, physicians should have the information and skills required to make informed decisions in CME.
This article examines the influence of physician-pharmaceutical industry interaction upon medical research. We analyze some of the problems arising from pharmaceutical companies’ sponsorship of clinical trials, such as biased results caused by multiple trials with predictable outcomes and publication biases. Furthermore, we propose specific measures to address and overcome these problems.
Physician-pharmaceutical industry interaction (PPII) is ubiquitous in medical research, education, and clinical care. Conflicts of interest, which occur in the interaction, are to be properly managed at the level of the health care institution as well as at the level of individual health care personnel. The purpose of that management is to control conflicts of interest to the maximum extent possible, thereby preserving the value of public trust. Public trust is founded on the principle of prioritizing patients’ interests. Founding principles of COI management are based on public trust, professional integrity, and publicity. With these founding principles the relevant stakeholders (the pharmaceutical industry, physicians, medical care institutions, and the general public) should make continuous efforts to manage COI appropriately. Above all, the awareness of influences is essential among those stakeholders. This article argues that medical professionals should appreciate and protect the value of professional integrity and that medical organizations and institutions should establish reasonable policies of COI management, including the constitution of COICs (conflicts of interest committees) and education programs. Furthermore, it is claimed that society as a whole shares the responsibility of providing an appropriate health care environment by compensating heath care providers with adequate payment in order to avoid inappropriate PPII development. Without providing reasonable health care reimbursement, legal restrictions designed to control inappropriate PPII maAy not achieve their goal.
The recently revised “Medical Law” in Korea gives rise to at least three questions. First, should doctors be subject to criminal punishment on the grounds that that the “Monopoly Regulation and Fair Trade Act” has not been effective in regulating the circulation of medicine and medical supplies? Second, will the provision of dual punishment in the new law achieve the desired results? Third, will social justice and ethics be promoted through the threat of criminal punishment? In this article we address these questions and argue for the following claims: (1) that the provision of dual punishment in the new law is illegitimate from a jurisprudential point of view, (2) that the provision of dual punishment will impede medical progress, and (3) that the tyranny of the majority and the problem of procedure in lawmaking will hinder the establishment of political justice and respect for the rule of law in Korea. The overall view defended in this article is that doctors and professional medical organizations should be granted autonomy in developing codes of conduct and professional ethics to regulate and promote the practice of medicine in Korea.