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2012, Vol.15, No.1

  • 1.

    QALY and the Ethical Debates over the Allocation of Health Care Resources

    Jeong Changrok | 2012, 15(1) | pp.1~23 | number of Cited : 8
    Abstract PDF
    The purposes of this article are to examine the ethical issues surrounding the concept of quality-adjusted life year (QALY) and to determine what criteria should be used for distributing medical resources. The article examines the views of John Harris, Peter Singer, and Norman Daniels, and argues that the fairness of the process is more important than the legitimacy of the result in distributing medical resources. The argument is based on the belief that each individual life is important as well as the fact that results are often unpredictable. However, it is also noted that too much emphasis on the fairness of the process can result in a waste of medical resources.
  • 2.

    Cardiopulmonary Criteria for Organ Procurement: An Analysis of the First Case of the Pittsburgh Protocol

    KIM Janghan | 2012, 15(1) | pp.24~33 | number of Cited : 0
    Abstract PDF
    While organ transplantation is accepted medical practice, it is hampered by the shortage of available donor organs. In an attempt to resolve the imbalance between the supply of, and demand for, organs for transplantation, a non-heart beating donor (NHBD) program was started by the University of Pittsburgh Medical Center in 1992. While this program has had desirable patient outcomes, concerns have been raised that it may jeopardize professional and public confidence in the field. This article examines the clinical, ethical, and legal issues in organ transplantation with a focus on the first case of the NHBD program at the University of Pittsburgh Medical Center. The article also considers what implications this case might have for organ transplantation in Korea. It is argued that the public, law enforcement agencies, and the media in Korea should assist the medical community in making explicit regulations that are medically, ethically, and legally defensible.
  • 3.

    Understanding the Experiences of Family Members Who Make Do-Not-Resuscitate Decisions for Cancer Patients

    옥정휘 | Yi, Myungsun | 2012, 15(1) | pp.34~51 | number of Cited : 7
    Abstract PDF
    The purpose of the study was to understand the experiences of family members of who made do-notresuscitate(DNR) decisions for patients with cancer. A phenomenological approach was used to understand and describe the decision-making experiences of such family members. The data were collected by individual in-depth interviews from six participants at their homes. All interviews were audio-taped and transcribed for later analysis. The data were analyzed using Colaizzi’s method to extract the major themes that describe the essence of the DNR experience. Upon analysis eight themes emerged: commitment to become a primary caregiver; painful acceptance of the impending death of the patient: DNR as a sentence to death; the intensive care room as a place of execution; discreet DNR decisions made for the patient’s comfortable death; DNR decisions made urgently without preparation; being alone with the dying patient; feelings of guilt and lingering attachment to the death of a patient. These themes characterize the DNR decision-making experiences of family members. The results of this study should assist oncology professionals and others in the understanding of family members who make DNR decisions on behalf of cancer patients.
  • 4.

    Korean College Students’ Attitudes and Preferences Toward Shared Decision-Making between Patients and Physicians

    이수현 | Heungsik Han | CHANG CHULHUN and 2other persons | 2012, 15(1) | pp.52~69 | number of Cited : 1
    Abstract PDF
    Purpose: The purpose of this study was to examine Korean college students’ attitudes and preferences toward shared decision-making (SDM). Methods: Questionnaires were collected from 142 college students in Korea. Subjects were asked about four main items: (1) attitudes toward SDM; (2) experiences with SDM; (3) preferences for treatment decision-making for four diseases; (4) barriers to SDM. Results: It was found that 78% of the participants had never heard of SDM and 61% indicated that the doctor-patient relationship is paternalistic. The majority of subjects believed that the final treatment decision should be made by doctors and patients together. While 39% of subjects said that their doctors had asked them to participate in treatment decision-making, only 10% of subjects felt that their doctors actually wanted them to participate in SDM. The type of disease in question had no effect on the subjects’ preferences for treatment decisionmaking; all subjects expressed a preference for playing a collaborative role in the decisionmaking process. Furthermore, subjects believed that when patients and physicians disagree on treatment options, patient preferences should take precedence. Finally, subjects indicated that the main factors impeding SDM are (a) a lack of information about prognosis (28%), (b)beliefs about doctors’ sole authority for treatment decision (25%), (c) the lack of consultation time with doctors (19%), (d) the difficulties of understanding medical terms, and (e) the scarcity of available opportunities for participation in SDM. Conclusion: Although most subjects in this study were not familiar with SDM, they showed high preferences for it. Additionally, subjects did not feel that their doctors often used shared decision making. Physicians in Korea should make greater efforts to engage in SDM with their patients.
  • 5.

    Experiences Using Peer Assessment on Small Group Discussions in Medical Ethics

    CHEONG Yoo-Seock | 2012, 15(1) | pp.70~77 | number of Cited : 1
    Abstract PDF
    Purpose: While peer-assessment (PA) is not new in higher education, it is not commonly used in medical schools in Korea. PA has been suggested as a method to enhance self-directed learning in various fields of education, but whether it actually improves performance is unclear. This study evaluated the impact of peer-assessment on small group discussions in medical ethics classes, and attempted to determine the suitability of PA for the evaluation of medical students. Methods: A questionnaire was developed consisting of 6 questions concerning students’ opinions of PA results. The surveyed was administered in 2010 and 2011 to fifth-year medical students at one medical college in South Korea; the participating students had recently performed PA at the end of a course in medical ethics. Student scores within groups were compared with their satisfaction with the PA results, opinions about PA, and opinions about the burdens of doing PA. Students were also asked to indicate what percentage of their PA scores they would want to contribute to their overall grades in the course. Results: A total of 91 students (82.4% male) participated in the survey. The average satisfaction score of the PA results is 6.32(±2.88) out of 10. A statistically significant correlation was found between students’ final PA scores and their levels of satisfaction with the PA (r=-0.471, p=0.000), their agreement with PA procedure (r=0.515, p=0.000), and the burden they experienced in doing PA (r=-0.312, p=0.000). On average, subjects thought that the PA should constitute about 24.5% of their final grade in the course. Conclusion: PA is promising as an alternative method of evaluating students’ contributions within small group discussions in medical ethics curricula. Further work is required to understand how PA can be used more effectively to enhance the learning experience.
  • 6.

    A Comparison of First-Year and Senior Nursing Students’ Ethical Values and Understanding of Biomedical Ethics

    Kim, Eun Hee | LEE, EUN JOO | 2012, 15(1) | pp.78~95 | number of Cited : 25
    Abstract PDF
    The purposes of this study were, first, to identify whether the clinical experience of nursing students influences their ethical values and, secondly, to determine what factors influence the understanding of biomedical ethics. A total of 811 nursing students (355 students with clinical practical experience [CPE]; 476 students with no clinical practice [NCP]) were recruited from six different BSN programs in one city in South Korea. Data were analyzed using descriptive statistics, a χ²-test, a t-test, a one-way ANOVA, and a Scheffé test using the SPSS/WIN 17.0 program. Comparing the differences in the values or ethical attitudes of the two groups, NCP students were found to have a more deontological orientation (2.76 for CPE students; 2.81 for NCP students). There were statistically significant differences between the responses of the two groups in the following areas: the right to life of a fetus, the right to life of newborns, artificial abortion, and brain death. For the NCP students, the predicting variables were the following: ethical values, club participation, and source for information or knowledge of biomedical ethics. On the basis of these results, it is argued that the clinical experience of nursing students should be regarded as an important factor inthe development of educational programs in biomedical ethics for nursing students
  • 7.

    Biobank and Broad Consent

    KIM Moon-Jeong | 2012, 15(1) | pp.96~111 | number of Cited : 1
    Abstract PDF
    The biobank, which is recently pursued by many countries, is supposed to play an important role for the development of the Biomedical science. Thus, I argue that there are a number of important ethical issues needed to be examined for the successful operation of the biobank. Especially, I've focused on “informed consent”, which is fundamental ethical norm in protecting donors' safety and right. But the informed consent for the biobank has to be quite “broad” due to the intrinsically uncertain nature of the future research related to it, and social, for the unique characteristics of genetic information. Therefore the focus of this study is to examine “broad consent” as an alternative approach for protecting of sujects safety and right in using human biological materials and personal medical information.