KJC Korea
Journal Central

Informed consent has problems with readability, length, complexity, and so on. On the one hand, rigid requirements related to informed consent discourage subjects to participate experiment. On the other hand, it distracts from more serious ethical problems in clinical research such as decision-making capacity. Recently, there is increasing evidence that some proportion of the population has difficulties with decision-making capacity. Therefore, the neuropsychological tests associated with decision making are needed before giving valid informed consent. The decision making related to informed consent can be described by the interplay between emotional and cognitive functions. How can we investigate this empirically? An appropriate scale measuring neuropsychological function in informed consent should include both cognitive and emotional abilities. Nowadays, the MacArthur Competence Assessment Tool(MacCAT) was widely used. But it relies predominantly on cognitive abilities such as understanding, appreciation, reasoning, and expression of choice. Considering recent empirical studies, the inclusion of emotional abilities in relation to decision-making seems to be essential. Iowa Gambling Task (IGT) requires emotional function as well as cognitive function to perform proper decision-making. Thus, it would be necessary to administer both the MacCAT and the IGT in people who have deficits in decision making and in giving valid or invalid informed consent.

The problem of generational justice in modern welfare states is how to equitably distribute social burdens and benefits of the welfare system across generations in a society. Because of the aging of society, however, contributors to the welfare system got fewer whereas beneficiaries from the welfare system got more. In the 1980's, 'liberal' welfare institutions seemed to fail to maintain generational equity so that 'liberal' welfare institutions, and 'liberalism' itself were harshly criticized. Against these criticisms, Daniels proposed a liberal theory of generation justice, 'prudential life-span account'. In this paper, I try to provide its adequate understanding and defend it. To achieve my aim, I clarify its horizontal and vertical contexts and draw its theoretical and practical implications. Actually, the problem of 'generational justice' is not one, but two problems which are 'justice between age groups' and 'justice between birth cohorts'. Justice between age groups is typically understood as a problem of interpersonal distribution. Considering the fact that we all age, it should be understood as a problem of interpersonal distribution. So understood, the guiding principle of justice between age groups is the principle of prudence which is adequately framed. Regarding justice between birth cohorts, all birth cohorts have to solve the problem of justice between age groups and the only sustainable solution is to maintain a stable transfer system between young and old generations. To maintain this transfer system, co-existing birth cohorts should make benefit ratios approximate to equality. After clarifying 'prudential life-span account, I defend it from Mckerlie's criticism.

Recent advances in the development of biotechnology have led to the creation of a variety of organisms, named part-human animals, with both human and animal components. Scientists have created part-human animals that have both human cells and animal cells in their body. I want to avoid the term 'chimera' and 'hybrid' because of using both creation methods of chimeras and hybrids in making part-human animals. The part-human animals might hold enormous potential for clinical application as well as basic research into human physiology. Despite its potential, however, the progression of part-human animal research has given rise to many ethical concerns. The arguments against the creation of part-human animals are related to the concerns about human dignity and moral confusion and also the crossing and violating of the “species boundary” are morally repugnant and wrong. For these reason, we found that the public's negative attitudes toward making part-human animals, We should know that part-human animals research is required the deeply consideration.

It is uncontroversial that human body parts, including human material, are physical beings. However, they seem to be treated not just as physical objects but as those of a special kind. There seems to be some ontological characters of human body parts that explain why we tend to feel uncomfortable or unpleasant when those parts are treated in certain ways that will be introduced in this paper. This paper explores the ontological characters of human body parts by means of comparison with other physical beings that also cannot be explained by reductive materialism-that is, human beings and works of art. For this goal, I examine Dworkin’s discussion of the sanctity of human life-based on the concept of ‘creative investment’- and Margolis’ analysis of the ontology of artworks-based on the concept of ‘cultural emergence’. The insight that each of these can offer as well as the applicability of these to human body parts will be discussed.

Physicians come face to face with many crises concerning the medical decision making. Apart from medical problems, they have to consider patient’s personal needs, social ethics and law. Because physician-patient relationship changed from doctor-centered to cooperation-based like shared decision making. Meanwhile the conflicts between patients and doctors are growing all the time, since each patient has to bear a socioeconomic cost of disease. Therefore, the approach by ethics and law is needed to solve their problem, for example, hospital ethics committee. In conclusion, the medical decision making process is an outcome from the interaction with three forces : medical opinion of doctor, personal needs of patient and limitation of society like law and ethics. This article shed light on these three main forces and propose practice model.

Although the Korean Pharmaceutical Manufacturers Association's Promotion Code has actual binding power over the medical community, the pharmaceutical industry and the medical community currently have cast their doubtful and skeptical eyes on the Code's legitimacy and efficacy. It is undeniable that the Code has many intrinsic problems such as the absence of provision allowing physicians' consultations and lectures, the unrealistic case number and compensation allowed in post marketing surveillance and the ambiguity of clinical trials provision. It's notable that such problems are not found in the United States or Japanese pharmaceutical promotion codes. In this context, it is highly needed to revise the provisions of the Code containing such problems in order to enhance the legitimacy of the Code.

Medical care largely depends on developments of medical sciences and technologies. Development of innovative medical procedure have to be based on medical evidence. And ethical climate among individual physicians, academic societies, specialists' organization, and healthcare institution which applies the procedure is as much critical as the ethical stance of the developer. Therefore, it is necessary to make decisions on clinical application and evaluation, social costs and benefits, reimbursement through rational procedure and standards taking into account issues like medical evidence and conflict of interests. Especially, in the case of innovative surgical and surgico-medical procedure, the adoption has almost been up to non-formal studies until recently. Formal review process based on basic principles of biomedical research ethics and evidence-based medicine, is to be proposed for development of innovative surgical and medical procedures. And this process is to be an integral part of biomedical technology assessment and ethical regulation. This paper suggests an ethical guideline for ethical review and evaluation of a new medical procedure from its initial attempt to clinical application. Though focused on innovations, this suggested guideline is also applicable to a new medical procedure. The paper consists of four parts. Firstly, it outlines the general discussion about surgical innovations from the ethical viewpoint. Secondly, prior researches about the need of guideline are reviewed. Thirdly, under this background, basic principles for process of review and evaluation, and fourthly, the very process is proposed. Lastly, the further suggestions in connection with health care policy are given.

This study was conducted over 1 month in 2012 to investigate doctors` attitude towards organ donation in brain death patient after restoration of spontaneous circulation from cardiac arrest. A total of 107 residents and staffs were answered the questionnaire. Participants were selected from departments that frequently involved in managing brain death patients after cardiac arrest. More than 50% responders had an experience of managing brain death patient after cardiac arrest. However they still had difficulties in making a decision whether their patient was brain death or not, suggesting organ donation to brain death patient`s family members. To improve results of organ donation from brain death patient after cardiac arrest, further education and attitude change of doctors who are in charge of taking care of those patinets will be needed.

The purpose of this study is to understand the personal meaning of death through the health personnel's death metaphor. Methods: A qualitative study design was utilized. Data were collected from the clinical experiences of physicians, nurses, and paramedics. Data were analyzed with qualitative content analysis. The texts were essays written by 43 health care personals about the impressions on death through their clinical experience. Results: There were three themes and fourteen theme clusters classified. The three themes that emerged were: death of human body as a medical failure; death as an occupational neutrality and controled emotion; and conversed death from a bad habit. Conclusion: The findings suggest a number of themes that health personnel's reported about meaning of death experiences through death metaphor that could be explored as a way of improving end-of-life care.