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pISSN : 2005-8284 / eISSN : 2234-3598

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2014, Vol.17, No.3

  • 1.

    Understanding of Informed Consent and Decisional Regret among Participants in Cardiology Clinical Trials

    윤은화 | Kim Jung Soon | Jeong Ihnsook | 2014, 17(3) | pp.237~252 | number of Cited : 5
    Abstract PDF
    This study was aimed to identify the objective understanding (OU) and subjective understanding (SU) of the informed consent and decisional regret (DR) and to determine the related factors to them in the cardiology clinical trials. The participants were 60 patients participating in the phase III clinical trials. Data was collected after giving informed consent form for OU and SU of the informed consent and 4 weeks after participating in the clinical trials for DR using self-reported questionnaires. Mean of OU, SU, and DR were 74.6, 58.6 and 42.9 based on 100 points, respectively. The predictors of OU were reading informed consent repeatedly (p=0.004), higher education than middle school (p<0.001), and time to giving information to consenting (p=0.034), and these variables explained 45.3% of OU variation. The predictors of SU were giving information by research nurses (p=0.025), higher education than middle school (p<0.001), making question before consenting (p=0.035), and these variables explained 48.8% of SU variation. The predictors of DR were giving information by research nurses (p=0.004), age (p=0.046), and these variables explained 23.6% of DR variation. SU showed negative correlation with DR (r=-0.34, p=0.008). In conclusion, the understanding of the informed consent, especially SU, was significantly lower and negatively correlated with DR. Therefore, it is needed to improve understanding of informed consent among participants in cardiology clinical trials to reduce DR.
  • 2.

    The Need for a Virtue Ethics Approach to Medical Ethics Education: Focusing on the Learning Objectives of『Medical Ethics』

    KIM Soo-Jung | KIM Junga | 2014, 17(3) | pp.253~271 | number of Cited : 2
    Abstract PDF
    Two objectives in medical ethics education—“creating virtuous physicians” and “providing a skill set for analyzing and resolving ethical dilemmas”—are often seen as mutually exclusive. However, both objectives are important and they are not as incompatible as they are assumed to be. This article argues that in contemporary medical ethics education the objective of creating virtuous physicians is often underemphasized despite its importance. The learning objective put forward by the Korean Society for Medical Ethics in 2013 also neglects this pedagogical objective and instead adopts a principle-based approach that makes no explicit mention of virtue ethics. After identifying the biases responsible for the omission of virtue-based approaches to medical ethics education, this article offers a critique of those biases as well as strategies for incorporating virtue-based models into the medical curriculum.
  • 3.

    Ethical and Legal Issues Concerning Advance Directives and Physician Orders for Life-Sustaining Treatment

    CHOI Kyungsuk | 2014, 17(3) | pp.272~285 | number of Cited : 6
    Abstract PDF
    This article examines advance directives (ADs) and physician orders for life-sustaining treatment (POLST), analyzes the differences between them as well as the differences between their English and Korean versions, considers some of the legal and ethical issues surrounding ADs and POLST, and proposes directions for their improvement in South Korea. In the United States, ADs consist of living wills and durable powers of attorney (DPA), both of which have merits and defects and give rise to unique ethical issues. However while POLST overcome some of the limitations of ADs, they cannot fully replace them. This article argues that ADs and POLST have a complimentary relationship. While Korean ADs are similar to those in the United States, the introduction of DPA into Korea may be difficult due to some special features of Korean culture. It is argued that public debate and academic analysis concerning the identity of proxy decision-makers is needed in order to prepare the legal and ethical ground for surrogate decision-makers in Korea. Additionally, this article emphasizes the need for establishing an institution that can assist patients in crafting ADs.
  • 4.

    Can Paternalism Be Justified in the Name of Autonomy? : The Relationship of Paternalism, Patient Autonomy, and the Best Interest of the Patient

    Sunwoo Cho | 2014, 17(3) | pp.286~299 | number of Cited : 1
    Abstract PDF
    In medical practice, the ethical principle of respect for patient autonomy sometimes clashes with the principle of beneficence. Whereas previously medical treatment was guided primarily by the objective of patient beneficence, in recent decades the right of patients to make their own medical decisions has received more emphasis, especially in western countries. At the same time, an increasing amount of attention has been given to the problems of beneficence-based, paternalistic interventions. Whether respecting patients’ autonomy should be ranked above the principle of beneficence has become one of the central questions of biomedical ethics. In an effort to answer this question, this article examines the discussion of Sjöstrand et al. on the possibility of justifying paternalism in the name of patient autonomy. It is argued that the problems of paternalism and neglect for patient autonomy stem from a misunderstanding of a patient’s best interest. Furthermore, it is claimed that patient autonomy should be thought of, not as an independent and rival consideration, but rather as a crucial part of the best interest of the patient.
  • 5.

    The Scope and Influence of Pharmaceutical Marketing to Medical Trainees in Korea

    CHEONG Yoo-Seock | 2014, 17(3) | pp.300~309 | number of Cited : 0
    Abstract PDF
    The pharmaceutical industry, through its various marketing activities, has a significant presence among trainees in medical residency and appears to influence their prescribing behavior. The purpose of this study was to assess the extent to which Korean medical trainees are exposed to pharmaceutical promotional activities, how they respond to such activities, and whether they are aware of the ‘dual-punishment law' that came into effect in 2010. An on-the-spot survey was conducted using a questionnaire given to 238 chief residents of internal medicine that participated in educational lectures at Jeonju, South Korea on April 22, 2011. Whether or not trainees accepted promotional activities was found to depend on the nature of the activities in question: 98.7% of trainees thought that it was acceptable to receive office supplies such as ball-point pens and notes; 66.1% found it unacceptable to receive monetary compensation for group dinners in return for designating a particular drug for use; 87.3% answered that they had changed their choice of prescription after being briefed on drugs. A mere 14.7% of trainees claimed to be aware of the “dual-punishment law,” only 11.2% had an ethical code regarding relationships with pharmaceutical companies within their medical communities, and a mere 9.5% of trainees had received any education on such matters. The influence of pharmaceutical promotional activities is widespread among medical trainees in Korea. Residency programs can benefit from policies and curricula that educate residents on the influence that pharmaceutical companies can have on them and the ways in which the information these companies present can be evaluated critically.
  • 6.

    Reproductive Right of HIV Infected Person and Assisted Reproduction

    Hyun A Bae | 2014, 17(3) | pp.310~330 | number of Cited : 0
    Abstract PDF
    Development of highly active antiretroviral therapy led to a spectacular increase in life expectancy and quality of life for HIV infected men and women. HIV now considered to be a chronic disease and as a consequence quality of life is an important aspect for men and women with HIV. Many of them express the desire to father or mother a child. Assisted reproduction technique such as intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection in combination with semen washing and elective caesarean section have been used to decrease the risk of HIV transmission. Cumulative evidence suggests that assisted reproduction technology (ART) is safe and effective for avoiding horizontal and vertical transmission of HIV. No maternal or neonatal HIV infections or death occurred. With providing the biotechnology such as ART, contextualized counseling and a respect for patients' decision regarding infertility or subfertility treatment should be adopted as public health policy and bioethical policy. It is neither ethically nor legally justifiable to categorically exclude individuals from infertility service on the basis of HIV infection. For complete this purpose, in Korean Prevention of AIDS Act has some limitation in applying the scientific changes and ethical basis for reproductive right of HIV infected men and women. It is needed the reconsidering medical evidence and reframing the Act for reproductive right and quality of life of HIV infected couples.
  • 7.

    Study on the Improvement of Ethics in Animal Research Curriculum

    Dong-Mi, Yoo | 모효정 | 2014, 17(3) | pp.331~348 | number of Cited : 2
    Abstract PDF
    The biggest debate in the field of animal ethics revolves around animal experimentation. Various discussions surround experiments on animal subjects, and considerations of the animal’s scope or the animal subject’s treatment method, experimental method etc. differ for each individual situation. The majority of those against the use of animal subjects in laboratories are cleared of anthropocentrism in order to fundamentally evaluate the justification of animal experimentation and demand efforts in improving experimental methods and processes while minimizing the animal subject’s sacrifice and suffering. In laboratory, animal experiments are different from regular experiments because they involve the treatment of animal life. Because this context may create ethical conflicts, the researchers who implement experiments on animals must receive the appropriate training so that they can recognize this distinctiveness. However, if we examine the current training under animal experimentation, even university curriculums have barely developed this type of training and, what is worse, the part of the government that regulates animal experimentation provides little training in animal ethics. To counter balance negative awareness about animal experimentation, we must increase the utility of such experiments and diffuse awareness of animal welfare. We must strengthen training in animal ethics to create a peaceful coexistence between nature and humankind.
  • 8.

    Safety Issues in Neuroenhancement

    SangMok Lee | CHOI Sinu | 2014, 17(3) | pp.349~362 | number of Cited : 2
    Abstract PDF
    Neuroenhancement refers to medical interventions through which healthy people improve their cognitive, emotional, and motivational function. Psychopharmaceutical substances—especially central nervous system stimulants including methylphenidate, amphetamine, modafinil—have recently become popular among students and night shift workers for enhancing cognitive function. Although health authorities in some countries have regarded pharmaceutical enhancement as a drug abuse issue and have issued restrictions or prohibitions, the use of stimulants remains prevalent. One reason why people use stimulants for neuroenhancement is that there is little information about the actual cognitive effects of stimulants; people using stimulants tend to rely on rumors which have not been proven scientifically. The purpose of this article is to provide objective information on the neuroenhancing effects and risks of stimulants. Although the possibility of addiction to methyphenidate has been exaggerated, meta-analysis shows this substance has only mild effects on cognition. Amphetamine has stronger effects on cognition than methyphenidate, but its use is ethically problematic since it can cause addiction and psychosis. Modafinil has strong cognitive enhancing effects and is safer than other psychoactive drugs, but recent studies show that it too can lead to addiction. Most studies point out that the effects of stimulants for neuroenhancement are benign and the risks of addiction should not be ignored. This article shows that the safety issue remains the main obstacle for legalizing the use of neuroenhancing drugs by healthy individuals.