The privatization of medicine raises a number of empirical, philosophical, and ethical issues that are best approached from an interdisciplinary perspective. In this paper, I approach the problem from philosophical-ethical viewpoint and argue as follows. Health care is an atypical commodity that can be privatized through imperfect or partial marketization. Additionally, while altruism is compatible with a certain kind of medical commercialism, a just health care system is one which accommodates equity, efficiency, and public accountability. Market instrumentalists hold that markets are the means to achieve the objective of a just health care system, whereas market fundamentalists regard markets as ends in themselves. I argue that while market instrumentalism is the superior view, when a market is implemented it should fulfil quite strict criteria.
A series of recent medical scandals in South Korea has led to calls for stricter regulation of medical licensing in this country. While the Korean government has recently revised its regulations, disagreements remain among the various stakeholders. This article explores the regulatory systems in Japan, the USA, the UK, and Canada to identify the most appropriate principles for self-regulation based on medical professionalism. The Japanese Medical Association has been working to improve its certificate system for specialists since 2011. The USA, the UK, and Canada have independent regulatory bodies to protect patients and improve medical professionalism and practice. This article explains how the licensing system for Korean physicians should be regulated.
This article examines the ethical justification for medical paternalism. After defining paternalism and distinguishing between the weak and the strong versions of that concept, this article considers two common justifications for paternalism: an argument from consent and a consequentialist argument. While weak paternalism is justified significantly by these two arguments, I claim that strong paternalism cannot be justified by the consent argument and also that there are limitations with using the consequentialist argument to justify strong paternalism. I defend a limited concept of paternalism by appealing to the diminished autonomy argument. Since a patient’s autonomy is diminished by illness, physicians have a limited moral obligation to prevent or at least to minimize harm to their patients, as expressed in the Hippocratic Oath.
The provisions of South Korea’s ‘Bioethics and Safety Act’ related to the creation of embryos using assisted reproductive technology allow for consent to be withdrawal at any stage in the process. However, in cases in which the creation of an embryo involves two individuals, the consent withdrawal of one participant may damage or infringe upon the other participant’s reproductive autonomy. In this article I argue that the provisions of the ‘Bioethics and Safety Act’ that allow for consent withdrawal at any time result from a tendency to identify informed consent with a flawed notion of autonomy, one that is found in the work of Beauchamp and Childress. The article criticizes this notion of autonomy and proposes relational concept of autonomy as a better alternative. Relational autonomy includes social, political, and even economic considerations in addition to individual relationships. Finally, this article suggests several methods to prevent conflicts from arising in the consent process for embryo creation.
The purpose of this study was to compare the perceptions of elderly patients and their caregivers toward life-sustaining treatment (LST). This study was a descriptive investigation using a structured questionnaire administered to ninety elderly patients and their main caregivers. The data were collected from three general hospitals in Seoul and analyzed using IBM SPSS Statistics version 23. The significant differences between the perceptions of the elderly patients and those of their caregivers are as follows: the experience of having heard of LST (χ2=3.90, p=.048), the time required to determine the need for an LST (χ2=13.49, p=.010), the main reason for the need for LST (χ2=12.18, p=.014), opinions on hospice palliative care (χ2=9.45, p=.002), the appropriate person to act as a patient’s surrogate (χ2=6.77, p=.034), and the requirements for acting as a surrogate (χ2=21.61, p<.001). Study findings indicate that both groups have a high level of interest in self-determination and Korean society is following the standard of substituted judgement, which presumes the opinion of the patient from a surrogate’s point of view. Therefore, developing guidelines for LST decision-making that takes into account the cultural features of South Korea could contribute to LST decision-making that respects the patients’ self-determination.
Doctors routinely deal with death, but their experience and impressions toward death are not well known. Examination into how doctors perceive death has been limited mainly due to complications in research methods. The purpose of this study is to assess doctors’ experience regarding death qualitatively by examining their first death pronouncement and to deduce their perceptions and awareness toward death related issues. Eleven first-year and second-year residents from a university hospital in Korea participated in in-depth interviews. Their comments were recorded, documented, and analyzed using grounded theory. Three major categories were identified: participants’ impressions when pronouncing death, participants’ views of their role in pronouncing death, and participants’ views on the need for education/training in pronouncing death. The first category was further divided into personal and professional impressions. The second category illustrated a doctor’s role in pronouncing death (i.e., defining death and a doctor’s role during bereavement). All participants expressed the need to be taught how to pronounce death and asked for further training in communicating with family members of the deceased. Participants shared negative feelings regarding their experiences in pronouncing death due to a lack of education in dealing with the death of a patient. It is essential for novice doctors to clearly understand their roles in pronouncing the death of a patient, a goal that may be achieved through education programs.
With the increased number of clinical trials being conducted in South Korea, Institutional Review Boards (IRBs) have acquired greater significance. In human clinical trials, unscientific studies may be unethical in light of their potential for causing harm to participants. Therefore, IRBs should review both the scientific and the ethical issues of any research protocol. However, research into the IRB review process is lacking in Korea. This study examined the protocols for clinical trials under the review of the IRB at Seoul National University Hospital. In total 1,244 protocols (752 between 2004 and 2006; 492 in 2013) were analyzed. Of these 22.7% were approved, 64.2% underwent minor revision, and 12.6% underwent major revision. In total, 62.2% of these protocols raised scientific issues, and 47.0% raised ethical issues. Among the scientific issues, “unclear sample size calculation” occurred most frequently. “Subjects’ recruitment/inclusion criteria” was the most frequently cited ethical issue. A total of 67.0% had consent issues and 41.3% raised questions about the case report form. Compared to the period from 2004 to 2006, the prevalence of protocols with “unclear study design” and those that raised questions about “privacy/personal data” increased in 2013. While scientific issues were the most frequent among investigator-initiated trials, consent issues were the most frequent in sponsor-initiated trials. Although all issues were significantly associated with the approval decision, the approval rate of studies with ethical issues was lowest. These results provide a basis for the development of guidelines for researchers by identifying common issues in clinical protocols