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pISSN : 2005-8284 / eISSN : 2234-3598

2020 KCI Impact Factor : 1.31
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2019, Vol.22, No.2

  • 1.

    The Application of Virtue Ethics-Based Professionalism to Medical Education and Its Implication

    Claire Junga Kim | Hwa Young Lee | kim, Soo Jung | 2019, 22(2) | pp.95~114 | number of Cited : 4
    Abstract PDF
    The value and importance of medical professionalism has been recognized for medical educators in Korea for several decades. However, the lack of a shared understanding of medical professionalism hinders its adoption and application in educational settings. This article introduces three mainstream understandings of medical professionalism, integrates a virtue-based and identity formation understanding into one virtue ethics understanding, and analyzes the concept of medical professionalism in the learning outcomes of the basic medical education of the Korea Association of Medical Colleges (KAMC). In particular, we borrow the notion of “practice” and the three necessary virtues for all practices from MacIntyre’s virtue theory and then apply those concepts to the medical professionalism in the learning outcomes of the basic medical education of KAMC. We find that KAMC documents adopt an outcome-based approach that needs more elaboration in terms of virtue ethics in order to present a comprehensive understanding of medical professionalism. In conclusion, we propose three necessary virtues for medical professionalism and argue for their utilization in medical education as an effective means to bridge the learning outcomes and objectives of the medical professionalism in KAMC documents.
  • 2.

    Reflections on the Life-Sustaining Treatment Decisions Act: A Medical Oncologist’s Perspective

    AHN Heui-June | 2019, 22(2) | pp.115~128 | number of Cited : 4
    Abstract PDF
    More than a year has passed since the implementation of the “Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life” (hereafter the “Life-Sustaining Treatment Decisions Act”) in South Korea. Although there have been complaints about the complicated legal documents that the law requires patients to complete when choosing to end life-sustaining treatment, overall this new law has been well received and more patients than expected have made use of the provisions of this law since it was implemented. However, it is now time to reconsider whether the law is serving the purpose for which it was originally designed. I argue in this article that while the expressed purpose of the Life-Sustaining Treatment Decisions Act is to respect and enhance patient autonomy, in practice the law seems to do more to reduce socio-economic burden than to protect patient autonomy. Furthermore, this law is transforming the ethical culture within the practice of medicine into a bureaucracy. Greater public debate on this matter is needed to ensure that the Life-Sustaining Treatment Decisions Act serves the purpose for which it was originally designed.
  • 3.

    Ethical Issues in the Use of Extracorporeal Membrane Oxygenation Related to Brain Death and Attitudes of Organ Harvest

    KIM DO KYONG | 2019, 22(2) | pp.129~139 | number of Cited : 0
    Abstract PDF
    Organ preserving extracorporeal membrane oxygenation (OP-ECMO) is used as a method of donor management in donation after brain determination of death (DBDD) or potential brain-death to acquire organs in a way that stabilize vital sign in hemodynamically unstable donors. Because it can cause physical and psychological harm to donors and their family members OP-ECMO for DBDD or potential brain death raises ethical issues. Donors who refuse life-sustaining treatment may not receive the end of life care they want, and family members may have difficulty in accepting the patient’s death because of the use of ECMO even after a brain-death declaration. In cases of a potential brain-death, a medical professional who initiates ECMO without informed consent betrays the patient, the family, and any third-party payers. In light of scarce medical resources, the use of OP-ECMO should be carefully examined. To address the potential ethical issues related to ECMO use in organ donors, medical professionals should indicate that the purpose of organ donation is not merely to harvest organs but rather give to the gift of life and should approach donor-centered organ donation and the harvesting process with respect for donor.
  • 4.

    The Impact of Moral Sensitivity and Moral Distress on End-of-life Care Performance among Intensive Care Unit Nurses

    LEE Jooseon | Ahn, Sukhee | 2019, 22(2) | pp.140~160 | number of Cited : 7
    Abstract PDF
    The purpose of this study was to examine the impact of moral sensitivity and moral distress on end-of-life care performance among intensive care unit (ICU) nurses in Korea. The study found (a) a significant relationship between moral sensitivity and end-of-life care performance (r=.22, 𝑝=.01), (b) a significant relationship between moral distress and end-of-life care performance (r=.23, 𝑝=.01), and (c) no significant relationship between moral sensitivity and moral distress (r=.14, 𝑝=.12). Multiple regression analysis indicates that the nurses with higher moral sensitivity and more than 37 months of clinical experience showed higher end-of-life care performance. The result of this study suggest that ethics education programs for ICU nurses should be designed to enhance their moral sensitivity.
  • 5.

    Suggestion on How to Balance between Physicians' Authority and Patients' Autonomy; Review of Debate on Patient Self-Determination Act(1990)

    Moon Jae Young | AHN Heui-June | 2019, 22(2) | pp.161~173 | number of Cited : 3
    Abstract PDF
    In February 2018 the “Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life” (hereafter the “Life-Sustaining Treatment Decisions Act”) went into effect in South Korea.” In order learn the lesson for Korean physicians’ practice in end-of-life care, we reviewed the debates surrounding the passage of similar legislation in the US. In particular, we examined the debates concerning the “Patient Self-Determination Act,” which was implemented in the US in 1991. We systemically searched for related medical articles on PubMed online and reviewed 17 articles that were retrieved through this search. One of the main findings of this review is that most of the articles expressed support for the Patient Self-determination Act on the grounds that it would enhance patient autonomy. In contrast with this, the Korean medical society criticized the Life-Sustaining Treatment Decisions Act on the grounds that it would undermine physician authority and limit respect for patient autonomy. This reflects the fact that Korean physicians are unfamiliar or uncomfortable with the idea of respecting patient autonomy as a way of furthering the patient’s best interests. In this article I argue that the reasons for welcoming the provisions of the Life-Sustaining Treatment Decisions Act are not only legal, but also medical and ethical: the law can improve the end-of-life care that is given in healthcare settings. However, in order to achieve this goal, patients must be fully informed about their rights and physicians should initiate discussions about advance care planning, as part of general health care, before serious illness arises.
  • 6.

    The Autonomy of the Elderly in Constructing Medical knowledge through Digital Media

    CHOI Eunjoo | 2019, 22(2) | pp.174~185 | number of Cited : 1
    Abstract PDF
    This paper focuses on the “medical knowledge” and “the elderly” that the autonomy of individuals who can freely use information obtained through digital media including the internet can interfere with knowledge collection. As the average life expectancy increases, the “Newly Elderly”, differentiated from the old age corresponding to the third period of the life cycle, are being reborn as the new economic subjects of the consumer market. On the other hand, problems that may arise in using health information through websites are overlooked because they are proficient and active in the use of digital devices. The main prior research was about health content strategies suitable for the environment of digital media and interactivity in websites providing health information. However, this paper is to present the necessity of literacy for medical knowledge by focusing on the web use of the elderly who have been granted a right position as a new consumer. There are prior studies that elderly people are still easily exposed to drug abuse and their degree varies depending on age, educational and economic levels, and residence in the metropolitan area. In this sense, it is insufficient to generalize the whole of the elderly, and to remain positive as a consumer as an economic entity, a selector of lifelong education as a subject of education, and a content maker as a culture creator. On the other hand, this paper points out the biased viewpoint of the media in which the elderly population is polarized by aging and social burden, and suggests the importance of medical literacy related to the life of the elderly. An empirical survey of data following the need for medical literacy and presentation of educational methods is left as a follow-up study.