2004, Vol.7, No.2

Korean Journal of Medical Ethics 2023 KCI Impact Factor : 1.21

pISSN : 2005-8284 / eISSN : 2234-3598
https://journal.kci.go.kr/medethics

Korean medical society has been in a big turmoil since the second part of the 1990s. The first impetus for this turmoil was given by a court rule against doctors who discharged critically injured patient and removed life-sustaining appliances following the request of the patient's wife. Other members of the family filed a law suit against the doctors and the wife, and they have become convicted murderers according to the criminal law. When the debate began to subside, another big trouble broke out. The government tried to implement the policy of division between prescription and preparation of drugs in the year 2000. Physicians regarded this policy as another attack on their professional autonomy and interest. To everyone's surprise they went on a strike. The third impact on the already confounded situation was the report that a team of Korean scientists has cloned human embryos by somatic cell nucleus transfer and extracted stem cells for the first time in the world. I argue that the three cases have been and will be the paradigm cases for the moral discourse in Korean health care field. Although the nature of the problems are not that different from the cases of the west, the way of discussion and the context of it is not be the same. Korean people have the tradition of emphasizing virtuous doctors embodying good human nature (德醫) rather than the specific medical virtues(醫德) they have. Virtuous doctors are the medical professionals who not only listen to the voices of patients but also deeply tune into the concrete situation of the people suffering from various problems. This kind of committment to the people coincides with the spirit of the medical professionalism and "thick" version of virtue ethics developed in the west. All these are the moral resources we can mobilize to make a moral contract of our own.

Purpose: This study was done to develop a guideline on legal, ethical and philosophical grounds for whole procedure of organ transplantation, which is a life-saving treatment and improvement of the quality of life. Methods: A survey questionnaire was sent to surgeons and nursing coordinators to get basic information about current situation of transplantation in 66 centers. 112 responded from 53 centers. The data were analyzed using SAS-program by descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. After this survey, series of discussion ethical and philosophical considerations were followed. Results: This study investigated the current situation of organ transplantation in Korea and discussed some problematic points in <Law of Transplantation of Human Organs>. We suggest organ transplantation from brain death donors should be more activated, but the rigor of current law has hindered it. The procedure of brain death determination, the role and construction of the brain death committee, and the procedure of "informed consent" should be improved. The case of Germany and U.S.A may be good example for the improvement. Human tissue transplantation has its own problems, and should be considered as a part of transplantation.

Most transplantation has been done by donation from living donors rather than dead in Korea. Lack of organs is also a big problem. It is said that the Human Organ Transplantation Law is an obstacle to harvest organs from dead people. The author tries to show limits and ethical considerations of the brain death decision committee of the Human Organ Transplantation Law. The limits are; 1. The roles of committee are overlapped as deciding brain death and assuring ethical affairs. 2. The committee causes a delay of harvesting organs from donors, so donors should endure unnecessary procedures such as medication keeping respiration and heart function. 3. In the law, family member and physician can request for the decision of brain death. Before this, it is important to confirm the will of donor. The author suggests for the above limits; 1. To devide roles of the committee into two. One is for physicians to decide brain death finally, the other is for ethic committee to examine ethical affairs such as assuring donor's will for donation. 2. To adjust the time of the committee meeting between the first and the second brain death examination. 3. To strengthen assuring the will of donor's for organ donation. For this, chances for expressing donation should be expended before losing competency.