2008, Vol.11, 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

Matters related to human life and death and medical healing are the concerns of patients, physicians, and other related persons, including family members of the patients. Existing medical decision-making models include paternalism and informed consent. However, these models have the limitation of being one-sided or unidirectional. Accordingly, shared decision-making is now emerging as a superior model of medical decision-making. In this model, physicians, who have medical knowledge, patients, and family members, who may have the best understanding of the patients’ life, jointly participate in making medical decisions. As a medical decision-making model, shared decision-making is often regarded as a process based on mutual respect and partnership between physicians and patients. A goal of medicine is to remove pain brought about by disease. In making medical decisions for individual patients, not only physicians, but also the patients themselves and their family members can play an important role. Family members can play such a role because of their familiarity with the patient and knowledge of his or her values. This is especially true in times of medical crisis when individual patients may have difficulties in making reasonable decisions. Thus, shared decision-making is an ideal method of decision-making, one in which patients, physicians, and family members work together to choose the best course of medical treatment for the patient.

Confidentiality has been regarded as one of the most important ethical principles for research on human subjects. Protecting research subjects’ confidentiality derives from the principle of respect for persons. As it is essential to maintain trust between researchers and subjects, research on human subjects cannot be conducted without protecting confidentiality, although it is not always easy to do so. Research that involves recording and observing illegal activities, including illegal drug studies, demands an especially high degree of confidentiality. Breach of research confidentiality can result in criminal or civil liability for the subjects in such research. When the researchers are subpoenaed, they are forced to provide information on their subjects. Most countries have no legal framework to protect both subjects and researchers from breaches of confidentiality. This paper discusses the ethical and legal considerations regarding the confidentiality of research on illegal activities. After examining domestic and international cases in which confidentiality and court orders were in conflict, the authors examine relevant policies and legal frameworks, including the Certificate of Confidentiality issued by the U.S. National Institute of Health (NIH). The authors argue that legal assurance to protect confidentiality should be provided to research subjects and researchers, especially considering the recent increase in research on illegal activities in Korea.

This study was performed to measure the moral judgment (P(%) and 4-stage) scores of student nurses four times over a three year period and to identify any statistically significant changes in participants’ scores. Data were collected through self-reported questionnaires from student nurses at one university in Korea from September 2005 to September 2008. The Korean version of the Defining Issues Test (DIT) was adopted to evaluate the moral judgment (P(%) and 4-stage) scores of participants. The results were as follows: 1) Participants’ consecutive P(%) scores were 45.81, 48.92, 42.69, 40.45, with of a mean of 44.74; and their consecutive 4-stage scores were 12.51, 12.78, 14.93, 17.08, with a mean of 14.15; and 2) the scores of P(%) rose until participants reached their 2nd grade, but then started to fall when they reached 3rd grade and continued to fall in the 4th grade, while the scores of 4-stage increased steadily during the study period. These moral judgment scores, especially those for 4th grade students, are very similar to the scores for Korean nurses. It is concluded that the moral judgment of student nurses is affected by nurses during their practical training. This study suggests that there is a need to develop the moral judgment of student nurses and nurses in nursing education and practice.