2011, Vol.14, 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

Although research on drugs and medical devices for human is well regulated and scrutinized through the existing IRB system, there is a need for a careful review of the current process for approving surgical procedures involving new medical devices. In particular, the clinical application of innovative surgical procedures with new or existing devices should be examined from an ethical point of view. There are, at this point, no formal ethical rules concerning innovative surgical procedures, and important terms are in need of clarification and definition. This article argues that while the adequacy of IRB process for surgical innovation has to be reviewed, there are needs to debate on some reasonable and valid definitions and ethical regulations of surgical innovation. In addition to, while the potential of professional surgical organizations for self-regulation has to be respected, the debates concerning the ethical issues associated with innovative surgical procedures should be opened up to the academic medical sector and those outside of the medical community.

Purpose: The purposes of this study were to identify future changes that may affect medical decision-making and to suggest future directions for the medical decision-making system in Korea. Methods: This study conducted Delphi surveys and in-depth group interviews with physicians and nurses working in two different university hospitals in Daegu and Busan. Results: The collected data suggest that the current medical decision-making system needs to be more clearly defined in accordance with clinical applications. The findings from professional group interviews suggest that the Korean government may need to regulate economic conditions in order to facilitate medical decision-making in the near future as hospital environments change and grow. Conclusion: The results of this study may help healthcare professionals working at various crisis settings to understand and apply decision-making systems in the context of end-of-life medical care. The future directions were proposed that national standard setting and financial support, hospital ethics committee constitution, nationwide information for social consensus, strengthening the education of health professionals.

Almost all countries in the world experience a scarcity of health care resources and the need to ration health care services. Each medical system is faced with difficult decisions concerning treatment coverage and priorities. Current methods of allocation are based on (1) substantial principles of justice, (2) cost-effectiveness analysis, (3) cost-value analysis, and (4) market mechanisms. Given these methods of allocating health care services, the question of legitimacy is rightfully raised. The question of legitimacy needs to be approached in an orderly manner. In the first place, the concept of democratic legitimacy needs to be articulated. Secondly, current methods of allocation must be evaluated. Thirdly, a legitimate method of allocation is needed. This article concentrates on the first and the second step. I argue that current methods of allocation fail to satisfy a democratic conception of legitimacy. However, this conclusion does not mean that these methods of allocating should be totally rejected. Each of these methods has an important element that at least contributes to democratic legitimacy. Based upon the evaluation provided in this article, I introduce a very promising method of allocating health care services, one developed by N. Daniels and J. Sabin.