2011, Vol.14, No.3

Korean Journal of Medical Ethics 2023 KCI Impact Factor : 1.21

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

This study aimed to validate one of the tools for assessing decision-making capacity: the University of California at San Diego’s Brief Assessment of Capacity to Consent (UBACC), which is composed of a 10-item scale that includes questions focusing on the understanding and appreciation of information concerning research protocol. The subjects in the study were 30 inpatients and 30 outpatients with schizophrenia or schizoaffective disorder and, for comparison, 30 healthy subjects, all of whom received information about a simulated clinical drug trial. Using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR) as a gold standard, inter-rater reliability with intra-class correlation coefficient (ICC) was measured. The ICC for inter-rater reliability ranged from 0.987 to 0.994. The UBACC was found to be a useful and valid instrument for the screening of decision-making capacity before obtaining informed consent. We recommend that it be used not only for schizophrenia patients but also for various vulnerable groups including the elderly or cognitively impaired subjects.

In order to promote the dignity of terminal patients and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The goal of this study was to assess the level of awareness of the guideline among physicians working in intensive care units (ICUs) in Korea and to identify barriers to the application of the guidelines. We surveyed 81 physicians working in ICUs in Korea. 32.1% of respondents were unaware of the guideline and 65.4% of respondents thought that the guidelines were not practical in the context of their ICUs. This study found that the biggest obstacle to the application of the guidelines was the lack of legal support. Ethical reasoning does not often work to resolve issues surrounding EOL care in Korean culture. In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the national health care system, more practical guidelines, and further social consultation are needed.

This survey, which was conducted over the course of 3 months in 2009, was designed to investigate what the medical residents of one university hospital in Seoul think about DNAR orders. A total of 214 out of 468 residents (45.7%) answered the questionnaire. Participants were divided into two groups according to their experiences with taking DNAR order. There was no difference between the two groups on the definition of DNAR, its limitations, and when to issue DNAR orders. However, the two groups showed different opinions concerning who should be consulted in obtaining consent for DNAR and whether or not it was necessary to review DNAR orders. Residents who were experienced in giving DNAR orders felt more inclined to discuss the situation with the patient’s family members rather than the patient herself and thought that DNAR orders would not need to be reconsidered. These differences in opinion may result from the different experiences the two groups of residents had in actually ordering DNAR in the clinical setting. This study shows that more research and discussion is needed in order to establish the limitations and precise definition of DNAR orders.