2013, Vol.16, 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

Physician autonomy and medical professionalism have been changing ever since the patient-physician medical relationship was changed to patient-physician-third-party payer medical relationships. Until now, physician autonomy has meant that physicians should have complete freedom to provide the best treatments for their patients, without external constraints, but ever since medical insurance was introduced, medical decisions have been controlled by the third-party payers, and many conflicts have emerged in the patient-physician-third-party payer medical relationships. The concept of physician autonomy thus has to be changed. That is, the society should respect the rational and deliberated decisions of the physicians to resolve the conflicts between their patients and the third-party payers beyond the obligation of beneficence towards the patients. To mediate between their patients and the third-party payers, the physicians should carry out two roles - as healer and as manager - and should adjust the different applicable principles, such as patient autonomy, beneficence, and justice. The physicians have to be well acquainted with such principles and should make the appropriate decisions so as to gain social trust. To help resolve the conflicts between the patients and the third-party payers, the physicians should effectively carry out their roles as healer and manager by considering evidence-based practice, the treatment goal, and cost-effectiveness in their clinical practice. These criteria can help the physicians make reasonable and well-deliberated decisions in relation to their just provision of medical care for their individual patients.

The purpose of this paper is to search for a justifiable concept of autonomy that feasibly applies to bioethics and, based on this inquiry, suggest a practical model in a modern pluralist society. For this purpose, we classify personal autonomy into ‘metaphysical autonomy’ as the ideal theory guiding practical theories and both ‘narrow bioethical autonomy’ and ‘wide bioethical autonomy’ as non-ideal theories. We criticize narrow bioethical autonomy theories such as those posited by Tom Beauchamp and James Childress. Not only do they fail to flesh out metaphysical autonomy theories such as Harry Frankfurt’s, but they are not feasible because they ignore patient relationships and circumstances. We argue that Amartya Sen’s capability approach compliments the feminist concept of relational autonomy. Not only can this combination overcome the weaknesses found in narrow bioethical autonomy theories, but it allows for a practical framework to remove injustice and support autonomy. We call this combination ‘relational autonomy based on the capability approach’ and classify it as a theory of ‘wide bioethical autonomy.’ Based on this inquiry, we suggest a ‘plural forms model’ in a reasonable pluralism, which can reduce many of the autonomy-related conflicts. This model is useful in medical institution reform for explaining the plurality in both physicians’ identities and cases of patients’ autonomy (such as ambivalence) while it enhances patient autonomy through institutional and non-institutional reforms.

This paper considers humanistic perspectives for nursing science considering the invisible aspects of human life in scientific nursing which is heavily dependent on positivism. Humanity care is caring based on a comprehensive understanding of the true nature of humanity. Humanity care has to be executed at the nursing education level. For this we need to examine accreditation in baccalaureate nursing programs, the educational objectives of nursing colleges, the nature of nursing, the features of nursing-science, the tendencies of modern nursing, and the views of nursing scholars. The common key-concepts of such categories can be summarized as follows: nursing professionalism, holistic care, and life. For this, I have grasped the current situation of the curriculum related to liberal arts taught at 60 nursing colleges, and nursing departments, nationwide, in view of these categories. The result is that subjects such as personality and self-development, life, writing, nursing philosophy, creativity exploration, culture and nursing, and art and nursing, are insufficient. So, this dissertation suggests that there is need to open these subjects sufficiently. Nursing-education has to be based on a curriculum enabling students to consider holistic care and life from the view of nursing-professionalism. The assignments for holistic care, an independent arena of nursing, include shedding new light on the nature of nursing and having educational introspection into reestablishing the status and identity of nursing-science.