2014, Vol.17, 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 was aimed to identify the objective understanding (OU) and subjective understanding (SU) of the informed consent and decisional regret (DR) and to determine the related factors to them in the cardiology clinical trials. The participants were 60 patients participating in the phase III clinical trials. Data was collected after giving informed consent form for OU and SU of the informed consent and 4 weeks after participating in the clinical trials for DR using self-reported questionnaires. Mean of OU, SU, and DR were 74.6, 58.6 and 42.9 based on 100 points, respectively. The predictors of OU were reading informed consent repeatedly (p=0.004), higher education than middle school (p<0.001), and time to giving information to consenting (p=0.034), and these variables explained 45.3% of OU variation. The predictors of SU were giving information by research nurses (p=0.025), higher education than middle school (p<0.001), making question before consenting (p=0.035), and these variables explained 48.8% of SU variation. The predictors of DR were giving information by research nurses (p=0.004), age (p=0.046), and these variables explained 23.6% of DR variation. SU showed negative correlation with DR (r=-0.34, p=0.008). In conclusion, the understanding of the informed consent, especially SU, was significantly lower and negatively correlated with DR. Therefore, it is needed to improve understanding of informed consent among participants in cardiology clinical trials to reduce DR.

Two objectives in medical ethics education—“creating virtuous physicians” and “providing a skill set for analyzing and resolving ethical dilemmas”—are often seen as mutually exclusive. However, both objectives are important and they are not as incompatible as they are assumed to be. This article argues that in contemporary medical ethics education the objective of creating virtuous physicians is often underemphasized despite its importance. The learning objective put forward by the Korean Society for Medical Ethics in 2013 also neglects this pedagogical objective and instead adopts a principle-based approach that makes no explicit mention of virtue ethics. After identifying the biases responsible for the omission of virtue-based approaches to medical ethics education, this article offers a critique of those biases as well as strategies for incorporating virtue-based models into the medical curriculum.

This article examines advance directives (ADs) and physician orders for life-sustaining treatment (POLST), analyzes the differences between them as well as the differences between their English and Korean versions, considers some of the legal and ethical issues surrounding ADs and POLST, and proposes directions for their improvement in South Korea. In the United States, ADs consist of living wills and durable powers of attorney (DPA), both of which have merits and defects and give rise to unique ethical issues. However while POLST overcome some of the limitations of ADs, they cannot fully replace them. This article argues that ADs and POLST have a complimentary relationship. While Korean ADs are similar to those in the United States, the introduction of DPA into Korea may be difficult due to some special features of Korean culture. It is argued that public debate and academic analysis concerning the identity of proxy decision-makers is needed in order to prepare the legal and ethical ground for surrogate decision-makers in Korea. Additionally, this article emphasizes the need for establishing an institution that can assist patients in crafting ADs.