2015, Vol.18, No.1

Korean Journal of Medical Ethics 2023 KCI Impact Factor : 1.21

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

Critically ill patients are vulnerable patient that could not speak for their interests due to their life-threatening condition. Sometimes they should get an invasive treatment in the intensive care unit (ICU) to overcome their fatal and serious illness, which involve pain they do not want. Thus the ethical conflict is common in the ICU and in particular, ethical issues related to the “right to life” or “death” are difficult and complex. Major sources of conflicts are behavioral issues among stakeholders, such as verbal abuse or poor communication between physicians and nurses, and end-of-life care issues including a lack of respect for the patient’s autonomy. These conflicts may cause ICU workers’ physical and mental exhaustion, which often result in threats to patient safety. When healthcare professionals lack knowledge to recognize the ethical implications, ethical conflicts occur frequently. The physicians themselves need to be more sensitive to behavioral conflicts and enable shared decision making in end-of-life care. At the same time, the institutions and administrators should develop their processes to find and resolve common ethical problems in their ICUs.

Vulnerability population cannot protect their interest themselves. Vulnerability in emergency medicine is not different. We assume the factors that influence the patient’s course or patient’s outcome badly. We will discuss three factors of the vulnerability in emergency medicine. Those are the family without relational autonomy, the incompleteness of emergency subrogation payment system, and a lack of decision making capacity. We will describe theory, concepts, systems related factors and then apply them to our case. The factors are not independent. We discuss things to be made up for the autonomy and medical interest of the vulnerable patients that influenced by factors.

The rights of patient in the medicine is emphasized recently, especially the right to be appreciated and the right to get adequate information about the management. Self-determination with the informed consent is the most important factor in the decision. There are several limitations in the process of decision-making for medical treatment in the children. Children usually have not enough capacity for decision. But the children are constantly developing and they have different capacity for the decision on the stage of development. So, health care professionals should seek the best options to reflect the opinions of children in the decision-making. Consent of assent of the children should be based on the capacity of the children. All the decisions are should be for the best benefits of the children. If there are some debate on the decisions, health care professionals should consult to social worker or ask the discussion in th committee for medical ethics.