2017, Vol.20, 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

This article advances the Autonomy Capability Model as a new theoretical framework for understanding the concept of patient autonomy and the right to self-determination in medical decision-making. After clarifying the basic concept and approach of the Autonomy Capability Model, the article goes on to confirm the theoretical usefulness of this model and apply it to the medical decision-making process. The applicability of the Autonomy Capability Model in relation to medical decision-making at the end of life is examined. The concept of patient autonomy used in the medical field today is defined as “independent self-determination by a subject with sufficient decision-making ability,” and it is understood that anything that interferes with the subject’s inherent decision-making ability is to be excluded. However, in practice, a patient who makes a medical decision is a prescriptive subject who has the final authority to make decisions about his or her own health and body, while at the same time experiencing a dependent condition that requires medical treatment and care by others. Therefore, the patient’s autonomy cannot be reduced to the self-determination of individuals with the capacity for rational judgment. It is argued that medical decision-making should be understood as a continuous process that involves ongoing communication with medical staff.

Due to the increase in the number of public health officials responding to outbreaks of infectious disease there is a need for new educational programs to nurture the appropriate skills in public health officials. This article examines the education and training programs that are currently available for public health officials and makes recommendations for new programs, including ethics education for epidemiological investigators of local governments. It is argued that such ethics education programs should focus on the following topics: contact tracing and autonomy infringement, isolation and free movement infringement, disease monitoring and privacy invasion, and vaccine and therapeutic testing. Furthermore, this article discusses ways to improve administrative regulations to establish a sustainable education system.

Shared decision-making is a collaborative medical decision-making process between patients and their health care providers. This process aims to assist patients in taking an active role in making decisions related to their own health. Patient-centered care can be seen as the ultimate goal. In order to exhibit its effectiveness as a process that actualizes patient-centered care, shared decision-making must resolve problems caused by an imbalance in both power and knowledge between doctors and patients. This article propose communicative feminist bioethics as theoretical foundation to resolve imbalance in shared decisionmaking. Communicative feminist bioethics regards empathy and relationships as the foundation of shared decision-making and seeks to strengthen the ability of patients and doctors to make decisions together. Shared decision-making based on empathy and relationships, doctors refrain from expressing or imposing their own values on patients and instead encourage patients to develop the skills necessary to look after themselves. This article argues from a feminist discourse and perspective that doctors should strive develop relationships of equality that respect patients as competent decision-makers.