2017, Vol.20, 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

The “Act on Life-Sustaining Treatment Determination” was passed in Korea in 2016 and will take effect after the enactment of certain ordinances and rules. In this study, we analyzed the decision-making process regarding the withholding and withdrawal of life-sustaining treatment in four countries: Taiwan, Japan, the US, and the UK. Each country introduced advance directives either through legal forms (Taiwan, the US), limited legal forms (the UK), or arbitrary forms (Japan). Japan takes a guideline-centered approach, whereas Taiwan takes law-centered approach. And while a patient’s will about life-sustaining treatment (LST) is respected as part of a patient’s self-determination in the US, physicians can refuse treatment if its benefits are extremely uncertain. On the other hand, in the UK, if a patient has lost decision-making capacity, physicians can make decision regarding the patient’s best interests. In this article, it is argued that minimal standards should be established in Korea to prevent possible abuse as well as to respect patients’ right to self-determination; however, it is desirable to support good decision-making processes between physicians and patients (and their family members) rather than to over-regulate current practice.

This article evaluates the codes of ethics for dentists in the United Kingdom, the United States, and Korea. Differences in the historical backgrounds, dental health care agendas, and social atmosphere of these three nations have given rise to different codes of ethics for dentists in these countries. In the UK, codes of ethics are bound by legislation since the health care system is run by the British government. On the other hand, codes of ethics in the US are considered to be virtues that are voluntarily drafted and implemented by autonomous organizations. In this article it is argued that codes of ethics in Korea should not merely imitate those of other countries but should rather reflect the unique circumstances of this country. Dentistry requires a team approach involving dentists, dental hygienists, and dental technicians; therefore, in order to obtain public trust in each of these professions, their common principles and values should be reflected in a comprehensive dental code of ethics. Social consultation and discussion are recommended to establish common ideas and values; furthermore, dental associations should partner with government bodies to best serve the public interest.

Korea has witnessed rapid growth in the clinical trial industry in past 10 years. Public concern regarding the rights and safety of human research participants has been a major issue in the field. As the need for a more effective system of protection for human subjects grows, one which surpasses the scope of the Institutional Review Board (IRB), the Korean Ministry of Food and Drug Safety (MFDS) has issued its “Operation Guidelines for Human Research Protection Program (HRPP)” in 2014. It is the first government- initiated adoption of a HRPP in the world. This study shows that there is great deal of variation in clinical trial institutes in terms of their size and systems of operation and that many small- to mediumsized clinical trial institutes are not willing to adopt HRPP. The current MFDS HRPP policy does not reflect the differences in the various clinical trial institutes, which leads to a low adoption rate in HRPP in Korea. Furthermore, the government-initiated HRPP policy may puts more burdens on smaller organizations. Despite the limitations of the current HRPP policy, it is argued in this article that strong leadership to promote HRPP by the Korean government can improve clinical trial participant protection and the quality of clinical trials in Korea. Future policy for establishing and promoting HRPP in Korea should encompass considerations of the variability in the characteristics of clinical trial institutes as well as measures for enhancing the understanding of HRPP in the research community.