2017, Vol.20, No.4

Korean Journal of Medical Ethics 2023 KCI Impact Factor : 1.21

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

New legislation on hospice-palliative care and end-of-life decision-making in Korea comes into effect in February 2018. Hospital Ethics Committees (HECs) will play a key role in deciding controversial cases. HECs have existed in Korea for decades, but most of their work has been directed toward dispute mediation. With the new legislation coming into effect, HECs will now concentrate on end-of-life issues. However, since there are many other ethical issues that arise in clinical practice, the roles of HECs need to be reconsidered and perhaps reconfigured. Since HECs tend to convene on a monthly basis, they are illequipped to deal with end-of-life decisions, which often must be made within hours or a few days. Clinical ethics consultation teams can bridge the gap between the urgent demands of clinical practice and the slower and more formal activities of HECs. This article argues that it is necessary for HECs to delegate some of their roles or responsibilities to clinical ethics consultation teams.

This article addresses the question of what is an appropriate Korean translation of “clinical ethics consultation” and also interprets clinical ethics as a branch of medical ethics. Three models of clinical ethics consultation are introduced: an authoritarian approach, a pure facilitation approach, and an ethics facilitation approach. The author argues that an ethics facilitation approach is the most desirable one in a pluralistic society. Contemporary Korean society is moving in the direction of a pluralistic society, with both eastern and western influences as well as progressive and traditional forces. Where there is no single, dominant value system, it is desirable that consultants try to help relevant parties reach reasonable conclusions within moral boundaries rather than recommend one conclusion. In a pluralistic society, an ethics facilitation approach does not imply moral relativism. Hospital ethics committees established according to the current law should be organized to provide clinical ethics consultation. While the current law limits the role of hospital ethics committees to the withholding or withdrawal of life-sustaining treatment that their role should be broadened into fully-fledged hospital ethics committees that cooperates with a team taking multi-disciplinary approaches to the resolution of ethical issues.

The purpose of this study was to investigate the nature and number of ethical conflicts faced by physicians and nurses working at university hospitals in South Korea and also to assess the need for clinical ethics consultation services. Data collection was conducted from August 6 to 24, 2015 at three university hospitals in metropolitan areas; a total of 316 physicians and nurses participated in the study. The results showed that 85.1% of physicians and 76.6% of nurses answered that they had experienced ethical problems more than once a year during the course of their career, and about one third of respondents experienced such conflicts at least once every three months. For physicians, ethical dilemmas arose most often in the context of end-of-life care, mainly in terminating life-sustaining treatment (65.7%) and notifying patients of the end of medical treatment (63.6%). Ethical dilemmas experienced by nurses related primarily to difficult care decisions other than life-sustaining treatment (73.9%), impaired decision-making in patients (66.7%), and dealing with surrogate decision-makers (66.7%). When faced with ethical dilemmas, healthcare professionals usually made decisions informally by themselves or in consultation with close colleagues. More than 97% of respondents answered that they needed a clinical ethics consultation service. Future research should focus on how the ethics consulting services described in the Life-sustaining Treatment Decision-making Act of 2018 can be developed into an effective model for solving ethical problems that arise in medical practice.