2021, Vol.24, 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

Purpose: This study attempts to clarify the difficulties faced by healthcare professionals in South Korea in making and implementing Life-Sustaining Treatment (LST) decisions for vulnerable patients who lack legally competent proxy decision-makers. Materials and Methods: First, a keyword analysis was performed on the official responses of the National Health Agency of Korea to 750 questions from healthcare workers. Second, a survey probing the difficulties that healthcare professionals face in making LST decisions was administered to the ethics committee members of 246 medical institutions. Results: From the keyword analysis, 139 keywords were categorized into ten subcategories. The survey had a 32.5% response rate, and of the respondents, 41.98% faced difficulties in making decisions for unrepresented patients because of the absence of family members or due to inadequate evidence. Among these patients, 82.35% did not have decision-making ability at the time of need and 85.29% had no family members to consult with. Conclusion: Four categories of “unbefriended” patients were identified in this study. Additionally, in uncovering evidence on how LST decisions are implemented and creating a category of “unbe-friended patients,” this study underscores the need to expand the scope of legal proxies under the LST Decisions Act.

Abortion is both a personal issue and a social problem. It should be viewed from a holistic point of view, one that takes into account, not only the decisions women make to terminate or continue pregnancies, but also their decisions concerning childbirth and nurturing. The dichotomous “pro-choice versus pro-life” debate is incapable of resolving the complex social and ethical issues associated with abortion. Moreover, discussions of the right to life of an embryo/fetus typically assume a controversial hierarchy of rights as well as a questionable concept of normality. And confusion between the right to life and protection of life raises new challenges in the policy debates concerning abortion. Liberty as non-domination is not something that one can enjoy as an isolated atomic entity. Rather, it is only in its relation to fellow citizens and the state that one can experience such freedom. Liberty as non-domination also emphasizes the state's civic responsibility to accept, and appropriately respond to, constructive criticism. This article advances the view that the ideal of liberty as non-domination has implications for abortion. Among other things, it provides an ethical basis for understanding and enhancing reproductive rights, which are also human rights.

The ethic of care in nursing presupposes a narrative understanding of patients in vulnerable situations. This ethic has both has both reciprocal and protective ethical dimensions. The ethics of reciprocity guides the relationship between nurses and patients such that each influences the other toward a good life and thereby helps to create an ethical narrative. A protective ethic calls for protecting the patient’s identity and responding to predicaments in which the dignity of the person is threatened. In particular, nurses are sometimes asked to provide existential advocacy for their patients. Moreover, in the context of the COVID-19 pandemic, where patient safety is a top priority, nurses must understand the existential threats facing patients and provide holistic care as existential advocates for patients and their families. However, it may be too much to require constant dedication and sacrifice from nurses. This article argues that it is important to establish an institutional support system for staffing, professional education, and self-care so that nurses can practice holistic care as professionals, rather than as “angels” or “heroes”. The ethics of care can contribute to self-growth and professional development toward a good life for both patients and nurses.