2026, Vol.29, No.3

Korean Journal of Medical Ethics 2025 KCI Impact Factor : 1.67

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

Shared decision-making (SDM) is widely recognized for integrating clinical evidence with patientvalues, yet standard SDM models presuppose elective conditions: ample time, intact capacity,and repeated consultations. Emergency surgery for colorectal cancer, which typically arises fromobstruction, perforation, or hemorrhage, undermines these prerequisites. Irreversible, value-ladenchoices concerning stoma formation, the extent of resection, or non-operative care in frail olderpatients must be made within hours, often under impaired capacity due to pain, sepsis, and opioids. Drawing on the perspective of a colorectal surgeon at a regional university hospital in South Korea,this article analyzes why standard SDM fails in this setting and argues that this shortfall mandatesreconstructing the SDM framework. Reinterpreting autonomy relationally, the study defendsstructured family participation as a legitimate expression of patient self-determination in the Koreancontext. It proposes a time-adapted SDM model that stratifies decisions by physiological urgency,incorporates the best-case/worst-case communication framework, utilizes bridging strategies suchas colonic stenting to render emergency choices semi-elective, and specifies the institutional anddocumentation supports required by regional medical centers.

Shared decision-making depends not only on clinician–patient interactions, but also on the qualityof the evidence clinicians bring to the clinical process. Pharmaceutical promotional brochures areone upstream source of such evidence, yet are unmonitored and exempt from mandatory review. Weassessed their compliance with established ethical standards and evaluated variations by companytype. In 2022, we collected 108 of 263 eligible brochures for top-300 best-selling prescription drugs(41.1% coverage at 17 academic conferences); the 91 presenting clinical results were evaluated againstWorld Health Organization (WHO) and Food and Drug Administration (FDA) criteria. Only 15(16%) met all nine WHO criteria. Multinational company brochures more frequently included safetyinformation (81% vs. 43%), manufacturer details, and appropriate references, while citing strongerevidence. After adjustment, this association persisted for the FDA composite score but remainedborderline for the WHO score. No brochures reported the number needed to treat or harm, and onlythree presented absolute risk reduction. Of 725 references, 28 (4%) could not be retrieved. Becauseshared decision-making presupposes trustworthy evidence, deficiencies in this upstream sourcemay weaken the informational basis for patient autonomy and physicians’ professional duties beforedeliberation begins.

Shared decision-making (SDM) operationalizes respect for patient autonomy, yet health professionseducation often evaluates it solely through self-reported confidence. This scoping review synthesizedhow artificial intelligence (AI) is used to teach, assess, or support SDM competency among clinicaltrainees and practitioners. A search of four databases in August 2026 identified 1,008 unique records,with 13 meeting inclusion criteria. AI served as an instructional environment (n=5), an assessmentinfrastructure (n=6), or catalyst for curricular improvement (n=2). Only one randomized educationaltrial was identified, and no study demonstrated durable transfer to clinical practice. Eleven sourcesexplicitly targeted patients’ values and preferences, yet only one addressed ethical reasoning, and onlytwo of five simulated encounter models articulated clinical options. Current approaches thereforeemphasize the informational dimension of consent at the expense of collaborative deliberation. Accordingly, we propose five ethical design principles for virtual standardized patients, formulated asa design specification warranting empirical evaluation.