• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.105-138
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• 2017

This is case comments of several representative legal cases regarding self- determination right of patient. In a case in which an intoxicated patient attempted suicide refusing treatment, the Supreme Court ruled that the medical team's respect for the patient's decision was an act of malpractice, and that in particular medical situations (medical emergencies) the physician's duty to preserve life supersedes the patient's rights to autonomy. Afterwards, at the request of the patient's family, and considering the patient's condition (irrecoverable death stage, etc.) consistent with a persistent vegetative state, the Supreme Court deduced the patient's intention and decide to withdraw life-sustaining treatment. More recently, regarding patients who refuse blood transfusions or other necessary treatment due to religious beliefs, the Supreme Court established a standard of judgment that can be seen as conferring equal value to the physician's duty to respect patient autonomy and to preserve life. An empirical study of legal precedent with regard to cases in which the physician's duty to preserve life conflicts with the patient's autonomy, grounded in respect for human dignity, can reveal how the Court's perspective has reflected the role of the patient as a decision-making subject and ways of respecting autonomy in Korean society, and how the Court's stance has changed alongside changing societal beliefs. The Court has shifted from judging the right to life as the foremost value and prioritizing this over the patient's autonomy, to beginning to at least consider the patient's formally stated or deducible wishes when withholding or withdrawing treatment, and to considering exercises of self determination right based on religious belief or certain other justifications with informed refusal. This will have a substantial impact on medical community going forward, and provide implicit and explicit guidance for physicians who are practicing medicine within this environment.

• The Korean Society of Law and Medicine
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• v.13 no.2
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• pp.217-261
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• 2012

Die Zeugen Jehovas lehnen Bluttransfusionen ab. Wiederholt haben Todesf$\ddot{a}$lle unter Jehovas Zeugen, die mit der Ablehnung von Bluttransfusionen in Verbindung gebracht werden, in den Medien f$\ddot{u}$r Aufsehen gesorgt, da die Zeugen Jehovas die $\ddot{U}$bertragung von fremdem Blut aus religi$\ddot{o}$sen Gr$\ddot{u}$nden entschieden ablehnen. Medizinische Behandlungen, auch Bluttransfusionen bed$\ddot{u}$rfen grunds$\ddot{a}$tzlich der Einwilligung des Patienten. Wenn sich ein Zeuge Jehovas gegen eine Transfusion entscheidet, ist dies zu respektieren. Ist ein erwachsener Patient Mitglied der Zeugen Jehovas und tr$\ddot{a}$gt dieser eine Patientenverf$\ddot{u}$gung bei sich, die eine Bluttransfusion ablehnt, weil es dadurch zu einer "Zerst$\ddot{o}$rung der Pers$\ddot{o}$nlichkeit" des Menschen aus religi$\ddot{o}$sen Gr$\ddot{u}$nden komme, so ist auch diese Verf$\ddot{u}$gung verbindlich, sofern sie ernsthaft ist. Bei Minderj$\ddot{a}$hrigen ist die Einwilligungsf$\ddot{a}$higkeit durch den Gesetzgeber bislang nicht geregelt. Minderj$\ddot{a}$hrige k$\ddot{o}$nnen grunds$\ddot{a}$tzlich selbst zustimmen, wenn sie ihrer geistigen und sittlichen Reife nach einsichtsf$\ddot{a}$hig sind. Bei Jugendlichen ab dem 16. Lebensjahr muss der Arzt ermitteln, wie einsichtsf$\ddot{a}$hig sie sind und inwiefern sie selbst in die medizinische Behandlung einwilligen k$\ddot{o}$nnen. Einwilligung kann aber nicht eingeholt werden, wenn der Patient einwilligungsunf$\ddot{a}$hig ist. Bei Kindern bis zum 16. Lebensjahr ersetzt die Einwilligung der Eltern in die medizinische Behandlung die Einwilligung der Kinder. Ob die Entscheidungen der Eltern $\ddot{u}$ber ihre unm$\ddot{u}$ndigen Kinder im Fall lebensbedrohlicher Krankheitsverl$\ddot{a}$ufe von den behandelnden $\ddot{A}$rzten akzeptiert werden m$\ddot{u}$ssen, ist umstritten. Die Ablehnung einer Bluttransfusion f$\ddot{u}$r ein transfusionsbed$\ddot{u}$rftiges Kind w$\ddot{a}$re eine Kindeswohlgef$\ddot{a}$hrdung. Bei Kindern ist der Weg $\ddot{u}$ber die $\ddot{U}$bernahme des Sorgerechts durch das Gericht unvermeidlich, falls die Eltern auf der Ablehnung einer lebensnotwendigen Transfusion beharren. Im Rahmen der objektiven Interessenabw$\ddot{a}$gung ist der Grundsatz "in dubio pro vita" zu beachten. Bei erheblicher unmittelbarer Gefahr ist allerdings ein direktes Eingreifen n$\ddot{o}$tig.

• The Korean Society of Law and Medicine
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• v.15 no.2
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• pp.3-29
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• 2014

The Supreme Court made a decision that the doctor cannot be punished for not taking a blood transfusion to the patient, depending on the patient's will to refuse the blood transfusion on June 24, 2014. The reason is that, in a special situation of conflict between the right of patients to self-determination and the duty of care, and when it was impossible to compare whether which has the superior value, if the doctor made a medical practice to respect either of those two values according to the professional sense, he cannot be punished. In principle, the doctor should make medical practices according to the patient's will. However, if the patient's life was at stake, I think, the doctor is obliged to try his best to save the life of patient. Yet to entrust the patient's life to the doctors professional sense, is to give up the obligation of the country to protect lives. In this regard, I think that the Supreme Court Decision should be reviewed, and that an ongoing research is needed.

• Childhood Kidney Diseases
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• v.6 no.1
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• pp.120-122
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• 2002

A 9-year-old boy of B blood group with end-stage renal disease due to IgA nephropathy received group O kidney transplantation from his father On day 9, he developed intravascular hemolysis, and anti-B autoantibody formation was confirmed. We diagnosed as immune hemolytic anemia due to passenger lymphocyte from donor, and cyclosporine withdrawl was done. Anemia resolved spontaneously, but on day 18, graft dysfunction developed, and graft biopsy revealed acute allograft rejection. Although hemolysis due to autoantibody is very rare and often mild, and the role of hemoglobinuria on acute rejection in this case is not certain, we recommend consideration of aggressive management on severe hemolysis after minor mismatched kidney transplantation. (J Korean Soc Pediatr Nephrol 2002 ; 6 : 120-2)

• Journal of The Korean Society of Inherited Metabolic disease
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• v.18 no.2
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• pp.50-54
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• 2018

Jehovah's Witnesses do not accept blood transfusions, because of their particular interpretation of the Old and New Testaments. When people with such religious convictions are in need of medical care, their faith and belief may become an obstacle for proper treatment, and pose legal, ethical, and medical challenges for the health care providers. We report two inherited metabolic disorder cases in South Korea where the infants died whilst under medical care because of parental refusal of blood transfusions for religious reasons. Case 1 had methylmalonic acidemia, Down syndrome and associated congenital cardiac anomalies requiring surgery. Case 2 had anemia and methylmalonic acidemia requiring dialysis to treat hyperammonemia and metabolic acidosis. For effective medical management, they needed life-saving blood transfusions. As a part of alternative treatment, Erythropoietin was administered in both cases. As a result, two babies died from their extremely low hemoglobin and hematocrit. The hemoglobin concentrations below 2.7 g/dL without cardiac problem and 5.4 g/dL with cardiac anomaly complicated by pulmonary hypertension are considered life-threatening hemoglobin threshold. The medical professional must respect and accommodate religious beliefs of the patients who can make informed decisions. However, when parents or legal guardians oppose medical treatment of their babies and incompetent care receivers on cultural and religious grounds, the duty to assist and save persons exposed to serious danger, particularly life-threatening events must come first.

• Journal of Yeungnam Medical Science
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• v.6 no.2
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• pp.159-172
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• 1989

This study was conducted to compare the date on knowledge, attitude and motivation toward blood donation between donors and nondonors. The study population included 622 donors and 322 nondonors who visited the mobile blood donation car of Taegu Red Cross Blood Center and participated the group appointed blood donation campaign managed by the center from March 1 to March 31, 1989. The donors and nondonors were questioned above mentioned items with a formulated questionnaire. Among the general characteristics of the subjects in the study, male predominace(84.1% in donors and 73.6% in nondonors) in young age group (16-24 years) was the outstanding feature. As a medium of information about blood donation, "television" was playing a dominant role(donors ; 75.2%, nondonors ; 78.9%), while "magazine"played more important roles among donors. Of the donors, 70.6% and of the nondonors, 58.1% replied that they had ever been induced to donate blood (p<0.01). Major inducers were friend and personnel of mobile blood donation vehicle. On the measuring of knowledge level, the average rates of correct answer was higher in donors (62.6%) than in nondonors (54.1%) (p<0.01). Higher the education level was presented, higher the knowledge level (p<0.05). There have been noticeable difference between donors and nondonors in blood replying the questionnaire set to measure their attitude toward blood donation. especially in the items such as "impression toward blood", "selection of transfusion blood source" and "view on the situation of blood shortage." The major motivation toward blood donation of the groups were "possible future need" and "altruism or humanitarian interest". The major reasons for not donating blood in both groups were "fear of the needle" and around to visit to mobile car or center."

• The Korean Society of Law and Medicine
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• v.10 no.2
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• pp.253-286
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• 2009

Die $\ddot{a}$mrztliche Behandlung des Patienten durch den Arzt geschieht im Rahmen eines Rechtsverh$\ddot{a}$ltnisses. Das Arzt-Patienten-Rechtsverh$\ddot{a}$ltnis stellt regelm$\ddot{a}$ssig der Arztvertrag oder Behandlungsvertrag dar. Arzt und Patient schliessen einen Arztvertrag ab. Grunds$\ddot{a}$tzlich verbindet der Arztvertrag die Partner pers$\ddot{o}$nlich. Aber minderj$\ddot{a}$hrige Patienten sind gesch$\ddot{a}$ftsunf$\ddot{a}$hig oder in der Gesch$\ddot{a}$ftsf$\ddot{a}$higkeit beschr$\ddot{a}$nkt. Minderj$\ddot{a}$hrige Patienten verm$\ddot{o}$gen also allein grunds$\ddot{a}$tzlich keine wirksamen Willenserkl$\ddot{a}$rungen abzugeben und somit keine wirksamen Arztvertr$\ddot{a}$ge zu schliessen. Arztvertr$\ddot{a}$ge von minderj$\ddot{a}$hrigen Patienten sind nur bei Einwilligung der gesetzlichen Vertreter wirksam. Vom Abschluss des Arztvertrags ist deutlich die Einwilligung zur Behandlung zu unterscheiden. Die Einwilligung ist kein Rechtsgesch$\ddot{a}$ft. Die Einwilligung durch die Eltern erfolgt nur solange der minderj$\ddot{a}$hrige Patient nicht reif genug ist, die Entscheidung selbst zu treffen. Jugendlicher Patient ist z.B. in der Lage, die Einwilligung selbst zu geben, sofern er Wesen, Bedeutung und Tragweite der Behandlung zu verstehen vermag. Der Vorschriften des KBGB zur Gesch$\ddot{a}$ftsf$\ddot{u}$hrung ohne Auftrag gelten, wenn der Arzt einen Bewusstlosen versorgt. Nach $\S$734 KBGB erfolgt die Gesch$\ddot{a}$ftsf$\ddot{u}$hrung ohne Auftrag dann zu Recht, wenn sie dem Interesse und dem wirklichen oder mutmasslichen Willen des Patienten entspricht. Der Patient kann aus einem Ausland stammen. F$\ddot{u}$r ausl$\ddot{a}$ndische Patienten gilt generell das koreanische Recht. Grunds$\ddot{a}$tzlich sollte man einen des Koreanischen nicht m$\ddot{a}$chtigen Ausl$\ddot{a}$nder nach M$\ddot{o}$glichkeit in seiner Sprache aufkl$\ddot{a}$ren und dann den Arztvertrag abschliessen. Aufgrund der Privatautonomie kann jeder Patient frei entscheiden, ob, mit wem und wor$\ddot{u}$ber er einen Arztvertrag abschliesst. Deswegen ist auch der Wille des Anh$\ddot{a}$ngers vom Sekten und abweichenden Lebensauffassung grunds$\ddot{a}$tzlich zu ber$\ddot{u}$cksichtigen. Zum Beispiel handelt der Zeuge Jehovas auf eigene Gefahr, wenn er eine notwendige Behandlung ablehnt. Aber die Freiheit, eine gebotene Behandlung abzulehnen, kann in Konflikt mit dem Schutz des minderj$\ddot{a}$hrigen Patienten gelangen. Sobald die sektiererische oder abweichende Haltung droht, einen minderj$\ddot{a}$hrigen Patienten zu gef$\ddot{a}$hrden, hat das elterliche Sorgerecht einzuschr$\ddot{a}$nken.