• The Korean Society of Law and Medicine
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• v.13 no.2
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• pp.285-308
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• 2012

The Korean supreme court said that Mrs Kim who was in a persistent vegetative state had a right to die if she had a presumed will or assumption of dying against Severance hospital in 2009. Presumed would be vague and can not be subjective to conjecture though, the court had a developed trial on the case. I recommend the higher valued notion such as the 'right to decide on the life extension' is more logical than assumptive will. To achieve this recommendation, I will search right to life, right to decision, human dignity and find the good relationship between them. In conclusion, I will announce that if PVS patients without advanced directives aren't able to express their will and no one could not assume their right to die in spite of meaningless life extension. So only the due and strict procedure about the extinction of meaningless PVS patients will allow them to sacrifice themselves or remove life extension ventilators. Also active euthanasia would be possible under the strict procedure of making advanced directives and the act of helping active euthanasia additionally, the crime of abetting suicide would not be executed in the legal scope.

• Journal of Korean Critical Care Nursing
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• v.15 no.2
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• pp.64-76
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• 2022

Purpose : This study aimed to verify the validity and reliability of the Korean version of the nurses' attitude scale toward advance directives of patients. Methods : We translated and back-translated the original tool consisting of 20 questions and tested and verified its content validity. Questions for which its content validity has been verified, a preliminary investigation was conducted among 20 nurses working in ICU, followed by the actual investigation. Data were analyzed using SPSS version 24.0 for Windows and Mac and AMOS version 24.0. To verify the validity, an item analysis was conducted for all 398 samples, and then an exploratory factor analysis for 200 samples that were randomly selected, followed by a confirmatory factor analysis for the remaining 198 samples. Results : Korean version of advance directives attitude scale (K-ADAS) consisting of 14 questions - 7 questions on 'patient rights,' 4 questions on 'role of a nurse,' and 3 questions on 'ethical judgment' - was verified its validity and reliability. Conclusion : In this study, the validity and reliability of the K-ADAS have been verified. We expect the verified tool to be useful in various fields that measuring the nurses' attitude toward advance directives of patients.

• Journal of Hospice and Palliative Care
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• v.18 no.1
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• pp.42-50
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• 2015

Purpose: This study was aimed to analyze how social workers understand the rights for elderly patient and family caregiver to make end-of-life (EOL) care decisions and their roles the decision making process. Methods: The study employed a quantitative research method of collecting data from a structured questionnaire that was filled out by 334 social workers at long-term care facilities. Data were analyzed by descriptive statistics, mean differences, correlation between variables, using SPSS 20.0 program. Results: The mean score for the understanding the rights to an EOL care decision was $3.46{\pm}0.69$ and of their own roles $3.48{\pm}0.84$. The level of understanding significantly differed by social workers' experience of assisting a process to make an EOL care decision such as advance directives and life sustaining treatment, work experience, and the number of beds. Positive correlation was observed between the level of understanding of the rights for EOL care decisions and of social workers' roles (Pearson r=0.329, P<0.001). Conclusion: This study proposes development of an education program for social workers and devising standards for the EOL care decision making process to protect elderly patients, family caregivers as well as social workers in a long term care facility.

• 한국노년학
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• v.30 no.4
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• pp.1197-1211
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• 2010

This research was concucted to present a model of advance directives(AD) when a patient, who is in consciousness, shows a preference for an end of life care as an act of preparing for an uncertain situation that may arise in the forseeable future. The subjects of the research are 383 doctors/nurese and adults, who live in six cities and provinces, to investigate the status of AD, attitude regarding a meaningless life-prolonging treatment, and moreover, an understanding of and a preference for AD. The research was done by the well-structured questionnaire. Also, SPSS 14.0 is used to analyse the collected data, focused on frequency analysis, avearage and standard deviation, X2 test. As the results of the study, the most of the surveyed doctors/nurese knew DNR orders and AD and a few of them used DNR orders and AD practically. Also, the result shows that there is a negative conception of meaningless life-prolonging treatment among the responents, in addition, most of them agreed upon the idea of introducing AD to Korea, filling it out and making it legally effective. As a method of making AD out, the respondents wanted to use a form that mixed living will with an Power of Attorney in a document. Also, considering the appropriate time, respondents prefered when they are diagnosed with terminal illness. At the moment, the introductory model for AD, which is suitable for the Korean culture and current situation is presented based on the result of this research. In the future, other researches should deal with specific measures that can lead to a social consensus to adopt AD in Korea.

• Journal of the Korea Convergence Society
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• v.11 no.12
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• pp.439-449
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• 2020

This study aimed to identify factors influencing the preferences for end-of-life (EOL) care among undergraduate nursing students. In this cross-sectional study, data were collected from December 2017 to February 2018. This study included 217 undergraduate nursing students. Factors influencing the preference for 'autonomous physiological decision-making' were the following: education level(by grade), having biomedical education, attitude towards death, and attitude towards life-sustaining treatments (LSTs). Preference for 'decision-making by healthcare professionals' was related to having a religion. Factors influencing the preference for 'spirituality' were education level, having a religion, and academic major satisfaction. Preference for 'pain control' was associated with education level, experience with dying patients, bad self-rated health, attitude towards death, and attitude towards LSTs. The study findings suggest that education regarding LSTs, EOL care, and EOL decision-making in nursing curricula is essential.

• Journal of Industrial Convergence
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• v.19 no.4
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• pp.49-55
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• 2021

This study attempted to review the research on biomedical ethics of nursing students published in Korea. Keywords included 'nursing students', and 'biomedical ethics', and a total of 26 studies were collected via databases such as KISS, NDSL, RISS. The biomedical ethics awareness was the main concept of biomedical ethics, consisted of right to life of fetus, artificial insemination, organ transplantation, and so on. There were differences in biomedical ethics awareness by ethical education experience, grade, clinical practice experience, and ethical education willingness to attend. Also, major keywords analysed with biomedical ethics were withdrawal of life-sustaining treatment, critical thinking, sexual attitude, nursing professionalism, and death perception. Study results can be used to provide basic data for preparing nursing ethics education in the future.

• Journal of Digital Convergence
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• v.19 no.5
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• pp.321-331
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• 2021

The purpose of this study is to establish well-dying education, well-dying culture, and industrialization for well-aging. For this, data was collected through Gallup Korea from February 1, 2021 to February 22, 2021. As a result of the study, well-dying education experience was 4.7%, and education satisfaction was surveyed with 2.88 points out of 5. As a result of analyzing the needs of well-dying education according to the age groups, the educational demands of youth and middle-aged were in the order of hospice education and information, life-sustaining medical information, and funeral information. In the case of the young old, it was in the order of hospice education and information, funeral information, and psychological overcoming related to death. In the case of the elderly, the survey was conducted in the order of hospice education and information, funeral information, and life-care related information. The perception of industrialization related to the well-dying culture was inspected in the order of the well-dying café where you can talk about life and death, the well-dying experience such as the entrance experience, and the development of travel products related to culture and art (p<0.05). Such results can be usefully utilized in the development of well-dying education programs for well aging, cultural spreading, and industrialization.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.25 no.3
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• pp.204-214
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• 2018

Purpose: This study aimed conducted to investigate biomedical ethics awareness and attitudes toward dignified death and advance directives among nursing students. Methods: Data were collected through structured questionnaires from 222 nursing students with clinical practice experience, from November 7 to 23, 2015. Data were analyzed by independent t-tests, one-way ANOVA, Kruskal-Wallis test, and Pearson's correlation coefficients using SPSS WIN 22.0. Results: The scores for biomedical ethics awareness and attitudes toward dignified death were 2.89 and 3.15, respectively. Regarding attitudes toward advance directives (ADs), most students agreed with writing ADs. The main reason given for writing ADs is "I want to receive my treatment of choice." As for the range and explanation method for ADs, 45.7% of participants responded, "do not know well." Regarding willingness toward life sustaining treatment, "only pain control, no life sustaining treatment" was indicated by 83.4% and, "all information about symptoms and prognosis" by 91.9% of participants. For willingness to write ADs, 70.0% of participants responded "yes." Conclusion: Curriculum for nursing ethics should be included in clinical training courses to improve related courses and provide an opportunity to deal with practical problems, such as biomedical ethics, death with dignity, and ADs.

• 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.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.