• The Journal of Korean Academic Society of Nursing Education
• /
• v.26 no.4
• /
• pp.383-392
• /
• 2020

Purpose: This study was a descriptive study to identify factors affecting the attitude toward life-sustaining treatment of nurses working at long-term care hospitals. Methods: Data were collected through structured questionnaires from August 2nd to 27th, 2019. Study participants consisted of 163 nurses who were working for at least 6 months from 7 long-term care hospitals in B and K city. Data were analyzed using t-test, ANOVA, Scheffe' test, Pearson's correlation coefficients, and hierarchical regression with SPSS WIN v 21.0. Results: There were significantly positive correlations between awareness of good death (r=.46, p<.001) and perception of patients' rights (r=.32, p<.001). The factors affecting participants' attitude toward life-sustaining treatment were awareness of good death (β=.35, p<.001) and their own view of death (β=.24, p=.001), which explained about 27.0% of the attitude toward life-sustaining treatment. Conclusion: Based on these results, it is necessary to develop nursing educational materials that can establish values for deaths, and cultivate legal and ethical knowledge related to attitude toward life-sustaining treatment. In addition, since the severity of a patient's condition varies and the characteristics of the institution vary depending on the type of hospital, a study is needed on the relevance of variables considering the hospital environment.

• Journal of Industrial Convergence
• /
• v.19 no.4
• /
• pp.49-55
• /
• 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 Korean Critical Care Nursing
• /
• v.16 no.3
• /
• pp.109-122
• /
• 2023

Purpose : This study aims to explore nursing activities after the decision to discontinue life-sustaining treatment, awareness of a good death, and perception of life-sustaining treatment decisions among nurses in intensive care units (ICUs) at tertiary general hospitals. Methods : Participants were 173 nurses working in two tertiary general hospitals. The data were collected using structured questionnaires and analyzed using an independent t-test, paired t-test, one-way ANOVA, Scheffé's test, and Pearson's correlation coefficient. Results : Participants were 173 nurses working in two tertiary hospitals. The nursing activity increase was the greatest in the spiritual domain, and the physical domain was where the activities decreased the most. There were significant associations between Awareness of good death (Clinical) and Perception of life-sustaining treatment decision(r=.26, p <.001), Awareness of good death (Closure) and Perception of life-sustaining treatment decision(r=.36, p <.001), and Awareness of good death (Personal control) and Perception of life-sustaining treatment decision(r=.49, p <.001). Conclusion : Based on the results, systematic education programs and job training are required to improve the awareness regarding good death and perception of life-sustaining treatment decision for nurses in ICUs where discontinuing life-sustaining treatment decisions are made.

• Journal of Hospice and Palliative Care
• /
• v.21 no.2
• /
• pp.51-57
• /
• 2018

Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.

• The Korean Society of Law and Medicine
• /
• v.10 no.2
• /
• pp.203-249
• /
• 2009

It is the so-called Shinchon Severance Hospital Case brought to an end by the decision of the Supreme Court that opened the real discourse of withholding or withdrawing of LST (Life-Sustaining Treatment) in the legal profession as well as medical profession in Korea. Everyone has sympathy with the validity and necessity of legal regulation on withdrawing-including withholding-of LST save the requirements & procedure of withdrawing of LST. In this situation, the legislative bill of amendment to the Korean Civil Law introducing of adult guardianship was pre-announced by the Ministry of Justice on September 18th 2009. The adult guardianship is a guardianship system that supports an mentally handicapped adult to deal with his affairs by support of a guardian. The object of adult guardianship includes affairs of body or well-being as well as property of adult wards. In particular, affairs of medical matters are of importance in the duty and authority of adult guardians. So, the introduction of adult guardianship is of much importance de lege lata as well as de lege ferena in the discussion of withdrawing of LST as a medical treatment. Since the legislation on withdrawing of LST intents to protect the right of death with dignity on the basis of patients' autonomy, the ratio legis of withdrawing of LST is variant from that of adult guardianship. In this context, it seems reasonable to legislate the withdrawing of LST separately from the adultguardianship. In the meantime, the adult guardianship of the legislative bill of amendment to the Korean Civil Law is related to the withdrawing of LST, since the main purpose of adult guardianship is to protect patients' quality of lives and to regulate guardianship contracts based on patients' autonomy. In that context, it seems reasonable to incorporate the legislation of withdrawing of LST into the adult guardianship system. In the latter case, it is not easy to adopt the withdrawing of LST into the legislative bill of the Korean Civil Law for the bill is pre-announced already as previously stated. However, the legislation of withdrawing of LST is not inferior to the legislation of adult guardianship as a matter of urgency. Moreover, it is likely that the legislative bill of Amendment to the Korean Civil Law generates discrepancies in interpretation of the requirements & procedure of withdrawing of LST as the amended German Civil Law did. In short, it is desirable for the legislator to revise the legislative bill despite delay.

• The Korean Society of Law and Medicine
• /
• v.25 no.1
• /
• pp.193-222
• /
• 2024

From a global trend, discussions on the patient's death with dignity are gradually progressing from the issue of withdrawal of life-sustaining treatment to the issue of whether to allow assisted death and its requirements. Several states in the United States and Western European countries such as Canada, Belgium, and the Netherlands have institutionalized treatment to accelerate the time of death through the assistance of doctors. In France, after a long period of raising and reviewing issues, discussions on related legislation are taking place at a slower pace than in other European countries. In France, social discussions and legislative attempts on death with dignity have been actively conducted since the late 20th century. The Leonetti Act of 2005 prohibited the continuation of meaningless treatment against the will of patients, and after the Clay-Leonetti Act of 2016, it was legalized to administer intensive and continuous sedatives to patients until death. However, unlike many neighboring European countries, treatment that speeds up the time of death itself is still prohibited in France, even if the patient wants. As the existential and universal question of whether to allow dying patients to die painlessly with the help of a doctor has recently emerged as an important issue, a number of lawmakers have submitted legislation to legalize assisted death. This paper examines the legislative process developed in relation to patients' rights to dignified death in France, and compares and reviews French legislation that attempts to legalize assisted death with the amendment to the Korean Life-Sustaining Treatment Act.

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

• Journal of Hospice and Palliative Care
• /
• v.14 no.2
• /
• pp.81-90
• /
• 2011

Purpose: This study is to understand how community members perceive past life recollection and preparation for death. Methods: Using a questionnaire, we surveyed 160 adult residents of one of the districts (gu) in Seoul, Korea. Descriptive statistics were used. Results: Participants chose their 30s and 40s as the most difficult time in their lives. The most painful experience was "an illness of a family member", followed by "trouble with a spouse", and "trouble with children". As for the most difficult social experience, "sense of loss in life" was ranked the highest. Personally, the happiest time was "accomplishment of a goal", while it was "happiness through children" in family relationship and "contribution to society through my career" in social life. As for the most regrettable experience, personally "having lived without purpose" was the highest, "not meeting my parents' expectation more" in family relationship; "not providing sufficient education" in relationship with children; "not having an occupation that I wanted" in work life, and "lack of social skills" in social life. More than 87% of the surveyed showed a positive attitude about the system of the do not resuscitate (DNS) order. For a situation where participants were supposed to have an incurable disease, "I want to be notified of the true condition" and "I want to write a will and advanced directives" ranked high, receiving more than 3.1 points out of 4. Conclusion: These results demonstrate the need for death education to provide people with an opportunity to accept their regrettable experiences in the past as part of their life. Also, this study suggests the importance of writing advanced directives for people to prepare for "death with dignity" how it can help their decision to be better respected.

• Korean Journal of Adult Nursing
• /
• v.28 no.3
• /
• pp.334-342
• /
• 2016

Purpose: This study was conducted to identify factors that influence on self-determination for withdrawal of life-sustaining treatment in the community dwelling elderly. Methods: This study used a descriptive correlational design. A convenience sample of 201 elderly were recruited from a welfare center located in Seoul, Korea. Data collection was done from September 1 to September 18, 2015. Four survey questionnaires were used: Multidimensional Scale of Perceived Social Support (MSPSS), Life Satisfaction Index-Z (LSI-Z), Attitude on Do Not Resuscitate (DNR), and Self-determination for Withdrawing Life-sustaining Treatment. Data analysis was done by t-test, ANOVA, Pearson's correlation, and hierrarchical multiple regression. Results: Hierarchial multiple regression showed that the factors predicting the level of self-determination for withdrawing life-sustaining treatment were educational level, DNR experience in family, life satisfaction, and DNR attitude. These factors explained 44% of the self-determination for withdrawing life-sustaining treatment in community dwelling elderly. Conclusion: The results of this study suggest developing educational programs aiming at changing elderly's DNR attitude positive ways so that they can enhance self-determination for withdrawing life-sustaining treatment. Further study is needed with more elderly population in extended areas.

• The Korean Society of Law and Medicine
• /
• v.9 no.1
• /
• pp.461-503
• /
• 2008

The right to live is the most valuable benefit and protection of the law. And Medical science is the study considering value of life as the top priority. As modern medical science has progressed and expanding lifespan skills have developed, the number of symptom, called a human vegetable, has been also increased. As a result, people concerns whether euthanasia should be permitted. (1) Active euthanasia is prohibited and a doctor who conduct it is punished. (2) Indirect euthanasia can be permitted unless it is against a patient's intention. (3) Permission of passive euthanasia depends on intention of a patient. In other words, when a patient accepts, a doctor respects the right of self determination of patient and irreversible situation such as brain death happens, treatment stop is permitted. Even a patient who is in the last stage of cancer has a right to die in the dignity and elegance. Solutions for ceasing medical treatment are as follows; First, establishment of 'Bioethics Committee'. Second, setting procedures to empower a court a right to decide whether medical treatment is ceased. Third, setting procedure a government to assist treatment fees. In this paper, direction for social agreement of legal policy regarding the ceasing treatment is provided.