• The Journal of Korean Society for School & Community Health Education
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• v.22 no.1
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• pp.55-72
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• 2021

Objectives: The aim of this study was to construct and verify a structural equation model of advance directive intent among a Korean group in their middle-age. Methods: Data were collected between May 1 and 30, 2017, from 398 people. The endogenous and exogenous variables of the hypothetical model consisted of elderly parents' care burden, health status, attitude towards withdrawal of life sustaining treatment, advance directive efficacy, and advance directive intent. The collected data were analyzed using the SPSS/WIN 24.0 and Mplus 7.4. Results: The hypothetical model demonstrated a good fit: χ2=223.79(df=109, p<.001), CMIN/df=2.05 CFI=.96, TLI=.96, RMSEA=.05, SRMR=.06. Elderly parents' care burden and health status showed statistically significant direct effects with attitude toward withdrawal of life sustaining treatment(β=.17, p=.001; β=.21, p<.001) and advance directive efficacy(β=.11, p=.040; β=.19, p=.002), respectively. Attitude toward withdrawal of life sustaining treatment and advance directive efficacy showed statistically significant direct effects on advance directive intent(β=.15, p=.007; β=.48, p<.001). Elderly parents' care burden and health status had a significant indirect effect on advance directive intent through attitude toward withdrawal of life sustaining treatment(β=.01, p=.041; β=.05, p=.036) and advance directive efficacy(β=.06, p=.049; β=.16, p=.006), respectively. The variables accounted for 26.1% of advance directive intent of the Korean group in their middle-age. Conclusion: It is necessary to develop an advance directive education program based on variables affecting advance directive intent for individuals in their middle-age.

• The Korean Society of Law and Medicine
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• v.14 no.1
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• pp.355-401
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• 2013

The first legislation for terminal health-care decision was California's Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life-sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self-Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

• Journal of Korean Public Health Nursing
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• v.34 no.2
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• pp.211-224
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• 2020

Purpose: This study was conducted to investigate death attitude, death anxiety, and knowledge toward advance directives of nursing students. Method: Participants were 157 nursing undergraduates in Korea. The students responded to a self-reporting questionnaire that included demographics, Death Attitude Profile-Revised (DAP-R), Revised Death Anxiety Scale (RDAS), and knowledge toward advance directives. The data collection period was December, 9-13, 2019. Data were analyzed by descriptive test, independent t-test, one-way ANOVA, and Pearson's correlation coefficient with SPSS/WIN 23.0. Results: The mean scores for death attitude, death anxiety, and knowledge toward advance directives were 2.70±0.58, 2.45±0.49, and 7.94±2.04, respectively. Knowledge toward advance directives was significantly different according to age, grade, and experience of end-of-life care education. Death attitude was significantly associated with death anxiety (r=. 27, p<.001). Conclusion: Knowledge toward advance directive was relatively low compared to the findings of previous studies. Therefore, nursing colleges need to include legal and institutional aspects when writing written letters on advance directive, death attitude, and ethical approaches to death anxiety.

• Journal of Korean Critical Care Nursing
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• v.3 no.2
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• pp.91-99
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• 2010

Purpose: The purpose of this literature review was to describe the roles of advanced practice nurses related to advance directives. Methods: A comprehensive literature review was conducted utilizing Pubmed, Ovid, and CINAHL. The key words for search were 'advance directives', 'living wills', 'durable power of attorney', 'advanced practice nursing', 'advanced practice nurse', 'nurse practitioner', and 'nurse specialist'. Research articles published between January 1990 and September 2010 and written in English were included. Review papers and expert's opinion were excluded. Results: Five articles were yielded and analyzed. Among them, two focused on the advanced practice nurses' role during the process of advance directives. The other three presented the outcomes depending on the type of nurses' involvement in each health care delivery system. Conclusion: Recently, Korea established advance directives and expanded to diverse sites. Advanced practice nurses' role in the advance directive decision-making process should be examined and developed in research and practice.

• 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.

• The Korean Society of Law and Medicine
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• v.10 no.1
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• pp.263-305
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• 2009

Is it lawful to withhold or withdraw life-sustaining treatment applied to a patient in a terminal condition or permanent unconscious condition? In Korea, there are no such laws or regulations which control affairs related to the withholding or withdrawal life-support treatment and active euthanasia as the Natural Death Act or the Death with Dignity Act in the U. S. A. And in addition there has had no precedent of Supreme Court. Recently Supreme Court has pronounced a historical judgment on a terminal care case. The court allowed the withdrawal of life-sustaining treatment from a patient in a permanent unconscious state. Fundamentally the court judged that the continuation of that medical treatment would infringe dignity and value of a patient as a human being. And the court required some legal grounds to consider such withdrawal or withholding of medical care lawful. The legal grounds are as follow. First, the patient is in a incurable and irreversible condition and already entered a stage of death. Second, the patient executed a directive, in advance, directing the withholding or withdrawal of life-support treatment in a incurable and irreversible condition or in a terminal condition. Otherwise, at least, the patient's will would be presumed through his/her character, view of value, philosophy, religious faith and career etc. I regard if a patient is in a incurable and irreversible condition or in a terminal condition, the medical contract between a patient and a doctor would be terminated because of the actual impossibility of achievement of it's purpose. So I think the discontinuation of life-sustaining care would be legally allowed without depending on the patient's own will.

• Journal of Convergence Society for SMB
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• v.6 no.4
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• pp.123-129
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• 2016

This study was conducted to understand influential factors in determining the advance directive attitudes of elderly patients. Structured survey questionnaires were distributed using a convenience sampling method to the residents of long-term-care facilities. As a result, the attitudes toward advance directives were accounted having 2.84 points, the functions of a family with 2.73 points, and the level of self-efficacy with 3.45 points. Participants who have higher family functions were found to have negative attitudes toward self-efficacy, as the relationship between two variables were in the negative correlation (r =-.324, p<.01). However, participants who have higher self-efficacy showed positive attitudes toward advanced directives as the two variables were in the positive correlation (r =.340, p<.01). This study will contribute to the settlement of the AD in Korea.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.9
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• pp.432-439
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• 2019

This study was a qualitative study that attempted to find out the meaning of preparation for dying well that the elderly think through a question of how to prepare for dying well. The focus group interview was conducted on 10 elderly people aged 65 or older who visited the elderly welfare center in B city, Gyeonggi-do, and a total of two groups were interviewed with five subjects as one group. As a result, eight themes were drawn from four dimensions of physical, psychological, social, and spiritual aspects. In physical preparation, 'health management' and 'doing what you want to do' were derived. In psychological preparation, 'not regretting' and 'giving to others' were derived, and in social preparation, 'organizing property', 'determining a place of death you wish', and 'writing a letter of advance life sustaining care directives' were derived. In spiritual preparation, 'relying on religion' was derived. The elderly were preparing for well-being in various aspects, and when developing a program for well-being, the program should be planned to prepare for actual death in various aspects.

• 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.