• The Korean Society of Law and Medicine
• /
• v.11 no.2
• /
• pp.239-274
• /
• 2010

Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. Firstly, the theoretical limitations of Advance directive may be categorized into conceptual and moral limitations. In case of conceptual limitations, authors of advance directives may not be well aware, in advance, of the particular situation in which he or her will experience in the future, and patients may experience the change in his or her values and lack the understanding and information about the future situation due to the changes in treatment methods. In case of moral limitations, a patient has a limited moral autonomy right and self identity that have an impact on his or her preference. Secondly, in case of practical constraints for advance directive, there exist cultural features, low ratio of documentation, as patients themselves admit, and low predictability and stability of patient's own preference regarding life-sustaining care. And the problem of validity and accuracy in proxy's decision making is also raised. Those who administer a living will, especially, may have a difficulty in understanding the directive by a patient, so that the accuracy of execution cannot be secured. In the sense, it is needed to implement a legal device in order to solve such problems. In summary, it is urgently required to understand the limitations and explore desired alternatives to overcome the relevant problems in advance, which must contribute to successfully adopting and effectively operating the advance directive system in Korea.

• Journal of Hospice and Palliative Care
• /
• v.19 no.2
• /
• pp.109-118
• /
• 2016

The purpose of this study was to evaluate Korean advance directives (K-AD) by examining the degree of adults' acceptance and reliability of the directive itself. Methods: Survey was performed with 181 adults aged 20 or older who were recruited from three regions. A questionnaire used to examine the participants' acceptance of their K-AD in terms of visual analogue scale score of complexity, difficulty, necessity, satisfaction, recommendation. Then, a retest was carried out by asking participants to write up a K-AD again to confirm the reliability of the directives. Results: On a scale of 100, the average acceptance score was 70 or above, which represents rather high level of acceptance in all five categories. The test-retest reliability kappa values ranged from 0.592 to 0.950, and the conformity degree was moderate or high. Regarding K-AD components such as values, treatment preference, proxy appointment, differences among age groups were observed in each component. Conclusion: The results of this study suggest that K-AD is a feasible instrument to analyze its acceptability and reliability for adult population. K-AD could be utilized to help people make their own decision on their end-of-life care. Further studies are needed to confirm this study results and promote widespread use of K-AD.