• Journal of Hospice and Palliative Care
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• v.26 no.2
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• pp.95-100
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• 2023

With the implementation of Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life, interests of the general public on self-determination right and dignified death of patients have increased markedly in Korea. However, "self-determination" on medical care is misunderstood as decision not to sustain life, and "dignified death" as terminating life before suffering from disease in terminal stage. This belief leads that physician-assisted suicide should be accommodated is being proliferated widely in the society even without accepting euthanasia. Artificially terminating the life of a human is an unethical act even though there is any rational or motivation by the person requesting euthanasia, and there is agreement thereof has been reached while there are overseas countries that allow euthanasia. Given the fact that the essence of medical care is to enable the human to live their lives in greater comfort by enhancing their health throughout their lives, physician-assisted suicide should be deemed as one of the means of euthanasia, not as a means of dignified death. Accordingly, institutional organization and improvement of the quality of hospice palliative care to assist the patients suffering from terminal stage or intractable diseases in putting their lives in order and to more comfortably accept the end of life physically, mentally, socially, psychologically and spiritually need to be implemented first to ensure their dignified death.

• Journal of Hospice and Palliative Care
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• v.13 no.1
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• pp.41-49
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• 2010

Purpose: This study was performed to explore the preference for care near the end-of-life of nurses who had been working in an acute hospital. Methods: Data were collected by using PCEOL-K which was originally developed in U.S. and standardized into Korean version. Two hundred nurses from one acute hospital who agreed to participate in the study filled out questionnaires and 177 questionnaires were analyzed for the study results. Results: Relatively positive preference toward spirituality and pain control and negative preference toward decision making by health care professional were uncovered. Conclusion: Nurses consider patient's autonomy, pain control and spirituality as important factors at the end-of-life care. Further studies regarding the preference for the care near the end-of-life of diverse groups such as patients, doctors, and family members are called for.

• Korean Journal of Adult Nursing
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• v.22 no.3
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• pp.329-341
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• 2010

Purpose: The purpose of this study was to understand the meaning of death experienced by medical and nursing students through end-of-life care practice. Methods: Data were collected by in-depth interviews with twelve (six nursing and six medical) students. Conventional qualitative content analysis was used to analyze the data. Results: This findings were analyzed in three areas: 'feeling from the word of death', 'color association of death', and 'relation between life and death'. Results were three major themes and sixteen categories from the analysis. Three major themes include 'reality of uncertain death', 'have to leave, and 'new perception about death'. Sixteen categories include 'being well', 'fear', 'unknown', 'boundless', 'being with', 'out of sight', 'new start', 'go back to', 'place going by itself', 'place to meet with', 'being transformed', 'a sense of futility', 'the same point', 'a different point', 'continuous line', and 'a crossroad'. Conclusion: The findings suggest a number of themes that nursing and medical students reported about the end of life experiences that could be explored as a way of improving end of life care.

• 한국사회정책
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• v.25 no.1
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• pp.99-123
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• 2018

Purpose: This study empirically investigates the utilization and expenditure of health care and long-term care at the last year of life for long-term care beneficiaries in Korea. Methods: This study used National Health Insurance and Long-term Care Insurance claims data of 271,474 LTCI beneficiaries, who died from July 2008 to December 2012. Their cause of death, place of death, health care costs, and the provision of aggressive care were analyzed. Results: Cardio-vascular disease(29.8%) and cancer(15.3%) were reported as their major cause of death, and hospital(64.4%), home(22.0%), social care facility(9.2%) were analyzed as the place of death. 99.3% of subjects used both health care and long-term care during the last 1 year of life. The average survival period were 516.2 days after they were LTCI beneficiaries. The health care expenditure gradually increased near the death, and the last month were three times more rather than the first month. Furthermore, 31.8% experienced some aggressive cares(CPR, blood transfusion, hemo-dialysis, etc.) at the last month of life. Conclusion: The results of this study suggest that it is important to develop the end of life care policies(for example, hospice, advanced care directives) for the LTCI beneficiaries. They might contribute to the improvement of quality of life and the reduction of health care expenditure of the elderly at the end-of-life.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.175-179
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• 2015

The intensive care unit (ICU) is the most common place to die. Also, ethical conflicts among stakeholders occur frequently in the ICU. Thus, ICU clinicians should be competent in all aspects for ethical decision-making. Major sources of conflicts are behavioral issues, such as verbal abuse or poor communication between physicians and nurses, and end-of-life care issues including a lack of respect for the patient's autonomy. The ethical conflicts are significantly associated with the job strain and burn-out syndrome of healthcare workers, and consequently, may threaten the quality of care. To improve the quality of care, handling ethical conflicts properly is emerging as a vital and more comprehensive area. The ICU physicians themselves need to be more sensitive to behavioral conflicts and enable shared decision making in end-of-life care. At the same time, the institutions and administrators should develop their processes to find and resolve common ethical problems in their ICUs.

• Journal of Hospice and Palliative Care
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• v.24 no.3
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• pp.144-153
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• 2021

Purpose: Advance care planning (ACP) is widely understood to improve end-of-life care. This systematic review and meta-analysis aimed to examine the effects of ACP interventions on decision conflict and psychological distress. Methods: A search of PubMed, CINAHL, CENTRAL, EMBASE, KISS, KoreaMed, and RISS was conducted in November 2020. The study included randomized controlled trials. Data were pooled using fixed- and random-effects models. Results: Fourteen studies were identified that cumulatively included 1,548 participants. ACP interventions were effective in alleviating decision conflict (d=-0.53; 95% CI: -0.83 to -0.23), depression (d=-1.22; 95% CI: -1.71 to -0.74) and anxiety (d=-0.76; 95% CI: -1.12 to -0.39). Conclusion: ACP interventions have significant positive effects on reducing decision conflict and psychological distress. A high level of bias was shown related to allocation concealment and blinding. The results of this study are expected to be useful for end-of-life care providers to improve the effectiveness of ACP interventions.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.9
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• pp.212-220
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• 2016

Purpose: The purpose of this study was to examine self-transcendence, life satisfaction, and preference for end-of-life care in elderly patients. Method: This was a descriptive survey study. The study period was between August 2013 and October 2013 and included 208 elderly patients. Results: The average scores for self-transcendence, life satisfaction, and preference for end-of-life care were 2.79, 9.97, and 3.24, respectively. Statistically significant positive correlations were observed between self-transcendence and life satisfaction, decision making by health care professionals, spiritual area, family area. A positive correlation was observed between: (1) life satisfaction and spiritual area, (2) decision making by health care professionals and family area, and (3) decision making by health care professionals and pain area. Self-transcendence was a significant predictor of PCEOL. Conclusion: This study will provide basic information for use in the development of a program to encourage self- transcendence and life satisfaction, as well as to consider the elder's autonomy, pain control, and spirituality as important factors at the end-of-life care.

• Journal of Hospice and Palliative Care
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• v.12 no.3
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• pp.115-121
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• 2009

Despite a recent increased nation's attention given to improving end-life care, we professionals need to be more critical and reflective on our realities surrounding hospice palliative care. The aim of this paper is to suggest that palliative care models can be used for patients/families in the last phase of life and examine whether they are appropriate for caring them in congruence with philosophy of hospice. The hospice experience model (HEM) of Eagan & Labyak and the developmental model of Byock are introduced and examined for their congruence with philosophy of hospice in applying to clinical practice. The HEM as a patient/family value-directed end of life care model emphasizes three principles; unique experience of patient/family, interactions/relationships among multiple dimensions of personhood and between family, and personal growth and development in the face of suffering through a life-completion. The developmental model stipulates dying as the last stage of living, a stage of life cycle in which patients/family may have growth through life-completion in multidimensional relationships of personhood. The model includes the developmental landmarks and tasks for life-completion as the framework to guide a means of professionals' to recognize their opportunity to grow. The landmarks and tasks include worldly and social affair, individual relationships, intrapersonal, and transcendent dimension. The models could work as appropriate palliative care models for patients/families in the last stage of living. The professionals need to be encouraged to apply the models to end of life care setting.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.1-4
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• 2016

As advance care planning is taking center stage in the field of end-of-life care, various tools have been developed to aid in the often emotional and difficult decision-making process. Video decision support tools are one of the most promising means of assistance, of which the modus operandi is to provide more comprehensive and precise information of medical procedures to patients and their families, allowing them to make better informed decisions. Despite such value, some are concerned about its potential negative impact. For example, video footages of some procedures may be shocking and unpalatable to non-medical professionals, and patients and families may refuse the procedures. One approach to soften the sometimes unpleasant visual of medical procedures is to show less aggressive or more relaxing scenes. Yet another potential issue is that the objectivity of video decision support tools might be vulnerable to the very stakeholders who were involved in the development. Some might argue that having multiple stakeholders may function as checks and balances and provide collective wisdom, but we should provide more systematic guarantee on the objectivity of the visual decision aids. Because the decision of the modality of an individual's death is the last and most significant choice in one's life, no party should exert their influence on such a delicate decision. With carefully designed video decision support tools, our patients will live the last moments of their lives with dignity, as they deserve.

• Journal of Korean Academy of Nursing
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• v.31 no.2
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• pp.279-291
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• 2001

Rapid progress in modern medical technology has made it possible to sustain life and/or delay death using 'heroic' treatments. The availability of life-sustaining treatment brings several issues in end-of-life care such as 'dying with dignity' and an radical increase in health care costs. The use of Advance Directives(AD) have been widely heralded by health care providers, gerontologists, and advocacy groups as means of protecting patients' right to accept or refuse life-sustaining treatment in end-of-life care. The use of AD can not only improve patients' autonomy and quality of life but also bring efficiency in distributing health care resources. The proportion of older persons in Korean population has been increasing. Those 65 years of age or over were about 7 percent of the population. Death and dying is not limited to older persons, but it is more prevalent among them. In conjunction with an aging population and the increasing prevalence of death, the issues of death and dying will become crucial in near future in terms of 'dying with dignity', 'autonomy', and 'self-control'. This paper attempts to explode and establish the concept of advance directives (AD) based on literature review. Data sources are computer searches with the MEDLINE database. Due to the lack of prior study on AD for a Korean cases, studies abroad are reviewed. This paper suggests the need for future study on the possibility of the use of AD in Korea.