• The Korean Society of Law and Medicine
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• v.24 no.4
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• pp.103-128
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• 2023

According to the current act of Decision-Marking in Life-Sustaining Medicine, the decision to withhold or discontinue life-sustaining treatment is primarily based on the wishes of a patient in the dying process. Decision-making regarding life-sustaining treatment for these patients is made by the patient, if he or she is conscious, directly expressing his/her intention for life-sustaining treatment in writing or verbally or by writing an advance medical directive and physician orders for life-sustaining treatment. It can be exercised. On the other hand, if the patient has not written an advance medical directive or physician orders for life-sustaining treatment, the patient's intention can be confirmed with a statement from the patient's family, or a decision to discontinue life-sustaining treatment can be made with the consent of all members of the patient's family. However, in the case of an unrelated patient who has no family or whose family is unknown, if an advance medical directive or physician orders for life-sustaining treatment are not written before hospitalization and a medical condition prevents the patient from expressing his or her opinion, the patient's will cannot be known and the patient cannot be informed. A situation arises where a decision must be made as to whether to continue or discontinue life-sustaining treatment. This study reviewed discussions and measures for unbefriended patients under the current law in order to suggest policy measures for deciding on life-sustaining treatment in the case of unbefriended patients. First, we looked at the application of the adult guardian system, but although an adult guardian can replace consent for medical treatment that infringes on the body, permission from the family court is required in cases where death may occur as a direct result of medical treatment. It cannot be said to be an appropriate solution for patients in the process of dying. Second, in accordance with Article 14 of the Life-Sustaining Treatment Decision Act, we looked at the deliberation of medical institution ethics committees on decisions to discontinue life-sustaining treatment for patients without family ties.Under the current law, the medical institution ethics committee cannot make decisions on discontinuation of life-sustaining treatment for unbefriended patients, so through revision, matters regarding decisions on discontinuation of life-sustaining treatment for unbefriended patients are reflected in Article 14 of the same Act or separate provisions for unbefriended patients are made. It is necessary to establish and amend new provisions. In addition, the medical institution ethics committee must make a decision on unbefriended patients, but if the medical institution cannot make such a decision, there is a need to revise the law so that the public ethics committee can make decisions, such as discontinuing life-sustaining treatment for unbefriended patients.

• 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.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.20 no.1
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• pp.46-55
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• 2013

Purpose: The purpose of this study was to identify university students' willingness to write advance directives and factors related to this willingness. Method: A cross-sectional survey design was used and 400 nursing students and 287 non-nursing students participated in the study. Data were collected by convenience sampling using self-report questionnaires. Data were analyzed with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. Results: The mean score for willingness to write advance directives was 4.09. From the multiple regression analysis, predictors of willingness to write advance directives were found to be majoring in nursing, awareness of advance directives, preference for autonomous decision making related to the end of life care, family preference related to the end of life care, and self esteem. Conclusion: The study results indicate that various factors are related to willingness to write advance directives and nurses need to consider client characteristics, knowledge, and own values when taking care of issues on advance directives.

• International conference on construction engineering and project management
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• 2011.02a
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• pp.273-279
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• 2011

Concerns over the environment have spawned a number of research studies in the construction industry, as the construction of built environments and large infrastructures involves diverse environmental impacts and loads of hazardous emissions. Many researchers have attempted to quantify these environmental loads, including greenhouse gases, carbon dioxide, nitrogen dioxide, and sulfur dioxide, to name a few. However, little research has been conducted regarding integrating the life-cycle assessment (LCA) of environmental loads with the current life-cycle cost analysis (LCCA) approach. This study aims to estimate the environmental loads as a monetary value using the European Climate Exchange (ECX) rate and, then, to integrate those impacts with the pure construction cost. Toward this end, this study suggests an integrated approach that takes into account the environmental effect on the evaluation of the life-cycle cost (LCC). The bill of quantity (BOQ) data of a real highway project are collected and analyzed for this purpose. As a result, considering the environmental loads in the pavement process, the total LCC increased 16% from the traditional LCC cost. This study suggests an integrated approach that will account the environmental effect on the LCC. Additionally, this study is expected to contribute to better decision-making, from the perspective of more sustainable development, for government as well as for contractors.

• Journal of Hospice and Palliative Care
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• v.23 no.3
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• pp.162-165
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• 2020

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill and has exposed the lack of preparedness of most nations' health care systems. Even in usual times, palliative care has not received its fair share of recognition as an important component of patient care; instead, the emphasis is often placed on aggressive patient management. Now, with the entire medical community and decision-making committees focussed on intensive patient care, end-of-life care has taken a backseat. Methods: This article is a brief communication. Results: COVID 19 infection has been shown to lead to greater mortality and morbidity in patients with pre-existing illnesses such as hypertension, diabetes, renal failure, and cancer. Patients typically in need of end-of-life care, such as those with late-stage cancer or heart failure, are therefore at a higher risk of both contracting COVID-19 and suffering a more severe disease course. The strict nationwide lockdowns being imposed in most countries have deterred patients from seeking medical attention or hospice care. Every day new research is coming to light regarding COVID 19. This has helped significantly in creating awareness and limiting the spread of disease. However, misinformation is also rampant, leading to discrimination and mistreatment of infected patients. Conclusion: This pandemic has been a terrifying ordeal for all and has exposed our entire population physically, psychologically, emotionally, and financially to unimaginable stresses. In the present scenario, EOL care is as much a necessity as intensive care and should be given at least a fraction of its importance.

• Journal of the Korean Society of Environmental Restoration Technology
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• v.21 no.1
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• pp.31-40
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• 2018

Since the Millennium Ecosystem Assessment Report was published in 2005, the conflict between development and the preservation of the ecological environment has turned to paying attention to value assessments in rational decision-making. In recent years, the concept of ecosystem services has been recognized as a viable one for making significant decisions. However, a trade-off between increase and decrease occurs between the ecosystem services sub-categories (cultural service, regulating service, supporting service, and provisioning service), for which research centering on target sites is needed. To this end, the present study aims to investigate the trade-off relationship between service categories to search for reasonable decision-making strategies. As the research method, a survey was conducted using the translated version of SoIVES(Social Value for Ecosystem Services) 3.0 questionnaire of the United States Geological Survey. The research findings demonstrate the economic value, based on the derived monetary value of each service category, the economic value of the target site was compared among landscape aesthetic value 8,050,000 won, recreation value 6,750,000 won, biodiversity value 4,610,000 won, healing value 3,970,000 won, life-sustaining value 2,090,000 won, and productive value 220,000 won. And then the primarily recognized value criteria of the Tancheon ecosystem services illustrate landscape aesthetic and recreation value. Besides, this study illustrates visualized trade-off relationships based on user perception, and the derived relations illustrate the trade-off relationship between the cultural service, regulating service, supporting service, and provisioning service, as well as relationships between the components of the sub-categories.

• The Korean Society of Law and Medicine
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• v.23 no.2
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• pp.67-96
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• 2022

"Aid in Dying" means that when a decision-making patient suffers from an incurable disease, a drug that can speed up death is prescribed by a doctor and used to lead to death. Since the suspension of life-sustaining treatment was institutionalized based on human dignity and patient autonomy, the question of whether assisted death can be legally justified in relation to the right to receive medical help to shorten one's life to die with dignity has recently been actively discussed. In Korea, since the suspension of life-sustaining treatment was institutionalized by the enactment of the Life-sustaining Treatment Decision Act in 2016, an amendment to the Life-sustaining Treatment Act was recently proposed to legalize Aid in Dying. The global trend is that human "Right to Die" is discussed in the division of life and death, from the suspension of life-sustaining treatment to assisted death, and again in the order of euthanasia. In this paper, we started discussing dignified death and institutionalized patients' right to self-determination, looked at the controversy in the United States, which legislated assisted death in many states since the 2000s, and analyzed the main contents of California's End of Life Option Act and the data after enforcement. The strict requirements for Aid in Dying, such as voluntary confirmation of patients' intentions and doctors' obligation to provide information, and the results of California's Aid in dying system, composed of relatively diverse races, were reviewed.

• Journal of Korean Academy of Nursing Administration
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• v.7 no.3
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• pp.403-414
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• 2001

The study was intended to identify the nurses' experiences, understanding, and attitudes on DNR. Also, the study was to provide the data base for a standard of DNR decision-making and practice. The sample consisted of 347 nurses in eight general hospitals. The data were collected between August 1 and August 31, 2000. The data were analyzed using descriptive statistics and $x^2-test$. The results of the study were as follows : 1. Regarding DNR-related experience, 74.6 percent of the participants experienced DNR situations. Eleven percent of the participants received DNR education. DNR was most frequently (81.5%) requested by family members and relatives of patients. The decision-making on DNR was most frequently (76.8%) made by agreement between family members and medical staff. The DNR order was recorded at 81.9 percent on charts. Problems after DNR order were negligence in treatment and nursing care (30.6%) and guilty feelings due to doing the best (22.1%). CPR (cardiopulmonary resuscitation) was performed about 49.8 percent of DNR cases. 2. Regarding understanding and attitude on DNR, most of the participants (93.1%) thought DNR was necessary. The major reasons for the necessity of DNR were impossible recovery (44.4%) and death with dignity (41.1%). The decision-making on DNR was most frequently made by patient and family members (47.8%) and followed by agreement between family members and medical staff (25.6%), and patients themselves (16.4%). Most of the participants thought that medical staff must explain DNR to critical and end-of-life patients and their family members. Forty four percent of the participants thought that the most appropriate time for DNR explanation was when patients with critical disease were admitted to hospitals. Most of the participants (90.2%) thought a guide book for DNR is necessary to be made in hospitals. 3. There were significant differences in the participants' understanding and attitudes on DNR according to religion career education and experience of DNR. Of the participants those who have religions and education experience on DNR thought that there would be more DNR requests after DNR is explained to patients and family members (p<.05). In addition, there was higher understanding on the necessity of DNR in those who have more career and DNR experience(p<.01). The findings of the study suggest that a guide book for DNR need to be made with inclusion of legal, ethical, and cultural aspects. Also, there needs to be more education on DNR in medical ethics to health care professional and to provide more information on DNR to the general public.

• Journal of the Korean housing association
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• v.9 no.2
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• pp.51-56
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• 1998

With the improved quality of life standards interior design is recently gaining more concerns than ever before. This requires more well organized and standardized business and marketing in the field. Consequently, a few interior design firms concern about computerizing their marketing process to do this. This paper focuses on developing a computerized consulting system assisting interior design. For this a standardized consulting process is developed. The process includes the input of customer's information, surveying customer's preferences on interior design styles, estimation and budget adjustment, suggesting packages and interior items, and printing consulting results. The system developed is valuable in three different viewpoints: First, from the customer's view it can be a decision-making tool. Second, from the consultant's point of view it is a front-end marking tool. Third, it is an information collector from the viewpoint of an interior design firm.

• Journal of Hospice and Palliative Care
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• v.26 no.1
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• pp.1-6
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• 2023

This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make end-of-life decisions. The clinician's prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician's prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.