• 의료법학
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• 제9권1호
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• pp.319-382
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• 2008

As a withdrawing care's study, the purpose of this study is searching about withdrawing care's acceptance and circumstances through Bora-mae hospital case(chapter 1). Withdrawing life-sustaining treatment has various forms. Though the meaning of euthanasia, death with dignity, natural death, physician assisted suicide are duplicated, the meaning of those are different slightly. Firstly, this study looks about the difference of the those meaning and acceptance range(condition) by withdrawing care's forms(chapter 2). Bora-mae hospital case sentenced guilty about physician who discharged incompetent patient who was after surgery by patient's wife determination. This Bora-mae case that sentenced guilty about discharge against medical advise(DAMA) that is regarded to custom has brought intensive confliction of legal, social, medical aspect, Bora-mae hospital case has many legal problems. First, as to criminal law rule 250(murder), the problem is whether discharge and withdrawing life-sustaining treatment is commission or omission. this study concluded omission(district court: omission, appeal, supreme court: commission). Because legal denounce point of discharge and medical treatment withdrawing is omission that physician who is obligatory on patient to cure. If physician's act is regarded omission, it is necessary to determine whether he has guardian status and obligation. Without guardian status and obligation, omission crime can't exist. This study decided that physician had guardian status and obligation and foundation of guardian status was pre-action or acceptance of emergency patient. Physician's medical treatment duty finished when patient(or patient's guardian) demands discharge. But when patient death is foreseen and other possible treatment does not exist, his duty of life prolonging treatment does not finish. This originate from physician's social responsibility and public status that limits patient's private liberty. This study regarded physician's action as accomplice about whether physician's discharging action is accomplice or the principal offender(district court: the principal offender, appeal, supreme court: accomplice). Though the principal offender needs criminal determination and action, there is no this common determination and functional action control of physician in Bora-mae case(chapter 3). Bora-mae hospital case partly originated from deficiency of legal, institutive system including medical security system shortage, the instruction is 1. medical security system strengthening, 2. hospital ethical committee's activity strengthening, 3. institutionalization of withdrawing life-sustaining treatment, 4. acceptance of pre-decision making system, 5. sufficient persuasion of physician for patient and faithful writing of medical paper, 6. respect for patients' self-determination and rights, 7. consciousness's changing for withdrawing life-sustaining treatment and persistent education about medical ethics(chapter 4). Considering Bora-mae case, medical sector is not the dead ground of a criminal punishment. Intervention of criminal law in medical sector give rise to ill effect, that is, excess medical examination and treatment, safeguard treatment, delay of discharge from a hospital. Because sufficient guarantee of life becomes mere empty slogan under situation that impose a burden of heavy cost to family or hospital, public and systematic solution should be given(chapter 5).

• 한국임상수의학회지
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• 제26권1호
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• pp.104-108
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• 2009

Global cerebral ischemia occurs commonly in patients who have a variety of clinical conditions including cardiac arrest and shock. Cerebral ischemia results in a rapid depletion of energy stores that triggers resulting in excitotoxic death. Imaging studies of the brain with computed tomography(CT) or magnetic resonance imaging(MRI) are necessary to confirm the clinical neurolocalization, identify any associated mass effect, and rule out other causes of focal brain disorders. Cardiopulmonary arrest was occurred by propofol anesthesia in a 1 year old, intact female Beagle dog. After successful cardiopulmonary resuscitation was performed within 5 minutes, clinical signs such as vocalization, paddling, opisthotonus and seizure were represented. At the 12th day, CT and MRI examinations of the brain were performed to evaluate the brain. After euthanasia, histopathologic examination was performed. On transverse image of CT, lesions appeared as a hypodense in the right dorsal surface of the frontal lobe and level of optic canal, and dorsomedial surface of occipital lobe of cerebrum. No contrast enhancement was represented following intravenous contrast administration. On MR images of brain, the lesions were seen as a hyperintense on T2-weighted(T2W) images and a isointense or mild hypointense on T1-weighted(T1W) images. Hyperintense lesions both T2W and T1W images were observed at the surrounding cerebral sulcus. There was no significant signal changes on contrast T1WI. Histopathologic examination after euthanasia revealed that the lesion was necrosis of the cerebral cortex caused by cerebral ischemia.

• 한국산학기술학회논문지
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• 제19권11호
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• pp.137-147
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• 2018

본 연구의 목적은 간호대학생을 대상으로 생명의료윤리 교육 이수에 따른 간호대학생의 생명의료윤리 의식, 관련지식, 인식 및 태도의 차이를 파악한 서술적 조사연구이다. 간호학과 112명을 대상으로 자가 보고식 설문지를 이용하여 자료를 수집하였고 t-test, Chi-Square test, Fisher's exact probability test, Pearson's correlation coefficient로 분석하였다. 두 그룹간에 생명의료윤리 의식의 하위 영역 중 인공수정, 안락사, 장기이식에서 통계적으로 유의한 차이를 나타내었다. 생명의료윤리 의식은 인체조직기증 및 이식에 관한 태도, 죽음에 대한 인식, 호스피스 완화의료 인식에서 유의한 양의 상관관계가 있었다. 본 연구결과 간호대학생은 생명의료윤리 교육에 참여한 후 인공수정, 안락사, 장기이식에 대한 의식이 통계적으로 유의한 차이를 보였고, 생명의료윤리 의식은 인체조직기증 및 이식에 관한 태도, 죽음에 대한 인식, 호스피스 완화의료 인식과 관련이 있으므로 이를 토대로 생명의료윤리 교육과정에 죽음, 호스피스 완화의료, 인체조직기증 및 이식 관련 다양한 교육과정의 개발 및 적용에 대한 연구가 필요함을 제언한다. 또한 본 연구의 대상자가 일개 대학교를 대상으로 한 연구여서 본 연구결과를 일반화하는데 무리가 있다고 보아 추후 반복연구를 제언하는 바이다.

• 한국심리학회지 : 문화 및 사회문제
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• 제23권1호
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• pp.1-24
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• 2017

본 연구의 목적은 사회적 가치와 생명윤리에 관한 의사결정의 관계를 검증하는데 있다. 연구 1에서는 한국 대학생들의 사회적 가치를 조사하였다. 대학생들이 성취의 가치를 선호할수록 배려의 가치를 선호하는 정도가 낮아서, 성취의 가치가 배려의 가치와 부적 상관관계에 있었다. 연구 2에서는 문장완성과제를 통해 성취/배려의 가치를 활성화시킨 조건에 따라 생명윤리에 관한 의사결정에서 차이가 나타나는지를 비교하였다. 그 결과, 성취/배려의 점화에 관계없이 동물실험, 안락사 및 장기이식의 활성화에 대해 전반적으로 동의하는 공리주의적 결정이 나타났다. 이에 비해 태아성감별과 인간복제연구에 관해서는 성취조건과 배려조건에서 모두 동의정도가 상대적으로 낮았다. 연구 3에서는 성취/배려의 가치를 활성화시킨 조건에서 단어완성과제를 통해 참가자들의 암묵적 가치 선호를 측정한 후, 생명윤리에 대한 의사결정이 달라지는지를 분석하였다. 그 결과 배려점화조건에서 배려의 가치를 암묵적으로 더 선호하는 참가자일수록 동물실험 및 장기이식의 활성화에 더 반대하는 경향이 나타났다. 반면, 태아 성감별과 인간복제연구에 대한 의사결정에서는 조건에 관계없이 전반적으로 반대하는 경향이 많이 나타나서. 실험상황에서 유도된 사회적 가치와 참가자 개인이 암묵적으로 선호하는 가치의 영향이 나타나지 않았다. 이 결과는 한 개인이 암묵적으로 선호하는 사회적 가치와 외부상황에서 부각되는 가치가 생명윤리에 관한 의사결정에 차별화된 영향을 줄 가능성을 시사한다. 논의에서는 사회적 가치와 윤리적 의사결정의 관계를 토론하고, 연구의 한계 및 후속연구의 방향을 다루었다.

• 의료법학
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• 제9권2호
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• pp.53-75
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• 2008

The end of life problem in the United States has been evolved from the development of concept of brain death over last 50 yr. The invention of ventilator and the development of emergency medicine also played a key role to elongate the end stage of life and which caused the American people to ask a question about the patients self determination and refusing the unwarranted medical treatment in the view of the death with dignity. With regard to the patient unable to self determination, surrogate decision was also considered. To guarantee the self determination, The patient self determination act also enacted on the level of Federal regulation in 1990s. But no law has effectively dealt with the situation when medical treatment became futile. Along with the significant debates on literature and court cases. The American Medical Association's Council on Medical and Judical Affairs presented formal opinion and the Texas was the first states to regulate the medical futile situation in 1999. Even though that definition was in controversy, the concept of medical futility mainly focused on the doctors' right to refuse the treatment.

• 한국의료질향상학회지
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• 제7권1호
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• pp.46-58
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• 2000

Background : Despite favorable effects of guidelines on patient care, guidelines often fail to achieve their objectives. Poorly implemented medical practice guidelines can produce only weak effects on the process of health care delivery. Therefore, we performed this study to investigate barriers related development of clinical practice guidelines. Methods : Cardiopulmonary resuscitation was selected as a target problem. Self questionnaires about management of cardiopulmonary resuscitation were developed by a researcher with advisory 8 experts. The questionnaires were designed as a unstructured methods. The data were collected from March 1 to May 31, 1999. A total 50 death case admitted inpatient to Inha University Hospital were subjected to evaluate the development and application of clinical practice guidelines for cardiopulmonary resuscitation. The data were examined by frequency, t-test with SPSS. Result : The article reviewed several common barriers that might limit successful implementation of guidelines in clinical practice, as illustrated by evaluating recommendations for cardiopulmonary resuscitation clinical practice guidelines. Some major problems with guidelines were characterized as follows (1) ethical problem : euthanasia, (2) occurrence on various emergency event and setting, (3) non-medical problems (4) unreliable of medical record etc. Conclusion : Careful analysis of guideline attributes, anticipated effect on medical care, and organizational factors revealed several barriers to successful guideline implementation that should be addressed in the design of future guideline-based interventions.

• 대한간호학회지
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• 제36권6호
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• pp.1055-1064
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• 2006

Purpose: The purpose of this study was to analyze and clarify the ambiguous concept of DNR, and to distinguish between DNR and euthanasia. Method: This study used the process of Walker & Avant's concept analysis. Result: The definable attributes of DNR were care for comfort, no further treatment and no CPR. The antecedents of DNR were the autonomy of patients and families feelings about death, the uselessness of treatment and the right to die with dignity. The process of the DNR decision should be documented and the antecedents of DNR also can be a basis for objective standards of DNR decision-making. The result of DNR was the acceptance of death by patients and families. Conclusion: DNR is decided and documented by the antecedents of DNR, and the result is a natural acceptance of death, the last process of human life. Hospice care should be activated and nurses must be patient's advocates and families' supporters in the process.

• 약학회지
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• 제48권4호
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• pp.241-246
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• 2004

Mercury is a widespread metal and consequently there are large populations that currently exposed to low levels of mercury. Endotoxin is a component of the gram-negative bacteria and promotes inflammatory responses. The present study was designed to determine the impact of mercury on lymphocytes phenotype populations and endotoxin-induced inflammatory cytokine expressions in immune organ, spleen and thymus. Male BALB/c mice were exposed continuously to 0, 0.3, 1.5, 7.5, or 37.5 ppm of mercuric chloride in drinking water for 14 days and at the end of the treatment period, lipopolysaccharide (LPS, 0.5 mg/kg) was injected intraperitoneally 2 h prior to euthanasia. The dose-range of mercury used did not cause hepatotoxicity. Mercury at 7.5 and 37.5 ppm dose-dependently decreased CD3$^{+}$ T lymphocytes in spleen; both CD4$^{+}$ and CD8$^{+}$ single positive lymphocyte populations were decreased. Exposure to 7.5 and 37.5 ppm of mercury decreased the CD8$^{+}$ T lymphocyte population in the thymus, whereas double positive CD4$^{+}$ / CD8$^{+}$ and CD4$^{+}$ thymocytes were not altered. Mercury altered LPS-induced inflammatory cytokine gene expressions such as, tumor necrosis factor $\alpha$, interferon ${\gamma}$, and interleukin-12 in spleen and thymus. Results indicated that decreases in T lymphocyte populations in immune organs and altered cytokine gene expression may contribute to the immune-modulative effects of inorganic mercury.ganic mercury.

• 한국융합학회논문지
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• 제6권6호
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• pp.255-261
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• 2015

본 연구의 목적은 대학생의 생명의료윤리 특성과 자존감과의 상관관계를 알아보고, 보건계열과 비보건계열 대학생의 생명윤리의식 간에 차이를 비교하는 것이다. 연구대상자는 일개 대학의 보건계열과 비보건계열을 포함한 대학생 651명으로 생명윤리의식과 자존감에 대해 2015년 5월 2주간 조사하였다. 그 결과 자존감은 생명의료윤리인식과 유의한 상관관계가 있는 것으로 나타났으며, 자존감이 높은 대학생이 생명의료윤리를 중요하게 생각하는 것으로 나타났다. 그러나 보건계열과 비보건계열의 생명의료윤리 인식을 비교한 결과 생명공학을 제외한 안락사, 뇌사 등에는 유의한 차이를 보이지 않았다.

• 한국수의병리학회지
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• 제1권2호
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• pp.157-160
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• 1997

Two 2 and 7 months-old holstin and one 3 months-old native Korean calf suffering from respiratory illness were submitted to the National Veterinary Research Institute for euthanasia and pathologic examination. At necropsy diffuse lobar pneumonia was present in apical cardiac and diaphragmatic lobes in all calves. Microscopically acute multifocal bronchiolitis and interstitial syncytial cell formation were frequently observed. in addition occlusion of bronchiolar lumen due to cellular proliferation and fibrosis accompanied by interlobular septal emphysema were also present. Immunohistochemically bovine respiratory syncytial virus antigen were positively identified in lung lesions including bronchial and bronchiolar epithelium alveolar macrophages and lymphocytes.