• Journal of Hospice and Palliative Care
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• 제20권3호
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• pp.159-166
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• 2017

항레트로바이러스제 치료의 확립, 조기치료로 HIV 감염인들의 바이러스의 조절과 면역저하의 개선이 이루어지고 있다. 다수의 환자들이 더 이상 에이즈 관련 합병증으로 사망하지 않고, 심혈관질환, 대사성질환, 간질환, 신장질환, 신경계질환과 같은 만성합병질환을 갖고 고령화되고 있다. 그러나 지금도 여전히 사회적 차별과 낙인이 존재하는 가운데 후기 발현자로 후천면역결핍증 상태로 방문하여 사망하거나 중증의 신경계합병증으로 장애를 갖는 환자들이 있다. 환자의 다양한 증상들에 대해 이른 시기부터의 완화의료적 접근이 필요하다. 원위 대칭성 감각 다발신경병증 등의 환자의 만성 통증은 저평가되어 왔고 이에 대한 적극적인 통증 중재가 필요하다. 이전 호스피스 기준은 현재 시점에서 새롭게 제시한다. 감염인의 약제 지속 등의 의학적 필요, 심리적 상태, 사회적 여건에 대한 이해가 필요하다. 표준주의 감염관리 원칙을 준수한다면 만성질환으로서의 보편적 호스피스 진료의 제공이 가능하겠다. 생의 말기 빠르고 적극적인 호스피스팀의 개입을 통해 환자들이 존엄하게 삶을 마무리하실 수 있도록 임상경험이 늘어나고, 제도가 마련되길 바란다.

• 의료법학
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• 제9권1호
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• pp.385-411
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• 2008

The goal of medicine is to contribute to promoting national health by preventing diseases and providing treatment. The scope of modern medicine isn't merely confined to disease testing, treatment and prevention in accordance to that, and making experiments by using the human body is widespread. The advance in modern medicine has made a great contribution to valuing human dignity and actualizing a manly life, but there is a problem that has still nagged modern medicine: treatment and healing for terminal patients including cancer patients. In advanced countries, pain care and hospice medicine are already universal. Offering a helping hand for terminal patients to lead a less painful and more manly life from diverse angles instead of merely focusing on treatment is called the very hospice medicine. That is a comprehensive package of medical services to take care of death-facing terminal patients and their families with affection. That is providing physical, mental and social support for the patients to pass away in peace after living a dignified and decent life, and that is comforting their bereaved families. The National Hospice Organization of the United States provides terminal patients and their families with sustained hospital care and home care in a move to lend assistance to them. In our country, however, tertiary medical institutions simply provide medical care for terminal patients to extend their lives, and there are few institutional efforts to help them. Hospice medicine is offered mostly in our country by non- professionals including doctors, nurses, social workers, pastors or physical therapists. Terminal patients' needs cannot be satisfied in the same manner as those of other patients, and it's needed to take a different approach to their treatment as well. Nevertheless, the focus of medical care is still placed on treatment only, which should be taken seriously. Ministry for Health, Welfare & Family Affairs and Health Insurance Review & Assessment Service held a public hearing on May 21, 2008, on the cost of hospice care, quality control and demonstration project to gather extensive opinions from the academic community, experts and consumer groups to draw up plans about manpower supply, facilities and demonstration project, but the institutions are not going to work on hospice education, securement of facilities and relevant legislation. In 2002, Ministry for Health, Welfare & Family Affairs made an official announcement to introduce a hospice nurse system to nurture nurse specialists in this area. That ministry legislated for the qualifications of advanced nurse practitioner and a hospice nurse system(Article 24 and 2 in Enforcement Regulations for the Medical Law), but few specific plans are under way to carry out the regulations. It's well known that the medical law defines a nurse as a professional health care worker, and there is a move to draw a line between the responsibilities of doctors and those of nurses in association with medical errors. Specifically, the roles of professional hospice are increasingly expected to be accentuated in conjunction with treatment for terminal patients, and it seems that delving into possible problems with the job performance of nurses and coming up with workable countermeasures are what scholars of conscience should do in an effort to contribute to the development of medicine and the realization of a dignified and manly life.

• 감성과학
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• 제13권2호
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• pp.337-346
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• 2010

본 연구는 블랙컬러 패션소재에 대한 색채감성과 선호도를 조사하고, 소재의 구조적 특성, 색채특성 및 색채감성이 선호도에 미치는 영향을 분석한 것이다. 선행연구를 기초로 선정한 9종의 블랙 패션소재에 대해서 대학생을 대상으로 색채감성과 촉감 및 구매선호도를 평가시켰다. 평가된 자료는 빈도분석, 평균, 요인분석, t-test, Kruskal-Wallis검정, 상관관계 및 회귀분석을 실시하여 분석하였다. 블랙컬러소재의 색채감성을 요인분석 한 결과, 심플/클래식, 우아함, 현대적, 위엄성 등 4개의 요인이 추출되었다. 이러한 색채감성 요인은 소재의 종류와 성별에 따라 유의한 차이를 보였다. 즉 검정 벨벳소재는 이들 색채감성을 가장 잘 표현하는 소재로 평가되었으며, 남자 대학생이 여자 대학생에 비해 블랙소재가 더 심플/클래식하고 우아하며 현대적이라고 평가하였다. 이들 색채감성 요인은 소재의 구조적 특성 및 색채특성과 유의한 상관관계를 나타내었다. 한편, 블랙컬러 패션소재 중에서 촉감이 좋다고 평가된 소재의 경우 구매 선호도가 높은 경향을 보였다. 또한 블랙컬러 패션소재의 촉감과 구매 선호도에 영향을 주는 주된 변인은 색채감성인 것으로 나타났다. 따라서 블랙컬러 패션소재는 심플/클래식, 우아함, 현대적, 위엄성 등의 색채감성을 나타내었고, 색채감성은 선호도에 영향을 주는 주요 변인임을 알 수 있었다. 이러한 결과는 패션상품기획시 추구 이미지에 따라 블랙컬러소재를 차별화하여 활용할 수 있을 것으로 기대된다.

• 의료법학
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• 제20권1호
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• pp.3-24
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• 2019

이 글은 현행 헌법의 규정과 헌법재판소 결정 그리고 개헌안의 건강권 신설 규정 등을 비판적으로 검토함으로써 건강권의 헌법적 의미를 특히 '인간다운 생활을 할 권리'와의 관련성 속에서 고찰하는 것을 목적으로 한다. 건강은 개인의 일반적인 행위 및 가치실현의 전제가 되는 기본적인 자유로서의 성격을 갖게 되었으며, 국가는 개인의 건강을 보호하여 가장 기본적인 '인간다움'의 조건을 보장하고 자유 실현의 기초를 마련해야 한다. 헌법 제36조 제3항에서 규정하는 보건 보호라는 국가 과제는 인간다운 생활을 할 권리에 관한 헌법 제34조의 구체적 내용으로 이해되어야 한다. 그리고 인간다운 생활을 할 권리를 '사회보장권'으로 이해할 경우, 헌법상 건강권은 '건강에 관한 사회보장권' 내지 '건강보장권'을 의미한다고 할 수 있다. 한편, 헌법재판소는 인간다운 생활을 할 권리에 대한 사법심사에서 소위 '최소한의 물질적인 생활 기준'을 채택함으로써 동 권리의 내용을 협소하게 파악하고 있다. 그러나 인간다운 생활을 할 권리는 '인간의 존엄성에 맞는 건강하고 문화적인 생활을 향유할 수 있는 권리'를 의미하고, 다만 그 보호의 수준이 어느 지점인지에 대한 판단이 일차적으로 입법재량에 맡겨져 있을 뿐이다. 그렇다면 인간다운 생활을 할 권리에 관한 사법심사는 입법재량의 통제 문제로 귀결된다.

• 보건행정학회지
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• 제28권3호
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• pp.222-225
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• 2018

Health policy is a historical product in the process of development, including the political and economic factors of the state as well as the social and cultural elements of the country. Bioethics began to debate the ethical questions that arise in the overall process of life's birth and death, and gradually evolved by presenting ethical directions for various social phenomena. Especially, according to the moral awakening of 'scientific medicine' which caused in some human problems in the rapidized scientific society from the late 19th century to the early 20th century, as a result of distress including the concept of various social relations, it is possible to say that it has reached the bioethics. Although health policy and bioethics are different in terms of starting and concept, they can be found in common with social, cultural, and political diversity in the times. In 2004, 'Bioethics Law' was enacted through the issue of research ethics in the life sciences. Therefore, in order to examine ethical aspects of current health policy direction and major issues, it can be divided into before and after enactment of 'Bioethics Law' in 2004. The authors would like to examine how the evolution of the ethical viewpoint on the health policy has changed in line with the enactment of the 'Bioethics Law' and how it is trying to solve it from an ethical point of view. Through the various events that took place in the 1990s and the 2000s, various discussions on bioethics were conducted in Korea. Prior to the enactment of the 'Bioethics Law,' ethical judgments of professions, distribution of healthcare resources, if the discussion focused on the ethical judgment of abortion, and the various events that appeared in the early 2000s became the beginning to inform that the ethical debate about the life, death, and dignity of human beings began in earnest in Korea with the enactment of the 'Bioethics Law.' Since then, 'Hospice and Palliative care Law' which was enacted in 2017, is based on the fact that the health policy of our country focuses on the treatment of the past diseases, health promotion, and delivery of health care services. It was an opportunity to let them know that even the quality problems were included. Therefore, considering the various circumstances, the ethical issue facing Korea's health care system in the future is the change of the demographic structure due to aging and what is to be considered as the beginning and the process of life in the overall process of life. It is the worry about how to die and when it sees as death. This has far exceeded the paradigm of traditional health care policies such as disease prevention and management and health promotion, and calls for innovative policy response at the national level that reflects the new paradigm, which in many cases creates a predictable ethical environment. And health policy should be shifted in the direction of future ethical review considering sustainability in the development process of future health care rather than coercive management.

• Journal of Hospice and Palliative Care
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• 제4권1호
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• pp.57-67
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• 2001

본 연구는 2000년 상반기 한 대학 병원의 호스피스 자원봉사자 교육에 참여한 84명의 설문 응답자를 대상으로 하여 호스피스 자원봉사자의 죽음에 대한 태도와 말기 환자 돌봄에 대한 요구, 말기환자와 가족 돌봄에 대한 태도를 알아보기 위한 서술적 연구이다. 개방형 질문을 이용한 자료에서 응답자의 대부분이 죽음에 임박한다면 가족에 대한 염려와 걱정, 죽음의 고통, 내세의 두려움이 가장 큰 불편함이 될 것이라고 답했고, 사랑과 관심 있는 임종 간호에 대한 요구를 보였으며, 죽음이라는 위기 상황을 극복할 수 있는 가장 큰 자신의 자원을 신앙심으로 인식하고 있다. FATCOD 도구에서(Cronbach ${\alpha}$는 0.778 이었으며) 말기환자와 가족 돌봄이 가치 있는 일이라고 여김에도 불구하고 죽음에 대해 이야기하는 것과 말기환자와 감정을 나누는 것은 여전히 어렵고 불편한 것임을 나타냈다. 또한, 말기환자 돌봄에서 가족 참여는 필수적인 것이고, 말기환자가 남은 여생을 가장 잘 살아갈 수 있도록 정상적인 환경을 유지해야 하며, 죽음이란 모든 인간이 자연스럽게 받아들여야 하는 삶의 한 과정임을 인식하고 있다.

• 대한기관윤리심의기구협의회지
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• 제5권1호
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• pp.21-32
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• 2023

Purspose: The purpose of this study is to examine the meaning and definition of vulnerable subjects in clinical trials in light of domestic and international regulations and guidelines, to analyze the contents of standard operation procedures (SOPs) among advanced general hospitals in Korea that conduct clinical trials, and to examine deliberation procedures for operation plans. Methods: The study examined how vulnerable research subjects were defined and described in related regulations and the classification of vulnerable research subjects presented in the IRB/HRPP SOPs of 18 clinical trial institutions, including 11 AAHRPP-accreditated general hospitals in Korea, as well as the operation of the IRB deliberation. Results: Among all domestic and international regulations and guidelines, only the The Council for International Organization of Medical Sciences (CIOMS) guidelines explain why vulnerability is related to judgments on the severity of physical, psychological, and social harm, why individuals are vulnerable, and for what reasons. However, the classification of vulnerable subjects by institutions differed from the classification by the International Conference on Harmonization-Good Clinical Practice (ICH-GCP). A total of the 16 institutions classified children and minors as vulnerable research subjects. 14 institutions classified subjects who cannot consent freely were classified as vulnerable subjects. 15 institutions classified sujects who can be affected by the organizational hierarchy were classified as vulnerable subjects. Subjects in emergency situations were regarded as vulnerable research subjects in 8 of institutions, while people in wards, patients with incurable diseases, and the economically poor including the unemployed were categorized as vulnerable research subjects in 7, 4, and 4 of institutions, respectively. Additionally, some research subjects were not classified as vulnerable by ICH-GCP but were classified as vulnerable by domestic institutions 15 of the institutions classified pregnant women and fetuses as vulnerable, 11 classified the elderly as vulnerable, and 6 classified foreigners as vulnerable. Conclution: The regulations and institutional SOPs classify subjects differently, which may affect subject protection. There is a need to improve IRBs' classifications of vulnerable research subjects. It is also necessary to establish the standards according to the differences in deliberation processes. Further, it is recommended to maintain a consistent review of validity, assessment of risk/benefit, and a review using checklists and spokeperson. The review of IRB is to be carried out in a manner that respects human dignity by taking into account the physical, psychological, and social conditions of the subjects.

• 한국의류학회지
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• 제3권1호
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• pp.1-11
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• 1979

This is a study on angels' costumes in religious paintings, especially as this relates to the questions of concepts and theological symbolism. Angels, as spiritual creatures in Christian thought, play the role of praising God's glory, as messengers of God, the role of guarding Israel and the Church, and protecting or punishing human beings. Sometimes the angels appear in incarnate form. They display no sexual differences and are not able to procreate. The angels' funtional classification being thus; nevertheless, they are pictured in various costumes and appearances according to characteristics of the paintings. The angel Michael appears as a man of dignity when pictured as a guard; the angel Gabriel in the annunciation is often portrayed as a woman of mystical beauty. Under the Renaissance, the mighty cherubim and seraphim at Yahweh's throne are degraded as plump child-angels, or winged child-heads looking alike Eros or Cupid. They have become playful and all too obviously non-heavenly chrubs, accepted features of the Temple decorations. However, cherubim are often depicted as naked or wrapped around with a piece of cloth and accompanied with wind, which symbolizes the Glory of God. The angels, costumes without seam are hung over or wrapped around the body, and when sewn they are simple and ample enough that they fall in a great many folds. However, by the 14C. angels are mostly dressed in costumes common to all Europe, and after that angels gradually appear in folk costumes; for example Italian, Flemish, etc. Dalmatic, the typical costume of Byzantine often shows up as angels' dresses even after the period. Originally the dalmatic was the Roman tunic to which Eastern influences added. The Roman clavus on the tunic had gradually lost distinction until, by the Imperial epoch, it was worn by the lowest servants. It was proudly therefore, as 'The servants of God', that the early Christians are shown wearing the clavus on their wide, ungirdled, sleeved dalmatics. In addition to their costume, angels have some other distinct charateristics. First, angels have a halo around their head; this symbolizes their holiness. Second, angels wear a narrow diadem or a queen's crown that seems to denote their glorious status close to God's throne. Third, the cloth band across the breast resembles a priest's stole, which suggests the sacred role of a priest and symbolizes the grace santified. Fourth, lilies in the annunciations are symbols of Mary's virginity. chastity, innocence and heavenly bliss. Angels hold palms or olives in their hands. The former denote prosperity. beauty and the Christians' reward after death; the latter represent peace and amity. the imperial crown made of olives means victory. Fifth, angels in paintings always have a pair of wings, which can be traced to scripture where cherubim and seraphim are described as having pairs of wings. Angels' wings often have colors of the rainbow, and the rainbow is compared to God's glory. Sixth, generally artists paint angels' costumes as white, blue, green, gold and purple. Other colors such as red rarely appear. According, to scriptures it is believed that angels should be depicted 'as white as snow'. According to the biblical expressions of angels as lightning, sun or a pillar of fire, angels should be described as creatures of light. Nevertheless being a form of art, religious paintings may differ in their presentation according to an artist's inspiration and intention. Since religious paintings illustrated above were almost all done before the Reformation, symbols of colors used in the Catholic Church will also be mentioned. The white color symbolizes chastity, purity, brightness, delight and divinity. Green represents new birth, eternal life, spiritual revival and the expectance of the grace of God. Blue, the color of sapphires, denotes chastity and truth. Red, the color of rubies, represents divinity, love and religious passion. Violet is the color of dignity, indicating the sovereign, royal or imperial power and the great Sacrifice of Christ. As mentionad above, angels' costumes were expressed in accordance with contemporary patterns or as indicated in the Bible, and accesories and colors correspond with Christian symbols. Therefore these facts should be taken into consideration when it comes to the study of costume history.

• 의료법학
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• 제10권2호
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• pp.309-341
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• 2009

According to a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009), the Supreme Court judges that 'the right to life is the ultimate one of basic human rights stipulated in the Constitution, so it is required to very limitedly and conservatively determine whether to discontinue any medical practice on which patient's life depends directly.' In addition, the Supreme Court admits that 'only if a patient who comes to a fatal phase before death due to attack of any irreversible disease may execute his or her right of self-determination based on human respect and values and human right to pursue happiness, it is permissible to discontinue life-sustaining treatment for him or her, unless there is any special circumstance.' Furthermore, the Supreme Court finds that 'if a patient who is attacked by any irreversible disease informs medical personnel of his or her intention to agree on the refusal or discontinuance of life-sustaining treatment in advance of his or her potential irreversible loss of consciousness, it is justifiable that he or she already executes the right of self-determination according to prior medical instructions, unless there is any special circumstance where it is reasonably concluded that his or her physician is changed after prior medical instructions for him or her.' The Supreme Court also finds that 'if a patient remains at irreversible loss of consciousness without any prior medical instruction, he or she cannot express his or her intentions at all, so it is rational and complying with social norms to admit possibility of estimating his or her own intentions on withdrawal of life-sustaining treatment, provided that such a withdrawal of life-sustaining treatment meets his or her interests in view of his or her usual sense of values or beliefs and it is reasonably concluded that he or she could likely choose to discontinue life-sustaining treatment, even if he or she were given any chance to execute his or her right of self-determination.' This judgment is very significant in a sense that it suggests the reasonable orientation of solutions for issues posed concerning withdrawal of meaningless life-sustaining medical efforts. The issues concerning removal of medical instruments for meaningless life-sustaining treatment and discontinuance of such treatment in regard to medical treatment for terminal cases don't seem to be so much big deal when a patient has clear consciousness enough to express his or her intentions, but it counts that there is any issue regarding a patient who comes to irreversible loss of consciousness and cannot express his or her intentions. Therefore, it is required to develop an institutional instrument that allows relevant authority to estimate the scope of physician's medical duties for terminal patients as well as a patient's intentions to withdraw any meaningless treatment during his or her terminal phase involving loss of consciousness. However, Korean judicial authority has yet to clarify detailed cases where it is permissible to discontinue any life-sustaining treatment for a patient in accordance with his or her right of self-determination. In this context, it is inevitable and challenging to make better legislation to improve relevant systems concerning withdrawal of life-sustaining treatment. The State must assure the human basic rights for its citizens and needs to prepare a system to assure such basic rights through legislative efforts. In this sense, simply entrusting physician, patient or his or her family with any critical issue like the withdrawal of meaningless life-sustaining treatment, even without any reasonable standard established for such entrustment, means the neglect of official duties by the State. Nevertheless, this issue is not a matter that can be resolved simply by legislative efforts. In order for our society to accept judicial system for withdrawal of life-sustaining treatment, it is important to form a social consensus about this issue and also make proactive discussions on it from a variety of standpoints.

• Journal of Hospice and Palliative Care
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• 제19권1호
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• pp.34-44
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• 2016

목적: 본 연구의 목적은 간호사의 환자죽음 수용 개념의 속성을 규명하여 임종간호에 대한 이론적 근거를 마련하는 것이다. 방법: 본 연구는 Walker와 Avant의 개념분석 과정을 따랐다. 간호사의 환자죽음 수용 개념의 사용 범위를 확인하기 위해 국내외 문헌을 고찰하였다. 간호사의 환자죽음 수용 개념의 속성을 찾고 조작적 정의를 내리기 위해 국내 논문 중 1999년부터 2015년까지 국내 학술지에 발표된 간호사의 환자죽음 경험에 대한 질적 연구 16편을 분석하였다. 결과: 본 연구에서 간호사의 환자죽음 수용의 선행요인은 간호사의 환자죽음 경험, 혼돈과 갈등, 부정적 감정, 수동적 대처, 환자죽음 회피로 확인되었다. 간호사의 환자죽음 수용 속성은 애도를 통해 도달, 삶을 반추하며 삶과 죽음의 통찰력 획득, 의연하게 바라보기, 인간 존엄 실천하기로 나타났다. 간호사의 환자죽음 수용정의는 '환자죽음을 경험한 간호사가 애도를 통해 도달하는 단계로써 자신의 삶을 반추해서 삶과 죽음에 대한 통찰력을 얻고 환자죽음을 의연하게 바라보며 인간 존엄을 간호 현장에서 실천하는 것'이다. 간호사의 환자죽음 수용의 결과는 전인적인 임종간호, 적극적인 삶 추구로 확인되었다. 결론: 간호사의 환자죽음 수용 개념의 속성과 조작적 정의는 실무 적용 가능한 임종간호 중재 방안 마련과 이론 개발의 기초 자료를 제공할 것이다.