• Journal of Hospice and Palliative Care
• /
• v.23 no.2
• /
• pp.93-102
• /
• 2020

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

• The Journal of the Korea Contents Association
• /
• v.20 no.3
• /
• pp.613-626
• /
• 2020

This study reconsiders covenant theology through the relationship between law and grace. In order to do this, it first evaluates whether the Sinaitic Covenant is a covenant of grace or a covenant of works. This has been in discussion for a long period of time among theologians, yet is far from settled. Traditional studies form a wide spectrum, which can be divided into at least four major branches. First, the Sinaitic Covenant is the same as the covenant of grace. Second, the Sinaitic Covenant is the same as the covenant of works. Third, the Sinaitic Covenant forms a third, independent category of covenant. Fourth, the Sinaitic Covenant exists in harmony with the covenant of grace. Each category is summarized along with its representative proponents. Also, even though the term covenant of works is not accepted as prevalently among modern theologians, observations is made on how each category connects to and continues in modern theological discussions regarding law. Special emphasis is given to the fourth category and the fourth perspective on law with respect to how they differ from the others in viewing the relationship between law and gospel. Moreover, recognizing that the unique understanding of the fourth view grows out of a careful observation of the Biblical text, the structural similarities between the Sinaitic Covenant and other Biblical covenants are compared based on the Biblical text. Based on this comparison, it is observed that God's grace and human duty coexist in several Bible covenants including the Sinaitic and New Testament covenants. From this observation, it is proved that conditionality regarding covenant fulfillment exists in them all. This conditionality does not entail from exclusiveness on the part of God, but from the weakness on the part of humans. However, some unconditional covenants, albeit few in number, can be found in the Bible. Therefore, the difference between unconditional covenants and conditional covenants is discussed. Lastly, the proper place and role of grace in covenants is studied.