• Journal of Korean Critical Care Nursing
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• v.12 no.2
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• pp.39-49
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• 2019

Purpose : The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and "a good death" affect attitudes toward terminal care. Method : Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the $Scheff{\acute{e}}$ test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program). Results : Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of "a good death") were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (${\beta}=.20$, p =.035), a sense of closeness(${\beta}=.19$, p =.041), and the perception of a life-sustaining treatment decision (${\beta}=.22$, p =.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj $R^2=.140$). Conclusion : A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of "a good death" and perceptions of life-sustaining treatment decisions.

• Journal of Industrial Convergence
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• v.18 no.6
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• pp.51-59
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• 2020

Although the life-sustaining treatment decision law is in effect, health care worker have many difficulties in determining life-sustaining treatment. Therefore, the relationship between the awareness of well-dying(WD), the attitude toward withdrawal of life-sustaining treatment(AWLST), and the attitude toward euthanasia(AE) for nursing students who will take care of dying patients in the future will be analyzed and used as basic data for bioethics classes. The study period was from April 1 to May 6, 2018, and a survey was conducted on 288 nursing students in D City. As a result of the study, WD was found to have positive (+) correlations with AWLST and AE, while AWLST was positive (+) with active and passive euthanasia. As nurses are expected to experience many ethical conflicts in the life-sustaining treatment process, it is necessary to receive education related to well-dying awareness, bioethics education, and life-sustaining treatment during the nursing student period.

• Journal of Hospice and Palliative Care
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• v.25 no.1
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• pp.1-11
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• 2022

The Act on Decisions on Life-Sustaining Treatment has been in effect since 2018 for end-of-life patients. However, only 20~25% of deaths of terminally ill patients comply with the law, while the remaining 75~80% do not. There is significant confusion in how the law distinguishes between those in the terminal stage and those in the dying process. These 2 stages can be hard to distinguish, and they should be understood as a single unified "terminal stage." The number of medical institutions eligible for life-sustaining treatment decisions should be legally expanded to properly reflect patients' wishes. To prevent unnecessary suffering resulting from futile life-sustaining treatment, life-sustaining treatment decisions for terminal patients without the needed familial relationships should be permitted and made by hospital ethics committees. Adult patients should be permitted to assign a legal representative appointed in advance to represent them. Medical records can be substituted for a patient's judgment letter (No. 9) and an implementation letter (No. 13) for the decision to suspend life-sustaining treatment. Forms 1, 10, 11, and 12 should be combined into a single form. The purpose of the Life-sustaining Medical Decisions Act is to respect patients' right to self-determination and protect their best interests. Issues related to the act that have emerged in the 3 years since its implementation must be analyzed, and a plan should be devised to improve upon its shortcomings.

• Journal of Hospice and Palliative Care
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• v.23 no.2
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• pp.85-92
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• 2020

Purpose: In 2018, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented and the scope of official recognition for terminally ill patients was expanded. The purpose of this study was to investigate the decisions made by patients with end-stage liver disease about their life-sustaining treatment in a clinical setting. Methods: The subjects of this study were patients with end-stage liver disease hospitalized at a tertiary hospital in Seoul, Korea who wrote physician orders for life-sustaining treatment (POLST). Data collection was done using patients' electronic medical records, and a retrospective analysis of POLST was conducted. Results: Among 101 patients, 18.8% were female and 81.2% were male, and their mean age was 61.8 (±10.61) years. Sixty-three patients (62.4%) wrote their POLST by themselves. Three patients withdrew the POLST, of whom two did so for liver transplantation, and one did so for chemotherapy. Conclusion: This study shows that sufficient consideration of liver transplantation is needed for end-stage liver disease patients before making decisions on life-sustaining treatment. The self-determination of patients must be respected and effective guidelines are urgently needed.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.11
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• pp.76-84
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• 2019

This study was a descriptive study to investigate the influence of moral self-concept and ethical values on attitude toward withdrawal of life-sustaining treatment among nursing students. The study subjects were 296 nursing students from 2 nursing colleges in G city. The data were collected from June 12 to June 23, 2017 and analyzed using the SPSS 23.0 program. The mean score of the moral self-concept was 3.48±0.33, of ethical values was 3.50±0.37 and of attitude toward withdrawal of life-sustaining treatment was 3.13±0.43. In attitude toward withdrawal of life-sustaining treatment, there were significant differences in grade(F=3.21, p=.024), practice(t=2.06, p=.040) and nursing ethics education(t=2.98, p=.003). There was a significant negative correlation between attitude toward withdrawal of life-sustaining treatment and moral self-concept(r=-.14, p=.017) and ethical values(r=-.42, p<.001). The significant predictors that influence the attitude toward withdrawal of life-sustaining treatment were ethical values and nursing ethics education. The explanatory power was 22.5%. Based on the above results, additional studies to determine the various factors affecting attitude toward withdrawal of life-sustaining treatment of nursing students should be conducted and systematic education programs need to be developed to foster utilitarian values in order to form a positive attitude toward withdrawal of life-sustaining treatment.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.5
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• pp.275-284
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• 2018

This study was a descriptive study to investigate the effects of nursing students' consciousness of biomedical ethics, good death recognition, and self-esteem on attitudes toward withdrawal of life-sustaining treatment. The subjects of this study were 204 nursing students attending university. The data were collected from October 24 to October 31, 2017 and analyzed using the SPSS Win. 22.0 program. Attitudes toward withdrawal of life-sustaining treatment scored $2.97{\pm}0.29$ out of 4, $3.01{\pm}0.31$ for biomedical ethics, $3.24{\pm}0.38$ for good death recognition and $3.23{\pm}0.41$ for self-esteem. There was a significant positive correlation between attitudes toward withdrawal of life-sustaining treatment and good death recognition, and there was a significant positive correlation between attitudes toward withdrawal of life-sustaining treatment and self-esteem. As a result of multiple regression analysis, it was found that good death perception affected nursing students' attitudes toward the withdrawal of life-sustaining treatment. In other words, elevated perception of good death was associated with more positives attitudes toward withdrawal of life-sustaining treatment. Based on the above results, it is necessary to develop a systematic education program for nursing college students. In addition, this researcher proposes an in-depth study to explore the variables that influence nursing students' attitudes toward withdrawal of life-sustaining treatment.

• Journal of Industrial Convergence
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• v.21 no.3
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• pp.159-169
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• 2023

This study analyzed the factors affecting the opinions of life-sustaining treatment among the elderly in Korea. The study subjects were 10,097 people who responded to the survey on the condition of the elderly (2020), and using the SPSS 25.0 program, first, the demographic characteristics of the research subjects were identified through descriptive statistics and the average and normality of major variables were identified. Second, the chi-square was analyzed by conducting a cross-analysis of opinions on life-sustaining treatment according to the characteristics of the elderly. Third, a correlation analysis was performed to analyze the correlation between major variables. Fourth, the relative influence on the life-sustaining treatment of the elderly was identified through multiple regression analysis. The main research findings are as follows. First, 8,565 (84.8%) of the elderly were opposed to medical treatment (life-sustaining treatment) to save them even if they were unconscious or difficult to live. Second, as a result of cross-analysis on life-sustaining treatment for the elderly, the 𝑥² values of education level, health status, living together with children, and cost of living in old age were found to be significant. Third, the educational level of the elderly, living together with children, and the cost of living in old age were found to have statistically significant negative effects on life-sustaining treatment. Such research results indicate that the elderly with a high level of education oppose life-sustaining treatment compared to those with a low level of education. In addition, in the case of the elderly with traditional values who responded that one of their children should live with the elderly (parents), the ratio of people in favor of life-sustaining treatment was high, and in the case of the elderly with modern values who responded that they did not have to live together, the ratio of opposition to life-sustaining treatment was high. appeared to be high. In addition, in the case of the elderly with traditional values who responded that the burden of living expenses in old age should be shared between the state and society and their children, the proportion in favor of life-sustaining treatment was high. This high figure expressed the desire for well-dying. Based on these research results, the value system was re-examined as a factor influencing the elderly's opinion on life-sustaining treatment, and basic data for welfare policies for the elderly were provided.

• The Journal of Korean Academic Society of Nursing Education
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• v.26 no.4
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• pp.383-392
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• 2020

Purpose: This study was a descriptive study to identify factors affecting the attitude toward life-sustaining treatment of nurses working at long-term care hospitals. Methods: Data were collected through structured questionnaires from August 2nd to 27th, 2019. Study participants consisted of 163 nurses who were working for at least 6 months from 7 long-term care hospitals in B and K city. Data were analyzed using t-test, ANOVA, Scheffe' test, Pearson's correlation coefficients, and hierarchical regression with SPSS WIN v 21.0. Results: There were significantly positive correlations between awareness of good death (r=.46, p<.001) and perception of patients' rights (r=.32, p<.001). The factors affecting participants' attitude toward life-sustaining treatment were awareness of good death (β=.35, p<.001) and their own view of death (β=.24, p=.001), which explained about 27.0% of the attitude toward life-sustaining treatment. Conclusion: Based on these results, it is necessary to develop nursing educational materials that can establish values for deaths, and cultivate legal and ethical knowledge related to attitude toward life-sustaining treatment. In addition, since the severity of a patient's condition varies and the characteristics of the institution vary depending on the type of hospital, a study is needed on the relevance of variables considering the hospital environment.

• Journal of East-West Nursing Research
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• v.28 no.2
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• pp.142-150
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• 2022

Purpose: The purpose of this study is to identify the factors affecting the role of nurses with regard to the perception of good death, knowledge of advance directives, and stress and attitude toward withdrawing life-sustaining treatment. Methods: Data were collected from 102 nurses working at a general hospital. Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Scheffé test, Pearson correlation coefficient, and multiple linear regression using the SPSS 28.0.1.0 program. Results: Educational level (β=.37, p=.001 for bachelor; β=.33, p=.005 for master or higher) and good death perception (β=.22, p=.024) were significant factors of the role of nurses associated with withdrawing life-sustaining treatment. Conclusion: Based on the result of this study, information about awareness of good death should be included in development of an educational program in order to strengthen the role of nurses in withdrawing life-sustaining treatment of patients.

• The Korean Society of Law and Medicine
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• v.10 no.2
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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.