• Journal of Hospice and Palliative Care
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• 제21권1호
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• pp.1-8
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• 2018

보라매 사건 이후 근 20년이 지나 국가위원회의 권고를 기반으로 연명의료결정법이 2018년 2월 4일 제정 시행되었다. 그러나 법률의 제정 과정에서 이해관계 당사자 및 관련자들의 의견 차이로 일부 내용은 수정 또는 삭제되었으며 제정 막바지에 호스피스 완화의료에 대한 내용이 덧붙여졌다. 이로 인해 국가위원회의 권고에 담긴 내용과는 일부 다르게 법률이 제정되어 여러 문제점들이 나타나고 있다. 그러므로 현행 법률 시행 초반 연명의료결정 수행 현장을 꼼꼼히 모니터링하고 다양한 관련자들의 의견을 잘 청취하여 문제점을 파악하고 해결 방안을 마련하여야 할 것이다. 이를 토대로 법률을 개정하여 입법 목적인 '환자의 최선의 이익을 보장하고 자기결정을 존중하여 인간으로서의 존엄과 가치를 보호'가 충실히 이루어질 수 있도록 하여야 할 것이다.

• 성인간호학회지
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• 제25권2호
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• pp.207-218
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• 2013

Purpose: The purpose of this study was to explore the chronic patients' preferences for care near the end of life. Methods: This is a descriptive survey research, with subjects of 161 outpatients with hypertension, diabetes mellitus or chronic renal failure. Results: The majority of the subjects do not want meaningless life sustaining treatment and they report thinking positively about family or health care professional to participate in their end of life decision making process. Subjects reported preferring adequate pain management and spiritual support at the end of life. In regard to advance directives (ADs), those subjects with chronic disease report thinking positively about the necessity of ADs and its institutionalization. However, the subjects report not having the detailed information on the proper time and method of writing their ADs. Conclusion: Based on these results, educational programs on end of life decision making for chronic patients need to be developed. Also, the nurse should try to reflect the opinion of chronic patients as much as possible when make an end-of-life decision.

• Journal of Hospice and Palliative Care
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• 제21권3호
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• pp.92-103
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• 2018

목적: 본 연구는 병원 근무자의 연명치료 중단에 영향을 미치는 장기기증, 장기이식, 죽음, 호스피스 완화의료의 지식, 태도 및 인식을 알아본 서술적 조사연구이다. 방법: K도 J시에 위치한 일개 상급종합병원에 근무하는 228명의 대학병원 근무자를 대상으로 자가 보고식 설문지를 이용하여 자료를 수집하였다. 자료는 SPSS WIN 21.0 프로그램으로 t-test, ANOVA, and Pearson's correlation coefficient를 이용하여 분석하였다. 결과: 대상자의 생명의료윤리 의식관련 지식은 연령, 학력, 직종, 근무부서, 생명의료윤리 교육유무에 따라 차이를 보였다. 뇌사 장기기증 장기이식에 대한 지식은 인체조직기증 및 이식에 대한 태도, 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식에서 유의한 양의 상관관계가 있었다. 인체조직기증 및 이식에 관한 태도는 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식, 연명치료 중단에서 유의한 상관관계가 있었고, 죽음에 대한 인식은 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식, 연명치료 중단에서 유의한 상관관계가 있었다. 호스피스 완화의료의 인식은 연명치료 중단에서 유의한 상관관계가 있었다. 연명치료 중단 태도에 영향을 주는 요인은 호스피스 병동 근무와 인체조직기증 및 이식에 관한 태도, 호스피스 완화의료의 인식으로 연명치료 중단 태도를 32.5% 설명하였다. 결론: 연명치료 중단 태도에 호스피스 병동 근무와 인체조직기증 및 이식에 관한 태도, 호스피스 완화의료 인식이 관련이 있었으며, 생명의료윤리에 기반을 둔 다양한 교육과정의 개발 및 적용에 대한 연구가 필요함을 제언한다.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.7-17
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• 2023

Purpose: The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). Methods: We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. Results: Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. Conclusion: Although the goals of hospice care are the same whether a patient has lung cancer or a non-malignant lung disease, because the characteristics of the respective diseases differ, end-of-life care practices and hospice approaches must be considered differently.

• Journal of Hospice and Palliative Care
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• 제11권3호
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• pp.140-146
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• 2008

목적: 말기 암 환자의 증가, 노년인구의 증가, 연명치료기술의 발달 등으로 완치될 수 없는 질환을 가진 말기 환자에 대한 치료 결정(End of life decision making)은 늘어나고 있다. 하지만 이에 대한 의료진의 태도나 환자 및 보호자의 인식은 낮은 상태에 있고 이로 인해서 말기 환자에게 말기진정과 같은 결정이 필요한 경우에 있어서도 그 시행에 많은 제약이 있으며 때로는 잘못된 시행으로 윤리적으로 어긋나는 경우가 발생되고 있다. 이에 의과대학 교육과정을 통하여 말기 환자 치료 결정에 대한 올바른 태도 변화를 가져올 수 있으며, 미래 의료계의 주역이 될 의과대학생들이 말기진정을 포함하여 능동적 안락사, 의사조력자살, 연명치료 유보 및 중단 등 말기 환자 치료결정에 대해 어떠한 태도를 가지고 있는가를 알아보기 위하여 본 연구를 시행하였다. 방법: 2007년 6월 25일부터 6월 29일 사이에 1개 의과대학 본과 1, 2학년 학생과 임상 실습중인 3학년 학생 총 388명을 대상으로 능동적 안락사, 의사조력자살, 연명치료 유보 및 중단, 말기 진정 등 말기 환자 치료결정에 대한 태도와 인구사회학적 자료를 설문 조사하였다. 응답이 완료된 267명을 대상으로 말기 환자 치료결정에 대한 태도와 각 인자들 간의 관련성을 분석하였다. 결과: 일개 의과대학생 267명을 대상으로 시행한 설문 조사에서 능동적 안락사, 의사조력자살, 연명치료의 유보 및 중단, 말기 진정의 시행에 찬성하는 비율은 각각 37.1%, 21.7%, 58.4%, 60.3%, 41.6%였다. 이 비율은 각 항목의 윤리적 타당성에 대한 설문 결과와 유사하였다. 1학년보다는 3학년에서 능동적 안락사와 의사조력자살은 더 반대하였고, 연명치료 유보 및 중단, 말기 진정에 대해서는 더 찬성하였다. 종교 활동 시간이 많을수록 각 항목에 대한 찬성이 적었으며 교육 경험 유무, 특히 임상실습경험이 있는 3학년 학생에서 말기 진정에 더 많이 찬성하였다. 연령, 임종 환자 경험 유무가 태도에 미치는 영향은 없었다. 결론: 말기 환자 치료 결정의 구체적 임상 행위에 대한 의과대학생의 태도에 이전 연구에서처럼 종교 또는 교육이 말기 환자 치료 결정에 영향을 미치는 것으로 나타났으며 특히, 임상실습을 통한 교육경험이 태도 변화에 중요하였다.

• 의료법학
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• 제11권2호
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• pp.239-274
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• 2010

Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. Firstly, the theoretical limitations of Advance directive may be categorized into conceptual and moral limitations. In case of conceptual limitations, authors of advance directives may not be well aware, in advance, of the particular situation in which he or her will experience in the future, and patients may experience the change in his or her values and lack the understanding and information about the future situation due to the changes in treatment methods. In case of moral limitations, a patient has a limited moral autonomy right and self identity that have an impact on his or her preference. Secondly, in case of practical constraints for advance directive, there exist cultural features, low ratio of documentation, as patients themselves admit, and low predictability and stability of patient's own preference regarding life-sustaining care. And the problem of validity and accuracy in proxy's decision making is also raised. Those who administer a living will, especially, may have a difficulty in understanding the directive by a patient, so that the accuracy of execution cannot be secured. In the sense, it is needed to implement a legal device in order to solve such problems. In summary, it is urgently required to understand the limitations and explore desired alternatives to overcome the relevant problems in advance, which must contribute to successfully adopting and effectively operating the advance directive system in Korea.

• 의학교육논단
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• 제24권2호
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• pp.113-127
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• 2022

Considering the recent medicalization of death, the importance of preparing both laypersons and medical students to have meaningful end-of-life conversations, which is among the objectives of death education, will grow. The Act of Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life provided a new source of momentum to death education for both laypersons and medical professionals, as the importance of education on death is widely recognized. However, problems remain regarding how to prepare people for productive conversations at the end-of-life and how to secure the continuity of care. Different focuses and deficiencies are observed in death education programs for each category of learner. In education for laypeople, tangible information on how to actualize one's existential and personal understanding of death through real-life options is lacking, except for presenting the "protocol" of the Act. Conversely, basic medical education lacks an understanding of or confrontation with death on the existential and personal levels. Death education should aim to build a shared understanding that can facilitate communication between the two groups. The scant overlap between layperson education and basic medical education even after the Act's enactment is worrisome. Further fundamental changes in death education are required regarding its content. Topics that patients and doctors can share and discuss regarding death and end-of-life care should be discovered and provided as educational content both to laypeople and future medical professionals.

• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.204-213
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• 2021

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decision-making process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion: Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

• 근관절건강학회지
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• 제20권3호
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• pp.197-206
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• 2013

Purpose: The purpose of this study was to investigate end-of-life care preferences of employees working in a university hospital. Methods: Of 650 eligible employees that were approached, 607 employees (386 nurses, 93 physicians, and 128 general staff) completed the Korean version of Preferences for Care Near the End of Life (PCEOL-K). Results: Among 5 dimensions of the PECOL-K, "Pain" was the most preferred care dimension and "Decision making by health care professional" was the least preferred care dimension. The item that received the highest mean score was "I want to let nature guide my dying and I do not want my life to be artificially prolonged in any way", and the lowest item was "I want health care providers to make all decisions about my care". As preferred care near the end of life, nurses gave lower scores to the life sustaining treatment and decision making by health care profession than physicians and general staff. Compared to physicians and nurses, general staff preferred the decision making by health care professional and by family. Conclusion: The results show that adequate pain relief is the most preferred care at the end of life among hospital employees and non-medical personnel preferred decision making by others.

• 의료법학
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• 제23권4호
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• pp.75-102
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• 2022

본 글에서는 보건의료관련 법령 중 「연명의료결정법」, 「정신건강복지법」, 「장기이식법」, 「인체조직법」, 「약사법」, 「에이즈예방법」, 「결핵예방법」, 「감염병예방법」을 검토하였다. 이들 법률에 민법적 사고가 필요한 부분은 환자의 자기결정권과 동의에 관한 부분이다. 그리고 환자가족을 통한 의사결정이 환자의 의사결정을 대행하는 것인지 환자가족이 환자를 위하여 고유의 권한으로 의사를 결정하는 것인지와 관련하여 성년후견제도에서 후견인의 동의대행과 비교하여 이해할 필요가 있다. 보건의료관련 법령은 환자의 자기결정권과 그 실현을 위한 동의대행의 문제에서 민법과 깊게 연관되어 있음에도 불구하고 개개 법률의 관련 규정은 민법의 동의에 관한 원칙이나 성년후견제도와 별개로 규정되어 있음을 확인할 수 있다. 보건의료관련법령의 일차적 목적이 환자의 자기결정권 실현에 있지 않다고 하더라도 의료관련 행정이 통일적으로 운영되기 위해서는 민법의 의사결정 및 그 대행에 관한 원칙을 이해할 필요가 있다.