• 의학교육논단
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• 제17권3호
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• pp.140-147
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• 2015

Medical education can provide students with an opportunity to encounter marginalized communities and motivate them to become involved with the needs of disadvantaged people. The College of Medicine of The Catholic University of Korea includes a social service program in the medical humanities and social sciences curriculum. The course has lectures on social welfare, human rights, and social service, as well as four days of social service in 'Flower Village,' which is a Catholic social welfare institution. This study analyzes the satisfaction, feedback, and reflection papers of students who completed the social service program and provides an educational model for the medical humanities and social sciences. Students' satisfaction with the program was scored at 4.23 out of 5. A qualitative study of students' reflection papers derived 7 key phrases, among which 'nature and practice of social service,' 'holistic understanding of humans,' 'empathy and communication,' and 'social responsibility' are identified as goals of this program and 'happiness,' 'respect for human life,' and 'compassion' are good indicators of students' compassionate participation. Encounters with marginalized communities within the medical curriculum allows students to serve people with social difficulties and work for the improvement of their living conditions. Students learn to approach social needs with concern and empathy and seek ways to contribute to those communities.

• 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.

• 한국노년학
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• 제37권2호
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• pp.497-516
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• 2017

본 연구는 서울시에 거주하는 65세 이상 남녀 임금근로자 12명을 대상으로 고령 임금근로자들의 일하는 삶이 갖는 의미와 본질적 구조를 탐색하였다. 심층적인 분석을 위해 질적 연구방법의 하나인 Giorgi(2012)의 현상학적 연구방법을 사용하였다. 연구결과 총 349개의 의미단위, 35개의 중심의미, 16개의 드러난 주제(하위 구성요소), 그리고 6개의 본질적 주제(구성요소)를 구성하였다. 본질적 주제는 괄시와 편견을 견디는 삶, 노년의 포도청(捕盜廳), 을 중의 을로서의 멍에, 뛰어 넘을 수 없는 벽, 일을 통해 청년의 시간 되살리기, 노동 자존감이었고, 이러한 6개의 본질적 주제는 '고단한 노년의 삶 속에서 간헐적으로 느끼는 작은 행복'으로 귀결되었다. 연구 참여자들은 고령 임금근로자에 대한 사회적 차별과 불안정한 고용환경으로 인해 삶이 고단하지만, 노년에도 일을 할 수 있다는 안도감과 노동을 통한 자긍심을 통해 고단함을 견딜 수 있는 것으로 드러났다. 고령임금근로자들에게 일은 경제적 고민을 덜어 줄 뿐만 아니라 노동을 통해 노년기 자존감을 높여주고 건강을 유지하게 해 주는 중요한 수단이었다. 일하는 노년의 삶은 고단하다. 그러나 노동 자체가 고령 임금근로자의 삶을 고단하게 만들기보다는, 단지 나이가 많다는 이유로 겪는 부당한 처우와 사회적인 편견, 괄시가 일하는 삶의 무게를 가중시킨다는 사실을 알 수 있었다. 연구결과를 토대로 다음과 같이 제언하였다. 첫째, 일하는 노인에 대한 사회적 차별과 부당한 근로환경은 인권보호의 관점에서 사회적 논의와 법적 조치가 필요하다. 둘째, 고령자들의 경험을 활용해 사회적으로 기여할 수 있는 다양한 서비스 일자리를 창출해야 한다. 셋째, 고령 근로자들이 컴퓨터를 활용한 업무능력을 향상시키고 스트레스를 줄일 수 있도록 컴퓨터 및 인터넷 교육 프로그램을 확대할 필요가 있다.

• 의료법학
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• 제18권2호
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• pp.105-138
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• 2017

이 글은 환자의 자기결정권에 관한 몇몇 대표적인 판례들을 연혁적으로 검토한 논문이다. 대법원은 과거 음주상태에서 농약을 음독하여 자살을 시도한 환자가 치료를 거부하자 치료를 포기한 의료진에게 특정 의학적 상태(응급상황)에서 의사의 생명보호의무가 환자의 자기결정권 존중보다 우선한다고 판단하여 의료과실을 인정하였다. 이후 대법원은 가족들의 요청에 의해 지속적 식물인간 상태인 환자에게 해당 환자의 의학적 상태(회복불가능한 사망의 단계 등)를 고려하고 환자의 의사를 추정하여 연명의료를 중단하게 하였다. 최근 대법원은 종교적 신념과 관련하여 수혈과 같은 필수적인 치료를 거부한 환자에 대하여 대법원은 환자의 생명 보호에 못지않게 환자의 자기결정권을 존중하여야 할 의무가 대등한 가치를 가지는 것으로 평가할 수 있는 판단 기준을 제시하였다. 인간의 존엄성에 근거한 환자의 자기결정권과 의사의 생명보호의무가 충돌하는 상황에 대하여 연혁적 판례 검토를 통해 법원의 입장이 우리 사회에서 환자의 주체적 역할과 자율성을 존중하는 방향을 반영하여 함께 변화되어 왔음을 확인할 수 있었다. 법원이 생명권이라는 최고의 가치만을 환자의 의사보다 더욱 우선하여 판단해오다가 적어도 명시적인 환자의 의사 또는 그렇지 못할 경우에 추정적 의사까지도 고려한 치료의 유보나 중단에 대하여 고려하기 시작한 것, 종교적 신념에 근거한 자기결정권의 행사로서의 수혈거부와 같은 치료거부에 대하여 충분한 정보에 근거한 치료거부의 몇 가지 적법한 요건들을 인정하기 시작했다는 것은 이후 우리나라 의료 환경에 적잖은 영향을 줄 것이고 의료현장에서 의료행위를 하는 의사들에게도 직 간접적인 지침이 될 것이다.

• 간호행정학회지
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• 제7권2호
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• pp.237-251
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• 2001

It is important for nursing managers to understand the lived experience of nursing care for dying patients in clinical nurses for the effective management of them. The purpose of this Phenomenological study was to explore the lived experience of nursing care for the dying patients in clinical nurses and identify the meaning and structure of their lived experience. This study was conducted from 1 of June, 2000 to 1 of November, 2000. Data were collected with several in-depth interviews until data were fully saturated, from 1 of June, 2000 to 10 of September, 2000. The Subjects were five nurses who had more than three-year job experience in caring for dying patients, three protestant christians and two atheists, one married and four unmarried persons. The range of their age was from 28 to 36. Data were analysed by the Colaizzi's methodology. Ten themes were extracted from fifty-one fomulated-meanings. Fomulated-meanings were extracted from the restatements and the significant-statements which were deriven from the raw data. Finally ten themes took form of five structures. Five structures of 'The lived experience of nursing care for the dying patients in clinical nurses' were : 1. Experiencing guilty feeling and anger due to their and other's manneristic and ignored attitude toward dying patients 2. Feeling heartily the necessity of the education of hospice care because of their incompetence due to lack of knowledge of hospice care 3. Recognizing the human rights of dying patient's thinking themselves and their families 4. Felling satisfaction with their nursing accomplishments and reflecting their life through nursing care of the dying patients 5. Experiencing low self-respect due to the other's negative perspective toward their job The results of the study would give useful information to nursing managers to understand the lived experience of nursing care for dying patients in clinical nurses and establish adequate strategies to support them.

• 한국병원경영학회지
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• 제4권1호
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• pp.1-20
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• 1999

Since the late 1980s, there have been radical changes in the managerial environment of Y University Medical Center(YUMC). Externally, the competition among hospitals has intensified due to the establishment of universal health insurance in 1939 and the entrance of large enterprises into the health care industry in the early 1990s. In addition, government regulation of medical institution is becoming stricter. Also, consumer groups have continued to demand the respect for patient rights and improvement of the quality of medical services. Internally, the financial condition of YUMC has worsened, not only because weak control and poor mediation in its large-scale structure have made its operation inefficient, but also because the rates of increase in the prices of goods and labor have grown faster than any increases in revenues. This study on materials management at YUMC presents a way for YUMC to reduce costs and increase its productivity, thereby overcoming its financial difficulties and dealing with external pressures. This study utilized the case studies of the materials purchasing and medical supply management in the United States and the comparative analysis of management to suggest short-term and long-term alternatives for innovation in YUMC. The goals of the short-term alternatives for innovation are to centralize the purchasing and supply departments and to simplify the decision-making processes. Through these attempts, it is estimated that YUMC's costs could be reduced by $600,000 per year. In the long-term, it is necessary to consider introducing a Supply Processing Distribution(SPD) system and setting up a centralized electronic system for supply and inventory management, although it is difficult to estimate the effect of cost-cutting because of the lack of analysis data. Thus, YUMC should thoroughly analyze initial investment costs and economical efficiency generated from long-term alternatives.

• 한국가정과교육학회지
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• 제36권1호
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• pp.1-18
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• 2024

본 연구의 목적은 청소년들이 관계형성역량을 키울 수 있도록 가정과교육의 방향을 탐색하고 구체적인 시사점을 제공하는 것이다. 이를 위해 한국의 인성교육과 영국의 관계교육 교육과정의 내용을 분석하였고, 결과는 다음과 같다. 한국의 인성교육은 책임, 존중, 배려, 소통 등의 인성교육 가치 덕목을 공교육 전반에서 교육하고 있다. 인성교육의 가치 덕목은 가정교과의 관계형성 역량 함양을 위한 학습 내용 요소와 상당 부분 일치하고 있다. 영국의 초, 중등 단계의 관계교육은 한국의 중학교 가정과교육의 건강한 관계를 이해하고 유지하기 위한 목표와 학습 내용이 유사하였다. 그러나 안전한 관계, 다른 사람과의 경계 설정, 성교육 내용 포괄성, 성교육 거부권, 평등권에 근거한 교육 내용 등에 있어서는 차이가 있었다. 이러한 결과를 토대로 가정과교육에서 관계형성역량 향상을 위해 관계에 대한 교육의 개념 정의와 체계적인 교육 내용 구성이 개발되어야 하며, 학생의 태도와 변화를 끌어내고 내면화할 수 있는 교수·학습 방법의 개발과 학습 프로그램 개발 연구도 필요하다는 결론을 얻었다. 그리고 추가·보완할 교육 내용과 고려할 점에 대한 시사점을 얻었다.

• 문화기술의 융합
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• 제4권1호
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• pp.153-163
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• 2018

본 연구는 요양병원에 근무하는 간호사들을 대상으로 윤리적 딜레마와 전문직업성 정도를 파악하여 윤리적 딜레마를 해결하기 위한 방안과 전문직으로서의 성장을 통한 질적인 간호를 제공하기 위한 자료를 마련하고자 시도하였다. 연구대상자는 14곳의 요양병원에 재직 중인 간호사 210명을 대상으로 하였고, 자료분석은 SPSS/WIN 24.0 프로그램을 이용하여 통계처리 하였다. 본 연구결과 요양병원 간호사의 윤리적 딜레마는 중간정도로 나타났고, 하위 영역 중 간호사와 대상자 영역이 가장 높았으며, 생명존중 및 건강의 권리 존중 영역이 낮게 나타났다. 대상자의 전문직업성은 중간정도로 나타났고, 소명의식 영역의 점수가 가장 낮은 것으로 나타났다. 요양병원 간호사들의 윤리적 딜레마 상황을 반영한 간호윤리 지침서를 개발하여 간호사들이 실무현장에서 겪게 되는 윤리적 딜레마상황에 대한 올바른 가치관을 심어주기를 제언한다. 또한 요양병원 간호사들의 전문직업성 교육을 계획할 때 간호직에 대한 신념과 가치관을 강조하여 소명의식을 높일 수 있는 전략이 필요하다.

• 의료법학
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• 제15권1호
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• pp.185-209
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• 2014

While the local health insurance and the employment-based insurance were integrated in July 2000, the insured is divided into employment-based insured and the local insured and the relevant premium has been applied to both groups. The health insurance premium having the feature of social solidarity has to be determined depending on income, that is, the ability to pay in accordance with the principles of social insurance. While employment-based insurance premium has been determined depending on the earned income, the local insurance premium for the local insured has been determined by scoring gross income(evaluated income), property and possession of automobiles. A variety of improvement approaches has been implemented including introduction of the employment-based insurance premium ceiling system (2002) and the change of property scoring system for the local insured (2006). However, the health insurance system which was merged in 2000 has been implemented up to now without significant change even though there were lots of socio-demographic change including increase of income level and the population structure such as low birth and aging. In other words, it is required to implement the premium rating system securing the income-based equity. Nevertheless, it was inevitable to apply the diverse rating standards in the early stage because it was very difficult to verify the income of the self-employed. Although the income verification rate was significantly increased from 23% in 1989 to 44% in 2010, the irrational standards including property, automobiles, living standard and activity rate have been still applied to the local insured because it is difficult to secure the validity of insurance premium rating system and it severely lacks of security. This paper investigated whether the current insurance premium rating system for the local insured imposing the premium on the basis of 'gender' and 'age' complies with the basic human rights secured by the current Constitution of the Republic of Korea with respect to the practical and theoretic irrationality of insurance premium rating system and standards for he local insured. In accordance with the analysis results, this paper proposed the approach to improve the system.

• 융합정보논문지
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• 제11권3호
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• pp.68-76
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• 2021

본 연구는 간호학 전공 대학생의 낙태와 안락사에 대한 태도 및 좋은 죽음에 대한 인식 수준과 관련요인과의 관계를 파악하기 위하여 시도되었다. 자료조사는 C시 및 G시에 소재한 대학교 2곳의 간호학 전공 학생들을 대상자로 선정하여 구조화된 설문지를 통하여 이루어졌다. 연구방법은 서술적 조사연구로서 변인에 대한 평균과 표준편차, 빈도분석, Pearson's correlation coefficients 분석을 실시하였다. 본 연구결과, 대상자의 낙태 반대에 대한 지지정도는 2.51±.56점(점수범위 1-4)으로 낙태에 대한 반대가 찬성보다 우위에 있었다. 안락사에 대한 인식은 3.06±.47점(4점 척도)로 중간보다 높은 수준으로 긍정적으로 인식하였고, 좋은 죽음 인식은 2.97±.47점(4점 척도)으로 중간 정도로 나타났다. 낙태에 대한 의사결정은 97.1%가 임신한 여성에게 있다고 하였으며 낙태를 경험한 대학생은 5.7%였다. 낙태에 대한 태도는 안락사에 대한 태도와 부적 상관관계(r=-.374, p<.001)를 보여 낙태반대를 지지할수록 안락사에 대해 긍정적인 태도를 나타내었다. 따라서 대상자들이 간호서비스를 제공하면서 생명의 존엄성과 인본주의적 사고에 기초하여 환자의 인권을 보호하고 존중할 수 있도록 생명과 죽음과 관련된 윤리교육이 필요하다.