• 제목/요약/키워드: The informed consent

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The Trend of Precedents about Calculation of Damage Compensation for Last Decade (손해배상액 산정에 관한 최근 10년간 판례의 동향 하(下))

  • Park, Young-Ho
    • The Korean Society of Law and Medicine
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    • v.11 no.1
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    • pp.397-445
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    • 2010
  • This thesis introduces the trends of korean courts' ruling on damages in medical malpractice cases for past 10 years. First of all, Korean courts' ruling have had a tendency to pay only non-economic damages for not taking the informed consent. If a doctor cannot get the informed consent from a patient, he compensate only non-economic damages for the infringement of self-determination rights of patient. It's enough for the plaintiff to prove the infringement of self-determination rights, if the plaintiff just want to get non-economic damages. The Korean Supreme court have ruled that if plaintiffs want to get economic damages for the infringement of self-determination rights or informed consent, plaintiffs must prove that the infringement of self-determination rights is the proximate cause of the economic damages of patient. There is another tendency for the Korean Supreme court to limit the damages in medical malpractice cases on the ground of patient's diseases' dangerousness or patient's idiosyncrasy. In the past courts often limit the damages only to 70~80% of total damages, but now a days courts mostly limit the damages to 20~30%. This thesis also introduce the Korean courts' trends about Valuing damages in personal injury actions awarded for gratuitously rendered nursing and medical care.

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Informed Consent and Refusal of Treatment in Emergency Medical Situation (응급의료에서의 설명·동의 원칙과 응급의료거부죄)

  • Lee, Jung-eun
    • The Korean Society of Law and Medicine
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    • v.23 no.1
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    • pp.37-80
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    • 2022
  • By analyzing informed consent and the refusal of emergency medical treatment (called patient dumping) under the current Emergency Medical Service Act, this study suggests that an emergency medical professional is only liable for patient dumping if their duty to protect the patient's life takes precedence over the patient's right to self-determination. In emergency medical situations, as in general medical situations, medical treatment should be performed after the emergency medical professional informs the patient about the medical treatment, including its necessity and methods, and obtains consent from the patient. Refusing or evading the performance of emergency medical services on the excuse of the informed consent not considering a waiver or alteration of informed consent requirements without reasonable reasons violates the Emergency Medical Service Act and thus makes an emergency medical professional liable to administrative disposition or criminal penalty. In other words, depending on the existence of a waiver of alteration of the informed consent, patient dumping may be established. If the patient is a minor or has no decision-making ability, and their legal representative makes a decision against the patient's medical interests, the opinion of the legal representative is not unconditionally respected. A minor also has the right to decide over their body, and the decisions of their legal representatives should be in the patient's best interests. If the patient refuses treatment, in principle, the obligation of life protection of emergency medical professionals is the top priority. However, making these decisions in the aforementioned situations in the emergency medical field is difficult because of the absence of explicit regulations regarding these exceptional problems. This study aims to organize the following precedents of the Supreme Court of Korea. The court states that, when balancing the conflicting interests between the duty to provide emergency medical service and the duty to inform is unavoidable for emergency medical professionals, they should put the duty to protect the patient's life ahead of the duty to inform if the patient's life matters. Exceptionally, when a patient has seriously considered whether they should receive treatment before the emergency medical situation, their right to self-determination can be considered equal to the obligation of emergency medical professionals to provide emergency medical treatment. This research also suggests that an amendment of the Emergency Medical Service Act should include the following. First, the criteria for determining the decision-making ability of emergency patients should consist of medical content. Second, additional consent from a medical professional is unnecessary for first-aid treatment. Finally, new provisions for emergency medical obligations for minors, new provisions for the decision standard when there are conflicting opinions about the treatment of a patient, and new penalty provisions for professionals who suspend emergency medical examinations and treatments need to be established.

Medico-legal Consideration of Gastric Lavage in Acute Intoxicated Patients -In the Supreme Court 2005.1.28, 2003da14119 (급성 약물중독 환자에서 위세척의 의료법학적 고찰 -대법원 2005.1.28, 2003다1419 판결을 중심으로-)

  • Bae, Hyun-A
    • Journal of The Korean Society of Clinical Toxicology
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    • v.3 no.1
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    • pp.1-10
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    • 2005
  • Gastric lavage is now known to be ineffective, unnecessary or hazardous in some circumstances where it used to be performed as a routine. This article concerns the medico-legal aspect of forced gastric lavage. The Supreme Court 2005.1.28, 2003da14119 is the case where a patient, who ingested the organophosphate insecticide to attempt suicide and refused lavage. At first we discuss the effectiveness or hazards of lavage because a very high degree of proof -of negligence, not error of clinical judgment - would be required. Lavage, with or without the informed consent, performed negligently which result in harm could, of course, give rise to a claim in negligence. A doctor might also be held negligent in failing to perform an act which he/she had a duty to perform.

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Readability of Patient Information Leaflets in Clinical Trials (임상시험 시험대상자설명서의 가독성 평가)

  • Choi, Im-Soon;Yong, Chul-Soon;Lee, Iyn-Hyang
    • Korean Journal of Clinical Pharmacy
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    • v.26 no.1
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    • pp.33-39
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    • 2016
  • Background: Elements of informed consent including capacity, disclosure, understanding, voluntariness, and permission of the participant, are all crucial for clinical trials to be legally and ethically valid. During the informed consent process, the patient information leaflet is an important information source which prospective research subjects can utilize in their decision-making. In the adequate provision of information, KGCP guideline necessitate 20 specific items, as well as the use language that individuals can understand. This study measures the vocabulary level of patient information leaflets in an effort to provide an objective evaluation on the readability of such material. Methods: The word difficulty of 13 leaflets was quantitatively evaluated using Kim kwang Hae's vocabulary grading framework, which was compared to the difficulty level of words found in the $6^{th}$ grade Korean textbook. The quantitative outcomes were statistically analyzed using chi-squared tests and linear by linear association for ordinal data. Results: There was a statistically significant difference between the vocabulary level and frequency of words in leaflets and the 6th Korean textbook. The leaflets were on average 260 sentences and about roughly 15 pages long, including lay language (easier or equal to language used in primary school) of around 12% less; technical language of around 4.5% more. As the vocabulary grades increase, there was a distinct difference in vocabulary level between Korean textbook and each information leaflet (p < 0.001). Conclusion: Patient information leaflets may fail to provide appropriate information for self-determination by clinical trial subject through the difficulty level of its wording. Improvements in the degree of patients' understanding and appropriate use of information leaflets are collaboratively equipped to strengthen patient's autonomy and therefore guaranteeing participant's rights.

The Cost of Child Rearing for Wrongful Conception (원치 않은 임신에 대한 아이의 부양비)

  • Bong, Young-Jun
    • The Korean Society of Law and Medicine
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    • v.12 no.2
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    • pp.219-263
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    • 2011
  • "Wrongful conception" is a medical malpractice claim in which the plaintiff is the parent of a normal, healthy infant whose conception was unplanned and unwanted. Medical malpractice in wrongful conception can be the result of a failure to provide informed consent to a patient, failure to properly perform a surgery, or a physician's negligent handling of a patient's problems. In the concrete, wrongful conception cases fall into two categories; those involving pre-conception negligence, such as a failed contraceptive, sterilization or failing of the controlling of embryo-number on the IVF, and those involving post-conception negligence, such as a failure to diagnose a pregnancy or to perform an abortion procedure. In addition, Medical malpractice can be the result of a failure to provide informed consent to a patient. When bad results occur by medical malpractice or failure to provide informed consent to a patient, the range of recovery of damages is decided by a traditional civil liability law. However the calculation of damages for wrongful conception is not easy because the high value of life is included in that case. So many courts opinions in foreign country and Seoul High Court decision in 1996 allow damages for the pregnancy, birthing process and sterilization costs, but refuses to allow damages for child rearing expenses. As to the range of recovery of damages for wrongful conception, one approach says that to allow damages in a suit such as this would mean that the physician would have to pay for the fun, joy and affection which plaintiff will have in the rearing and educating of the plaintiff's baby. To allow such damages would be against the dignity of the baby based on article 10 of the Constitution. However another approach says that damages are recoverable for all expenses related to child birth as well as for child rearing costs. Because the damages that the parents should bear a burden to the tort damage done is not a baby itself but child rearing costs. In other words, although the baby is healthy or not, economic burden of the parents can not be disregard. And denial of compensation for costs of child rearing may invalidate the role of liability law, grant the physician with a exemption certificate of liability. As a result, the medical field of procreation can be easily isolated from a liability of reparation. Therefore, on the liability law like the other medical malpractice action, parents who became pregnant or gave a birth by physician, wrongfully performed sterilization operation, etc. should be compensated for all damages relevant to unplanned and unwanted conception or birth as well as costs of child rearing.

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Consideration on Flap Surgery in Vegetative Patients Having Nosocomial Infection (병원 감염 창상을 가진 식물 인간 상태에서의 피판술시 고려사항)

  • Kim, Jeong Tae;Kim, Kee Woong;Kim, Yeon Hwan;Kim, Chang Yeon
    • Archives of Plastic Surgery
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    • v.36 no.3
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    • pp.277-282
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    • 2009
  • Purpose: The vegetative state is a clinical condition with complete unawareness of self and environment, but with preservation of brain - stem functions. Vegetative patients may have nosocomial infections in their wounds, like pressure sores and infected craniums after cranioplasties. Usually flap surgery is necessary for those wounds, but decision of undergoing surgery is difficult because of various adverse conditions of vegetative patients. We share our experience of several successful flap surgeries in vegetative patients, and evaluate obstacles and requirements to get satisfactory results. Methods: From December 2005 to September 2008, a total of 4 vegetative patients underwent surgeries. In 2 patients with infected artificial craniums, scalp reconstructions with free flaps were performed. In other 2 patients with huge pressure sores with sepsis, island flap coverage of wounds was done. Retrospective study was done on hospital day, vegetative period, number of surgeries done, underlying diseases, causative bacteria, and contents of informed consent. Results: Mean hospital day was 14 months and mean vegetative period was 17.5 months. Patients underwent average of 4.5 surgeries under general anesthesia. There were several underlying diseases like hypertension, DM, CHF and chronic anemia. MRSA(Methicilin - resistant Staphylococcus Aureus) was cultured from every patient's wounds. Informed consent included a warning for high mortality and a need of attentive familial cooperation. Conclusion: There are three requirements for doing flap surgeries in vegetative patients. First, to prevent aggravation of brain damage and underlying diseases by general anesthesia, multidisciplinary team approach is needed. Second, operation should be beneficial for prolonging patient's lifespan. Third, because postoperative care is very difficult and long hospitalization is needed, detailed informed consent and highly cooperative attitude of family should be confirmed before operation.

Training future Korean medicine doctors to perform bee venom acupuncture and obtain informed consent using an objective structured clinical examination (객관 구조화 임상시험을 활용한 봉약침 시술 전 과정에 대한 교육효과)

  • Cho, Eunbyul;Jeon, Hyesoo;Kwon, O Sang;Hong, Jiseong;Lee, Jaehoon;Jung, Eunho;Park, Jiwon;Seo, Wookcheol;Lim, Kyu Sang;Cho, Nam geun
    • The Journal of Korean Medicine
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    • v.43 no.1
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    • pp.6-17
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    • 2022
  • Objectives: This study describes the implementation of a training course that aimed to increase the competency of undergraduate students of Korean medicine at a single college to obtain informed consent and perform bee venom acupuncture using an objective structured clinical examination (OSCE). Methods: We developed and implemented a short training course for 111 fourth-year students of Korean medicine during their clinical rotation at the Department of Acupuncture and Moxibustion Medicine. Lectures were conducted on the effects of and hypersensitivity reactions to bee venom acupuncture, obtaining informed consent, performing skin test and bee venom acupuncture. Due to the COVID-19 pandemic, some students were offered online lectures, and some could not experience the performance of OSCE in person. A survey with 16 closed and three open questions was used to investigate self-efficacy, opinions about the online lectures, and the OSCE. Results: Out of 111 questionnaires, 104 were completed (94%). Students were generally satisfied with the online lectures and OSCE. For the subjective questionnaire about what was helpful in the training of bee venom acupuncture techniques and OSCE, the authenticity of the teaching method was recorded the highest. Conclusions: This study showed that online lectures were effective in teaching clinical skills of Korean Medicine. It is necessary to produce standard educational materials for clinical skills of Korean Medicine, and studies to analyze the reliability and validity of OSCE are needed.