• Title/Summary/Keyword: Withdrawing of life-sustaining treatment

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Factors Influencing Self Determination for Withdrawing Life-Sustaining Treatment of the Community Dwelling Elderly (지역사회거주 노인의 연명치료 중단에 대한 자기결정 영향 요인)

  • Kim, Hyun Sook;Jang, Hye Kyoung;Shin, Sung Rae
    • Korean Journal of Adult Nursing
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    • v.28 no.3
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    • pp.334-342
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    • 2016
  • Purpose: This study was conducted to identify factors that influence on self-determination for withdrawal of life-sustaining treatment in the community dwelling elderly. Methods: This study used a descriptive correlational design. A convenience sample of 201 elderly were recruited from a welfare center located in Seoul, Korea. Data collection was done from September 1 to September 18, 2015. Four survey questionnaires were used: Multidimensional Scale of Perceived Social Support (MSPSS), Life Satisfaction Index-Z (LSI-Z), Attitude on Do Not Resuscitate (DNR), and Self-determination for Withdrawing Life-sustaining Treatment. Data analysis was done by t-test, ANOVA, Pearson's correlation, and hierrarchical multiple regression. Results: Hierarchial multiple regression showed that the factors predicting the level of self-determination for withdrawing life-sustaining treatment were educational level, DNR experience in family, life satisfaction, and DNR attitude. These factors explained 44% of the self-determination for withdrawing life-sustaining treatment in community dwelling elderly. Conclusion: The results of this study suggest developing educational programs aiming at changing elderly's DNR attitude positive ways so that they can enhance self-determination for withdrawing life-sustaining treatment. Further study is needed with more elderly population in extended areas.

Attitude of Social workers toward Withdrawal 0f Life Sustaining Treatment

  • Lee, Gyeong-Nam;Lee, Hyun-Ju
    • Journal of the Korea Society of Computer and Information
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    • v.23 no.12
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    • pp.171-177
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    • 2018
  • Purpose : This study is conducted to research the attitude of social workers toward withdrawing life sustaining treatment and compare and analyze the different types of their attitudes. Methods : Research design of this study is Q methodology approach. The study population is 23 social workers. Q sample to investigate the attitude of social workers toward withdrawing life sustaining treatment included 30 statements. After listening to the purpose and method of the study, the 23 social workers agreed to fill out a survey asking sociodemographic information and have been forced to be distributed in 9 scale Q-sample. Results : The collected data was processed through QUANL PC program, sorted into 3 types as followings. The first type was 'the pursuit of quality of life' that the quality of life is more important than the length of life, the second 'choosing to withdraw life sustaining treatment' that they want to write or encourage family to write advanced directive, the third 'withholding life sustaining treatment' regardless of the cost. Conclusion : In conclusion, the social workers attitudes toward withdrawing life sustaining treatment were grouped as three different types, the first type was 'the pursuit of quality of life', the second 'choosing to withdraw life sustaining treatment', the third 'withholding life sustaining treatment'.

A Study on Medical-criminal Problem of Withdrawing Life-Sustaining Treatment (치료중단행위에 대한 의료형법적 고찰 -의학적 충고에 반한 퇴원 사례를 중심으로-)

  • Cho, In-Ho
    • The Korean Society of Law and Medicine
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    • v.9 no.1
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    • pp.319-382
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    • 2008
  • As a withdrawing care's study, the purpose of this study is searching about withdrawing care's acceptance and circumstances through Bora-mae hospital case(chapter 1). Withdrawing life-sustaining treatment has various forms. Though the meaning of euthanasia, death with dignity, natural death, physician assisted suicide are duplicated, the meaning of those are different slightly. Firstly, this study looks about the difference of the those meaning and acceptance range(condition) by withdrawing care's forms(chapter 2). Bora-mae hospital case sentenced guilty about physician who discharged incompetent patient who was after surgery by patient's wife determination. This Bora-mae case that sentenced guilty about discharge against medical advise(DAMA) that is regarded to custom has brought intensive confliction of legal, social, medical aspect, Bora-mae hospital case has many legal problems. First, as to criminal law rule 250(murder), the problem is whether discharge and withdrawing life-sustaining treatment is commission or omission. this study concluded omission(district court: omission, appeal, supreme court: commission). Because legal denounce point of discharge and medical treatment withdrawing is omission that physician who is obligatory on patient to cure. If physician's act is regarded omission, it is necessary to determine whether he has guardian status and obligation. Without guardian status and obligation, omission crime can't exist. This study decided that physician had guardian status and obligation and foundation of guardian status was pre-action or acceptance of emergency patient. Physician's medical treatment duty finished when patient(or patient's guardian) demands discharge. But when patient death is foreseen and other possible treatment does not exist, his duty of life prolonging treatment does not finish. This originate from physician's social responsibility and public status that limits patient's private liberty. This study regarded physician's action as accomplice about whether physician's discharging action is accomplice or the principal offender(district court: the principal offender, appeal, supreme court: accomplice). Though the principal offender needs criminal determination and action, there is no this common determination and functional action control of physician in Bora-mae case(chapter 3). Bora-mae hospital case partly originated from deficiency of legal, institutive system including medical security system shortage, the instruction is 1. medical security system strengthening, 2. hospital ethical committee's activity strengthening, 3. institutionalization of withdrawing life-sustaining treatment, 4. acceptance of pre-decision making system, 5. sufficient persuasion of physician for patient and faithful writing of medical paper, 6. respect for patients' self-determination and rights, 7. consciousness's changing for withdrawing life-sustaining treatment and persistent education about medical ethics(chapter 4). Considering Bora-mae case, medical sector is not the dead ground of a criminal punishment. Intervention of criminal law in medical sector give rise to ill effect, that is, excess medical examination and treatment, safeguard treatment, delay of discharge from a hospital. Because sufficient guarantee of life becomes mere empty slogan under situation that impose a burden of heavy cost to family or hospital, public and systematic solution should be given(chapter 5).

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Factors Affecting the Role of Nurses Related to Withdrawing Life-sustaining Treatment in a General Hospital (종합병원 간호사의 연명의료중단 역할인식 영향요인)

  • Jo, Jae Jung;Lee, Jia
    • 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 effects of death orientation and attitude toward withdrawal of life-sustaining treatment on awareness of biomedical ethics among paramedic students

  • Park, Yunhee;Song, Hyo-Suk
    • Journal of the Korea Society of Computer and Information
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    • v.25 no.2
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    • pp.181-188
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    • 2020
  • This study was conducted to identify the effects of the degree of death orientation, attitudes toward withdrawing life-sustaining treatment, and awareness of biomedical ethics on paramedic students' own biomedical ethics. The participants of this study were 228 paramedic students from a college located in D city. Data were collected from April to June 2019 through a self-report questionnaire. There was a positive correlation between awareness of biomedical ethics and attitude toward withdrawing life-sustaining treatment (r=.63, p<.001). Multiple linear regression analysis showed that the factors affecting students' awareness of biomedical ethics were religion (β=.12, p=.018) and their attitude toward withdrawal of life-sustaining treatment (β=.61, p<.001), with an explanatory power of 41.0%. Educational programs must focus on attitudes toward withdrawing life-sustaining treatment to improve paramedic students' awareness of biomedical ethics.

The Medico-Legal and Ethical Problems of Withholding / Withdrawing of Futile Life-Sustaining Mechanical Respirator treatment (연명(延命)치료적 인공기계호흡요법의 보류(保留)/중지(中止)를 전후한, 법의학적 및 윤리적 문제들과 그 대처방안)

  • KIM, Keun-Youl
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.3
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    • pp.213-229
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    • 2005
  • The first and the longest criminal indictment case of Korean medico-legal battle, so called BORAMAE Hospital Incident, was finally on its end by Korean Supreme Court's decision on June 24, 2004, after 7 years long legal dispute via Seoul District Court and Seoul Superior Appeal Court's decision. Boramae Hospital case was the first Korean legal case of Withdrawing Life-sustaining treatment of mechanical respirator on 58 years old Extradural Hematoma victim who was on Respirator under Coma after multi-organ failure postoperatively(APACHE II score: 34-39). Two physicians who have involved patient's care and had helped to make discharge the Near-death patient to home after repeated demand of patient's wife, due to economic reason, were sentenced as homicidal crime. This review article will discuss the following items with the review of US cases, Quinlan(1976), Nancy Cruzan(1990), Barber (1983), Helen Wanglie(1990), Baby K (1994) and Baby L cases, along with Official Statement of ATS and other Academic dignitaries of US and World.: [1] Details of Boramae Hospital incident, medical facts description and legal language of homicidal crime sentence. [2] The medical dispute about the legal misinterpretation of patient's clinical status, regarding the severity of the victim with multi-organs failure on Respirator under coma with least chance of recovery, less than 10% probability. [3] Case study of US, of similar situation. [4] Introduction of ATS official Statement on Withdrawing/ Withholding Life sustaining treatment. [5] Patient Autonomy as basic principle. [6] The procedural formality in Medical practise for keeping the legitimacy. [7] The definition of Medical Futility and its dispute. [8] Dying in Dignity and PAS(Physician Assisted Suicide)/and/or Euthanasia [9] The Korean version of "Dying in Dignity", based on the Supreme Court's decision of Boramae Hospital incident (2004.6.24.) [10] Summary and Author's Note for future prospects.

The Adult Guardianship and Medical Issue According to the Amendments of Civil Code (성년후견과 의료 -개정 민법 제947조의 2를 중심으로-)

  • Park, Ho-Kyun
    • The Korean Society of Law and Medicine
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    • v.13 no.1
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    • pp.125-153
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    • 2012
  • The adult guardianship system has been introduced through amendments of Korean Civil Code for the first time in the March 2011(Act No. 10429, 7. 1. 2013. enforcement). The adult guardianship system has the main purposes to provide a lot of help vulnerable adults and elderly, and protect them on the welfare related with property act, treatment, care, etc. There could be a controversy about whether the protection Legal Guardian's consent(formerly known as the Mental Health Act) or permission of the Family Court(revised Civil Code) are required to, or the Mental Health Act should be revised, when mental patient will be hospitalized forcibly. The author proposes that mental patient with Adult guardians should be determined by Legal Guardian's consent and approval of the Family Court, but mental patient without Adult guardians could be determined by Legal Guardian's consent. The issue of Withdrawing of life-sustaining treatment could be occurred due to the aging society and the development of modern medicine, and this has provided difficult, various problems to mankind in Legal, ethical, and social welfare aspects. The need of Death with dignity law or Natural death law has been reduced for a revision of the Civil Code. Therefore, on the issue of Withdrawing of life-sustaining treatment, in the future, intervention of the court is necessary in accordance with the revised Civil Code Section, and Organ Transplantation Act and the brain death criteria may serve as an important criterion.

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Association of Physician Orders for Life Sustaining Treatment Completion and Healthcare Utilization before Death (연명의료계획서 작성과 사망 전 의료이용의 관계)

  • Eunji Kim;Hongsoo Kim
    • Health Policy and Management
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    • v.33 no.1
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    • pp.19-28
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    • 2023
  • Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

Effects of Death Preparation Education on Awareness of Hospice Palliative Care and Withdrawing Life Sustaining Treatment in City Dwellers (죽음준비교육이 일반인의 연명치료중단 및 호스피스·완화의료에 대한 인식에 미치는 효과)

  • Tsung, Pei-Ling;Lee, Yoon Joo;Kim, Su Yeon;Kim, Seul Ki;Kim, Si Ae;Kim, Hyeon Ji;Nam, Yi;Ham, Suk Young;Kang, Kyung Ah
    • Journal of Hospice and Palliative Care
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    • v.18 no.3
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    • pp.227-234
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    • 2015
  • Purpose: This study was done to analyze how a death preparation education program have the effects on awareness of hospice palliative care and withdrawing life sustaining treatment in older adults. Methods: This study employed a non-equivalent control group design among quasi-experimental designs. The experimental group was comprised with 35 adults and the control group with 40 adults. The death preparation program consisted of five two-hour sessions and was administered once a week for five straight weeks. Data were analyzed by descriptive statistics, t-test, ${\chi}^2$ test, Fisher's exact test, and ANCOVA using SPSS version 18.0. Results: The mean age of the participants was 66.2 years. A significant difference between the experimental and control groups was observed in withdrawing life sustaining treatment (F=3.380, P=0.040). However, no significant difference was found in awareness of hospice palliative care (F=0.163, P=0.850). Conclusion: The study results indicate that death preparation training could positively affect people's awareness of withdrawing life sustaining treatment. More studies should be conducted to explore effects of death preparation education for all ages and help people better understand hospice palliative care.

A Study on the Method of Legislation on Withholding or Withdrawing of LST -In relation to the introduction of adult guardianship- (연명치료 중단의 입법화 방안에 관한 연구 - 성년후견제도의 도입과 관련하여 -)

  • Lee, Eun-Young
    • The Korean Society of Law and Medicine
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    • v.10 no.2
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    • pp.203-249
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    • 2009
  • It is the so-called Shinchon Severance Hospital Case brought to an end by the decision of the Supreme Court that opened the real discourse of withholding or withdrawing of LST (Life-Sustaining Treatment) in the legal profession as well as medical profession in Korea. Everyone has sympathy with the validity and necessity of legal regulation on withdrawing-including withholding-of LST save the requirements & procedure of withdrawing of LST. In this situation, the legislative bill of amendment to the Korean Civil Law introducing of adult guardianship was pre-announced by the Ministry of Justice on September 18th 2009. The adult guardianship is a guardianship system that supports an mentally handicapped adult to deal with his affairs by support of a guardian. The object of adult guardianship includes affairs of body or well-being as well as property of adult wards. In particular, affairs of medical matters are of importance in the duty and authority of adult guardians. So, the introduction of adult guardianship is of much importance de lege lata as well as de lege ferena in the discussion of withdrawing of LST as a medical treatment. Since the legislation on withdrawing of LST intents to protect the right of death with dignity on the basis of patients' autonomy, the ratio legis of withdrawing of LST is variant from that of adult guardianship. In this context, it seems reasonable to legislate the withdrawing of LST separately from the adultguardianship. In the meantime, the adult guardianship of the legislative bill of amendment to the Korean Civil Law is related to the withdrawing of LST, since the main purpose of adult guardianship is to protect patients' quality of lives and to regulate guardianship contracts based on patients' autonomy. In that context, it seems reasonable to incorporate the legislation of withdrawing of LST into the adult guardianship system. In the latter case, it is not easy to adopt the withdrawing of LST into the legislative bill of the Korean Civil Law for the bill is pre-announced already as previously stated. However, the legislation of withdrawing of LST is not inferior to the legislation of adult guardianship as a matter of urgency. Moreover, it is likely that the legislative bill of Amendment to the Korean Civil Law generates discrepancies in interpretation of the requirements & procedure of withdrawing of LST as the amended German Civil Law did. In short, it is desirable for the legislator to revise the legislative bill despite delay.

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