• The Korean Society of Law and Medicine
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• v.24 no.4
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• pp.103-128
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• 2023

According to the current act of Decision-Marking in Life-Sustaining Medicine, the decision to withhold or discontinue life-sustaining treatment is primarily based on the wishes of a patient in the dying process. Decision-making regarding life-sustaining treatment for these patients is made by the patient, if he or she is conscious, directly expressing his/her intention for life-sustaining treatment in writing or verbally or by writing an advance medical directive and physician orders for life-sustaining treatment. It can be exercised. On the other hand, if the patient has not written an advance medical directive or physician orders for life-sustaining treatment, the patient's intention can be confirmed with a statement from the patient's family, or a decision to discontinue life-sustaining treatment can be made with the consent of all members of the patient's family. However, in the case of an unrelated patient who has no family or whose family is unknown, if an advance medical directive or physician orders for life-sustaining treatment are not written before hospitalization and a medical condition prevents the patient from expressing his or her opinion, the patient's will cannot be known and the patient cannot be informed. A situation arises where a decision must be made as to whether to continue or discontinue life-sustaining treatment. This study reviewed discussions and measures for unbefriended patients under the current law in order to suggest policy measures for deciding on life-sustaining treatment in the case of unbefriended patients. First, we looked at the application of the adult guardian system, but although an adult guardian can replace consent for medical treatment that infringes on the body, permission from the family court is required in cases where death may occur as a direct result of medical treatment. It cannot be said to be an appropriate solution for patients in the process of dying. Second, in accordance with Article 14 of the Life-Sustaining Treatment Decision Act, we looked at the deliberation of medical institution ethics committees on decisions to discontinue life-sustaining treatment for patients without family ties.Under the current law, the medical institution ethics committee cannot make decisions on discontinuation of life-sustaining treatment for unbefriended patients, so through revision, matters regarding decisions on discontinuation of life-sustaining treatment for unbefriended patients are reflected in Article 14 of the same Act or separate provisions for unbefriended patients are made. It is necessary to establish and amend new provisions. In addition, the medical institution ethics committee must make a decision on unbefriended patients, but if the medical institution cannot make such a decision, there is a need to revise the law so that the public ethics committee can make decisions, such as discontinuing life-sustaining treatment for unbefriended patients.

• 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.12 no.1
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• pp.20-26
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• 2009

Purpose: We undertook this study to find out the recognitions of terminal cancer patients and doctors about advance directives (ADs), of how they would do in non-response medical conditions and whether ADs could be one of medical options for their dying with dignity. Methods: One hundred thirty four cancer patients in the Hospice Unit, St. Vincent's Hospital, and 97 medical doctors in the Department of Internal Medicine, Catholic Medical Center, were asked about ADs, including Do-Not-Resuscitate (DNR), medical power of attorney, living will and medical options. Results: One hundred thirty patients (97%) and 38 doctors (39.2%) were unfamiliar with ADs, however, 128 patients (95.5%), 95 doctors (97.9%) agreed with it. Seventy nine patients (59.0%) and 96 doctors (99.0%) wanted DNR rather then intensive treatments if they were in non-response medical conditions. Eighty four patients (62.7%) and 75 doctors (77.3%) were agreeable to medical power of attorney. One hundred Thirty four patients (100.0%) and 94 doctors (96.9%) did not want medical options to be in terminal conditions, and hoped to die in peace. Conclusion: Most of patients did not know about ADs and how to make it. However, they showed positive attitudes about it. If we advertise it properly, it is highly likely that a large number of cancer patients would make their living wills easily by ADs. Nevertheless, many legal and ethical problems have to be solved. Doctors should engage their patients in an ongoing communication about the end-of-life. Therefore, let the patients have opportunities to plan their own deaths.

• Journal of Chest Surgery
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• v.27 no.11
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• pp.922-929
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• 1994

This research represents an attempt to study the postoperative results among 32 patients who underwent complete resections of primary lung and involved mediastinal lymph nodes between January 1988 and June 1993. Ages ranged from 34 to 73 years with a mean age of 51.31 $\pm$ 8.17 years. There were 29 male patients[90.6%]. Left lung cancers were more frequent than right lung cancers. There were 19 cases of left lung cancers accounting for 59.4% of the total lung cancers. The difference, however, was insignificant. There was no T1 lesion. T2 and T3 lesions were 21[65.6%] and 11 cases[34.4%], respectively. As for cell type, squamous cell carcinomas were reported in 25 cases making up 78.1% of the cell types. Pneumonectomy was conducted on 20[62.5%] cases. Lobectomy and sleeve lobectomy were conducted on 12[37.5%] cases respectively. Mediastinal lymph node involvemednts were most frequent in subcarinal lymph node[9/13] among right lung cancers, while subaortic lymph noce[12/19] was most frequent among left lung cancers. Postoperative complications were reported in 18.9% of the total cases, including 2 cases each of paralysis of the recurrent laryngeal nerve and 1 case each of chylothorax and pyothorax. They were more frequent among patients who underwent pneumonectomy. The operative mortality stood at 3.1% with 1 patient who underwent pneumonectomy dying of pulmonary edema. The 1-year and 5-year survival rates were 50.8% and 30.1%, respectively. Patients treated with squamous cell carcinoma, involvement of single level mediastinal lymph node and lobectomy showed a higher level of survival. These fidings suggest that a long-term survival can be expected of a considerable number of N2 non-small cell lung cancer patients with a selective complete surgical resection of primary lung cancers involved mediastinal lymph nodes.

• Journal of Yeungnam Medical Science
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• v.21 no.1
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• pp.120-126
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• 2004

Sinonasal Undifferentiated Carcinoma (SNUC) is a very rare, highly aggressive malignant tumor of the nasal cavity and paranasal sinuses. SNUC tends to present with advanced-stage disease, often with intracranial invasion. It requires an aggressive multimodality therapy that includes surgical resection. A cure rate of less than 20% is generally reported in the literature, with most patients dying within 1 year of onset of the disease. Three patients diagnosed as SNUC were treated at the Yeungnam University Medical Center between the years 2000 and 2003 were analyzed retrospectively. All patients presented with the disease very advanced. The three cases were given chemotherapy or chemotherapy with radiotherapy. Two patients died of the disease, surviving only 6 and 11 months following treatment, respectively. We did a follow-up on just the one remaining case with incomplete controlled disease for 27 months. The overall prognosis of SNUC is very poor. We consider that more intensive multimodality therapies are recommended for all patients with SNUC.

• The Korean Society of Law and Medicine
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• v.13 no.2
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• pp.285-308
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• 2012

The Korean supreme court said that Mrs Kim who was in a persistent vegetative state had a right to die if she had a presumed will or assumption of dying against Severance hospital in 2009. Presumed would be vague and can not be subjective to conjecture though, the court had a developed trial on the case. I recommend the higher valued notion such as the 'right to decide on the life extension' is more logical than assumptive will. To achieve this recommendation, I will search right to life, right to decision, human dignity and find the good relationship between them. In conclusion, I will announce that if PVS patients without advanced directives aren't able to express their will and no one could not assume their right to die in spite of meaningless life extension. So only the due and strict procedure about the extinction of meaningless PVS patients will allow them to sacrifice themselves or remove life extension ventilators. Also active euthanasia would be possible under the strict procedure of making advanced directives and the act of helping active euthanasia additionally, the crime of abetting suicide would not be executed in the legal scope.

• Korean Journal of Adult Nursing
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• v.20 no.6
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• pp.960-972
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• 2008

Purpose: The purpose of this study was to validate the nursing intervention standards of home care to home care setting for a guide in giving quality care to home hospice patients. Methods: The developed nursing standards were applied to 79 home hospice patients at K hospital, C university. Data were collected through the developed nursing intervention standards of home care with 19 selected nursing interventions and 418 associated nursing activities from January to June in 2006. Results: The performance frequency was 509 times for total nursing interventions and 7,815 times for total associated nursing activities. The most frequently used nursing activity was 722 times(9.24%) on teaching prescribed medication, followed by surveillance(718 times, 9.18%), and vital signs & neurologic monitoring nursing intervention(701 times, 8.97%). The highest mean nursing activity performance rate showed on Intravenous therapy(82%), followed by dying care(81%), and vital signs & neurologic monitoring (80%). Among 418 nursing activities, there were three classifications: 168 as core activities, 165 as major, and 85 as accessory activities. Conclusion: The final validated nursing intervention standards can guide home care nurses to perform quality care and contribute to computerized nursing services and request of nursing fees.

• Journal of Home Health Care Nursing
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• v.20 no.1
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• pp.63-71
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• 2013

Purpose: This study was performed to identify nursing college students' attitudes towards death and was conducted as a pre-investigation to prepare them for coping with terminally ill patients in their clinical practice. Methods: The subjects consisted of 321 nursing students. Their attitudes towards death were measured by using the Collett-Lester Fear of Death Scale(CLFODS). The data obtained were analyzed by using the one-wayANOVA and Duncan's multiple test using the SAS 9.2 soft ware program. Results: The mean CLFODS score was 2.99. Among the 4 subscales, there were significant differences among the students with respect to grade, indirect experience of death, social isolation, daily life stress, and suicidal ideation in the past year. Conclusion: A negative attitude towards death was observed in the psychosocial characteristics, with indirect experience of death, social isolation, daily life stress, and suicidal ideation in the past year. It is necessary to educate students on how to care for dying patients before clinical practice. This education can be carried out by developing a death education program after considering the above mentioned psychosocial characteristics noted in this study.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.5-10
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• 2016

Purpose: This study reviewed what the location of death (LOD) means as an outcome and how to use LOD to assess end-of-life (EOL) care. This study also examined the reason why LOD is significant for the quality of EOL care. Methods: A literature review was performed, using LODs and home deaths as outcomes in the field of EOL care, and analyzed the findings associated with key fields in regards to LOD. Results: Palliative care research used LOD, in particular, hospital death (versus home death) as a significant outcome when examining cost savings, quality of life care, and patient and family preferences. Based on substantial evidence from previous research, home hospice or continuous palliative care in non-hospital settings (i.e. homes, nursing homes) have been designed and available for dying patients in developed countries. Conclusion: The LOD delivers practical significance as an outcome for diverse reasons. In-depth examination on LOD in South Korea is needed despite limitations to interpretation of its meaning in the country.

• Proceedings of the Korea Contents Association Conference
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• 2015.05a
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• pp.273-274
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• 2015

본 연구의 목적은 성찰일지를 이용한 임종간호교육이 간호대학생의 영성, 죽음에 대한 태도, 임종간호태도에 미치는 영향을 평가하기 위해 비동등성 대조군 사전사후 설계를 시행하였고 대상자는 실험군 69명, 대조군 68명으로 구성되었다. 교육은 회기당 100분간 12회기로 매주 시행하였다. 자료는 일반적 특성, 영성, 죽음에 대한 태도, 임종간호태도로 구성된 구조화된 설문지를 이용하여 수집하였다. 실험군과 대조군 간에 영성과 임종간호태도에서 유의한 차이가 있었다. 본 연구는 성찰일지를 이용한 임종간호교육이 간호대학생들에서 영성과 임종간호태도 향상에 효과가 있음을 제안한다.