Purpose: The purpose of this study was to examine the life-sustaining treatment decisions of terminal cancer patients. Methods: Data on 10 terminal cancer patients who decided to withhold or withdraw from treatment were collected using in-depth interviews conducted from February 8 to October 30, 2019. Data were collected until saturation was reached and then analyzed using Colaizzi's phenomenological method. Results: In this study, six thematic clusters were identified: "having complicated feelings", "making choices to protect everyone", "accepting and preparing for death", "feeling distress", "pursuing spiritual wellbeing", and "evaluating the new system". Conclusion: When facing death, terminal cancer patients often made choices to protect their family and their dignity with uneasiness of mind when deciding to withdraw from life-sustaining treatments. Though many patients had accepted and prepared for death, they experienced distress about leaving children behind after death. They also pursued spiritual well-being to find peace after deciding to withdraw from life-sustaining treatment. In addition, participants evaluated the new system of policies pertaining to decisions on life-sustaining treatment. Thus, various approaches regarding acceptance and preparation for death, communication with family, hope, and spiritual comfort should be taken in educational interventions to assist terminal cancer patients as they decide whether to withdraw from life-sustaining treatment.
The Journal of Korean Academic Society of Nursing Education
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v.9
no.1
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pp.7-16
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2003
The purpose of this study was to classify the subjectivity type toward death among college students and to understand the characteristics of attitudes and orientations toward death of each type. Since attitudes and orientations toward death is very subjective and unique, Q-methodology was employed in this study. Q-methodology explains the respondent's subjectivity by objectifying his subjectivity for himself. The P-sample consisted of 63 students of K university in D city. Forty statements concerning attitudes and orientations toward death, which developed by Yeun(1999) were utilized for Q-sample. Forty Q-statements were sorted according to the level of agreement or disagreement by forced normal distribution. The Q-sorts by each subjects were coded and analysed with the PC-QUANL program. Five types of subjectivity toward death were identified and labeled. Type 1 'the death- preparation' think frequently about his own death and talk openly about the problem of death with a positive attitude. Type 2 'the life-esteemed' respect the dignity of life most of all. Type 3 'the realty-oriented' do not believe the afterlife and is very concerned about the present life itself instead of thinking about death. Type 4 'the ambivalent' think importantly the aspect of present life and orient the afterlife at the same time. This type reveals opposite attitude of preparing and scaring the death at the same time. Type 5 'the destiny-recipient' attribute death to the destiny and deny suicide. On the basis of this result, the studies about applying and developing educational program on death and hospice care for nurses who care terminal cancer patients and families are needed.
How an elderly people meets death is the matter of how he has lived his life. It is very important for an elderly people at the last step of his life to re-light up life and to meet death with dignity. The purpose of this study is to investigate where fear or anxiety of death come from among the four dimensins of death anxiety and to compare the differenced between the elderly group and non-elderly group, For this research, the 473 of the subjects from 20 to 80 years old attending social welfare center and community areas in Seoul have been questionned. The summary for the study mentioned the following: First, the overall scores of death anxiety, in the non-aged group, gender and religiosity are important factors affecting the decrease of death anxiety, On the other hand, in the aged group, self-respect, death readiness and number of friends are significant factors. Secondly, for death anxiety of self, age and spouse are significant relationships among non-aged group and gender, death readiness and number of friends for aged-group. In the dying of self, the following each three significant variables: gender, self-respect and spouse among non-aged group and gender, self-respect and number of friends among aged group. In death anxiety of others, age, view on next world and spouse are best predictor for non-aged group. Finally, family-relationship, self-respect and spouse are significant factors for aged group. In dying of others, only one factors are influenced for non-aged group, on the other hand, gender, self-respect and death readiness are important factors for aged group. There remains the need for more detailed examination into the nature of this relationship and the extent to which core components strongly affecting the above subscales.
As population aging increases the burden of cancer, the quality of death of patients with cancer is emerging as an important issue alongside their quality of life. To improve the quality of death, it is necessary to prepare for death, allowing patients to die comfortably and with dignity at the end. Considering these issues, I aim to discuss the practical aspects of notifying the patient of the terminal phase of cancer and planning for end-of-life care (i.e., advance care planning). When cancer treatment that can extend the patent's lifespan becomes difficult, the patient enters a treatment transition period. Treatment is shifted from life-prolonging care to life-enhancing care, and end-of-life care must be well planned. Medical providers often worry too much about whether the patient will be disappointed or psychologically traumatized when notified of the terminal phase of their cancer, thus delaying plans for end-of-life care. In fact, patients can accept their condition and prepare for end-of-life care better than we expect. During the treatment transition period, notification of terminal status should be given, and a well-prepared advance care plan should be established early when the patient has decision-making ability. In addition to conveying information, it is always necessary to be sensitive to whether the patient and caregiver understand the information and respond to their emotions.
This study has been performed to identify meanings of good deaths among 350 old people aged 65 from September, 2010 until February, 2011. In this study, the subjects were asked about good meanings of death based on qualitative study of free format, and their statements were categorized into similar content areas. The results show that first, the subjects felt that the good death is a dignity death not weighing burdens to others, memorized as a good life, until th end of my life, a death receiving at home, comfortable death, a death like a sleep, with out pain, not long, a prepared process, a death after doing my best, receiving after doing my best, death after offering benevolence to others, within my beliefs, and finally a good death is after seeing good life of my descendent. These 16 free answers were also categorized into 6 meaningful areas such as considering others, at my home, comfortable scene, prepared, and death after living my wanted time.
"Aid in Dying" means that when a decision-making patient suffers from an incurable disease, a drug that can speed up death is prescribed by a doctor and used to lead to death. Since the suspension of life-sustaining treatment was institutionalized based on human dignity and patient autonomy, the question of whether assisted death can be legally justified in relation to the right to receive medical help to shorten one's life to die with dignity has recently been actively discussed. In Korea, since the suspension of life-sustaining treatment was institutionalized by the enactment of the Life-sustaining Treatment Decision Act in 2016, an amendment to the Life-sustaining Treatment Act was recently proposed to legalize Aid in Dying. The global trend is that human "Right to Die" is discussed in the division of life and death, from the suspension of life-sustaining treatment to assisted death, and again in the order of euthanasia. In this paper, we started discussing dignified death and institutionalized patients' right to self-determination, looked at the controversy in the United States, which legislated assisted death in many states since the 2000s, and analyzed the main contents of California's End of Life Option Act and the data after enforcement. The strict requirements for Aid in Dying, such as voluntary confirmation of patients' intentions and doctors' obligation to provide information, and the results of California's Aid in dying system, composed of relatively diverse races, were reviewed.
This study examined that the black dress is the one of having aesthetic value as well as symbolism while delivering specific image, from the perspective of color, which is essential element in forming design of the Stage Costume. This study carried out the theoretical research of centering on the literature consideration and the empirical research of centering on a case side by side. It analyzed the works and design based on the clothing, which had been performed in Korea with a revival version of Musical 'Chicago'. Aesthetic characteristics in more than two are being shown in one dress. If so, the following are the results that considered on aesthetics characteristics in black, which were shown in Stage Costume of Musical 'Chicago', which is increasing the theme consciousness through Stage Costume, which is simple and sexy black. First, as emotion of coming to stay in agony and sadness on the basic fact called death, the Stage Costume in black led to being shown sorrow of implying death, fear and murder. Second, the dignity, which corresponds to noble beauty in the aesthetic category, expresses dignity and elegance with flat material in black, and is revealed the aspect of expressing fashion, which emphasized spirit rather than body. Third, as the aesthetic characteristic of causing sexual desire, the sensuality was shown, which has the aspect of being expressed through exposure, concealment and emphasis. Fourth, it was expressed with androgyny, which evokes androgynous image. Fifth, black in Musical 'Chicago' formed the whole mood with a sense of weight by arranging the whole feeling with color in similar tone, thereby having been indicated the harmony of being formed with theme, which is aimed to be indicated in drama.
The purpose of this study was to investigate the degree of awareness of the concept of 'hospice palliative medical care' and decision of 'life-prolonging medical care' by the general public subjects. A survey was conducted on 346 participants and officials who participated in an event held in September 2016. As a result of the research, the subjects' responses results to the life-prolonging medical care decision showed that people with religion wanted natural death compared to people without religion, and had more active attitude toward decisions related to dignity death. Religion is an important factor that can influence perceptions of life and death, believing that afterlife is after death, so it is possible to take a more firm stance on the extension of meaningless life at the last minute. Therefore, in order to stabilize the hospice care and prescription medical decision law to the general public and to improve the quality of the death and the dignity of life, it is necessary to develop awareness through various educational programs in consideration of age, education level. In addition, education and promotion should be strengthened so that the general public can fully understand the knowledge of hospice palliative care and health care and government standardization and policies for hospice personnel and breeding programs will be urgent.
Gaines depicts the process of transformation of a black young who accepts his execution with dignity in A Lesson Before Dying. There two personas of the protagonist, Jefferson, appear in this novel. The former seen in the black and white community is the persona of falsehood and submission, and the latter appeared in the black community is the true persona. The former, the pig persona in black-and-white community is created, forced onto them by whites and the human persona in the black community is made by their own standards without being forced. Jefferson has been depersonalized by his pig persona. He implements their false persona by mimicking pigs to confront its reality. And then he retrospects the pleasure of relationship throughout his own life. Grant's expensive gift, the radio, becomes a trigger to realize the significance of his existence and the social solidarity. Moreover, many black visitors look at him with expectant eyes of fulfilling their historical burden. After all, Jefferson is executed as a human being with dignity, and the transformation of Jefferson from a pig to a human is getting rid of the white values and standing on the black values. In other words, it is the procedure of creating the new myth out of the false myth, from meaningless life to meaningful death.
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.
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