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Recognition of Advance Directives by Advanced Cancer Patients and Medical Doctors in Hospice Care Ward (호스피스병동 말기 암 환자 및 내과의사의 사전의료지시(서)에 대한 인식)

  • Sun, Der-Sheng;Chun, Yeon-Joo;Lee, Jeong-Hwa;Gil, Sang-Hyun;Shim, Byoung-Yong;Lee, Ok-Kyung;Jung, In-Soon;Kim, Hoon-Kyo
    • 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.

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Public Perception and Acceptance of the National Strategy for Well-Dying (웰다잉 국가 전략에 대한 일반 국민들의 인식 및 수용도)

  • Lee, Seo Hyun;Shin, Dong Eun;Sim, Jin Ah;Yun, Young Ho
    • Journal of Hospice and Palliative Care
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    • v.16 no.2
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    • pp.90-97
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    • 2013
  • Purpose: Ten years have passed since the Korean government announced its plan to institutionally support hospice and palliative care in 2002. In line with that, this study aims to suggest future directions for Korea's hospice and palliative care policy. Methods: We conducted a survey on people's perception and acceptance of well-dying. Data were collected from 1,000 participants aged 19~69 years between June 1 and June 11, 2012 via computer-assisted telephone interviews. Results: The most important factor for well-dying was placing no burden of care on others (36.7%) and the second most important factor was staying with their family and loved ones (19.1%). Among nine suggestions of policy support for well-dying, the most popular was the promotion of voluntary care sharing (88.3%), followed by the palliative care training support for healthcare providers (83.7%) and the support for palliative care facilities instead of funeral halls (81.7%). The idea of formulating a five-year national plan for end-of-life care drew strong support (91%). According to the survey, the plan should be implemented by the central government (47.5%), the National Assembly (20.2%) or civic groups (10%). Conclusion: This study demonstrated the public consensus and their consistent direction toward policy support for well-dying. Results of this study may serve as a foundation for the establishment of policy support for people's well-dying and palliative care at the national-level.

Traditional Performing Arts and Nomadic Entertaining Troupes Depicted in "Nectar of Immortality" (감로탱에 묘사된 전통연희와 유랑예인집단)

  • Jeon, Kyung-Wook
    • (The) Research of the performance art and culture
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    • no.20
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    • pp.163-204
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    • 2010
  • "Nectar of Immortality", also known as Suryukwha, is a painting which is hung on the wall during Suryukjae, a rite to console the spirits residing on both land and water. The Suryukwha at Bonyung Temple in the Ming Dynasty consisted of 139 scrolls depicting separate scenes. In Korea, however, Nectar of Immortality combines all the scenes into one large painting. The lower part of Nectar of Immortality describes pain, disasters, and the frailty of human life in this world. This is intended to inspire people to embrace Buddhism and be delivered from their worldly existence. However, it reflects the social realities of that time as well. The scenes at the bottom of the painting of nomadic troupes of entertainers and their performances are part of this reflection. In this section, various scenes of traditional Korean performance are illustrated, such as double and single tightrope walking, Sotdaetagi (performing atop a pole), Ssangjulbaegi (one form of Sotdaetagi), tumbling, bell juggling, mask dramas, dish spinning, puppet shows, the dance of Sadang, and sword dancing. Among these performances, some, such as Sotdaetagi, Ssangjulbaegi, double tightrope walking, bell juggling and sword dancing (Punggakjaengipae), have since ceased to exist. The troupes of entertainers depicted in Nectar of Immortality are Sadangpae, Namsadangpae, Sotdaejaengipae, Choranipae, Punggakjaenipae, Gutjungpae, and circus troupes. When, after itinerant lives, these entertainers die, they become forlorn wandering spirits with no descendants to perform their memorial services. The entertainers in the performance scenes are the embodiment of souls who are the subjects of salvation through Suryukjae. Among these entertainers, Sotdaejaengipae, Sadangpae, Choranipae, Punggakjaenipae and Gutjungpae no longer exist. In sum, Nectar of Immortality provides insight into the vanished content of numerous historic forms of performance and the activities of nomadic troupes of entertainers.

Research on the Soul & Body Thought of 'Dong-Jin Northern & Southern Dynasty' (동진남북조시기(東晉南北朝時期) 형신문제(形神問題)의 초보적(初步的) 탐구(探究))

  • CHO, Won-il
    • The Journal of Korean Philosophical History
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    • no.23
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    • pp.275-294
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    • 2008
  • The specific concern of 'Xing'(形) & 'Shen'(神) theory is considering the body and the soul of human being. If either of the body and the soul including the life of human as of basic items is not existed, it may not seem to be alive. A great number of philosophers during 'Dong-Jin Northern & Southern Dynasty'(東晉南北朝) had the most active and furthest discussion throughout the history of China to study the concerns; Having a question such as "Where the body and the soul come out around us?", "What is the essence of complicated and delicate mental operation?" "Are there any relationships between the body and the soul?" and then "How do the human soul exist after death?" First, during 'Don-Jin' period as body and soul theory was based on 'Yin'(陰) and 'Yang'(陽). 'He Cheng Tian'(何承天) said that everything which was burn on earth should die because the soul couldn't stay the dead body longer. In the same age, 'Ming Fo Run'(明佛論) and 'Da Xing Run'(達性論) which denied that the soul couldn't exist forever were main topics of the discuss among the distinguished philosophers. Next, during 'Northern & Southern dynasty', body and soul theory was divided into two. First of all, body and soul of 'Heng Cun'(恒存) might be harmonized, however, that was not perfectly put together. Because, after human death, even if the body of human might be existed, the soul left elsewhere but always stayed around us. The body was the soul which meant that the soul was to the nature of the body and the body was to the usage of soul. Many philosophers insisted that nobody meant no soul according to 'Shen Bu Mie Run'(神不滅論) and 'Shen Mie Run'(神滅論) which was the main topic as an academic argument in those days. Finally, during Dong-Jin dynasty covered the significance of Body and Soul theory and analyzed the influence into the history of the history philosophy in china.

An Interpretation of the Folktale 'the Servant Who Ruined the Master's House' from the Perspective of Analytical Psychology: Centering on the Trickster Archetype (민담 '주인집을 망하게 한 하인'의 분석심리학적 이해: 트릭스터 원형을 중심으로)

  • Myoungsun Roh
    • Sim-seong Yeon-gu
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    • v.37 no.2
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    • pp.184-254
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    • 2022
  • Through this thesis, the psychological meaning of the Korean folktale 'the servant who ruined the master's house' was examined. The opposition between the master and the servant is a universal matter of the human psychology. It can be seen as a conflict between the hardened existing collective consciousness and the new consciousness to compensate for and renew it. From different angles, it has become the opposition between man's spiritual and instinctive aspects, between the conscious and the unconscious, or between the ego and the shadow. In the folktale, the master tries several times to get rid of the youngest servant, but the servant uses tricks and wits to steal food, a horse, the youngest sister, and all money from the master, and finally, take his life. It ends with the marriage of the youngest sister and the servant. Enantiodromia, in which the master dies, and the servant becomes the new master, can be seen that the old collective consciousness is destroyed, and the new consciousness that has risen from the collective unconscious takes the dominant position. In an individual's psychological situation, it can be seen that the existing attitude of the ego is dissolved and transformed into a new attitude. In the middle of the story, the servant marries the youngest sister by exploiting naive people to rewrite the back letter written by the master to kill him. This aspect can be understood negatively in the moral concept of collective consciousness, but it can also be seen as a process of integrating mental elements that have been ignored in the collective consciousness of the Joseon Dynasty, symbolized by a woman, a honey seller, and a hungry Buddhist monk. The new consciousness, represented by the servant, has the characteristics of a trickster that is not bound by the existing frame, so it can encompass the psychological elements that have been ignored in the collective consciousness. Such element may represent compensation or an alternative to the collective consciousness in the late Joseon Dynasty. The master puts the servant in a leather bag and hangs it on a tree to kill the servant. However, the servant deceives a blind man; he opened his eyes while hanged. Instead of the servant, the blind man dies, and the servant is freed. As the problem of the conflict between master and servant is finally entrusted to the whole spirit (Self) symbolized by a tree, the blind man gets removed. It can be understood as an intention of the Self to distinguish and purify the elements of recklessness, stupidity, and greed included in the trickster. Through these processes, the servant, which symbolizes a new change in collective consciousness or a new attitude of ego, solves the existing problems and takes the place of the master. While listening to the cunning servant's performance, the audience feels a sense of joy and liberation. At the same time, in the part where the blind man and the master's family die instead and the servant becomes the master, they experience feelings of fear and concern about the danger and uncontrollability of the servant. The tricksters appearing in foreign analogies are also thoroughly selfish and make innocent beings deceive or die in order to satisfy their desires and escape from danger. Efforts to punish or reform these tricksters are futile and they run away. Therefore, this folktale can also be seen as having a purpose and meaning to let us know that this archetypal shadow is very dangerous and that consciousness cannot control or assimilate it, but only awe and contemplate it. Trickster is an irrational manifestation of revivifying natural energy that rises from the unconscious as a compensation for hardened existing structure and order. The phenomenon may be destructive and immoral from the standpoint of the existing collective mind, but it should be seen as a function of the collective unconscious, a more fundamental psychic function that cannot be morally defined. The servant, a figure of the trickster archetype, is a being that brings transformation and has the duality and contradiction of destructiveness and creativity. The endings of this folktale's analogies are diverse, reflecting the diversified response of the audience's mind due to the ambivalence of the trickster, and also suggesting various responses toward the problem of the trickster from the unconscious. It also shows that the trickster is a problem of inconclusive and controversial contradictions that cannot be controlled with a conscious rational attitude, and that we can only seriously contemplate the trickster archetype within us.

A Study on the Religiosity of Filial Piety Ethics in Daesoonjinrihoe (대순진리회의 효 윤리에 나타난 종교성 연구)

  • Cha, Seon-keun
    • Journal of the Daesoon Academy of Sciences
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    • v.27
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    • pp.171-200
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    • 2016
  • This paper will analyze the filial piety based ethics of Daesoonjinrihoe (大巡眞理會) and the traditional filial piety of Confucianism (儒敎), Buddhism (佛敎) and Taoism (道敎) through comparing and contrasting their unique systems. The traditional Korean ethics regarding filial piety are in great need of reformation as the relationship between the parents and children should not be vertical or unilateral but parallel and reciprocal. However, there have not been sufficient in-depth studies on this specific ideology and alternative approaches. Regarding this prospect, one representative Korean indigenous new religion, Daesoonjinrihoe has emerged and directly engages in the collision between traditionalism and modernity. The modernity of Daesoonjinrihoe, enables the observation of how the filial piety based ethics have developed within a system of doctrine and thereby provides an exemplary model of traditional filial piety reimagined in accordance with modern sensibilities. A brief summary of comparative findings is as follows: First, Daesoonjinrihoe and Confucianism have taken serving parents with respect as an ethic within filial piety, but Confucianism engenders this ideal through the unilateral and unconditional sacrifice of younger people based on patriarchal feudalism whereas Daesoonjinrihoe has rejected such unilateral sacrifice and instead promotes mutual beneficience between parents and children. This difference occurs, in part, due to the filial piety of Confucianism rising in the midst of the feudal order whereas the ideology of Daesoonjinrihoe contains ideals such as "the reciprocation of favor for mutual beneficence (報恩相生)" and "respect for humanity (人尊)," both of which serve as key principles of the new religious world as envisioned by Daesoonjinrihoe. Second, filial piety in Buddhism and Taoism tends to be passive and inactive and is often expressed by praying for happiness and longevity for one's parents while they are alive and later praying for the heavenly rebirth of one's parents after they die. The filial piety of Daesoonjinrihoe also partially contains such ideas, however; they are extended much further and arrive upon novel and profound expressions. The spectrum of the filial piety in Daesoonjinrihoe expands to the extent children perform actions to resolve their parent's sins and pave a new road for their parents. This filial piety requires a cultivation practice from both parents and children. This system of dual cultivation was established because the world-view of Daesoonjinrihoe enables both parents and children to enjoy happiness and wealth both of which are achieved through the completion of religious objectives following cultivation practice. Third, Confucianism and Daesoonjinrihoe hold memorial services for ancestors with sincerity as an expression of filial piety. Filial piety in the Confucian context excludes ideas from Shamanism and thereby memorial services are held for impersonal entities, however; in the Daesoonjinrihoe context, memorial services are held for personal-entities. Accordingly, holding a memorial service for ancestors with sincerity has a greater sense of realism in Daesoonjinrihoe than it does in Confucianism. Fourth, while Confucianism and Daesoonjinrihoe both aim to requite the grace received from ancestors, the contents of grace and reciprocation of favors (報恩) are viewed differently. In Confucianism, since the ancestors existed previously and bestowed the gift of life to their children and indirectly, all of their descendents. Therefore, memorial services for ancestors are held to convey gratitude and filial piety. However, in Daesoonjinrihoe, ancestors not only bestowed the gift of earthly life to their descendents, in the spirit realm, ancestral spirits also spend sixty years accumulating the merit necessary to imbue each of their descendents with spiritual insight. Consequently, filial piety is expressed through memorial services as well as spiritual cultivation. Fifth, in Confucianism, achieving the fame and prestige indicative of success in the mundane world can be an act of filial piety as it would bring pride to one's ancestors, but in Daesoonjinrihoe, succeeding in religious objectives through spiritual cultivation is considered to be a higher form of filial piety. Sixth, Confucianism, Buddhism and Taoism all observe filial piety as system of familial ethics based in morality. This is likewise true of Daesoonjinrihoe, however; Daesoonjinrihoe confers greater importance on filial piety as an essential form of ethics for religious redemption. This is due to the Daesoon interpretation that the absence of filial piety was the direct cause which led to the sickened state of the world and its collapse. Forgetting the grace of parents who have given the gift of life or the grace of ancestral spirits who have accumulated merit on behalf of their descendents are acts of ingratitude which are unacceptable during the period of Reordering of the Universe. Judging from these findings, Daesoonjinrihoe embraces parts of traditional filial piety as it exists in Confucianism, Buddhism and Taoism, but it does so on the ground of its own unique culture. Through re-interpretation and re-creation, ideas regarding filial piety are being further developed. Namely, filial piety in Daesoonjinrihoe is regulations founded upon the reciprocation of favors for mutual beneficence and respect for humanity. Therefore, it is understood as a concept wherein one's own cultivation practice is performed in order to reach religious objectives, the perfection of personal character, and spiritual insight. This requires that even recipents of filial piety (i.e., parents) perform certain cultivation practices to enjoy happiness and wealth. Additionally, filial piety in Daesoonjinrihoe manifests a reinforced religious character and also serves as a system ethics which is soteriologically essential for salvation during the period known as the Reordering of the Universe.

Initial Experience of the Emergency Bypass System ($EBS^{(R)}$) for the Patients with Cardiogenic Shock due to an Acute Myocardial Infarction (급성 심근경색으로 인한 심인성 쇼크 환자에 대한 경피적 순환 보조장치($EBS^{(R)}$) 적용의 초기경험)

  • Ryu, Kyoung-Min;Kim, Sam-Hyun;Seo, Pil-Won;Ryu, Jae-Wook;Kim, Seok-Kon;Kim, Young-Hwa;Park, Seong-Sik
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.329-334
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    • 2008
  • Background: Percutaneous cardiopulmonary support. (PCPS) has the potential to rescue patients in cardiogenic shock who might otherwise die. PCPS has been a therapeutic option in a variety of the clinical settings such as for patients with myocardial Infarction, high-risk coronary intervention and postcardiotomy cardiogenic shock, and the PCPS device is easy to install. We report our early experience with PCPS as a life saving procedure in cardiogenic shock patients due to acute myocardial infarction. Material and Method: From January 2005 to December 2006, eight patients in cardiogenic shock with acute myocardial infarction underwent PCPS using the CAPIOX emergency bypass system($EBS^{(R)}$, Terumo, Tokyo, Japan). Uptake cannulae were inserted deep into the femoral vein up to the right atrium and return cannulae were inserted into the femoral artery with Seldinger techniques using 20 and 16-French cannulae, respectively. Simultaneously, autopriming was performed at the $EBS^{(R)}$ circuit. The $EBS^{(R)}$ flow rate was maintained between $2.5{\sim}3.0L/min/m^2$ and anticoagulation was performed using intravenous heparin with an ACT level above 200 seconds. Result: The mean age of patients was $61.1{\pm}14.2$ years (range, 39 to 77 years). Three patients were under control of the $EBS^{(R)}$ before percutaneous coronary intervention (PCI), three patients were under control of the $EBS^{(R)}$ during PCI, one patient was under control of the $EBS^{(R)}$ after PCI, and one patient was under control of the $EBS^{(R)}$ after coronary bypass surgery. The mean support time was $47.5{\pm}27.9$ hours (range, 8 to 76 hours). Five patients (62.5%) could be weaned from the $EBS^{(R)}$ after $53.6{\pm}27.2$ hours. (range, 12 to 68 hours) of support. All of the patients who could successfully be weaned from support were discharged from the hospital. There were three complications: one case of gastrointestinal bleeding and two cases of acute renal failure. Two of the three mortality cases were under cardiac arrest before $EBS^{(R)}$ support, and one patient had an intractable ventricular arrhythmia during the support. All of the discharged patients are still surviving at $16.8{\pm}3.1$ months (range, 12 to 20 months) of follow-up. Conclusion: The use of $EBS^{(R)}$ for cardiogenic shock caused by an acute myocardial infarction could rescue patients who might otherwise have died. Successfully recovered patients after $EBS^{(R)}$ treatment have survived without severe complications. More experience and additional clinical investigations are necessary to elucidate the proper installation timing and management protocol of the $EBS^{(R)}$ in the future.