• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3153-3157
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• 2015

Background: Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. Materials and Methods: This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). Results: A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (${\geq}10times$) (p=0.016). Conclusions: Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.

• The Korean Society of Law and Medicine
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• v.22 no.2
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• pp.81-109
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• 2021

This paper review about the relationship between the prohibition against medical refusal and the principle of private autonomy in medical contracts. The obligation to this Prohibition in Medical Law does not restrict the liberty of contracting a medical contract. On the other hand, the prohibition limits the freedom to terminate medical contracts. Medical contracts can be terminated if the trust between doctors and patients is vanished. However certain restrictions should be placed on termination of the medical contract, because termination of the contract should not be detrimental to patients' health. According to the current medical law the medical contract is to be enforced in principle and can be revoked only with justifiable reason. At the Civil Code on Medical Contracts the freedom to terminate the medical contract is permitted, but this paper suggests the restrictions of the revocation under certain conditions. The Criminal Punishment Regulations against medical refusal should be removed. Refusal the provide medical service should be regulated by administrative sanctions under the National Health Insurance Act's obligation.

• Journal of Oriental Neuropsychiatry
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• v.21 no.4
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• pp.219-231
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• 2010

Objectives : School refusal is usually considered as individual's behavioral problem. These days. however. the adolescents' school refusal needs some kind of medical approaches because it is related to mental disorder of the adolescents. Due to too much pressure and stress from the competition between classmates and from good performance in school. the number of adolescents who refuse to go to school is increasing. Despite this circumstance. school refusal is neither regarded as a single independent disorder nor endorsed as an officially classified disease. which makes difficult to conduct research on this issue and to establish standardized treatment for it. In addition. there is a lack of research on this topic. especially in oriental medicine. so there is no a case report or study on school refusal. This study is trying to comment on school refusal from the perspective of oriental medicine. Methods : We tried to examine the effect of oriental medicine treatment for school refusal with four adolescent cases. The patients commonly have at least more than one mental disorder (including depression disorder. anxiety disorder. and anorexia nervosa). have some problem with the relationship with their family. in particular with mother. do not have father or not be loved by their father. and have irregular eating habits. Thus. we diagnosed them as qi transforming into fire (氣鬱化矢) spleen-stomach deficiency cold (脾胃虛寒) and heart blood deficiency (心血虛) due to stress from the family issues and unhealthy eating habits. The patients received supportive therapy. family therapy. etc among many oriental mental treatments and their progress had been observed through hospitalization and outpatient treatment. Results : All four cases were reported positive progress on their symptoms and started coming back to school. We also examined whether they were well fitting into the school while they received outpatient treatment. and the results show that all four patients continue to settle down in normal school life. Conclusions : This study closely reviewed the mental disorder of school refusal cases and showed that the Oriental medical treatment was effective in helping the patients come back to school. More future research is required to better treatment for school refusal cases in oriental medicine.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7283-7288
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• 2013

Background: Tobacco use among adolescents is a major public health concern, and identifying predictors of smoking is necessary for planning prevention programs. The present study examined the relationship between refusal self efficacy, self esteem, smoking refusal skills and water pipe (hookah) smoking among Iranian male adolescents. Materials and Methods: A cross-sectional study was conducted with 380 Iranian male adolescents aged between 15-19 years selected by multistage sampling. The participants completed an anonymous, voluntary, self-report questionnaire. Variables independently associated with water pipe (WP) smoking were identified by multiple logistic regression analysis. Results: The mean age of the participants was $16.7{\pm}1.3$ years. The prevalence of WP smoking was 17.3%. Logistic regression analysis revealed that knowledge (OR=0.56; 95% CI: (0.37-0.79), attitude (OR=0.69; 95% CI: (0.52-0.89), self esteem (OR=0.67; 95% CI: (0.55-0.82), smoking refusal skills (OR=0.73; 95% CI: (0.55-0.87), and self efficacy (OR=.82; 95% CI: (0.61-0.93) were all signifcant prediting facotrs for adolescents WP smoking. Conclusions: The findings have implications for public health interventions. Indeed, self efficacy and smoking refusal skills should be considered when developing tailored measures for the prevention of WP smoking among adolescents.

• The Korean Society of Law and Medicine
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• v.21 no.3
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• pp.117-144
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• 2020

In accordance with Article 15 of the Medical Law, medical personnel in Korea cannot refuse treatment of a patient unless there is a justifiable reason, and violation of this obligations is subject to criminal penalties. Japan also stipulates the same content in the law. However, this violation of obligations in Japan is not subject to criminal penalties, and is used as a judgment element of the liability for damages of doctors only in the case of damage to the patient. However, in both countries, it is difficult to interpret and apply the law because the regulation is a little ambiguous. In particular, the key is to find out what is the justifiable reason for the doctor to refuse treatment of the patient. Recently, Japan has completed the work of re-examining the discussion on medical refusal from a modern perspective in terms of improving the excessive working environment of doctors. On the other hand, in Korea, it is not clear in what cases it is possible to refuse treatment. because there is a lack of systematic discussion on medical refusal. Rather, unnecessary misunderstandings and controversies have resulted in the loss of trust between patients and doctors. In Korea, there is already a legal right for a doctor to reject it according to his religious beliefs or conscience in the implementation of the suspension of life-sustaining treatment decisions. And in the case of an abortion, debates are underway that doctors should be given the right to refuse it. This study introduces the current state of discussion in Japan, and examines the issues surrounding medical refusal in Korea. It is hoped that this study will facilitate further discussions on the medical refusal.

• The Korean Journal of Emergency Medical Services
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• v.13 no.3
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• pp.77-90
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• 2009

Civil complaints and lawsuits filed in the process of providing emergency medical service include fall accident on the way of carrying the patient, transfer consent, refusal and rejection of rescue request, range and behavior restriction of emergency medical technicians, false registry of logbook, neglect of duty and emergency patient, and violation of traffic laws on the way of dispatch to the scene of accident. This study suggested the measures by cases as follows. 1. The accidents on the way of carrying a patient could be divided into fall of patient and fall by paramedic's mistake. In the former case, damages caused by the ambulance's shaking must be notified to the patient and guardian and recommended to fasten seat belt, in the latter case, the plan of patient's posture, route of transport, rescue and equipments should be comfirmed before fixing the patient. 2. Transfer consent must be made as implied when the patient is unconscious under delusion and was not able to consent physically, and paramedic must take an action by his judgment and record details of services on logbook. 3. When a patient refused to transfer, get 'confirmation of transfer refusal' and inform him of refusal. Paramedic should receive the signature. In addition, in case of refusal, transfer request should be made after hearing doctor's opinion and it should be notified to transfer request and superintendent of fire station after making 'confirmation of transfer refusal'. 4. Emergency medical technicians should perform their duties within the range of services prescribed by Article 41 of Law of Emergency Medical Service and Article 33 of Its Enforcement Regulations and shall not make announcement of death. In case of reporting the death to guardian, it is desirable to use record data like ECG results. 5. The best way to have protection from legal problems is making and keeping the exact records of accident and patient. Paramedic should not mention his subjective opinion about the accident-related matter. He must record correctly and keep the original medical records. 6. As emergency medical technicians are responsible for taking care of emergency patients, they must contact a briefing room when they meet a difficult situation suddenly due to vehicle stop or treatment of other patients and then must have support from neighboring hospital and other safety centers. 7. Since the ambulance operator is responsible for safety and careful driving of ambulance, he must be careful when he violates traffic regulations unavoidably. The operator should drive slowly below 10km/h at an intersection and pass it after getting way from general vehicles driving from all directions.

• Fire Science and Engineering
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• v.19 no.4 s.60
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• pp.47-56
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• 2005

The regulation on organization and operation of rescue and aid party was amended. This Regulation is designed to provide legal formality in order to protect not only the patients' right but also 119 rescuers from liability, which is due to treatment refusal by patient and the discretionary refusal of transfer by 119 rescuers on the non-emergency situation. This study looked over the constitute of violation of emergency medical service act related to the discretionary refusal of 119 rescuers, the criminal liability owing to omission and the possibility of national indemnities on the damage of patients. This study also analyzed the courts' decision and attitude by exploring overseas judicial precedents and examined what should be considered on the execution of the newly enacted law. Finally, this study put emphasis on the importance of medical director's control, documentation of every procedure, 119 rescuer's authorization on the refusal of transfer by securing patient's informed consent.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.105-138
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• 2017

This is case comments of several representative legal cases regarding self- determination right of patient. In a case in which an intoxicated patient attempted suicide refusing treatment, the Supreme Court ruled that the medical team's respect for the patient's decision was an act of malpractice, and that in particular medical situations (medical emergencies) the physician's duty to preserve life supersedes the patient's rights to autonomy. Afterwards, at the request of the patient's family, and considering the patient's condition (irrecoverable death stage, etc.) consistent with a persistent vegetative state, the Supreme Court deduced the patient's intention and decide to withdraw life-sustaining treatment. More recently, regarding patients who refuse blood transfusions or other necessary treatment due to religious beliefs, the Supreme Court established a standard of judgment that can be seen as conferring equal value to the physician's duty to respect patient autonomy and to preserve life. An empirical study of legal precedent with regard to cases in which the physician's duty to preserve life conflicts with the patient's autonomy, grounded in respect for human dignity, can reveal how the Court's perspective has reflected the role of the patient as a decision-making subject and ways of respecting autonomy in Korean society, and how the Court's stance has changed alongside changing societal beliefs. The Court has shifted from judging the right to life as the foremost value and prioritizing this over the patient's autonomy, to beginning to at least consider the patient's formally stated or deducible wishes when withholding or withdrawing treatment, and to considering exercises of self determination right based on religious belief or certain other justifications with informed refusal. This will have a substantial impact on medical community going forward, and provide implicit and explicit guidance for physicians who are practicing medicine within this environment.

• Journal of the Korean Society of School Health
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• v.32 no.2
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• pp.116-124
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• 2019

Purpose: This study was performed to measure the influence of drinking motives, drinking refusal self-efficacy, and self-determination on the intention to control drinking among nursing students. Methods: A cross-sectional survey was done with the participation of 258 nursing students attending four universities in G city. Data collection was conducted from May to June, 2018, using a self-report questionnaire. Data were analyzed using the t-test, ANOVA, $Scheff{\acute{e}}$ test, Pearson's correlation coefficients, and Hierarchical multiple regression. Results: The average scores for drinking motives, drinking refusal self-efficacy, self-determination, and intention to control drinking were 2.29, 4.54, 3.89, and 4.29 respectively. There were significant differences in the intention to control drinking according to grade, religion, and age of alcohol initiation. The factors influencing the intention to control drinking in nursing students were identified as self-determination (${\beta}=.24$), drinking refusal self-efficacy (${\beta}=.17$) and drinking motives (${\beta}=-.17$). This factor explained 26% of the nursing students' intention to control drinking. Conclusion: Therefore, it is necessary to develop a alcohol education program to improve the drinking culture of nursing college students and to improve their self-regulation skills in order to help them form a desirable drinking habit, and it is also necessary to apply the developed intervention program and test the effect.

• Health Policy and Management
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• v.31 no.4
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• pp.479-490
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• 2021

Background: Conflict in the medical world in 2020 led to the rejection of the national examination for doctors. This study explained the process until the end of the national test refusal situation triggered in 2020 through the signaling game theory. The government has succeeded in requiring medical students to take the national exam. Methods: To explain the rejection of the national examination, we first compose and show an example of two small non-signaling games where medical students know which type the government is of, then combine them to play a signaling game. Results: The behavior of the government and medical students was examined through the signaling game model. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the government makes an ultimatum, whatever the type. And the medical students accept it. They judged that the government could not be expected to abolish the policy. If COVID-19 had not occurred, medical students would have been able to continue the confrontation. Conclusion: The government instilled in the other party the perception that the government would not bend its policies because it was the surly type and would not be afraid of a strong confrontation. Through the image created in this way, the government was forced to accept the ultimatum by medical students. Academically, this study is to deal with the policy-making process through the signaling game theory. In the area of health care policy, this study suggests that various situations such as the type of government or the spread of COVID-19 can become important in addition to the rationality of the policy itself.