• The Korean Society of Law and Medicine
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• v.21 no.2
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• pp.75-103
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• 2020

There is a growing voice that medical information should be shared because it can prepare for genetic diseases or cancer by analyzing and utilizing medical information in big data or artificial intelligence to develop medical technology and improve patient care. The utilization and protection of patients' personal information are the same as two sides of the same coin. Medical institutions or medical personnel should take extra caution in handling personal information with high environmental distinct characteristics and sensitivity, which is different from general information processors. In general, the patient's personal information is processed by medical personnel or medical institutions through the processes of collection, creation, and destruction. Still, the use of terms related to personal information in the Medical Service Act is jumbled, or the scope of application is unclear, so it relies on the interpretation of precedents. For the medical personnel or the founder of the medical institution, in the case of infringement of Article 24(4), it cannot be regarded that it means only medical treatment information among personal information, whether or not it should be treated the same as the personal information under Article 23, because the sensitive information of patients is recorded, saved, and stored in electronic medical records. Although the prohibition of information leakage under Article 19 of the Medical Service Act has a revision; 'secret' that was learned in business was revised to 'information', but only the name was changed, and the benefit and protection of the law is the same as the 'secret' of the criminal law, such that the patient's right to self-determination of personal information is not protected. The Privacy Law and the Local Health Act consider the benefit and protection of the law in 'information learned in business' as the right to self-determination of personal information and stipulate the same penalties for personal information infringement such as leakage, forgery, alteration, and damage. The privacy regulations of the Medical Service Act require that the terms be adjusted uniformly because the jumbled use of terms can confuse information subjects, information processors, and shows certain limitations on the protection of personal information because the contents or scope of the regulations of the Medical Service Law for special corporations and the Privacy Law may cause confusion in interpretation. The patient's personal information is sensitive and must be safely protected in its use and processing. Personal information must be processed in accordance with the protection principle of Privacy Law, and the rights such as privacy, freedom, personal rights, and the right to self-determination of personal information of patients or guardians, the information subject, must be guaranteed.

• The Korean Society of Law and Medicine
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• v.22 no.4
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• pp.185-210
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• 2021

On September 24, 2021, the new provisions(Article 38-2 of the Medical Service Act) mandatory CCTV installation in operating rooms where the unconscious patient is operating such as general anesthesia. The revised medical law aims to effectively prevent illegal activities that may occur in the operating rooms and to promote appropriate resolution to medical dispute. According to the law, medical institutions operating unconscious patients, such as general anesthesia, must install CCTVs in the operating rooms by September 25, 2023, and film surgical scenes only at the request of patients and their guardians, regardless of the consent of the medical personnel. The bill delegated the legislative device to minimize infringement of fundamental rights to subordinate statutes without stipulating it in the law.(Article 38-2(10)) The most realistic policy plan to minimize the infringement of the fundamental rights of patients is to prepare specific regulations. Therefore, this study examines the legislative background and main contents of the amended CCTV installation bill, and suggests issues to be reviewed when preparing subordinate statutes by analyzing major issues. It was reviewed based on compliance with the principle of minimizing infringement of fundamental rights of information subjects in the operating rooms. The information subjects of CCTV are health professionals and patients. Suggesting issues should be considered when preparing subordinate statutes so that the purpose of the CCTV installation law can be achieved while minimizing infringement of right of self-determination of personal information, personality rights, and human rights. It is hoped that this paper will be referred when discussing subordinate statutes and regulations to contribute minimizing infringement of fundamental rights.

• The Korean Society of Law and Medicine
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• v.17 no.2
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• pp.257-279
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• 2016

Recently, the Well-dying Act was legislated in Korea, and it will come into effect in August 4, 2017. This Act allows to withdraw the life sustaining treatment from impending death patients and also provide the hospice and palliative treatment to terminal patients. In the Supreme Court's case so called "Madam Kim", medical condition of Madam Kim was a persistent vegetative status owing to brain damage and her family members wanted to remove the artificial ventilation. In 2009, the Supreme Court allowed to withdraw the artificial ventilation under the specific conditions. We applied this new Well-dying Act to the Madam Kim's case hypothetically in order to know this Act can reasonably solve the problem of life sustaining treatment for dying or terminal patients. For the impending patients, the Well-dying Act has the problem not to withdraw the futile treatment due to the advance directives of patients. Vice versa, the terminal patients have no chance to withdraw the life sustaining treatment due to the this Act impose the duty to provide the hospice and palliative treatment despite of advance directives. We need to ruke out the persistent vegetative patients from the terminal patients caused by the cancer, acquired immune deficiency syndrome, chronic obstructive lung disease and chronic liver cirrhosis, In addition, we have to discuss the effect of the advance directives of terminal patients in view of self determination right.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.359-395
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• 2012

In a broad term, health and medical data means all patient information that has been generated or circulated in government health and medical policies, such as medical research and public health, and all sorts of health and medical fields as well as patients' personal data, referred as medical data (filled out as medical record forms) by medical institutions. The kinds of health and medical data in medical records are prescribed by Articles on required medical data and the terms of recordkeeping in the Enforcement Decree of the Medical Service Act. As EMR, OCS, LIS, telemedicine and u-health emerges, sharing and protecting digital health and medical data is at issue in these days. At medical institutions, health and medical data, such as medical records, is classified as "sensitive information" and thus is protected strictly. However, due to the circulative property of information, health and medical data can be public as well as being private. The legal grounds of health and medical data as such are based on the right to informational self-determination, which is one of the fundamental rights derived from the Constitution. In there, patients' rights to refuse the collection of information, to control recordkeeping (to demand access, correction or deletion) and to control using and sharing of information are rooted. In any processing of health and medical data, such as generating, recording, storing, using or disposing, privacy can be violated in many ways, including the leakage, forgery, falsification or abuse of information. That is why laws, such as the Medical Service Act and the Personal Data Protection Law, and the Guideline for Protection of Personal Data at Medical Institutions (by the Ministry of Health and Welfare) provide for technical, physical, administrative and legal safeguards on those who handle personal data (health and medical information-processing personnel and medical institutions). The Personal Data Protection Law provides for the collection, use and sharing of personal data, and the regulation thereon, the disposal of information, the means of receiving consent, and the regulation of processing of personal data. On the contrary, health and medical data can be inspected or delivered of the copies, based on the principle of restriction on fundamental rights prescribed by the Constitution. For instance, Article 21(Access to Record) of the Medical Service Act, and the Personal Data Protection Law prescribe self-disclosure, the release of information by family members or by laws, the exchange of medical data due to patient transfer, the secondary use of medical data, such as medical research, and the release of information and the release of information required by the Personal Data Protection Law.

• Journal of Korean Academy of Nursing
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• v.52 no.2
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• pp.157-172
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• 2022

Purpose: This study aimed to construct and test a hypothetical model to explain the predictive factors and causal pathways for exercise levels in patients with ankylosing spondylitis based on the self-determination theory. A conceptual framework was constructed assuming that autonomy support by health care providers would satisfy the three basic psychological needs of patients, which would increase their autonomous motivation for exercise, resulting in its initiation and continuation. Methods: This cross-sectional study included 221 patients with ankylosing spondylitis who were visiting rheumatology clinics in two tertiary hospitals. Health Care Climate Questionnaire-exercise regularly, Basic Psychological Needs Satisfaction scale, Behavior Regulation in Exercise Questionnaire-2, and exercise level were used to collect data. Results: The fitness of the hypothetical model met the recommended level (𝛘²/df ≤ 3, SRMR ≤ .08, RMSEA ≤ .08, GFI ≥ .90, AGFI ≥ .85, NFI ≥ .90, TLI ≥ .90, CFI ≥ .90). The model effect analysis revealed that autonomy support by health care providers had a positive effect on patients' autonomy, competence, relatedness, autonomous motivation, and exercise level. Competence and relatedness had positive effects on autonomous motivation and exercise level, respectively. Autonomous motivation had a positive effect on exercise level. Conclusion: The predictive factors of exercise level in patients with ankylosing spondylitis were autonomous motivation, health care providers' autonomy support, competence, and relatedness. Considering these factors, we recommend the development of an effective program for improving exercise levels in these patients.

• Therapeutic Science for Rehabilitation
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• v.12 no.2
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• pp.43-53
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• 2023

Objective : In this study, the rehabilitation motivation evaluation tool for stroke patients was identified, and the characteristics of the evaluation tool were analyzed to analyze the conceptual framework and characteristics used in the composition of the evaluation contents. Methods : From 2000 to May 2022, documents registered in major domestic and foreign databases (PubMed, NDSL, Medline, and EMbase) were searched and selected according to the selection and exclusion criteria. The evaluation tools used in the selected documents were analyzed, and the characteristics of this evaluation tool were analyzed. Results : A total of 30 documents were selected, and they were classified into a total of five rehabilitation motivation evaluation tools. The most widely used in Korea was the measurement tool for rehabilitation motivation for the disabled, and the most widely used overseas was the intrinsic motivation inventory. Three evaluation tools constructed the evaluation contents based on the self-determination theory, and two constructed the evaluation contents through expert agreement. The number of evaluation items and 8 to 45 items were varied, and the evaluation scale was also used in various ways from 4 to 7 point scale. Conclusion : It was possible to identify the evaluation tools mainly used for the evaluation of rehabilitation motivation, and to identify the main conceptual framework based on the development of the rehabilitation motivation evaluation tool. The results of this study are expected to be used as basic data for research on the development of rehabilitation motivation evaluation tools for stroke patients in the future.

• Journal of Digital Convergence
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• v.15 no.10
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• pp.281-291
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• 2017

This purpose of study was to identify variables predicting basic psychological need in hemodialysis patients. The participants were 134 patients from two major general hospitals and two dialysis center located in J city. Data were collected using self-report questionnaires and physiological index. Data analysis was done by using SPSS WIN 18.0 program for one-way ANOVA, independent t-test, Pearson correlation coefficients, and multiple regression. This study showed a negative correlation between basic psychological need and uncertainty(r=--.464, p<.001), depression(r=-.422, p<.001). In addition, relationships and physiological index were Positively correlated. The uncertainty(${\beta}=-.345$), depression(${\beta}=-.279$), physiological index(${\beta}=-.117$) have a 29% explanatory power for the basic psychological need in hemodialysis patients. Physiological index, uncertainty and depression in turn influenced the basic psychological needs of hemodialysis patients. It is necessary to develop nursing strategies and programs to reduce disease uncertainty and depression in order to increase self-deterministic health behavior through autonomy, competence and relationship satisfaction.

• The Korean Society of Law and Medicine
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• v.21 no.1
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• pp.3-32
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• 2020

Under the Korean case law, physicians are obliged to disclose or inform the risk associated with a specific treatment to their patients before they perform the treatment. If they fail to do this, they are liable to compensate pain and sufferings. If the patient can establish that he or she would not have consented at all to the treatment had he or she been informed, the physicians are liable to compensate all the loss incurred by the treatment. In this article, the author examines the legitimacy of this case law from the perspective of legal doctrine as well as its practical affect on the medical practice and the furtherance of self-determination of the patient. The fundamental findings are as follows: The case law that has physicians who failed to inform treatment risk compensate pain and sufferings for the infringement of the right of self-determination seems to be a disguised and reduced compensation of all the loss based on the possible malpractice, which cannot be justified in view of the general principles of tort liability. It is necessary to adhere to the requirements of causation and imputation between the failure to inform treatment risk and the specific patient's consent to the treatment. If this causation and imputation is established, all the loss should be compensated. Otherwise, there shall be no liability. The so-called hypothetical consent defence shall be regarded as a part of causation between the failure to inform and the consent. The suggested approach can preserve the essence of physician-patient relationship and fit for the very logic of informed consent better.

• The Korean Society of Law and Medicine
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• v.14 no.1
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• pp.355-401
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• 2013

The first legislation for terminal health-care decision was California's Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life-sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self-Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

• Journal of Korean Academy of Nursing
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• v.47 no.4
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• pp.514-525
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• 2017

Purpose: The purpose of this study was to construct and test a structural equation model for Diabetes self-management (DSM) behavior and Quality of life (QoL) in older adults with diabetes who use Citizen Health Promotion Centers. The theory used this study was a combination of the Information-Motivation-Behavioral Model (IMB) and Self-Determination Theory (SDT) to reflect autonomous characteristics of participants. Methods: Data were collected from April 20 to August 31, 2015 using a self-report questionnaire. The sample was 205 patients with type 2 Diabetes who regularly visited a Citizen Health Promotion Center. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factor affecting the participants' DSM behavior and QoL. Results: The supported hypotheses were as follows; 1) The variable that had a direct effect on QoL was health behavior adherence (${\gamma}=.55$, p=.007). 2) The variables that had a direct effect on DSM behavior were DSM information (${\gamma}=.15$, p=.023), DSM confidence (${\gamma}=.25$, p<.001), and autonomous motivation (${\gamma}=.13$, p=.048). 3) The variable that had a direct effect on DSM confidence was autonomy support (${\gamma}=.33$, p<.001). Conclusion: The major findings of this study are that supporting patient's autonomous motivation is an influential predictor for adherence to DSM behavior, and integrative intervention strategies which include knowledge, experience and psychosocial support are essential for older adults with diabetes to continue DSM behavior and improve QoL.