• Research in Community and Public Health Nursing
• /
• v.28 no.3
• /
• pp.291-301
• /
• 2017

Purpose: This study aims to investigate the relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life among hemodialysis patients. Methods: A descriptive correlational study was conducted with 103 hemodialysis patients. Data were collected using a structured questionnaire from May to September of 2016, and analysed by using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. Results: The participants' knowledge level on advance directive was $5.47{\pm}2.08$ out of 9, the attitudes towards the withdrawal of life-sustaining treatment was $3.22{\pm}0.49$ out of 5, and the quality of life was $3.35{\pm}0.92$ out of 6. The knowledge on advance directive was positively correlated with attitudes towards the withdrawal of life-sustaining treatment (r=.21, p=.037) and quality of life (r=.21, p=.036). Conclusion: According to the results of this study, the level of knowledge on advance directive is preferred to improve the quality of life of hemodialysis patients. It is needed to support and maintain ongoing education opportunities in order to improve the level of knowledge on advance directive among patients undergoing hemodialysis.

• Journal of Hospice and Palliative Care
• /
• v.25 no.1
• /
• pp.12-24
• /
• 2022

Purpose: This descriptive study compared the perceptions, determinants, and needs of patients, family members, nurses, and physicians regarding life-sustaining treatment decisions for patients with hematologic malignancies in the hematology-oncology department of a tertiary hospital in Seoul, Korea. Methods: In total, 147 subjects were recruited, gave written consent, and provided data by completing a structured questionnaire. Data were analyzed using analysis of variance, the chi-square test, and the Fisher exact test. Results: Nurses (F=3.35) and physicians (F=3.57) showed significantly greater familiarity with the Act on Decisions on Life-Sustaining Treatment than patients (F=2.69) and family members (F=2.59); (F=19.58, P<0.001). Many respondents, including 19 (51.4%) family members, 16 (43.2%) physicians, and 11 (29.7%) nurses, agreed that the patient's opinion had the greatest effect when making life-sustaining treatment decisions. Twelve (33.3%) patients answered that mental, physical, and financial burdens were the most important factors in life-sustaining treatment decisions, and there was a significant difference among the four groups (P<0.001). Twenty-four patients (66.7%), 27 (73.0%) family members, and 21(56.8%) nurses answered that physicians were the most appropriate people to provide information regarding life-sustaining treatment decisions. Unexpectedly, 19 (51.4%) physicians answered that hospice nurse practitioners were the most appropriate people to talk to about life-sustaining treatment (P<0.001). Conclusion: It is of utmost importance that the patient and physician determine when life-sustaining treatment should be withdrawn, with the patient making the ultimate decision. Doctors and nurses have the responsibility to provide detailed information. The goal of end-of-life planning is to ensure patients' dignity and respect their values.

• Journal of Korean Critical Care Nursing
• /
• v.10 no.1
• /
• pp.41-50
• /
• 2017

Purpose: The purpose of this study was to describe what critical care nurses perceived about life-sustaining treatment at end of life. Methods: A qualitative content analysis method was utilized. The unit of analysis was interview text obtained from fifty critical care nurses of a general hospital. Results: Seven categories in two content areas were abstracted. In the negative perception area, the following five categories were abstracted: patients' suffering, dying with damaged dignity, patients' isolation from family members, regret about choosing life-sustaining treatment, and family members' burden. In the positive perception area, the following two categories were abstracted: willingness to sustain life and duty as family members. Conclusions: Nurses have better competencies pertaining to understanding patients' responses and suffering than any other health care professions do. Nurses should play an important role in advocating for patients and their family in the process of end-of-life care decision making.

• The Korean Society of Law and Medicine
• /
• v.10 no.2
• /
• pp.309-341
• /
• 2009

According to a case of Supreme Court's Sentence No. 2009DA17417 (May 21, 2009), the Supreme Court judges that 'the right to life is the ultimate one of basic human rights stipulated in the Constitution, so it is required to very limitedly and conservatively determine whether to discontinue any medical practice on which patient's life depends directly.' In addition, the Supreme Court admits that 'only if a patient who comes to a fatal phase before death due to attack of any irreversible disease may execute his or her right of self-determination based on human respect and values and human right to pursue happiness, it is permissible to discontinue life-sustaining treatment for him or her, unless there is any special circumstance.' Furthermore, the Supreme Court finds that 'if a patient who is attacked by any irreversible disease informs medical personnel of his or her intention to agree on the refusal or discontinuance of life-sustaining treatment in advance of his or her potential irreversible loss of consciousness, it is justifiable that he or she already executes the right of self-determination according to prior medical instructions, unless there is any special circumstance where it is reasonably concluded that his or her physician is changed after prior medical instructions for him or her.' The Supreme Court also finds that 'if a patient remains at irreversible loss of consciousness without any prior medical instruction, he or she cannot express his or her intentions at all, so it is rational and complying with social norms to admit possibility of estimating his or her own intentions on withdrawal of life-sustaining treatment, provided that such a withdrawal of life-sustaining treatment meets his or her interests in view of his or her usual sense of values or beliefs and it is reasonably concluded that he or she could likely choose to discontinue life-sustaining treatment, even if he or she were given any chance to execute his or her right of self-determination.' This judgment is very significant in a sense that it suggests the reasonable orientation of solutions for issues posed concerning withdrawal of meaningless life-sustaining medical efforts. The issues concerning removal of medical instruments for meaningless life-sustaining treatment and discontinuance of such treatment in regard to medical treatment for terminal cases don't seem to be so much big deal when a patient has clear consciousness enough to express his or her intentions, but it counts that there is any issue regarding a patient who comes to irreversible loss of consciousness and cannot express his or her intentions. Therefore, it is required to develop an institutional instrument that allows relevant authority to estimate the scope of physician's medical duties for terminal patients as well as a patient's intentions to withdraw any meaningless treatment during his or her terminal phase involving loss of consciousness. However, Korean judicial authority has yet to clarify detailed cases where it is permissible to discontinue any life-sustaining treatment for a patient in accordance with his or her right of self-determination. In this context, it is inevitable and challenging to make better legislation to improve relevant systems concerning withdrawal of life-sustaining treatment. The State must assure the human basic rights for its citizens and needs to prepare a system to assure such basic rights through legislative efforts. In this sense, simply entrusting physician, patient or his or her family with any critical issue like the withdrawal of meaningless life-sustaining treatment, even without any reasonable standard established for such entrustment, means the neglect of official duties by the State. Nevertheless, this issue is not a matter that can be resolved simply by legislative efforts. In order for our society to accept judicial system for withdrawal of life-sustaining treatment, it is important to form a social consensus about this issue and also make proactive discussions on it from a variety of standpoints.

• Journal of the Korea Society of Computer and Information
• /
• v.25 no.2
• /
• pp.181-188
• /
• 2020

This study was conducted to identify the effects of the degree of death orientation, attitudes toward withdrawing life-sustaining treatment, and awareness of biomedical ethics on paramedic students' own biomedical ethics. The participants of this study were 228 paramedic students from a college located in D city. Data were collected from April to June 2019 through a self-report questionnaire. There was a positive correlation between awareness of biomedical ethics and attitude toward withdrawing life-sustaining treatment (r=.63, p<.001). Multiple linear regression analysis showed that the factors affecting students' awareness of biomedical ethics were religion (β=.12, p=.018) and their attitude toward withdrawal of life-sustaining treatment (β=.61, p<.001), with an explanatory power of 41.0%. Educational programs must focus on attitudes toward withdrawing life-sustaining treatment to improve paramedic students' awareness of biomedical ethics.

• Journal of Korean Academy of Nursing
• /
• v.37 no.7
• /
• pp.1166-1176
• /
• 2007

Purpose: The purpose of this study was to categorize adult's subjectivity of their attitudes towards life sustaining treatment, and thereby understand the differences among these life sustaining treatment types using Q methodology. Methods: Q-methodology, which provides a method of analyzing the subjectivity of each item, was used. Thirty selected Q-statements received from 52 adults were classified into a shape of normal distribution using a 7 point scale. The collected data was analyzed using a QUANL pc program. Result: Four types of attitudes toward life sustaining treatment were identified. Type I is called one's autonomy type. Type II is called potentiality of resuscitation type. Type III is called DNR (Do not resuscitation) type. Type IV is calledone's effort type. Conclusion: The results of the study indicate that different approaches of life support care programs are recommended based on the four types of life sustaining treatment attitudes among Korean adults.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.22 no.2
• /
• pp.539-547
• /
• 2021

This study was conducted to identify the effects of knowledge of Advance Directives (AD) and the patient's perception of a peaceful death on their attitude toward the withdrawal of life-sustaining treatment and to provide basic data for the development of a nursing intervention program for activating self-determination in the withdrawal of life-sustaining support of patients. The subjects were 167 adult cancer patients who received outpatient or inpatient treatment, from September 15, 2019, to March 30, 2020. The data was analyzed by mean, standard deviation, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression by using SPSS 21.0. From the results, it was observed that the knowledge of AD was 8.87±2.46 out of 12, perception of a peaceful death was 2.87±0.42 out of 4, and attitude toward withdrawal of life-sustaining treatment was 3.46±0.49 out of 5. There was a positive correlation between knowledge of AD, perception of a peaceful death, and their attitude toward withdrawal of life-sustaining treatment. The influencing variables were the knowledge of AD, perception of a peaceful death, discussion with family on withdrawal of life-sustaining treatment, and explanation power was 16.0% (F=10.355, p<.001). Therefore, it is necessary to develop a program that would improve the perception of a peaceful death, increase the knowledge of AD to improve the patients' attitude toward the withdrawal of life-sustaining treatment. An intervention to assist a discussion between the patients and their families in advance would also be useful.

• The Korean Society of Law and Medicine
• /
• v.10 no.1
• /
• pp.263-305
• /
• 2009

Is it lawful to withhold or withdraw life-sustaining treatment applied to a patient in a terminal condition or permanent unconscious condition? In Korea, there are no such laws or regulations which control affairs related to the withholding or withdrawal life-support treatment and active euthanasia as the Natural Death Act or the Death with Dignity Act in the U. S. A. And in addition there has had no precedent of Supreme Court. Recently Supreme Court has pronounced a historical judgment on a terminal care case. The court allowed the withdrawal of life-sustaining treatment from a patient in a permanent unconscious state. Fundamentally the court judged that the continuation of that medical treatment would infringe dignity and value of a patient as a human being. And the court required some legal grounds to consider such withdrawal or withholding of medical care lawful. The legal grounds are as follow. First, the patient is in a incurable and irreversible condition and already entered a stage of death. Second, the patient executed a directive, in advance, directing the withholding or withdrawal of life-support treatment in a incurable and irreversible condition or in a terminal condition. Otherwise, at least, the patient's will would be presumed through his/her character, view of value, philosophy, religious faith and career etc. I regard if a patient is in a incurable and irreversible condition or in a terminal condition, the medical contract between a patient and a doctor would be terminated because of the actual impossibility of achievement of it's purpose. So I think the discontinuation of life-sustaining care would be legally allowed without depending on the patient's own will.

• The Korean Society of Law and Medicine
• /
• v.18 no.2
• /
• pp.139-161
• /
• 2017

In this paper, The Supreme Court of Korea 2016. 1. 28. 2015Da9769 was reviewed. In the previous case, Korean Supreme Court 2009Da17417 for the element to requirement for permission of the withdrawal of life-sustaining treatments, the patient's consent for withdrawal of life-sustaining treatments was assumed a declaration of intention to terminate the contract. But the consent for withdrawal of life-sustaining treatments corresponds not to those. The consent for medical treatments is not the juristic acts but the real acts. If the presumptive intention about these withdrawal regards as the termination of medical contract, the contract must be up to the starting the civil proceedings. According to this case, although the partial cancellation of medical contract is admitted, on the other hand medical expenses obligation ist exempted only after the final decision. At the withdrawal of life-sustaining treatments the medical obligation ist exempted because of the inability to providing the medical payment, which confirmed by the final decision about the withdrawal of life-sustaining treatments. Therefore the judgement of this case ist appropriate in that sense, the medical obligation ist waived only after the final decision. However that legal basis lies not at the partial cancel but at the partial inability.

• The Korean Society of Law and Medicine
• /
• v.23 no.2
• /
• pp.67-96
• /
• 2022

"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.