• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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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.

• 동의신경정신과학회지
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• 제21권4호
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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.

• 의료법학
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• 제21권3호
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• pp.117-144
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• 2020

우리나라 의료인은 의료법 제15조에 따라 정당한 사유가 없는 한 환자의 진료를 거부할 수 없으며, 정당한 사유 없이 진료를 거부한 행위는 형사처벌의 대상이 된다. 일본도 의사법에서 동일한 내용을 규정하고 있지만, 진료거부행위가 형사처벌의 대상이 되는 것은 아니다. 환자에게 손해가 발생한 경우에 한하여 의사의 손해배상책임 여부를 판단하는데 고려되는 일 요소로서 활용되고 있다는 차이가 있다. 그러나 조항 자체가 매우 추상적으로 규정되어 있어 양 국가는 의사가 환자의 진료를 거부할 수 있는 정당한 사유가 무엇인지를 구체화하기 위해 노력한다. 최근 일본은 의사의 과도한 근무환경을 개선한다는 관점에서 진료거부에 관한 논의를 현대적 관점에서 재조명하는 작업을 완료한 바 있다. 반면 우리나라는 진료거부에 관한 체계적인 논의가 부족하여 어떠한 경우에 진료를 거부할 수 있는지 명확히 알 수 없을 뿐만 아니라 오히려 불필요한 오해와 논란만 가중됨에 따라 환자와 의사간의 신뢰가 상실되는 결과를 초래하고 있다. 한편 우리나라에서는 이미 연명의료결정 중단 시행에 있어 의사가 종교적 신념 또는 양심에 따라 이를 거부할 수 있는 권리가 법적으로 보장되고 있으며, 최근 낙태의 경우에도 의사에게 이를 거부할 권리를 보장해야 한다는 논의가 진행 중에 있다. 본 연구는 일본의 논의 현황을 소개하며, 우리나라에서 확인할 수 있는 진료거부 사례를 검토하고, 이에 덧붙여 오늘날의 의료현실에서 검토가 필요한 사례를 제시하였다. 이 연구를 통해 의사의 진료거부금지 의무에 관한 발전적 논의가 촉진되기를 기대한다.

• Journal of the Korean Wood Science and Technology
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• 제28권1호
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• pp.42-47
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• 2000

본 연구는 CCA 2호를 이용한 소나무, 낙엽송, 북양가문비나무 원추가공재의 가압 방부처리시 처리변수가 처리도(방부제의 침투깊이와 보유량)에 미치는 영향을 파악하기 위하여 수행되었다. 처리변수로는 전배기 시간(30, 45, 또는 60분)과 최대 가압력 (8.5, 10.5, 또는 14.0 kg/$cm^2$)이 조사되었으며, 가압은 목재 내로 방부제가 더 이상 주입되지 않는 refusal point까지 지속되었다. 수종에 관계없이 전배기 시간의 30분 이상 연장은 처리도에 영향을 미치지 않았다. 그리고 가압력의 증가는 방부제 침투깊이에는 영향을 미치지 못하였으나 보유량에는 영향을 미쳤다. 전반적으로 볼 때, 방부제의 침투깊이는 소나무>북양가문비나무${\geq}$낙엽송의 순이었는데 변재폭이 넓은 소나무는 적용된 압력에 관계없이 사용환경구분 H5 지역에 사용할 수 있는 CCA 처리재의 최소 방부제 침투깊이를 만족하였다. 그러나 변재폭이 좁은 낙엽송과 북양가문비나무는 방부제 침투깊이가 깊지 않아 자상처리 등 처리도 개선을 위한 전처리가 필요하였다. 소나무의 보유량은 가압력의 영향을 받지 않았으나, 난주입수종인 낙엽송과 북양가문비나무의 경우 가압력 14.0 kg/$cm^2$ 에서는 유의성이 인정되는 보유량의 증가가 관찰되었다. 방부제의 목재내 침투가 종료되는 시점인 refusal point에 대한 처리조건의 영향은 불분명하였으나, 가압 소요시간은 북양가문비나무>낙엽송>소나무 순으로 변재율이 높을수록 전반적으로 가압 소요시간이 단축됨을 알 수 있었다.

• 한국화재소방학회논문지
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• 제19권4호
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• pp.47-56
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• 2005

비응급상황에 대한 제한적인 구급요청의 거절 및 환자 등의 이송거부로 인한 법적 분쟁으로부터 당해 구급대원을 보호하고 이에 대한 절차를 엄격히 하여 응급환자를 보호하기 위하여 $\ulcorner$구조대 및 구급대 편성$\cdot$운영에 관한 규칙$\lrcorner$이 개정되었다. 이에 대하여 본 논문은 구급대원의 이송거절 거부에 따라 발생할 수 있는 법적 책임으로 응급의료거부죄의 구성요건 해당성을 고찰하고 부작위에 의한 형사책임 및 환자에게 발생한 손해에 대한 국가배상책임의 발생가능성에 대하여 연구하였다. 구급대원을 법적 책임으로부터 보호하기 위해 개정된 규칙의 준수에 있어서 유의해야 할 점과 외국의 판례들을 고려하여 법원의 태도를 살펴보았다. 결론적으로는 구급대원의 법적인 보호를 위해 지도의사의 의료지도 확보 및 적법한 절차를 따라 문서화된 서식을 충실히 기록함으로써 구급대원의 의무에 대한 충실한 이행 및 환자의 동의를 확보하여 이송거절 및 거부에 대한 정당성을 확보하는 것이 중요함을 강조하였다.

• 의료법학
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• 제18권2호
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• pp.105-138
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• 2017

이 글은 환자의 자기결정권에 관한 몇몇 대표적인 판례들을 연혁적으로 검토한 논문이다. 대법원은 과거 음주상태에서 농약을 음독하여 자살을 시도한 환자가 치료를 거부하자 치료를 포기한 의료진에게 특정 의학적 상태(응급상황)에서 의사의 생명보호의무가 환자의 자기결정권 존중보다 우선한다고 판단하여 의료과실을 인정하였다. 이후 대법원은 가족들의 요청에 의해 지속적 식물인간 상태인 환자에게 해당 환자의 의학적 상태(회복불가능한 사망의 단계 등)를 고려하고 환자의 의사를 추정하여 연명의료를 중단하게 하였다. 최근 대법원은 종교적 신념과 관련하여 수혈과 같은 필수적인 치료를 거부한 환자에 대하여 대법원은 환자의 생명 보호에 못지않게 환자의 자기결정권을 존중하여야 할 의무가 대등한 가치를 가지는 것으로 평가할 수 있는 판단 기준을 제시하였다. 인간의 존엄성에 근거한 환자의 자기결정권과 의사의 생명보호의무가 충돌하는 상황에 대하여 연혁적 판례 검토를 통해 법원의 입장이 우리 사회에서 환자의 주체적 역할과 자율성을 존중하는 방향을 반영하여 함께 변화되어 왔음을 확인할 수 있었다. 법원이 생명권이라는 최고의 가치만을 환자의 의사보다 더욱 우선하여 판단해오다가 적어도 명시적인 환자의 의사 또는 그렇지 못할 경우에 추정적 의사까지도 고려한 치료의 유보나 중단에 대하여 고려하기 시작한 것, 종교적 신념에 근거한 자기결정권의 행사로서의 수혈거부와 같은 치료거부에 대하여 충분한 정보에 근거한 치료거부의 몇 가지 적법한 요건들을 인정하기 시작했다는 것은 이후 우리나라 의료 환경에 적잖은 영향을 줄 것이고 의료현장에서 의료행위를 하는 의사들에게도 직 간접적인 지침이 될 것이다.

• 한국응급구조학회지
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• 제13권3호
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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.

• 대한임상독성학회지
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• 제3권1호
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• pp.33-39
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• 2005

Purpose: Nowadays the Korean society is in the center of time of the social change. Because of dissociation of traditional family, IMF (International Monetary Fund) crisis and economic recession, the mortality rate of suicidal attempts are increasing annually. The majority of suicidal attempts were by poisoning considering the characteristics of korean society. Therefore we studied to find out the characteristics of suicidal poisoning before and after social economic stress, and to suggest the direction for the proper management. Methods: We reviewed medical records of 547 patients of suicide by poisoning who visited the emergency medical centers of St. Mary's hospitals from 1997 to 2004. For the annual trends analysis, we analyzed the demographic and toxicologic data of these patients compared with before and after IMF crisis (1998) and the economic recession ($2003\~2004$). Results: At the time of IMF and the economic recession, the number of suicidal poisoning increased, especially in fifth decade. The refusal rate of toxicological emergency treatment increased. Also the mortality rate and the admission rate to ICU (Intensive Care Unit) increased during the same period. In the result of the comparison analysis, clinical severity and mortality of social problem group were higher. However they couldn't be treated appropriately because of financial problem and the family indifference. Conclusion: At the economic recession period, the severity of suicidal poisoned patients was high. But the refusal rate of toxicologic treatment also increased, so the patients had lost the chance for proper toxicologic treatment. Therefore they would be supported by medical institution and public health.

• 대한유전성대사질환학회지
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• 제18권2호
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• pp.50-54
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• 2018

Jehovah's Witnesses do not accept blood transfusions, because of their particular interpretation of the Old and New Testaments. When people with such religious convictions are in need of medical care, their faith and belief may become an obstacle for proper treatment, and pose legal, ethical, and medical challenges for the health care providers. We report two inherited metabolic disorder cases in South Korea where the infants died whilst under medical care because of parental refusal of blood transfusions for religious reasons. Case 1 had methylmalonic acidemia, Down syndrome and associated congenital cardiac anomalies requiring surgery. Case 2 had anemia and methylmalonic acidemia requiring dialysis to treat hyperammonemia and metabolic acidosis. For effective medical management, they needed life-saving blood transfusions. As a part of alternative treatment, Erythropoietin was administered in both cases. As a result, two babies died from their extremely low hemoglobin and hematocrit. The hemoglobin concentrations below 2.7 g/dL without cardiac problem and 5.4 g/dL with cardiac anomaly complicated by pulmonary hypertension are considered life-threatening hemoglobin threshold. The medical professional must respect and accommodate religious beliefs of the patients who can make informed decisions. However, when parents or legal guardians oppose medical treatment of their babies and incompetent care receivers on cultural and religious grounds, the duty to assist and save persons exposed to serious danger, particularly life-threatening events must come first.

• 중환자간호학회지
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• 제9권2호
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• pp.48-60
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• 2016

Purpose: The purpose of this study was to identify the attributes of the concept, of psychological resistance to antihypertensive medication. Methods: The study was conducted in accordance with Walker and Avant's conceptual analysis process. We reviewed 47 related studies selected from 4 international and Korean databases including Medline, CINAHL, NDSL, and RISS to perform the analytical processes from January 1980 to September 2015. Results: The attributes of psychological resistance to antihypertensive medication include 1) reservation, 2) opposition, 3) denial, 4) refusal, and 5) seeking alternative therapy. The antecedents of the concept can be classified into patient factors such as reactance trait and knowledge deficit, provider factors, interpersonal factors, and environmental factors. The consequences of psychological resistance to antihypertensive medication are non-compliance, deterioration of the disease, developing complications, increased anxiety, and changes in life. Conclusions: The concept of psycho logical resistance to antihypertensive medication can provide guidance for the development of an intervention program that promotes the compliance to medication regimen of hypertensive patients. Further research needs to be done to develop a measurement tool for psychological resistance to antihypertensive medication.