• Journal of Hospice and Palliative Care
• /
• v.12 no.1
• /
• pp.20-26
• /
• 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.

• Journal of Hospice and Palliative Care
• /
• v.14 no.2
• /
• pp.91-100
• /
• 2011

Purpose: This study was performed to investigate patients' preferences on receiving life-sustaining treatments (LST) and to analyze the relationship between patients' characteristics and LST selection. We also examined any discrepancy between LST patients' choices regarding medical intervention and actual medical intervention given/not given within 48 hours before death. Methods: This cross-sectional study was performed from March 1, 2008 to August 31, 2008 in the Palliative Care Unit of Korea University Hospital. Electric medical records (EMR) of 102 hospice cancer patients were reviewed, and 74 patients with Glasgow coma scale (GCS) ${\geq}$10 at the time of signing the advance medical directives (AMD) were selected for the first analysis. Then, patients alive at the end of this study, transferred to other hospitals or dead within 48 hours were excluded, and the remaining 42 patients were selected for the second analysis. Results: Preferred LST included antibiotics, total parenteral nutrition, tube feeding, transfusion, and laboratory and imaging studies. The relationship between patients' characteristics and LST could not be analyzed due to skewed preferences. LST chosen at the time of signing the AMD and actual medical intervention given/not given in the last 48 hours showed discrepancy in most cases. Conclusion: When making AMD in hospice cancer patients, it is important to consider the time and possibility of changing the choices. Above all, patients must fully understand the AMD. Thus, LST should always be provided with careful consideration of all possibilities, because legal and social aspects of AMD have not been established yet.

• Journal of Internet of Things and Convergence
• /
• v.6 no.1
• /
• pp.45-53
• /
• 2020

This study aimed to examine the relationship of the knowledge of end-of-life(EOL) care, life-sustaining treatment(LST), and advance directive(AD) with the educational needs regarding AD writing among nurses in convergence era. For this cross-sectional study, participants were 169 nurses at a general hospital in South Korea. Data were collected from July 19 to 26 in 2018 using structured questionnaires. Knowledge on EOL care scored 8.56 out of 11 points, knowledge on LST scored 5.11 out of 6 points, and knowledge on AD scored 8.02 out of 9 points. Educational needs regarding AD writing scored 4.31 out of 5 points. There were statistically correlations between knowledge on LST and educational needs regarding AD writing (r=.182, p=.018), and between knowledge on AD and educational needs regarding advance AD writing (r=.234, p=.002). The findings can be used to develop the educational program regarding AD.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.20 no.9
• /
• pp.432-439
• /
• 2019

This study was a qualitative study that attempted to find out the meaning of preparation for dying well that the elderly think through a question of how to prepare for dying well. The focus group interview was conducted on 10 elderly people aged 65 or older who visited the elderly welfare center in B city, Gyeonggi-do, and a total of two groups were interviewed with five subjects as one group. As a result, eight themes were drawn from four dimensions of physical, psychological, social, and spiritual aspects. In physical preparation, 'health management' and 'doing what you want to do' were derived. In psychological preparation, 'not regretting' and 'giving to others' were derived, and in social preparation, 'organizing property', 'determining a place of death you wish', and 'writing a letter of advance life sustaining care directives' were derived. In spiritual preparation, 'relying on religion' was derived. The elderly were preparing for well-being in various aspects, and when developing a program for well-being, the program should be planned to prepare for actual death in various aspects.

• The Korean Society of Law and Medicine
• /
• v.9 no.2
• /
• pp.53-75
• /
• 2008

The end of life problem in the United States has been evolved from the development of concept of brain death over last 50 yr. The invention of ventilator and the development of emergency medicine also played a key role to elongate the end stage of life and which caused the American people to ask a question about the patients self determination and refusing the unwarranted medical treatment in the view of the death with dignity. With regard to the patient unable to self determination, surrogate decision was also considered. To guarantee the self determination, The patient self determination act also enacted on the level of Federal regulation in 1990s. But no law has effectively dealt with the situation when medical treatment became futile. Along with the significant debates on literature and court cases. The American Medical Association's Council on Medical and Judical Affairs presented formal opinion and the Texas was the first states to regulate the medical futile situation in 1999. Even though that definition was in controversy, the concept of medical futility mainly focused on the doctors' right to refuse the treatment.

• Clinical and Experimental Pediatrics
• /
• v.52 no.8
• /
• pp.843-850
• /
• 2009

A recent High Court's decision regarding the withdrawal of life supporting medical treatment (artificial ventilator) from an elderly female patient in the terminal stage has opened up a new era of the "euthanasia dispute" in Korea. With this decision, the legitimate withdrawal of life supporting treatment became possible under certain conditions and the Korean Medical Association is working toward the establishment of practical guidelines for the terminal-stage patients. However, there are still very few debates on the cases of pediatric patients in the terminal stage or suffering from fatal diseases. For pediatric patients, the core principle of autonomy and following procedure of "advance directives" are hardly kept due to the immaturity of the patients themselves. Decisions for their lives usually are in the hands of the parents, which may often bring out tragic disputes around "child abuse", especially in Korea where parents have exclusive control of the destiny of their children. Some developed countries such as the U.S.A., the U.K. and Canada have already established guidelines or a legal framework for ensuring the rights of the healthcare system regarding children suffering from severe illness, permitting the withdrawal of Life supporting medical treatment (LSMT) in very specific conditions when the quality of life of the children is severely threatened. For the protection of the welfare and interest of the children, we should discuss this issue and develop guidelines for the daily practice of pediatricians.

• Journal of Hospice and Palliative Care
• /
• v.23 no.2
• /
• pp.85-92
• /
• 2020

Purpose: In 2018, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented and the scope of official recognition for terminally ill patients was expanded. The purpose of this study was to investigate the decisions made by patients with end-stage liver disease about their life-sustaining treatment in a clinical setting. Methods: The subjects of this study were patients with end-stage liver disease hospitalized at a tertiary hospital in Seoul, Korea who wrote physician orders for life-sustaining treatment (POLST). Data collection was done using patients' electronic medical records, and a retrospective analysis of POLST was conducted. Results: Among 101 patients, 18.8% were female and 81.2% were male, and their mean age was 61.8 (±10.61) years. Sixty-three patients (62.4%) wrote their POLST by themselves. Three patients withdrew the POLST, of whom two did so for liver transplantation, and one did so for chemotherapy. Conclusion: This study shows that sufficient consideration of liver transplantation is needed for end-stage liver disease patients before making decisions on life-sustaining treatment. The self-determination of patients must be respected and effective guidelines are urgently needed.

• Korean Journal of Hospice Care
• /
• v.7 no.2
• /
• pp.26-41
• /
• 2007

There are three things that are not known to the human being. That is when, where and how one will die. Most people live ignoring death. However, elements of death linger everywhere. The purpose of this treatise is investigates about justification Deciding for Other directions. First, I will investigate about Deciding for Other directions, when patient can not decide own, I will do investigate agent's decision's problem. Second, These four principles provide the common ground for biomedical ethics. Principlism argue that a method using four principles can resolve controversies in bioethics. The method holds that there are four principles-respect for autonomy, nonamleficence, beneficence, justice- that articulate the necessary conditions of common morality for health care and bioethics. Beauchamp and Childress respond by arguing that the two problems are nc the meaning or interpretation but the process of specification. Third, So, Supplement four principles' problem to Levinas concept of the Other theory. Levinas concept of the Other is very resemblant with 'Love your neighbour as yourself." Christians believe that Love is above all and they act accordingly. They base this faith mainly upon the motto of "love your neighbour as yourself." Fourth. difficult part of Levinas concept of the Other is that there is no human to equal infinite sense of responsibility. Can be supplemented about this through cooperation of community. Four principles can be brought to bear on moral choices. And they asserts that each principles has weigh but they do not assign a priority weighting of ranking. All the principles are equal in moral decision making.

• Journal of Hospice and Palliative Care
• /
• v.24 no.3
• /
• pp.184-193
• /
• 2021

Purpose: This study attempted to develop clinical guidelines to help patients use hospice and palliative care (HPC) at an appropriate time after writing physician orders for life-sustaining treatment (POLST) by identifying the characteristics of HPC use of patients with terminal cancer. Methods: This retrospective study was conducted to understand the characteristics of HPC use of patients with terminal cancer through decision tree analysis. The participants were 394 terminal cancer patients who were hospitalized at a cancer-specialized hospital in Seoul, South Korea and wrote POLST from January 1, 2019 to March 31, 2021. Results: The predictive model for the characteristics of HPC use showed three main nodes (living together, pain control, and period to death after writing POLST). The decision tree analysis of HPC use by terminal cancer patients showed that the most likely group to use HPC use was terminal cancer patients who had a cohabitant, received pain control, and died 2 months or more after writing a POLST. The probability of HPC usage rate in this group was 87.5%. The next most likely group to use HPC had a cohabitant and received pain control; 64.8% of this group used HPC. Finally, 55.1% of participants who had a cohabitant used HPC, which was a significantly higher proportion than that of participants who did not have a cohabitant (1.7%). Conclusion: This study provides meaningful clinical evidence to help make decisions on HPC use more easily at an appropriate time.

• The Korean Journal of Health Service Management
• /
• v.12 no.4
• /
• pp.191-202
• /
• 2018

Objectives: The purpose of this study was to identify the factors influencing factors university students' will toward brain death organ donation. Methods: Data from 250 students were collected using a structured questionnaire. The data were analyzed using a chi-squared test, independent t-test, and binary logistic regression with the SPSS 23.0 program. Results: Factors influencing will of brain death organ donation were announcing to decision to engage in brain death donation(Confidence interval(CI)=3.02-32.14, p<.001), experience of having discussed brain death organ donation with others(CI=1.26-5.72, p=.011), intention to make advance directives(ADs)(CI=1.90-9.57., p<.001), and positive attitude toward ADs(CI=1.05-1.29, p=.004). Conclusions: The most important factors affecting the will of brain death organ donation were making an informed decision regarding organ donation, intending to make an AD, having engaged in organ donation conversation, and a positive attitude toward ADs.