• 한국임상약학회지
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• 제31권2호
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• pp.145-152
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• 2021

Background: The Life-Sustaining Treatment Decision-Making Act has allowed anyone aged 19 or older to sign an Advance Directive not to receive life-sustaining treatment when they are in the 'death process'. Recently, the Korean Pharmaceutical Association announced to raise awareness of the Advance Directive to the general public through community pharmacies across the country. This study aimed to investigate the public's willingness to accept pharmacist's consultation regarding the Advance Directive and to present future directions to pharmacists Methods: This cross-sectional questionnaire study using 16-items was conducted in adults, Study subjects were recruited by convenience sampling method during August 5-15, 2020. Results: Of 460 respondents, 51.7% were younger than 30-year-old and 58.7% were not in the healthcare field in terms of job or major. 60.2% knew about the Advance Directive and 81.7% agreed the necessity to sign when healthy. 50.0% had the willingness to consult with pharmacists on the Advance Directive for well-dying and 80.4% preferred verbal explanation together with written information. Simple linear regression analysis results showed a significant relationship between trust in pharmacists or satisfaction with pharmacist's communication and willingness to use pharmacist' consultation on the Advance Directive (1-point increases in values measured on a five-point scale are associated with 0.464 and 0.486 increases, respectively.) Conclusion: This study suggests that pharmacists need to improve the public's trust and communication capability to satisfy with public's demands on well-dying service.

• 의료법학
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• 제14권1호
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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.

• 사물인터넷융복합논문지
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• 제6권1호
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• pp.45-53
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• 2020

본 연구는 일 종합병원 간호사의 임종기 치료, 연명치료, 사전의료의향서에 대한 지식과 사전의료의향서 작성에 대한 교육요구도의 상관관계를 확인하는데 그 목적이 있다. 연구의 대상자는 서울시 소재 일 종합병원에 근무하는 임상경력 3개월 이상의 간호사 169명이다. 자료수집기간은 2018년 7월 19일부터 7월 26일까지였고, 수집된 자료는 SPSS/WIN 23.0을 이용하여 분석되었다. 간호사의 임종기 치료에 대한 지식은 8.56±1.61점(11점 만점), 연명치료에 대한 지식은 5.11±0.94점(6점 만점), 사전의료의향서에 대한 지식은 8.02±1.33점(9점 만점)이었고, 사전의료의향서 작성에 대한 교육요구도는 4.31±0.58점(5점 만점)이었다. 사전의료의향서 작성에 대한 교육요구도는 연명치료에 대한 지식수준이 높을수록 높았고(r=.182, p=.018), 사전의료의향서에 대한 지식수준이 높을수록 높은 것으로 나타났다(r=.234, p=.002). 본 연구결과는 향후 사전의료의향서 교육프로그램 개발을 위한 기초자료를 제공하는데 그 의의가 있다.

• 중환자간호학회지
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• 제13권1호
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• pp.27-43
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• 2020

Purpose : This integrative review aimed to synthesize studies on intensive care unit (ICU) nurses' attitude, perceptions, and experiences toward end-of-life care decision-making. Methods : Using Whittermore and Knafl (2005)'s methods, we identified and synthesized research articles published in domestic journals between the years 2003 and 2019 and evaluated the quality of selected articles using the Mixed Methods Appraisal Tool. Results : In the 13 studies reviewed, 12 were published prior to enactment of the "The Act for Hospice and Palliative Care and Decision-Making about Life-Sustaining Treatment (2018)." All nine quantitative studies identified were based on cross-sectional descriptive survey. In four qualitative studies, content analysis (n=2) and phenomenology (n=2) were used. Overall, ICU nurses were well-aware of the necessity of communicating and limiting life-sustaining treatments. Many ICU nurses had positive attitude towards limiting life-sustaining treatments to promote patients' comfort and dignity. Although nurses were willing to take active roles, they also reported having experienced high stress in the process of decision-making and implementation. Conclusions : It is important to prepare ICU nurses with proper knowledge and attitude regarding the topic area. It is also equally important to develop systems to support nurses' emotional stress and moral distress during communication, decision-making, and implementation.

• 의료법학
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• 제11권2호
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• pp.239-274
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• 2010

Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. Firstly, the theoretical limitations of Advance directive may be categorized into conceptual and moral limitations. In case of conceptual limitations, authors of advance directives may not be well aware, in advance, of the particular situation in which he or her will experience in the future, and patients may experience the change in his or her values and lack the understanding and information about the future situation due to the changes in treatment methods. In case of moral limitations, a patient has a limited moral autonomy right and self identity that have an impact on his or her preference. Secondly, in case of practical constraints for advance directive, there exist cultural features, low ratio of documentation, as patients themselves admit, and low predictability and stability of patient's own preference regarding life-sustaining care. And the problem of validity and accuracy in proxy's decision making is also raised. Those who administer a living will, especially, may have a difficulty in understanding the directive by a patient, so that the accuracy of execution cannot be secured. In the sense, it is needed to implement a legal device in order to solve such problems. In summary, it is urgently required to understand the limitations and explore desired alternatives to overcome the relevant problems in advance, which must contribute to successfully adopting and effectively operating the advance directive system in Korea.

• Journal of Hospice and Palliative Care
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• 제14권2호
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• pp.91-100
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• 2011

목적: 이 연구는 첫째, 입원 당시 호스피스 암환자들이 작성한 사전의료의향서를 통해 연명치료에 대한 선호 및 호스피스 암환자들의 특성과 연명치료 항목간의 관련성을 분석하며, 둘째, 호스피스병동 입원 시 작성한 사전의료의향서의 내용과 임종 48시간 이전에 시행되었던 의료중재간의 일치 여부를 평가하는 데 있다. 방법: 2008년 3월 1일부터 8월 31일까지 대학병원 완화의료센터에 입원하여 사전의료의향서를 작성한 호스피스 암환자 102명의 전자의무기록을 검토하여, 그 중 사전의료의향서 작성 당시 의식이 명료했던($10{\geq}GCS$) 74명을 대상으로 선택항목에 대한 빈도와 환자의 어떤 특성이 항목선택 요인으로 작용하는지 단변량 로지스틱 분석을 통하여 알아보았고, 그 중 사망한 42명을 대상으로 환자의 선택과 의료중재의 일치 여부를 대상자 별로 나누어 빈도로 나타내었고, 항목별로는 맥네마 검정을 시행하였다. 결과: 환자들은 항생제, 정맥영양, 경관영양, 수혈, 검사실 검사 및 방사선 검사를 연명치료로서 선호하였다. 환자의 특성과 연명치료 선택과의 상관관계는 연명치료에 대한 편향된 선호로 인해 분석할 수 없었다. 사전의료의향서 작성 당시 환자가 선택한 연명치료 여부와, 사망 48시간 이전에 실제로 시행되거나 시행되지 않은 연명치료는 거의 모든 경우에서 불일치를 보였다. 결론: 호스피스 암환자들에게 있어서, 사전의료의향서의 작성은 그 시기도 중요하지만, 환자, 보호자 및 대리인의 선택이 바뀔 수 있음도 고려해야 하고, 가장 중요한 것은 사전의료의향서에 대하여 작성자가 충분히 이해하고 있는 가이다. 따라서 사회적, 법적 제도화가 이루어지지 않은 현 시점의 연명치료는 모든 가능성을 염두에 두고 항상 신중하게 이루어져야 한다.

• 호스피스학술지
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• 제7권2호
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• pp.26-41
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• 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
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• 제24권3호
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• pp.184-193
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• 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.

• 한국산학기술학회논문지
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• 제16권1호
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• pp.397-407
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• 2015

본 연구는 일상생활이 가능한 65세 이상 노인에게 연명치료중단 교육프로그램을 적용한 후 대상자들의 심폐소생술 금지(Do-Not-Resuscitate, DNR)에 대한 지식, 태도 및 시행의지에 미치는지 효과를 규명하기 위한 목적으로 시도 되었다. 연구대상은 S시에 소재한 J복지관출석 노인 총 40명 이었고 자료수집은 2012년 10월 2일에서 동년 11월 9일까지 진행되었다. 실험군에게는 연명치료중단 교육프로그램을 1회당 50분, 주 2회, 3주에 걸쳐 실시하였으며, 대조군에게는 시간차를 두고 설문지만 작성하게 하였다. 연구결과 연명치료중단 교육프로그램을 실시 후 DNR 지식점수(F=4.158;p=.049)와 DNR 태도점수(F=39.60; p=.001)는 실험군이 대조군에 비해 유의하게 높았다. 또한 연명치료중단 교육프로그램 실시 후 DNR 시행의지 점수는 형제자매(p=.344), 자녀(p=.109)를 제외한 본인(p=.006), 배우자(p=.039), 부모님(p=.006)에서 실험군이 대조군에 비해 유의하게 높았다. 이상의 연구결과로 연명치료중단 교육프로그램이 일반 노인의 DNR 지식, DNR 태도 및 형제자매, 자녀를 제외한 DNR 시행의지에 영향을 미치는 것으로 나타났으며 추후 노인들의 DNR 의사결정을 돕기위한 자료로 활용될 수 있겠다.

• 한국산학기술학회논문지
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• 제20권9호
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• pp.432-439
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• 2019

본 연구는 웰다잉을 어떻게 준비하고 있는가에 대한 질문을 통해 노인들이 생각하는 웰다잉을 위한 준비의 의미를 알아보기 위해 시도된 질적 연구이다. 경기도 B시의 노인복지관을 방문하는 65세 이상의 노인 10명을 대상으로 포커스그룹 인터뷰를 진행하였으며, 5명의 대상자를 한 그룹으로 하여 총 2그룹을 인터뷰 하였다. 연구결과 노인들은 신체적, 심리적, 사회적, 영적 준비 영역 4개 차원에서 웰다잉을 준비하고 있었고, 각 차원에서 총 8개의 주제가 도출되었다. 신체적 준비에서는 '건강 관리하기', '하고 싶은 것 하기'가 도출되었고, 심리적 준비에서는 '후회하지 않는 마음 갖기', '주변 사람에게 베풀기'가 도출되었다. 사회적 준비에서는 '재산 정리하기', '희망하는 죽음의 장소 정하기', '사전 연명의료 의향서 작성하기'가 도출되었으며, 영적인 준비에서는 '종교에 의지하기'가 도출되었다. 노인들은 웰다잉을 위해 하나의 측면이 아닌 신체적, 심리적, 사회적, 영적의 다양한 측면에서 웰다잉의 준비를 하고 있었다. 따라서 웰다잉을 위한 프로그램 개발 시 다양한 측면에서 실제적인 죽음 준비가 이루어지도록 프로그램이 기획되어야 할 것이다.