bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal DIT Study of the Moral Judgments of Student Nurses at One University in Korea
Authors: LEE Mi-Aie
Published: May 2019

This study was performed to measure the moral judgment (P(%) and 4-stage) scores of student nurses four times over a three year period and to identify any statistically significant changes in participants’ scores. Data were collected through self-reported questionnaires from student nurses at one university in Korea from September 2005 to September 2008. The Korean version of the Defining Issues Test (DIT) was adopted to evaluate the moral judgment (P(%) and 4-stage) scores of participants. The results were as follows: 1) Participants’ consecutive P(%) scores were 45.81, 48.92, 42.69, 40.45, with of a mean of 44.74; and their consecutive 4-stage scores were 12.51, 12.78, 14.93, 17.08, with a mean of 14.15; and 2) the scores of P(%) rose until participants reached their 2nd grade, but then started to fall when they reached 3rd grade and continued to fall in the 4th grade, while the scores of 4-stage increased steadily during the study period. These moral judgment scores, especially those for 4th grade students, are very similar to the scores for Korean nurses. It is concluded that the moral judgment of student nurses is affected by nurses during their practical training. This study suggests that there is a need to develop the moral judgment of student nurses and nurses in nursing education and practice.
Ethical Considerations in Articles Published in Nursing Journals*
Authors: JEONG Ihnsook , UM Young Rhan , KIM Keum Soon
Published: May 2019

Purpose: The purpose of this study is to identify the presence/absence of ethical considerations in the published articles of nursing journals.
Methods: The ethical considerations of 331 articles published in six nursing journals having ethical considerations in their “instructions for authors” were examined. The following ethical considerations were reviewed: compliance with the Helsinki Declaration, approval of an independent ethical review committee (IRB), informed consent, protection of privacy and confidentiality, and the notification of conflicts of interest.
Results: Two hundred and seventy three of 331 (82.2%) articles had at least one ethical consideration, the most common of which was obtaining informed consent (80.1%). However, none of the articles included compliance with the Helsinki Declaration, and only 15.7% of the articles included obtaining written informed consent. The articles written in English showed more ethical considerations than those written in Korean in the aspects of IRB approval (p<0.0001) and obtaining written informed consent (p=0.050). For research methodology, qualitative studies had more ethical considerations than experimental studies or surveys in terms of protecting privacy and confidentiality (p=0.022) and obtaining written informed consent (p=0.011).
Conclusion: The ethical considerations in the articles published in the nursing journals examined did not fully reflect the ethical considerations listed in the journals’ instructions for authors. This study suggests that editors should pay greater attention in determining whether or not articles published in their journals follow the ethical considerations in their instructions for authors.
Reflections on the Ethics of Withdrawing Life-prolonging Medical Treatment: The Decision of the Seoul Western District Court
Authors: LEE Dong-Ik
Published: May 2019

This article examines the ethical issues involved in a recent decision of the Seoul Western District Court stating that a hospital in Seoul has an obligation to comply with a request made by the family of a 76-year-old female patient to remove the patient from the respirator on which she is dependent. This article defends the following claims concerning this court decision: 1) that removing the respirator from this patient is not a form of euthanasia; 2) that the removal of the respirator does not infringe the patient’s right to treatment; 3) that the free will of the patient may have been respected, even though there was no written consent; and 4) that the court’s decision does not acknowledge the right to death of the patient. The article also examines the concept of death with dignity, since the removal of a respirator that meaninglessly prolongs a patient’s life has implications for a dignified death. When treatment merely delays the time of death, it is more of a source of pain for the patient than it is a form of medical treatment. Hence it is inhumane. However, even in these cases “ordinary treatment” should not be neglected.
Killing or Letting Die? On the Intended Act of Anticipating Death
Authors: KIM Moon-Jeong
Published: May 2019

The question of what is a “good” and “dignified” death for a terminally ill patient is difficult to answer. The Code of Medical Ethics of the Korean Medical Association forbids physicians from participating in euthanasia. The code also approves of the withholding or withdrawal of life-sustaining medical treatment in certain conditions. Most legal experts seem to believe that while active and direct euthanasia is not permissible, passive euthanasia or “death with dignity” is acceptable. Indirect euthanasia as an anticipated side-effect, in which the patient dies as a result of analgesic treatment administered to alleviate pain, is legally permitted. There are various considerations that help to justify indirect euthanasia, such as the absence of an intention to murder and its acceptance as a form of permitted risk. This article examines some of the legal and ethical issues associated with indirect euthanasia and intended acts of willful negligence.
A Patient’s Right to Know and Self-Determination
Authors: AHN Seon-Hwa , KIM Yong-Soon , YOO Moon-Sook , BANG Kyung-Sook
Published: May 2019

Purpose: The purposes of this study were a) to examine the level of awareness among patients of their right to know and their right to self-determination, and b) to determine the relationship between patients’ awareness of these two rights.
Method: For this descriptive-correlational study, participants were recruited at the endoscopic examination rooms of two university hospitals. Responses to self-report questionnaires were collected from 236 participants from 20 December 2007 to 10 November 2008.
Results: On the basis of a five-point scale, the average scores were 3.67 for patients’ awareness of their right to know and 2.81 for their awareness of their right to self-determination. The relationship between their awareness of these two rights was not significant. The recognition of a patient’s right to know was higher among those with a college education. Awareness of a patient’s right to self-determination varied according to age, education level, and economic status.
Conclusion: There is an insufficient awareness among patients of their rights to know and to self-determination, especially for those with a lower education. Nurses should consider a patient’s right to know when providing medical treatment and to assist their right to self-determination. Systematic educational programs on patients’ rights need to be developed for both patients and medical personnel.
Patient and Family Determination in Medical Decision-making
Authors: Lee Sang Mok
Published: May 2019

Medical decision-making is influenced by a variety of factors, including cultural norms, regional practices, patient values, physician responsibilities, and patient autonomy. Whether or not a patient’s family members should also influence the medical decision-making process is a legitimate question. This article defends the view that it is appropriate to involve families in the medical decision-making process at least in those cultures in which the family is the dominant social unit; in such cultures, it is necessary to recognize the rights of a patient’s family in making medical decisions.
A Study of the Attitudes of Patients, Family Members, and Physicians toward the Withdrawal of Medical Treatment for Terminal Patients in Korea
Authors: KWON Ivo , KOH Younsuck , Ho Yun Young , HEO Dae Seog , SEO Sang Yeon , KIM Hyeonchul , CHOI Kyungsuk , BAE Hyuna , AHN Kyungjin
Published: May 2019

A survey was conducted from September to December 2008 to examine the attitudes of patients, family members, and physicians toward the withdrawal of medical treatment for terminal patients and other related issues. The subjects for the study were 91 cancer patients, 96 family members of cancer or other terminally ill patients, and 140 physicians. Most subjects acknowledge the need for an appropriate regulatory framework for the withdrawal of treatment for terminal patients. However, some discrepancies were found among the different groups (patients, family members, physicians) in this study. Patients showed a stronger preference for the withdrawal of treatment than did family members. Also, most patients claimed they wanted to receive the diagnosis of a terminal illness from their physician, while most family members seem to think it is their own duty to convey such a diagnosis to the patient. Both groups prefer co-decision-making about the withdrawal of treatment over individual decision-making by the patient. However, most family members admit that they do not know much about the patient’s wishes and lack the time for sufficient conversation with the patient. Physicians are skeptical of the authenticity of the decisions made by family members, and some physicians also regard hospital ethics committees as being ineffective for resolving these issues. The results of this study paint a unique picture of clinical culture in Korea, where family members still exert strong influence on clinical decision-making and little information is shared between patients, family members, and physicians. The study points to a need for greater public education in Korea on the practical and ethical issues surrounding the withdrawal of treatment for terminal patients.
지구촌 생명윤리정책 개발의 전제조건들 : 어떤 목적, 태도, 노력 및 체계가 필요한가?
Authors: CHOI Kyungsuk
Published: May 2019

혹자는 <생물학 및 의학 적용에 있어 인권과 인간존엄 보호를 위한 EU 협약>의 한계를 지적하며, 생명윤리 쟁점들에 대한 지구촌 정책은 모호함과 비일관성을 지니고 있다고 주장한다. 그러나 의·생명과학 연구의 세계화와 그에 따른 생명윤리 쟁점의 세계화로 인해, 지구촌 차원의 생명윤리정책을 개발할 필요성이 대두되고 있다. 지구촌 생명윤리정책은 중첩적 합의에 기초하여 개발될 수 있다. 중첩적 합의는 모든 사회 구성원들 사이에서 의견의 일치를 보이는 견해로서 생명윤리문제를 다룸에 있어 최소한의 기준을 제공해 준다. 뿐만 아니라 지구촌 생명윤리정책은 생명윤리에서 우리가 추구하는 이상과 가치가 무엇인지 알게 해 준다. 이런 점에서 지구촌 생명윤리정책은 윤리적 관점에서 일종의 구속력을 행사한다. 이러한 지구촌 생명윤리정책을 개발하기 위해서는 관용과‘이성적임(reasonableness)’이란 태도를 요구한다. 이것들은 이성적 불일치가 종종 목격되는 다원주의 사회에서 우리들이 견지해야 할 덕으로 간주된다. 생명윤리정책의 개발에 있어 토론과 토의는 필수적이다. 왜냐하면 토론과 토의는 무엇이 이성적 불일치를 야기하는지 알려주고 이견을 지닌 사람들 서로를 이해하는 데 도움을 주기 때문이다. 또한 우리는 하나의 학제적 학문 분야로서‘생명윤리정책’을 연구하고, 문화적 차이를 고려하며 생명윤리문제를 연구하는 문화 생명윤리학 연구를 증진해야 한다. 새로운 학문분야로서의 생명윤리정책은 생명윤리의 쟁점에 대한 개인적 차원의 윤리적 해답을 얻는 데 그치지 않고, 사회적 차원의, 나아가 지구촌 차원의 해답으로서 무엇이 바람직한지 연구한다. 아울러 지구촌 생명윤리정책 개발을 위해 우리는 국제적 의사결정기구, 국가간 전문가들 사이의 네트워크, 토론을 위한 정기회의 개최 등의 협력 체계를 구축해야 한다.
Justifying the Information on Hospice Care that octors should provide to Terminally Ill Patients
Authors: CHEONG Ha-Yoon , SOHN Myoung-Sei , Heo Dae-Seog , Lee Won-Hee
Published: May 2019

This article identifies the two key functions that doctors should perform prior to accepting erminally ill patients’ requests for hospice care. In the first place, doctors caring for terminally ill atients should inform relevant family members of the patient’s condition, provide patients and family members with information on hospice care, and offer patients an opportunity to choose to receive hospice care or not. Secondly, doctors should consult with other medical professionals concerning patients’ choices and, when appropriate, provide hospice care needs for terminal patients and their families. In order to perform these two functions effectively, doctors caring for terminally ill patients should be provided with due information on hospice care. This article reviews the relevant moral justifications for providing hospice care and argues that it not only satisfies both medical and ethical objectives but is also in terminal patients’ best interests.
Attitudes and Experiences Regarding Stem Cell Research Among Korean Researchers in the Life Sciences
Authors: Kim Hee-Jung
Published: May 2019

Purpose: This study examines the attitudes, experiences, current situations, and educational needs of researchers in the life sciences in order to develop an educational program for stem cell related research ethics.
Method: A total of 275 researchers in the life sciences participated in this study. The instrument used was a self-reporting Likert-type questionnaire consisting of 38 assumptions related to ethical issues in stem cell research.
Result: The average score of subjects’ attitudes toward stem cell research was 3.26±0.50. The items that received a positive response were ‘Informed consent,’ the ‘Moral superiority of adult stem cell research,’ and the ‘Ethical control of science.’ Items showing a negative response were ‘Prohibitions on the use of remaining fetal tissue,’ ‘Restrictions on the replication of animals,’ and ‘Prohibitions on hESC research.’ Age, gender, and religion were found to influence attitude scores. Additionally, only 37.8% of respondents had received some form of stem cell ethics education, but most agreed with the need for such education.
Conclusion: Stem cell researchers should identify ethical problems related to stem cell research in each specialized area within the life sciences. Furthermore, there is a need to develop well-designed and integrated stem cell ethics education programs for stem cell researchers and students in the life sciences and medicine.
The Concepts and Discussions about Medical professionalism in Korea
Authors: Kang Yunesik
Published: May 2019

There are high dissatisfactions and crisis perceptions about socioeconomic status of physicians among Korean physicians. Determining which is profession distinguished from general occupations is not easy, meanwhile theoretical and systematic knowledge, professional ethics and society, service-oriented trait and high job autonomy are general characteristics of profession. considering these characteristics, Physicians are typical profession in Korea.
There are two different perspectives about physician as a profession. First is structural functionalism. In this perspective, medical knowledge itself implies the legitimation of medical profession and its social status. In contrast, social status of medical profession is determined by the way how medical knowledge is constructed socially rather medical knowledge itself in perspective of confliction theory.
High job pride and low ethical consciousness, sensitivity for group interest and insufficient social contact skill, confusion about job identity and anxiety for the future are current situation of Korean physicians roughly.
Nowadays, reflective education about society and medicine, humanistic training for understanding of human and medicine is required in training of physicians in medical school.
One reason to discuss about medical professionalism is to get trust from general citizens and to have a rational status of medical profession through it. This can not be achist d by short-term remedies, but is a long term work can be done by reflections and efforts of all medical doctors. Therefore, the issue of medical professionalism should be pursued and discussed thoroughly and the future of Korean physicians status would be influenced deeply by these activities.
Understanding the Attitude of Korean Adults toward Dignified Dying: Q-Methodological Approach
Authors: Jo Kae Hwa , Kim Gyun Moo
Published: May 2019

Purpose: The purpose of this study was to analyze attitude that Korean adults have toward dignified dying.
Method: The study employed a Q-methodology, which provides a method of analyzing the subjectivity of test items. Thirty-four selected Q-statements from each of the 34 subjects were arranged in a normal distribution using a 9-point scale. The collected data were then analyzed using a QUANL PC program.
Result: Three types of attitudes toward dignified dying were identified. Type I is a positive self-recognition. These types of people thought positively and was said to be happy and thankful for the time of death. Type II is a rational comport-orientation. These type of people accepted death and want peaceful dying. Type III is emphasis on the supportive relationship. These types of people want to die peacefully in the bosom of family members.
Conclusion: Understanding each type could be helpful that supporting and death education for Korean adult.
Research Ethics Education in Korean Dental Schools
Authors: Jung Jin-Hee , Park Hee-Kyoung , Bae Kwang-Hak , Jin Bo-Hyoung
Published: May 2019

This study was designed to investigate the state of research ethics curricula in undergraduate and postgraduate programs at dental education institutions in the Republic of Korea. Educators at 11 institutions participated in the study. Applying Delphi research methods, we evaluated the key elements of the current research ethics curricula at the participating institutions and the educators’ opinions concerning the necessity of dental research ethics. It was found that most of the participating dental schools focus on professional and/or medical ethics rather than research ethics in their educational programs. As such, there is a need for educational programs in the field of research ethics and the composition of a professional group for dental research ethics. We suggest that the main priority should be the development of an educational organization and special training programsin dental research ethics.
한국의 심폐소생술 금지(Do-Not-Resuscitate, DNR) 대한 통합적 고찰
Authors: Kim Sanghee , Lee Won-Hee
Published: May 2019

본 연구는 한국의 중환자 혹은 말기환자의 생애말기 결정의 하나로 널리 선택되고 있는 심폐소생술 금지(Do-Not-Resuscitate, DNR) 결정에 대하여 출간된 연구논문의 특성을 규명하고 심폐소생술 금지 결정과 관련된 특성을 고찰하고자 시도되었다.
연구방법으로는 통합적 문헌고찰을 적용하였고 연구대상으로는 1998년부터 2010년까지 3개의 한국 의료 데이터베이스에서 한국어로 쓰여진 심폐소생술 금지와 관련된 논문 20개를 찾아 분석하였다.
연구결과는 다음과 같다. 첫째, 한국에서 수행된 대부분의 심폐소생술 금지와 관련된 연구는 의료인들을 대상으로하여 서술적 조사연구로 이루어지거나 의무기록의 후향적 고찰을 통해 진행되어 왔다. 둘째, 연구논문의 결과를 통해 확인된 심폐소생술 금지와 관련된 주요 특성은 다음과 같다. 심폐소생술 금지 결정은 환자보다는 가족이나 의사에 의해 따라 결정되는 것으로 나타났고, 한국의 의료상황에서 심폐소생술 금지 결정에 영향을 미치는 요인으로는 의학적 무용성, 연령, 품위 있는 죽음, 및 경제적인 어려움을 포함하는 것으로 조사되었다.
본 연구의 결과가 의료분야에 시사하는 바는 다음과 같다. 첫째, 가족 중심의 한국 사회 문화에서 가족들이 환자의 심폐소생술 금지와 관련된 결정을 할 때, 환자의 소망과 선호도를 잘 파악하고 이를 따른 결정을 할 수 있도록 돕는 것이 필요하겠다. 둘째, 생애 말기에 처한 환자를 돌보는 여러 관련 의료인 중에 간호사는 환자의 가족과 의사 사이에서의 중간자 역할을 잘 수행할 책임이 있겠다. 셋째, 환자의 소망과 선호도에 관해 보다 적극적으로 의사소통을 하는 것은 현 상황에서의 의사결정 주체인 가족의 부담감을 줄이고 의료진의 도덕적 고뇌를 감소시키는 데에 도움이 될 것이다. 마지막으로 이러한 내용이 실무에서 잘 반영되기 위해서, 심폐소생술 금지와 관련된 추후 연구들은 환자를 포함한 연구대상, 다양한 연구방법론을 적용하여 더욱 활발히 이루어져야 하겠다.
Nurses’ Attitudes toward Stem Cell Therapy
Authors: KIM Hee-Jung
Published: May 2019

Purpose: This study examined the knowledge, attitudes, experiences, and educational needs regarding stem cell therapy of nurses in a Korean hospital in order to develop an educational program for stem cell therapy ethics.
Method: A total of 277 nurses participated in this study. The instrument used was a self-reporting Likert-type questionnaire consisting of 35 assumptions related to knowledge and attitudes regarding stem cell therapy and 20 assumptions related to subjects’ characteristics.
Result: For the knowledge level of stem cell therapy, the average score of all subjects was 9.97±4.13. For the attitudes towards stem cell therapy, items receiving positive responses included ‘informed consent’ and ‘oversight and control of stem cell research’; items receiving negative responses included ‘xenotransplantation of hESC’ and ‘cloning of human life.’ Knowledge levels concerning stem cell therapy were influenced by several factors including the following: age, education level, working experience, and need for stem cell education. Nurses who ranked higher in any of these categories tended to have more strict views on the ethical issues associated with stem cell therapy.
Conclusion: Nurses should have the ability to make ethical decisions in clinical situations requiring stem cell therapy. There is a need for well-designed and integrative education programs regarding stem cell therapy for clinical nurses working in Korean hospitals.
Influence of Physician-Pharmaceutical Industry Interaction upon Research
Authors: KIM Seong Who , HONG Jeong-Hwa , KIM Ock-Joo
Published: May 2019

This article examines the influence of physician-pharmaceutical industry interaction upon medical research. We analyze some of the problems arising from pharmaceutical companies’ sponsorship of clinical trials, such as biased results caused by multiple trials with predictable outcomes and publication biases. Furthermore, we propose specific measures to address and overcome these problems.
A Factor Analysis of the Impediments to End-Stage Medical Decision-Making as Perceived by Nurses and Physicians in South Korea*
Authors: JO Kae Hwa , AN Gyeong Ju , KIM Gyun Moo
Published: May 2019

Purpose: This study was designed to identify the impediment factors for end-stage medical decisionmaking as perceived by nurses and physicians in Korea.
Method: The subjects in this descriptive exploratory study were 82 nurses and 61 physicians working in university hospitals in the Korean cities of Daegu and Busan. Principal component analysis was implemented in the exploratory factor analysis study, where the eigen value 1 was used for the basis of factor extractor and Varimax rotation was used to divide the factors. The data were analyzed by a SPSS/WIN 15.0 program.
Result: The analysis of the impediment factors for end-stage medical decision-making revealed 15 statements and 5 categorized factors: legal compliance, prescriptive health professionals, interpersonal preparation, hospital systems, and ethical belief. These factors explained 66.84% of the total variance. Legal compliance was requested excessive roles and responsibilities of healthcare providers. Prescriptive health professionals were indicated reflection of paternalistic decision making type. Interpersonal preparation was claimed for readiness toward appropriate medical decision making issues among patient,families and healthcare providers. Hospital systems were showed inappropriate management of hospice palliative wards. Ethical belief was determined as an impediment factors for end stage medical decision making.
Conclusion: We divided impediment factors for appropriate end stage medical decision-making into 5 separate categories. There is a need for a formation of a decision making system that includes the patient - health professional - family which is based on promoting the free choice of the patient while providing an atmosphere of open communication between health professionals which will facilitate the decision making process. The results of this study may contribute to the development of a new endstage decision-making system that is appropriate for medical care in Korea.
Research Ethics and Bioethics Education in Biomedical Science
Authors: KIM Sang-Deuk
Published: May 2019

The purpose of this article is to inquire into the nature of research ethics in biomedical science and argue for the necessity of bioethics education. The article examines extrinsic problems, such as research misconduct (“FFP”), as well as intrinsic problems that arise in the process of carrying out biomedical research. Since bioethics refers to the moral problems that arise in biomedical science, there is an essential connection between research ethics and bioethics. In particular, this article argues that bioethics should be treated as a core component of research ethics education and, furthermore, that it is a violation of research ethics not to teach research ethics and bioethics within the field of biomedical science.
Level of Awareness, Self-efficacy and Knowledge of Research Ethics among Nursing Graduate Students*
Authors: OH Eui Geum , KIM Sang Hee , YOO Jae Yong
Published: May 2019

This study aimed to identify the level of awareness, self-efficacy, and knowledge of research ethics among nursing graduate students. A descriptive survey design was used. A total of 102 nursing graduate students were recruited from one nursing school in Korea. Data collection instruments were developed based on the core instructional areas of Responsible Conduct of Research (RCR) from the Office of Research Integrity at the research team’s institution. Participants completed a self-reported questionnaire consisting of questions on research ethics. The data were analyzed with descriptive statistics using PASW Statistics 18.0 Window program. Participants (mean age=31 years) consisted of master’s (77.5%) and doctoral (22.5%) level students. Only 25.5% of participants had taken a course in research ethics, and 26.5% of participants had experience conducting research as principle investigators. The level of awareness (mean score 2.91 out of 5) and self-efficacy for good research practice (3.15 out of 5) were moderate. The level of knowledge regarding research ethics was low (10.59 out of 16). The area of lowest awareness was ‘protection of intellectual property and patents,’ followed by ‘justifying authorship’;the area of least knowledge was ‘writing research articles,’ followed by ‘criteria for authorship.’ Statistically significant correlations were found between awareness, self-efficacy, and knowledge of research ethics (all p<0.05). These results support the conclusion that educational programs for enhancing awareness, self-efficacy, and knowledge of research ethics for graduate nursing students are needed in order to help students conduct ethically sound research.
A Legal Perspective on a Fetus’s Capacity for the Enjoyment of Rights
Authors: YOO Ji Hong
Published: May 2019

Although biotechnology plays an important role in modern medicine, it does give rise to a host of legal and ethical issues. This article examines the legal status of unborn life in order to establish the proper future direction of biotechnology. When Civil Law was first legislated, an “unborn life” was considered to be a fetus in a mother’s body and something generated by sexual intercourse. However, biotechnology has since changed the scope of that term. For instance, an embryo can now be created in number of ways in addition to sexual intercourse, such as in vitro fertilization and somatic cell cloning. Furthermore, biotechnology allows for the detection of the genetic identity and growth potential of a fertilized egg, which arguably supports the view that the legal status of an artificial embryo is equal to that of a fetus. The author of this article examines the legal status of fetuses in Civil Law. It is claimed that clauses of Civil Code for the protection of fetuses should be interpreted as exceptional provisions. It is also argued that a fetus acquires the capacity for enjoying private rights in utero and that Article 3 of the Civil Code should be revised to state that a human being is the subject of rights and obligations from fertilization and throughout survival.
An Analysis of Authoritarian Mechanisms in the Korean Medical Community and Medical Ethics Education in Korea with a Focus on Erich Fromm*
Authors: JEONG Chang Rok
Published: May 2019

This article examines some of the ethical issues associated with authoritarianism in the Korean medicalcommunity from the perspective of Erich Fromm. The article first describes the authoritarianism inthe Korean medical community using Fromm’s concepts of “alientation” and “escape.” The article thenintroduces Fromm’s concept of “activity” as a means of overcoming some of the problems with authoritarianismin the Korean medical community.
Can Paternalism Be Justified in the Name of Autonomy? : The Relationship of Paternalism, Patient Autonomy, and the Best Interest of the Patient*
Authors: CHO Sunwoo
Published: May 2019

In medical practice, the ethical principle of respect for patient autonomy sometimes clashes with the principle of beneficence. Whereas previously medical treatment was guided primarily by the objective of patient beneficence, in recent decades the right of patients to make their own medical decisions has received more emphasis, especially in western countries. At the same time, an increasing amount of attention has been given to the problems of beneficence-based, paternalistic interventions. Whether respecting patients’ autonomy should be ranked above the principle of beneficence has become one of the central questions of biomedical ethics. In an effort to answer this question, this article examines the discussion of Sjöstrand et al. on the possibility of justifying paternalism in the name of patient autonomy. It is argued that the problems of paternalism and neglect for patient autonomy stem from a misunderstanding of a patient’s best interest. Furthermore, it is claimed that patient autonomy should be thought of, not as an independent and rival consideration, but rather as a crucial part of the best interest of the patient.
Commentary:Ethical Issues on Critically Ill Patients
Authors: KIM DO KYONG
Published: May 2019

중환자실에서 치료를 받는 환자들은 의료에 절대적으로 의존해야 하는 취약한 상태에 처해 있다. 그들에게 의료윤리의 4원칙인 자율성 존중, 선행과 해악금지, 정의 원칙은 의료의 개입이 중요한 위기 시점에 있지 않는 환자들과 같을 수 없으며, 주로 더 복잡하고 첨예하게 얽혀서 갈등을 일으킨다.
The Ethics of Therapeutic Gene Editing Research
Authors: JUN Bang-Ook
Published: May 2019

The method of adding multiple copies of transgenes, which was adopted in early gene therapy, has had a variety of adverse effects as well as a problem of controlling experimental outcomes. The development of site-specific nucleases, specifically CRISPR-Cas9, has brought new promise to the field but has also given rise to ethical dilemmas. Pre-clinical research has been conducted to correct mutated genes by establishing induced pluripotent stem cells, and primary clinical research has been carried out on delivering gene editing tools and transplanting corrected cells to patients. Germline editing requires strict guidelines because it leads to permanent genetic change that will affect future generations. This article discusses how to avoid therapeutic misconceptions during translation from pre-clinical to primary clinical research, how to estimate the social risks and benefits often neglected in the risk/benefit analysis, and how to decide the specificity of gene targeting effects. In addition, this article addresses the status of embryos, a topic that is largely ignored in germline editing research. As gene editing technology advances, the legislation and regulations governing clinical practice based on conventional gene therapeutic research should be reconsidered.
The Ethical Leadership of Nurse Managers and Their Effects on the Perceived Ethical Confidence of Nurses
Authors: JUNG Min
Published: May 2019

The purpose of this study was to assess the ethical leadership of nurse managers and to identify their effects on the perceived ethical confidence of nurses. Participants were 219 nurses drawn from three general hospitals in South Korea. The data were analyzed using a descriptive analysis, t-test, ANOVA, Pearson correlation coefficient, and a stepwise multiple regression. The mean scores of seven ethical leadership factors are as follows: people orientation (3.23±0.69), task responsibility fairness (3.53±0.79), relationship fairness (3.93±0.86), power sharing (3.21±0.54), concern for sustainability (3.50±0.62), ethical guidance (3.35±0.63), and integrity (3.50±0.66). The mean score of perceived ethical confidence is 3.31± 0.52. The factors found to influence perceived ethical confidence are ethical guidance (β=.38), clinical career (β=.34), ethics education experiences (β=.17), with an explanatory power of 27.2%. The results of this study indicate that the ethical leadership of nurse managers affects the perceived ethical confidence of nurses. Thus, improving nurse managers’ ethical leadership and ethics education for nurses would likely increase their perceived ethical confidence.
The Development of an Educational Program for Improving the Ethical Problem-Solving Ability of Medical Students*
Authors: PARK Hye Jin , KANG E Cheol
Published: May 2019

The main educational objective of modern colleges of medicine is to nurture good doctors. Although all medical colleges in South Korea currently provide medical ethics education, these programs have not been designed systematically. The purpose of this study was to develop a model for improving the ethical problem-solving ability of medical students and to analyze its effects. The model requires students to engage in a variety of problem-solving activities, such as preparing materials, searching for information, collaborating with others, sharing information, examining options, and reflecting on results. The model was based on the principles and steps of case-based learning, discussion learning, cooperative learning, and moral teaching-learning model. The model was implemented in classroom settings and its effectiveness was analyzed with satisfaction surveys as well tests of students’ problem-solving abilities before and after the course. The survey results show that the professors and students were generally satisfied with the program (professor M=4.4, students M=4.2), and a T-test found a significant improvement (t=-3.34, p<.001) in students’ problem-solving scores following this course.
The Influence of Accepting Attitude toward One’s Own Death on Life Satisfaction: the Mediating Effects of Social Support
Authors: LEE Jong-Wook , WOO Young-Mi
Published: May 2019

This study analyzes the factors that affect life satisfaction of Korean elderly persons. In particular this study considers the question of whether having thought about one's own funeral procedure affects his or her life satisfaction. The study also attempts to verify direct effects and indirect effects, focusing on the mediator of social support. A sample of 10,451 cases were drawn from the “2014 Profiles and Welfare Needs of Elderly Persons,” conducted by the Korea Institute for Health and Social Affairs in cooperation with the Ministry of Health and Welfare. The results of the analysis indicate that while an accepting attitude toward one's own death does not show a meaningful relationship with one’s life satisfaction, the completely mediated effect of social support does have a meaningful relationship with life satisfaction. In other words, an accepting attitude toward one’s own death has an indirect influence on life satisfaction only by changes in social support. These results suggest that it is possible to improve life satisfaction of elderly persons by providing professional programs that diminish their anxiety toward death.
Levels of Concern and Other Factors Influencing the Awareness of Biomedical Ethics among Nursing Students
Authors: KANG Bok-Hee , WON Seon-Ae , KANG Hyun-Hee
Published: May 2019

This study was designed to assess the level of concern and awareness of biomedical ethics among nursing students and to identify the factors that might be influencing or correlated with nursing students’ level of awareness of biomedical ethics. Participants were 435 nursing students in one nursing college in South Korea. Data were analyzed using descriptive statistics, an independent t-test, a one way ANOVA, a Scheffé test, a Pearson Correlation, and a Multiple Regression. The most influential factor for awareness of biomedical ethics was concern of bioethics (β=.517, p<.000), followed by teaching methods (β=.129, p=0.02), age (β=.115, p=.004), desire to study ethics (β=.103, p=.011), interesting teaching methods (β=.096, p=.016), effective teaching methods (β=.090, p=.016) and information source (β=.079, p=.026). These factors accounted for 34.9% of the variance in awareness of biomedical ethics (F=158.279, p=.000). Using the results of this study strategies can be developed to increase the awareness of biomedical ethics among nursing students.
The Autonomy Capability Model of Medical Decision-Making*
Authors: SONG Yoon Jin
Published: May 2019

This article advances the Autonomy Capability Model as a new theoretical framework for understanding the concept of patient autonomy and the right to self-determination in medical decision-making. After clarifying the basic concept and approach of the Autonomy Capability Model, the article goes on to confirm the theoretical usefulness of this model and apply it to the medical decision-making process. The applicability of the Autonomy Capability Model in relation to medical decision-making at the end of life is examined. The concept of patient autonomy used in the medical field today is defined as “independent self-determination by a subject with sufficient decision-making ability,” and it is understood that anything that interferes with the subject’s inherent decision-making ability is to be excluded. However, in practice, a patient who makes a medical decision is a prescriptive subject who has the final authority to make decisions about his or her own health and body, while at the same time experiencing a dependent condition that requires medical treatment and care by others. Therefore, the patient’s autonomy cannot be reduced to the self-determination of individuals with the capacity for rational judgment. It is argued that medical decision-making should be understood as a continuous process that involves ongoing communication with medical staff.
Comparison of the Death Anxiety and Preferences for Care Near the End of Life between Nurses and Physicians*
Authors: CHO Kyoung-Hee , PARK Yong-Kyung , SUH Soon-Rim
Published: May 2019

The purpose of this study was to compare attitudes toward death anxiety and preferences for care near the end of life between nurses and physicians. Data were collected from 225 employees (150 nurses, 75 physicians) working in a tertiary hospital in South Korea. The study found a higher presence of death anxiety in nurses than physicians. Within the category of death anxiety, the “dying of others” was highest in nurses, whereas the “death of others” was highest in physicians. Among the five dimensions of the preferred care near the end of life, “pain” was the most preferred dimension while “decision-making by health care professionals” was the least preferred dimension for both nurses and physicians. Physicians preferred autonomous decision-making and decision-making by healthcare professionals; nurses preferred pain and spirituality. The results show that adequate pain relief is the most preferred care at the end of life for both nurses and physicians. This study indicates that nurses and physicians consider patient autonomy, pain control, and spirituality as important factors in end-of-life care. On the basis of these findings, we conclude that educational intervention programs are needed to reduce the death anxiety of nurses and physicians and thereby improve their terminal care performance.
The Current Status and Consideration for Nursing Ethics Education in South Korea
Authors: HWANG Hyeyoung
Published: May 2019

Although nursing ethics education in South Korea continues to expand quantitatively in terms of number of courses offered, the quality and satisfaction of the education remains low due to the lack of a systematic curriculum. Many nursing colleges offer lectures on nursing ethics as a modules in other courses instead of as an independent subject. The purpose of this study is to contribute to the development of nurses’ sense of professional ethics by examining the present state and problems of nursing ethics education in Korea and to suggest directions in which to expand and strengthen nursing ethics education. There are three types of problems with nursing ethics education in Korea: a lack of recognition of nursing ethics; imprecise definitions of nursing ethics; and a lack of nursing ethics experts. This study proposes an evaluation plan as follows. First, it is necessary for a deeper reflection and understanding on the nature of nursing ethics. Second, it is necessary to set the goals of nursing ethics education as an independent subject and to develop a standardized curriculum according to these established educational goals. Third, it is necessary to hire nursing ethics specialists who can accurately grasp the academic characteristics of nursing ethics. Finally, it is necessary to link ethics education between nursing colleges and the work of practitioners in the clinical field.
Artificial Intelligence and Medical Resource Allocation
Authors: JANG Un Hyuk , JEONG Chang Rok
Published: May 2019

While artificial intelligence (AI) offers the promise of liberating humans from mundane labor, it also has the potential to create an unemployment problem in various economic sectors, including the healthcare industry. Exactly how AI will or should be used within the context of healthcare has emerged as an important ethical question. This article shows how a surplus of human resources will arise from the introduction of AI in the healthcare system and explains how medical resource should be allocated. It is argued that the surplus of human resources caused by the introduction of AI in healthcare should be used for those patients that receive the fewest benefits from the healthcare system.
Revisions to the Korean Medical Association’s Code of Ethics and Self-Regulation Based on Medical Professionalism
Authors: PARK Seokgun , CHEONG Yooseok
Published: May 2019

In 2017, the Korean Medical Association (KMA) revised its Code of Ethics at the request of the Korean Society for Medical Education. Through this revised Code, which incorporates the concept of medical professionalism, the KMA hopes to strengthen and improve its self-regulatory powers. This article examines different aspects of self-regulation and explores the connection between self-regulation and medical professionalism. Using the examples of maintenance of competency and the management of conflict of interests, it is argued that medical professionalism is the goal of self-regulation. Additionally, since medical professionalism cannot be implemented through the efforts of individual doctors or even medical institutions without broader social support, it is suggested that society as a whole should be fully informed of the importance of self-regulation and medical professionalism.
A Three-fold Approach to Medical Ethics Education That Combines Quantitative and Qualitative Reasoning
Authors: JEON Dae Seok
Published: May 2019

This article consists of two parts: the first explores the content and purpose of medical ethics; the second explains some of the practical difficulties with medical ethics education while presenting relevant analytical methods based on logic and critical thinking. The development of Information and Communication Technology(ICT) has given rise to ethical issues in a number of areas, including the field of medicine. Recent research in medical ethics education tends to focus on quantitative reasoning, which has the advantage of being able to identify trends regarding which ethical theories are considered important to medical students. On the other hand, quantitative reasoning is limited in its understanding of the underlying reasons for such trends. There is also the criticism that medical ethics education lacks rigorous analysis and is simply reciting professional codes of conduct. As such, medical ethics education needs to establish a method that combines quantitative research with qualitative reasoning. Accordingly, in this article a three-fold approach to medical ethics education is developed and proposed, one that consists of three types of inferences or evaluations: intuitive-qualitative, quantitative, and analytical qualitative. The proposed approach is an effective and workable method for medical ethics education under the circumstances of limited time and restricted educational resources.
PENYULUHAN NILAI-NILAI PANCASILA KEPADA ORGANISASI SISWA INTRA SEKOLAH (OSIS) SEKOLAH MENENGAH KEJURUAN (SMK) NEGERI 39 JAKARTA
Authors: Liany Lusy , Jufri Ely Alawiyah , Umardani Mohammad Kharis
Published: May 2019

Abstrak: Pancasila bagi masyarakat Indonesia bukanlah suatu hal yang baru dan asing. Pancasila terdiri dari lima sila yang tertuang dalam Pembukaan UUD 1945 Alinea ke-IV dan diperuntukkan sebagai dasar negara Republik Indonesia. Di Indonesia, pelaksanaan  pendidikan nasional diatur dalam UU No. 20 Tahun 2003 Tentang Pendidikan Nasional. Pasal 2 UU No. 20 Tahun 2003  menyebutkan bahwa: “Pendidikan nasional berdasarkan Pancasila dan Undang-Undang Dasar Negara Republik Indonesia Tahun 1945. Pada saat ini Pancasila seiring dengan perkembangan dan perubahan zaman yang begitu pesat dan kompleks yakni di era globalisasi ini,moralsiswa-siswi Indonesia mulai dipertanyakan. Di tengah hegemoni media, revolusi iptek tidak hanya mampu menghadirkan sejumlah kemudahan dan kenyamanan hidup bagi manusia modern, melainkan juga mengundang serentetan permasalahan dan kekhawatiran terhadap kepribadian bagi seluruh bangsa Indonesia khususnya dalam hal ini para siswa-siswa. Untuk itulah, pemberian materi tentang nilai-nilai Pancasila kepada siswa-siswi mutlak diperlukan supaya para siswa-siswa agar dapat memahami nilai-nilai yang terdapat didalam Pancasila itu sendiri sehingga dapat menerapkannya dalam kehidupan berbangsa,bernegara dan bermasyarakat.Abstrak: Pancasila for the Indonesian people is not something new and unfamiliar. Pancasila consists of five precepts contained in the 1945 opening paragraph of all IV and designated as the foundation of the Republic of Indonesia. In Indonesia, the implementation of national education stipulated in Law No. 20 Year 2003 on National Education. Article 2 of Law No. 20 of 2003 states that: "The national education based on Pancasila and the Constitution of the Republic of Indonesia Year 1945. At this time Pancasila along with the development and the changing times is so rapid and complex that in this era of globalization, moralsiswa-Indonesian student was questioned. In the center of media hegemony, a revolution in science and technology is not only able to present a number of conveniences and comforts of life for modern humans, but also invited a spate of issues and concerns about the personality of the people of Indonesia, especially in this case the students. For this reason, the provision of material about the values of Pancasila to students is absolutely necessary in order for the students to understand the values contained in Pancasila itself so that it can apply in the life of the nation, the state and society.
PEMBERDAYAAN MASYARAKAT DESA LONG BILA DAN DESA PULAU SAPI KABUPATEN MALINAU MELALUI OPTIMALISASI POTENSI LOKAL MELALUI REVOLUSI MENTAL MEWUJUDKAN DESA MANDIRI DAN MELAYANI
Authors: Nugroho Endik Deni , Vlorensius Vlorensius
Published: May 2019

Kabupaten Malinau ditetapkan sebagai Kabupaten Konservasi di Kalimantan Utara, namun belum ada integrasi upaya konservasi dan pemanfaatan secara lestari atas sumber daya alam yang dimiliki. Salah satu program yang diterapkan oleh pemerintah Malinau yaitu Gerdema. Program ini merupakan pembangunan milik rakyat dengan agenda pemulihan ekonomi nasional yang berpihak pada masyarakat dalam mewujudkan kesejahteraan rakyat secara nyata. Program tersebut menuju ke arah pemberdayaan masyarakat desa yang kurang berkembang dalam model pembangunan, yang dilakukan secara terpadu, sinergis dan partisipatif dengan memanfaatkan sumberdaya potensi lokal tingkatan bawah seperti kepala desa sampai pemerintah kabupaten. Program kemintraan masyarakat (PKM) bertema Revolusi Mental dengan gerakan Indonesia Melayani dan Gerakan Indonesia Mandiri dapat membantu pemerintah desa dan Masyarakat. Metode yang digunakan dalam penelitian ini adalah metode parsipatoris. PKM berbasis revolusi mental dengan gerakan Indonesia melayani terfokus pada perbaikan administrasi dan peningkatan kualitas Sumber daya Manusia dan keterbukaan akses informasi publik, kegiatan tersebut mengandung nilai-nilai strategis instrumental revolusi mental yaitu Integritas dan Etos Kerja. Sedangkan gerakan Indonesia mandiri terfokus pada pada pemanfaatan potensi sumber daya alam daerah tertinggal, Mendukung dan mendorong kewirausahaan serta ekonomi kreatif memberdaakan potensi lokal menjadi ekowisata, Sosialisasi produk-produk dalam negeri yang berpotensi untuk dikembangkan. Berdasarkan hasil data masih banyak masyarakat dan perangkat desa yang menggunakan puas dan memahami gerakan revolusi mental Indonesia bersih  sebanyak 90%.