bluuebunny/crossref_metadata_2025 huggingface dataset:
Legal Issues Concerning the Competence of Minors in Clinical Investigation
Authors: Ryoo Hwa-Shin
Published: May 2019

This article examines some of the legal issues associated with consent and the competence of minors. A study was designed to evaluate the self-decisions of competent minors who are regarded as vulnerable subjects. The study begins with the Grimes Case (Grimes versus Kennedy Krieger Institute, Inc., 2001), which has established some special relationship between research institutes and human subjects. Since minors do not have the legal competence to complete a contract without the consent of their parents there is a conflict between the consent of parents as guardians and that of minors as self-decision makers. This article argues that the self-decisions of competent minors should take precedence over parental rights and that the authority of parents should be restricted. The article discusses the role of IRBs in protecting the consent of the competent minors.
Ethical Aspects of Complementary and Alternative Medicine
Authors: CHEONG Yoo-Seock
Published: May 2019

The increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and medical institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. When CAM and conventional medical therapies intersect, there is the potential for serious physician–patient conflicts as well as harm to patients. Some CAM therapies in and of themselves can be hazardous, but harm can also occur indirectly when patients choose less effective CAM treatments instead of conventional methods that have demonstrated efficacy. Physician–patient conflicts arising from issues related to CAM therapies are common, but the physician-patient relationship is more likely to remain intact if physicians are willing to engage creatively with patients when problems seem unsolvable. Even in the absence of scientific evidence for CAM therapies, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to clarify the patient’s core values and beliefs when counseling about CAM therapies. The commitment to joint problem-solving over time, which is a central obligation of the physician–patient relationship, becomes even more important when considering the use of CAM therapies. A long-standing, carefully nurtured partnership between a physician and a patient that has grown over time may be strained or completely destroyed if common ground in such situations cannot be found. The way forward for physicians involves not only preventing negligence and fraud, but also facilitating therapeutic exchanges between various healthcare providers and their patients. The use of case-based reasoning in questions of CAM therapy allows a fuller appreciation of the way in which circumstances play an intrinsic role in moral judgments.
This paper presents two prototypical cases that illustrate the challenges already discussed as well as other ethical challenges that will arise as CAM therapies gain popularity in Korea.
Philosophical Perspectives on Medical Ethics and Research
Authors: KANG Myoung-Sheen , SOHN Myoung-Sei
Published: May 2019

Medical ethics, which is expanding in scope, now includes public health ethics, bioethics, and biomedical or health care ethics. Though it started as a form of professional ethics, medical ethics is one of the most important fields of practical ethics, a branch of philosophy. According to Rawls, much of moral theory is independent from the other parts of philosophy. That is, the study of moral concepts and their relation to our moral sensibility has its own distinctive problems and subject matter, requiring unique forms of study. But what is the relation between ethics and medical ethics? In this article we argue that moral theory and medical ethics are necessarily interconnected and that they support each other. Professional duties are influenced by health care systems and policies, and public health ethics is influenced by ethical and political theory. Therefore, we argue that problems in medical ethics should be addressed from a meta-viewpoint that takes other disciplines into consideration.
Legal Perspectives on the Educational Goals of Ethics Programs for Medical Trainees
Authors: PARK Hyoung-Wook , KIM So-Yoon , SOHN Myong-sei
Published: May 2019

In 2007, the Korean Society for Medical Ethics Education and the Korean Academy of Medical Sciences published “The Educational Goals of Ethics Programs for Medical Trainees,” which presents 47 case reports and related discussions. Although the legal and medical responsibilities of medical professionals are closely related, they can often be distinguished. Therefore, in omitting some of the legal aspects of the case reports, the aforementioned publication fails to guide trainees in how to deal with issues similar to those raised in the case reports. The present article examines the legal responsibilities of the doctors described in those case reports. The result shows that the publication discusses the legal responsibilities of doctors in only nine of 31 relevant cases. We argue that the ethical and legal responsibilities of medical professionals need to be taught in an integrative manner. Furthermore, we claim that the legal aspects of medical case reports must be studied with the help of legal professionals and should be reflected in publications used to train medical professionals.
The Present Status and Future Directions of Nursing Ethics Education
Authors: PARK Jin-Hee , KIM Yong-Soon , KIM Won-Ok
Published: May 2019

In today’s rapidly changing and technologically sophisticated health-care environment, nurses frequently encounter ethical issues in caring for patients. While ethical values have always been a part of nursing education, the resources needed for ethics education have not always been readily available to nursing students and practicing nurses. This review aims to describe the state of nursing ethics education in Korea and provide insights into its requirements and priorities. In order to train nurses to participate in ethical decision making, more contemporary models of ethics education are being implemented in nursing programs. It is important for nurse educators to understand that ethics education should provide students with ways of conceptualizing ethical dilemmas and arriving at practical solutions. Furthermore, we argue that there is a need to develop Web-based continuing-education courses to enhance nurses’ ethical decision-making and advocacy roles.
Ethical Issues in Embryonic Research
Authors: KU In-Hoe
Published: May 2019

The concept of personhood is central to the ethical issues surrounding embryonic research. The fundamental questions are “When does human life begin?” and “From which stage of development should the embryo be protected?” These questions cannot be answered merely through scientific research but instead require reasoned reflection and argumentation. In this article I argue that all human beings must be protected from the moment of conception. The protection of human life must not depend on value judgments or selection criteria such as stages of development or grades of humanity.
A Comparison of Nursing and Medical Students’ Knowledge and Attitudes about Stem Cell Technology
Authors: Kim Hee-Jung , Kim Nam-Cho
Published: May 2019

This article reports on a study designed to assess the knowledge and attitudes about stem cell technology among nursing and medical students. The subjects consisted of 272 nursing students and 211 medical students. The instrument used was a self-reporting Likert-type questionnaire consisting of 57 assumptions related to stem cell technology. With respect to the level of stem cell knowledge, the score for all subjects was 54.7±20.3; the medical students’ score (59.1±15.5) was higher than that of nursing students (51.3±21.0) (p=.00). Attitudes toward stem cell technology varied according to individual topics. With respect to attitudes toward embryonic stem cells, the score for nursing students (3.28±0.47) was higher than that for medical students (3.18±0.51) (p=.02). The results of this study also show that knowledge about stem cell technology varies according to gender and experience with stem cell education, while attitudes toward stem cell technology vary according to religious convictions and beliefs about the intentions of ovum donation. Based on these results, we argue that there is a need for bioethics education programs that can raise the knowledge and attitudes about stem cell technology among nursing and medical students.
Medical Futility in Decision-making concerning the Withdrawal of Life-Sustaining Treatment
Authors: KIM Jin-Kyung
Published: May 2019

Most discussions about medical futility focus on the determination of when continued medical treatment is futile. However, there are no simple answers to this question, despite best efforts to define medical futility. Decisions concerning medical futility should involve not only physicians,but also patients and their family members, since value judgments are also relevant to the determination of medical futility. This raises the question of who actually holds the authority to make final decisions concerning medical futility. In this article we argue that shared decisionmaking should occur between patients, physicians, and family members. Even if disagreements arise in the decision-making process, each party’s opinions should be voiced and taken into consideration in reaching a resolution. Furthermore, we argue that, for the purposes of establishing a futility standard, what is needed is not a fixed and invariable law, but a process, which assists patients, physicians, and family members to debate, consult, and reach a resolution. In other words, communication skills as well as policy guidelines are required in order to optimize decision-making concerning medical futility.
Moral Sensitivity and Moral Distress among Korean Hospital Nurses
Authors: kim Hae Ri , Ahn Sung Hee
Published: May 2019

The purpose of this descriptive study was to examine the moral sensitivity and moral distress among clinical nurses in South Korea. Data were collected from 361 nurses between March and April 2009 using the following self-reported questionnaire: the Moral Sensitivity Questionnaire(Han, et al., 2009) and the Nurses’ Moral Distress Measurement Tool(Yu, 2003). An SAS program(version 9.1) was used to analyze the data by means of a t-test, ANOVA, and Scheffé test. The mean score of moral sensitivity was 5.13, and the sub-domain of patient-oriented care had the highest score (5.69). The mean score of moral distress was 2.89, and the emotional subdomain had the highest score (3.65). Scores for other sub-domains of moral distress were as follows: recognizable distress (2.94), situational distress (2.86), and behavioral distress (2.67). Moral distress was significantly higher among the nurses who had education beyond the postgraduate level, clinical practice of 3-5 years, working experience in the emergency room, ethics education at a clinic, or experience in moral dilemma. The positive relationship between nurses’ moral sensitivity and moral distress were relatively weak. Future research needs to explore the factors that could have an effect on between nurses’ moral sensitivity and distress.
Ethical Challenges and Regulations concerning Surgical Innovation
Authors: KANG Myoung-Sheen , PARK Jae-Hyun
Published: May 2019

Although research on drugs and medical devices for human is well regulated and scrutinized through the existing IRB system, there is a need for a careful review of the current process for approving surgical procedures involving new medical devices. In particular, the clinical application of innovative surgical procedures with new or existing devices should be examined from an ethical point of view. There are, at this point, no formal ethical rules concerning innovative surgical procedures, and important terms are in need of clarification and definition. This article argues that while the adequacy of IRB process for surgical innovation has to be reviewed, there are needs to debate on some reasonable and valid definitions and ethical regulations of surgical innovation. In addition to, while the potential of professional surgical organizations for self-regulation has to be respected, the debates concerning the ethical issues associated with innovative surgical procedures should be opened up to the academic medical sector and those outside of the medical community.
Future Changes and Directions for the Construction of a Medical Decision-Making System in Korea: Focused on delphi surveys*
Authors: Jo Kae Hwa , An Gyeong Ju , Kim Gyun Moo
Published: May 2019

Purpose: The purposes of this study were to identify future changes that may affect medical decision-making and to suggest future directions for the medical decision-making system in Korea.
Methods: This study conducted Delphi surveys and in-depth group interviews with physicians and nurses working in two different university hospitals in Daegu and Busan.
Results: The collected data suggest that the current medical decision-making system needs to be more clearly defined in accordance with clinical applications. The findings from professional group interviews suggest that the Korean government may need to regulate economic conditions in order to facilitate medical decision-making in the near future as hospital environments change and grow.
Conclusion: The results of this study may help healthcare professionals working at various crisis settings to understand and apply decision-making systems in the context of end-of-life medical care. The future directions were proposed that national standard setting and financial support, hospital ethics committee constitution, nationwide information for social consensus, strengthening the education of health professionals.
Macro-allocation of Health Care Resources and Democratic Legitimacy
Authors: Park Sanghyuk
Published: May 2019

Almost all countries in the world experience a scarcity of health care resources and the need to ration health care services. Each medical system is faced with difficult decisions concerning treatment coverage and priorities. Current methods of allocation are based on (1) substantial principles of justice, (2) cost-effectiveness analysis, (3) cost-value analysis, and (4) market mechanisms. Given these methods of allocating health care services, the question of legitimacy is rightfully raised. The question of legitimacy needs to be approached in an orderly manner. In the first place, the concept of democratic legitimacy needs to be articulated. Secondly, current methods of allocation must be evaluated. Thirdly, a legitimate method of allocation is needed. This article concentrates on the first and the second step. I argue that current methods of allocation fail to satisfy a democratic conception of legitimacy. However, this conclusion does not mean that these methods of allocating should be totally rejected. Each of these methods has an important element that at least contributes to democratic legitimacy. Based upon the evaluation provided in this article, I introduce a very promising method of allocating health care services, one developed by N. Daniels and J. Sabin.
A Narrative Analysis of Ethical Issues regarding End of Life Care Decision
Authors: Kwon Ivo , Hyunah Bae
Published: May 2019

In order to understand fully the issues involved in end-of-life care decisions, it is important to know the genuine wishes and thoughts of terminal patients themselves. This article reports on a narrative analysis of the data drawn from structured interviews with a number of terminal patients suffering from critical diseases such as cancer. Most patients approve of the withdrawal of life support treatment in irreversible and extremely painful conditions. They also admit the necessity of “advance directives” and even active euthanasia. However, their attitudes toward disease and death are emotionally complex. In facing their own death, patients need more emotional/medical support and pain control. Their relationships with family members or friends are also critical in this regard. Terminal patients are not entirely satisfied with current methods of communication with care givers, although they appreciate their concerns and goodwill. This analysis concludes that it is necessary to approach end-of-life care decisions in a more subtle and humane way that should be customized to the demand of each individual patient these decisions should be treated as part of the overall medical care given to terminal patients.
Validation of University of California’s Brief Assessment of Capacity to Consent (UBACC)*
Authors: JEONG Ihn Sook , KIM Sung-Gon , LEE Jin-Seong , JUNG Bong Ju
Published: May 2019

This study aimed to validate one of the tools for assessing decision-making capacity: the University of California at San Diego’s Brief Assessment of Capacity to Consent (UBACC), which is composed of a 10-item scale that includes questions focusing on the understanding and appreciation of information concerning research protocol. The subjects in the study were 30 inpatients and 30 outpatients with schizophrenia or schizoaffective disorder and, for comparison, 30 healthy subjects, all of whom received information about a simulated clinical drug trial. Using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR) as a gold standard, inter-rater reliability with intra-class correlation coefficient (ICC) was measured. The ICC for inter-rater reliability ranged from 0.987 to 0.994. The UBACC was found to be a useful and valid instrument for the screening of decision-making capacity before obtaining informed consent. We recommend that it be used not only for schizophrenia patients but also for various vulnerable groups including the elderly or cognitively impaired subjects.
A Survey of Residents’ Views of DNAR Orders in One University Hospital
Authors: LEE Tae Rim , SHIN Tae Gun , SIM Min Seob , JO Ik Joon , SONG Hyoung Gon , SONG Keun Jeong , JEONG Yeon Kwon , CHOE B.I
Published: May 2019

This survey, which was conducted over the course of 3 months in 2009, was designed to investigate what the medical residents of one university hospital in Seoul think about DNAR orders. A total of 214 out of 468 residents (45.7%) answered the questionnaire. Participants were divided into two groups according to their experiences with taking DNAR order. There was no difference between the two groups on the definition of DNAR, its limitations, and when to issue DNAR orders. However, the two groups showed different opinions concerning who should be consulted in obtaining consent for DNAR and whether or not it was necessary to review DNAR orders. Residents who were experienced in giving DNAR orders felt more inclined to discuss the situation with the patient’s family members rather than the patient herself and thought that DNAR orders would not need to be reconsidered. These differences in opinion may result from the different experiences the two groups of residents had in actually ordering DNAR in the clinical setting. This study shows that more research and discussion is needed in order to establish the limitations and precise definition of DNAR orders.
The Attitudes of College Students Regarding Doctors’ Disclosing Medical Errors
Authors: LEE Su Hyun , KIM Han A , HAN Heung Sik , KIM Sung Soo
Published: May 2019

Object: The purpose of this study was to identify the attitudes of patients regarding medical error. Methods: The questionnaires were administrated to 145 college students in Busan, one hundred twenty three usable 123 questionnaires were analyzed. The questionnaires consist of 4 major concepts; 1) knowledge, 2) attitudes toward disclosure of medical error, 3) expectations for doctors' behaviors, 4) barriers to the disclosure of the medical error. Results: Approximately 92% of respondents supported the immediate disclosure of medical errors, and 62.6% supported full disclosure including near misses. Approximately 57% believed that it would be most effective if doctors themselves communicated errors to patients, while almost 93% said that it was a doctor’s obligation to do so. Regarding reasons for disclosure, 44.7% said that it would reduce doctors’ feelings of guilt, while 45.5% said that it would also increase patient trust for doctors. Respondents also thought that the barriers to the full disclosure of medical errors were (1) damaged reputations (30.9%), (2) worries about medical lawsuits (22.8%), and (3) professional discipline (22.0%). Conclusion: Most of the participants in this survey support the immediate disclosure of medical errors regardless of the seriousness of the error. Furthermore the participants regarded disclosure of medical error as doctors' obligation. In order to meet the patients' high expectation regarding the medical error, this might be a good time for us to find a way to close the gap between patients' expectation and doctors' current practice.
Management of Conflicts of Interest in Physician-Pharmaceutical Industry Interaction
Authors: KANG Myoung Sheen , KOH Younsuck
Published: May 2019

Physician-pharmaceutical industry interaction (PPII) is ubiquitous in medical research, education, and clinical care. Conflicts of interest, which occur in the interaction, are to be properly managed at the level of the health care institution as well as at the level of individual health care personnel. The purpose of that management is to control conflicts of interest to the maximum extent possible, thereby preserving the value of public trust. Public trust is founded on the principle of prioritizing patients’ interests. Founding principles of COI management are based on public trust, professional integrity, and publicity. With these founding principles the relevant stakeholders (the pharmaceutical industry, physicians, medical care institutions, and the general public) should make continuous efforts to manage COI appropriately. Above all, the awareness of influences is essential among those stakeholders. This article argues that medical professionals should appreciate and protect the value of professional integrity and that medical organizations and institutions should establish reasonable policies of COI management, including the constitution of COICs (conflicts of interest committees) and education programs. Furthermore, it is claimed that society as a whole shares the responsibility of providing an appropriate health care environment by compensating heath care providers with adequate payment in order to avoid inappropriate PPII development. Without providing reasonable health care reimbursement, legal restrictions designed to control inappropriate PPII maAy not achieve their goal.
The Development and Evaluation of a Research Ethics Course for a Graduate-level Educational Program in Nursing
Authors: OH Euigeum , KIM Sanghee , YOO Jae Yong , KIM Sosun , KIM Sunah , CHO Eunhee
Published: May 2019

Purpose: This study was conducted to develop and evaluate a research ethics course in a graduatelevel educational program in nursing.
Methods: This study consisted of three major parts. First, an initial course was developed based on a review of the existing literature regarding research protocols and the ethical issues involved in research. Second, this initial course was delivered to the graduate students in one nursing program and a quasiexperimental study was applied to evaluate the course. Third, based on an analysis of quantitative responses from the participating nursing students, as well as input from a panel of experts, a final research ethics course was developed for this graduate program in nursing.
Results: The initial course involved the following six content areas: the concept of research ethics,bioethics and research ethics, research ethics for the protection of human subjects, statistical analyses in research ethics, ethical issues in publishing and intellectual property, and research ethics in nursing. The quantitative research reports showed a significant increase in the nursing students’ perception, self-efficacy, and knowledge regarding research ethics. Further analyses show that graduate nursing students still need structured course work in order to increase their ability to carry out good research. Additionally, a course in research ethics in nursing was designed as a 1-credit, pass/fail official course consisting of the following five content areas: the concept of research ethics, the protection of human subjects in nursing, data management and research ethics, statistical management and research ethics, and publication and research ethics.
Conclusion: This study was carried out to develop and evaluate a course in research ethics for a graduate-level educational program for nursing students.
QALY and the Ethical Debates over the Allocation of Health Care Resources
Authors: JEONG Chang-Rok
Published: May 2019

The purposes of this article are to examine the ethical issues surrounding the concept of quality-adjusted life year (QALY) and to determine what criteria should be used for distributing medical resources. The article examines the views of John Harris, Peter Singer, and Norman Daniels, and argues that the fairness of the process is more important than the legitimacy of the result in distributing medical resources. The argument is based on the belief that each individual life is important as well as the fact that results are often unpredictable. However, it is also noted that too much emphasis on the fairness of the process can result in a waste of medical resources.
Dispute on Morality of Baby Box
Authors: JEONG Chang-Rok
Published: May 2019

There was dispute on ‘baby box’ in the second half of 2011. In 2009, clergyman, Lee Jong-rak made a baby box on church wall. Actually, 26 new born babies were abandoned in the ‘baby box’. The babies who had disability were thrown out from the unmarried mothers with letters. If there was no baby box,the babies could die by hypothermia in the cold weather. But Ministry of health and welfare, and Gwanak Ward Office are requesting to remove baby box because it is illegal for non-authorized facility to look after baby. Baby box was installed to prevent from abandonment of baby in cold weather and risk. But it is on dispute between ‘protection of infant’ and ‘encouragement of abandonment’. Like dispute surrounding abortion or contraception, baby box is a complicated problem and it is not easy to conclude. It is a difficult subject that anybody cannot judge awkwardly. This is because the subject is related to human life. This thesis tried to evaluate this problem from ethical view. First, contradictory views are reviewed - the views are if baby box is for encouragement of abandonment, or if it is for protection of infant. Second, this problem is investigated from positions of Deontology and Teleology which are representative views of ethics. And this paper applies principles of modern medical ethics from the dispute to evaluate the problem. Finally, this subject is treated with from positions of personal ethic and social ethic.
The Effects of Medical Students’ Attitudes toward Death and Their Empathic Abilities on Suicidal Impulse Control
Authors: LEE Su Hyun , CHOI Eun Hye Ra , KIM Sung Soo
Published: May 2019

The purpose of the study was 1) to examine the relationship between medical students’ attitudes toward death and their suicidal impulse control and 2) to investigate the effects of empathy on death attitudes and suicidal impulse control. A questionnaire was developed consisting of six death-attitude factors, a suicidal impulse control item, and two empathy related items. The questionnaire was administrated to medical students at one university in Pusan, South Korea. One hundred and six completed questionnaires were analyzed. The results show that the more often respondents think about death and consider death as liberation, the lower their ability is to control suicidal impulses. Respondents who avoided thinking about death or who thought the impact of their death on their family members would be high were more likely to have a higher level of control of suicidal impulses. The impact of their own death on family members was most strongly correlated with an attitude toward death as a natural part of life. Regarding the effects of empathy on suicidal impulse control, cognitive empathy had a stronger correlation with suicidal impulse control than affective empathy. The results of regression show that cognitive empathy has the strongest effect on suicidal impulse control compared to other significant factors. The results of this study imply that the causes of suicide are not limited to the conventional psychological factors, such as depression. Understanding attitudes toward death and empathy could enhance society’s continuing efforts to reduce suicide among college students generally and medical students in particular.
The Night Duty Assignments for Specialists at Emergency Care Facilities and Assessing Ethical Argument
Authors: JEONG Chang-Rok
Published: May 2019

In 2010 a four-year-old child with intussusception died after failing to receive treatment at the emergency care unit of Kyungpook University Hospital. In August 2012 the Ministry of Health & Welfare implemented the revised Enforcement Decree of Emergency Medical Service Act. According to the law, all emergency medical facilities must have specialist physicians on duty for all treatment areas. Hospitals that do not abide by the law are subject to a financial penalty, and the concerned specialists can receive a license suspension for a maximum period of two months. While patients have welcomed this new law, the Korean Medical Association insists that it exploits specialists and threatens people’s right to life. This article examines the ethical issues involved in the dispute over the night duty system for specialists at emergency care facilities.
The Neuroethics of Informed Consent*
Authors: Kim Yang-Tae , Lee SangMok
Published: May 2019

Informed consent has problems with readability, length, complexity, and so on. On the one hand, rigid requirements related to informed consent discourage subjects to participate experiment. On the other hand, it distracts from more serious ethical problems in clinical research such as decision-making capacity. Recently, there is increasing evidence that some proportion of the population has difficulties with decision-making capacity. Therefore, the neuropsychological tests associated with decision making are needed before giving valid informed consent. The decision making related to informed consent can be described by the interplay between emotional and cognitive functions. How can we investigate this empirically? An appropriate scale measuring neuropsychological function in informed consent should include both cognitive and emotional abilities. Nowadays, the MacArthur Competence Assessment Tool(MacCAT) was widely used. But it relies predominantly on cognitive abilities such as understanding, appreciation, reasoning, and expression of choice. Considering recent empirical studies, the inclusion of emotional abilities in relation to decision-making seems to be essential. Iowa Gambling Task (IGT) requires emotional function as well as cognitive function to perform proper decision-making. Thus, it would be necessary to administer both the MacCAT and the IGT in people who have deficits in decision making and in giving valid or invalid informed consent.
Revisiting Autonomy in Bioethics: Focusing on ‘Relational Autonomy Based on the Capability Approach’ and the ‘Plural Forms Model’*
Authors: MOK Kwangsu , RYU Jaehan
Published: May 2019

The purpose of this paper is to search for a justifiable concept of autonomy that feasibly applies to bioethics and, based on this inquiry, suggest a practical model in a modern pluralist society. For this purpose, we classify personal autonomy into ‘metaphysical autonomy’ as the ideal theory guiding practical theories and both ‘narrow bioethical autonomy’ and ‘wide bioethical autonomy’ as non-ideal theories. We criticize narrow bioethical autonomy theories such as those posited by Tom Beauchamp and James Childress. Not only do they fail to flesh out metaphysical autonomy theories such as Harry Frankfurt’s, but they are not feasible because they ignore patient relationships and circumstances. We argue that Amartya Sen’s capability approach compliments the feminist concept of relational autonomy. Not only can this combination overcome the weaknesses found in narrow bioethical autonomy theories, but it allows for a practical framework to remove injustice and support autonomy. We call this combination ‘relational autonomy based on the capability approach’ and classify it as a theory of ‘wide bioethical autonomy.’ Based on this inquiry, we suggest a ‘plural forms model’ in a reasonable pluralism, which can reduce many of the autonomy-related conflicts. This model is useful in medical institution reform for explaining the plurality in both physicians’ identities and cases of patients’ autonomy (such as ambivalence) while it enhances patient autonomy through institutional and non-institutional reforms.
The Ethical Debate on Cognitive Enhancement*
Authors: LEE Sang Mok , CHOI Jong Hyun
Published: May 2019

Since the last part of the 20th century, some healthy people have widely used central nervous system stimulants as cognitive enhancers and this phenomenon has become not only a social issue but also an important academic issue. When some scholars, especially neuroethicsts seek to legalize the cognitive enhancers used by healthy adults, there has been a huge debate over legalizing cognitive enhancement. Critics on cognitive enhancement point out five ethical problems if cognitive enhancement would be allowed by the pharmaceutical authority and widely spread in a western society. First, cognitive enhancement has a safety problem and could cause various side effects, addiction, and cognitive tradeoff. Second, cognitive enhancement is morally undesirable because it is unnatural. Third, cognitive enhancement before the exam might be cheating. Forth, cognitive enhancement would cause social inequality and thus widen cognitive gap between riches and poors. Fifth, if cognitive enhancement would be allowed and widely spread among our society, many people might face pressure to take cognitive enhancers for winning the competition or doing their work well. However, proponents on cognitive enhancement argue that these ethical concerns are exaggerated or will be resolved near in the future. They also argue that together with discussing cognitive enhancement, the evidence-based research on cognitive enhancement should take place and this would clearly reveal the risk and benefit of cognitive enhancers.
Free Will and Neural Determinism*
Authors: CHOI Kyungsuk
Published: May 2019

The development of neuroscience and brain science makes people express the way of thinking based on brain centrism or neural centrism. Brain centrism or neural centrism may wrongly lead us to think that a brain is identified with a self in itself. Neural determinism is a strongest and most extended version of physicalism than a physicalist’s account that allows causation in neural activities and provides physical accounts for our behaviors. I argue against neural determinism and for the physicalism that allows free will and also makes neuroscience research possible. With the denial of the dichotomy between mind and body, I argue that free will can be understood to be a neural activities for decision making involving cognitive activities and the ability of volition. We cannot know what mental contents will occur when we observe particular areas of brain activated. In addition, even if the same areas are activated across individuals, different mental contents will be made depending on an individual’s belief system as well as his/her past experience and memory. Therefore, there may be neural activities that physicalism applies and are explained by causation. But this does not imply that neural determinism is true. The possibility of causal explanation does not imply the denial of free will. Cognitive activities involving free will may be ones to recognize perceptive responses, to evaluate them, to form beliefs, to compare and evaluate beliefs and values, and to judge them. Thus, the outcomes of these activities are hard to predict. In this respect, they are not deterministic.
Respect for Autonomy and Its Emotional Aspects in Cases of Akrasia: Tappolet’s Care-based Account of Autonomy*
Authors: CHO Sunwoo
Published: May 2019

Over the last few decades ‘respect for autonomy’ has emerged as one of the most important ethical principles governing modern medicine. This is due at least in part to the influence of Beauchamp and Childress’s Principles of Biomedical Ethics. However, there seem to be two major problems with this principle of respect for autonomy: one is that it has become something of a dogma; the other is that the concept of autonomy is unclear. In many areas of life, including that of medical care, it is difficult to discern which agents are truly autonomous, which decisions (or acts) are truly autonomous and, accordingly, which of these are to be respected. It seems that a better understanding of autonomy is very much needed. This article responds to that need by providing a careful examination of both rationalist and care-based conceptions of autonomy. It argues that rationalist conceptions of autonomy cannot account for cases of akrasia, and that care-based conceptions of autonomy help to illuminate the intimate relationship between autonomy and the emotions.
A Social Contracts-Based Approach to Medical Ethical Decision-Making: Approach by Diachronic Formation of Medical Professional Responsibility
Authors: LEE Hyo Jean
Published: May 2019

The normative principles of medical ethics are classified into two categories: traditional ethical theories (utilitarianism and deontological ethics) and empirical principles like the Hippocratic Oath. Each of these two streams of medical ethics has strengths and limitations. This article presents social contract theory as a new approach to understanding medical ethics. On this view, medical professions are based on social contracts for protecting patients from therapists with no licenses. These social contracts consist of hyper-norms, general or whole social contracts, regulations, stewardships and personal contracts. Medical professionals and medical societies both must uphold all of the social responsibilities (including legal liability) of these contracts. In order to strengthen the observance of these social contracts, this article proposes a process of medical ethical decision-making based on social contracts. Additionally, to reduce patient-physician conflicts, this article identifies the appropriate decision-making participants and argues for the necessity of hierarchical clinical ethics committees.
Two Teaching Methods to Improve Nursing Students’ Moral Intelligence, Moral Sensitivity and Moral Judgment: Theatre of Situations and Pro-Con Debate*
Authors: KIM Min A
Published: May 2019

This study was designed to compare the effects of two teaching methods, i.e., ‘Theatre of Situations’ and ‘Pro-Con Debate’ on moral intelligence, moral sensitivity and moral judgment of students taking nursing ethics classes. Two-group pretest-posttest design was used. The subjects, 87 nursing students, were randomly allocated to two groups, i.e., experimental group A, ‘Theatre of Situations’ consisting 45 students and experimental group B, ‘Pro-Con Debate’ consisting 42 students. The same four nursing hypotheticals dealing with ethical issues or dilemmas were used for both groups. Each of ‘Theatre of Situations’ and ‘Pro-Con Debates’ was conducted for 150 minutes after 450 minutes of regular nursing ethics lectures. Data were collected before and after the classes to measure moral intelligence, moral sensitivity and moral judgment of the subjects. The data were analyzed by a paired t-test using SPSS. The findings from this study are as follows: (1) in group A, moral meaning perceived by the subjects (a sub-domain of moral sensitivity) was significantly improved; (2) in group B, kindness and tolerance (sub-domains of moral intelligence) were significantly improved. Both methods are recommendable for enhancing nursing ethics education.
The Effects of Gerotranscendental Life-styles on Quality of Life: The Possibility of Combining Gerotranscendental Education Programs for Dying Patients
Authors: LEE Mee Ae , LEE Seong Gyu , KIM Hyun Ran
Published: May 2019

According to Erikson, gerotranscendence involves the development of effective personality traits andpositive attitudes toward life and death. The purpose of this study was to analyze the effects of gerotranscendentallife-styles on the quality of life of middle-aged persons in Korea. The results of the analysisshow a positive correlation between gerotranscendental life-styles and quality of life. Thinking about dyingand death and preparing for it seem to be closely related to living well. Medical institutions in Koreathat place too much emphasis on sustaining life may be hindering the dying process. This article arguesthat in order to improve patients’ quality of death, gerotranscendental life-styles should be introducedin the context of educational programs concerning death preparation.
The Influence of Moral Sensitivity and Critical Thinking Dispositions on Biomedical Ethics Awareness of Nursing Students*
Authors: KIM Eun A , PARK Hyunyoung , CHOI So Eun
Published: May 2019

The purpose of this study was to identify the influence of moral sensitivity and critical thinking dispositionson the biomedical ethics awareness of nursing students. Data collection was done using aself-report questionnaire answered by 508 nursing students from six universities located in G city and Jprovince. The collected data was analyzed using a t-test, ANOVA, Pearson's correlation coefficients, andstepwise multiple regression using SPSS 20.0 program. Biomedical ethics awareness had a significantpositive correlation with moral sensitivity (r=.55, p<0.001) and critical thinking dispositions (r=.59,p<0.001). Ethical values, critical thinking dispositions, moral sensitivity, intent to attend biomedical ethicsclass, religion, academic year, and university transfer significantly predicted 60.4% of the biomedicalethics awareness of nursing students. The results of this study suggest that the biomedical ethics awarenessof nursing students may be increased through curricula and teaching strategies that aim to nurturestudents’ moral sensitivity and critical thinking dispositions.
A Comparison of Moral Intuitions about Professional Ethics between the Medical Students and Residents in a University Hospital*
Authors: PARK So Youn , KWON Ivo , KWON Oh Young , YOON Tai Young
Published: May 2019

This study was designed to determine whether or not there are differences between the moral intuitionsof medical students and those of residents in clinical fields. A total of 370 of 490 (75.5%) students(n=340) and residents (n=30) at one university in South Korea responded to a survey consisting of theMoral Foundations Questionnaire (MFQ30) and additional items on moral judgments concerning theduty to care during pandemic influenza. Both groups selected beneficence/non-maleficence (as opposedto autonomy or justice) as the primary ethical principle(s) in medical practice. The mean scores on a0~5 scale for the five moral foundations for the students were not significantly different from those ofthe residents (harm; 3.6 vs. 3.4, fairness; 3.5 vs. 3.3, loyalty; 3.1 vs. 3.0, authority; 2.9 vs. 2.8, sanctity; 3.1vs. 3.0, respectively). However, there was considerable variability in individual items forming the scalesfor the fairness foundation. Interestingly, when respondents chose justice first among ethical principles,they felt that physicians had a duty to treat patients with influenza, even if in doing so they placed themselvesor their families at risk (OR 2.27, 95% CI 1.23~4.18). Our data suggest that social intuitionismmay be useful for explaining differences in Korean physicians’ moral judgments and also that it may bean effective tool for feedback in medical ethics education.
The Need for a Virtue Ethics Approach to Medical Ethics Education: Focusing on the Learning Objectives of 『Medical Ethics』
Authors: KIM Claire Junga , KIM Soojung
Published: May 2019

Two objectives in medical ethics education—“creating virtuous physicians” and “providing a skill set for analyzing and resolving ethical dilemmas”—are often seen as mutually exclusive. However, both objectives are important and they are not as incompatible as they are assumed to be. This article argues that in contemporary medical ethics education the objective of creating virtuous physicians is often underemphasized despite its importance. The learning objective put forward by the Korean Society for Medical Ethics in 2013 also neglects this pedagogical objective and instead adopts a principle-based approach that makes no explicit mention of virtue ethics. After identifying the biases responsible for the omission of virtue-based approaches to medical ethics education, this article offers a critique of those biases as well as strategies for incorporating virtue-based models into the medical curriculum.
Study on the Improvement of Ethics in Animal Research Curriculum*
Authors: YOO Dong-Mi , MO Hyojung
Published: May 2019

The biggest debate in the field of animal ethics revolves around animal experimentation. Various discussions surround experiments on animal subjects, and considerations of the animal’s scope or the animal subject’s treatment method, experimental method etc. differ for each individual situation. The majority of those against the use of animal subjects in laboratories are cleared of anthropocentrism in order to fundamentally evaluate the justification of animal experimentation and demand efforts in improving experimental methods and processes while minimizing the animal subject’s sacrifice and suffering. In laboratory, animal experiments are different from regular experiments because they involve the treatment of animal life. Because this context may create ethical conflicts, the researchers who implement experiments on animals must receive the appropriate training so that they can recognize this distinctiveness. However, if we examine the current training under animal experimentation, even university curriculums have barely developed this type of training and, what is worse, the part of the government that regulates animal experimentation provides little training in animal ethics. To counter balance negative awareness about animal experimentation, we must increase the utility of such experiments and diffuse awareness of animal welfare. We must strengthen training in animal ethics to create a peaceful coexistence between nature and humankind.