bluuebunny/crossref_metadata_2025 huggingface dataset:
Epoxyscillirosidine Induced Cytotoxicity and Ultrastructural Changes in a Rat Embryonic Cardiomyocyte (H9c2) Cell Line
Authors: Isa Hamza , Ferreira Gezina , Crafford Jan , Botha Christoffel
Published: May 2019

Moraea pallida Bak. (yellow tulp) poisoning is the most important cardiac glycoside-induced intoxication in ruminants in South Africa. The toxic principle, 1α, 2α-epoxyscillirosidine, is a bufadienolide. To replace the use of sentient animals in toxicity testing, the aim of this study was to evaluate the cytotoxic effects of epoxyscillirosidine on rat embryonic cardiomyocytes (H9c2 cell line). This in vitro cell model can then be used in future toxin neutralization or toxico-therapy studies. Cell viability, evaluated with the methyl blue thiazol tetrazolium (MTT) assay, indicated a hormetic dose/concentration response, characterized by a biphasic low dose stimulation and high dose inhibition. Increased cell membrane permeability and leakage, as expected with necrotic cells, were demonstrated with the lactate dehydrogenase (LDH) assay. The LC50 was 382.68, 132.28 and 289.23 μM for 24, 48, and 72 h respectively. Numerous cytoplasmic vacuoles, karyolysis and damage to the cell membrane, indicative of necrosis, were observed at higher doses. Ultra-structural changes suggested that the cause of H9c2 cell death, subsequent to epoxyscillirosidine exposure, is necrosis, which is consistent with myocardial necrosis observed at necropsy. Based on the toxicity observed, and supported by ultra-structural findings, the H9c2 cell line could be a suitable in vitro model to evaluate epoxyscillirosidine neutralization or other therapeutic interventions in the future.
West Nile Virus Associations in Wild Mammals: An Update
Authors: Root J. Jeffrey , Bosco-Lauth Angela M.
Published: May 2019

Although West Nile virus (WNV) is generally thought to circulate among mosquitoes and birds, several historic and recent works providing evidence of WNV activity in wild mammals have been published. Indeed, a previous review tabulated evidence of WNV exposure in at least 100 mammalian species. Herein, we provide an update on WNV activity in wild and select other mammals that have been reported since the last major review article on this subject was published in early 2013. Of interest, new species, such as Hoffman’s two-toed sloths (Choloepus hoffmanni), are now included in the growing list of wild mammals that have been naturally exposed to WNV. Furthermore, new instances of WNV viremia as well as severe disease presumably caused by this virus have been reported in wild mammals (e.g., the Virginia opossum [Didelphis virginiana]) from natural and semi-captive (e.g., zoological institution) settings. Regrettably, few recent challenge studies have been conducted on wild mammals, which would provide key information as to their potential role(s) in WNV cycles. Largely based on these recent findings, important future lines of research are recommended to assess which mammalian species are commonly exposed to WNV, which mammal species develop viremias sufficient for infecting mosquitoes, and which mammal species might be negatively affected by WNV infection at the species or population level.
Herpes Virus, Oral Clinical Signs and QoL: Systematic Review of Recent Data
Authors: Crimi Salvatore , Fiorillo Luca , Bianchi Alberto , D’Amico Cesare , Amoroso Giulia , Gorassini Francesca , Mastroieni Roberta , Marino Stefania , Scoglio Cristina , Catalano Francesco , Campagna Paola , Bocchieri Salvatore , De Stefano Rosa , Fiorillo Maria Teresa , Cicciù Marco
Published: May 2019

This manuscript aims to highlight all the clinical features of the herpes virus, with a particular focus on oral manifestations and in the maxillofacial district about Herpes Simplex Virus-1 (HSV-1) and Herpes Simplex Virus-2 (HSV-2). Oral herpes virus is a very common and often debilitating infectious disease for patients, affecting oral health and having important psychological implications. The collection of relevant data comes from the scientific databases Pubmed, Embase; initially this collection obtained an extremely high number of results, 1415. After applying the inclusion and exclusion criteria, as well as a manual screening, the results included in this review were limited to 14. The results were expressed by evaluating all the signs and symptoms that this pathology entails during the study, paying attention to the characteristics linked to the quality of life and the psychological implications. This pathology has numerous therapies, which often make the healing phase of the manifestations of this viral pathology more comfortable. The therapies currently used for the treatment of this viral infection are pharmacological, topical, systemic, or instrumental, for example with laser devices.
Evaluation of the Dual Crop Coefficient Approach in Estimating Evapotranspiration of Drip-Irrigated Summer Maize in Xinjiang, China
Authors: Li Fengxiu , Ma Yingjie
Published: May 2019

A dual crop coefficient approach was validated experimentally to estimate evapotranspiration of drip-irrigated summer maize with partial mulch and no mulch in an arid region in Aksu, Xinjiang, China, during 2016–2017. In this study, five treatments were established based on fixed or variable irrigation cycles. Summer maize transpiration and evapotranspiration were estimated by the dual crop coefficient approach. Evapotranspiration was validated, and a positive regression with those values was obtained using the water balance method, with a root mean square error (RMSE) of 10 mm. The estimated transpiration also had a positive regression with measurements obtained by the stable carbon isotope technique, with a RMSE of 20 mm. By analyzing the RMSE, regression coefficients, and concordance index, we suggest that the dual crop coefficient approach is an effective method to estimate and partition evapotranspiration. Across the entire growing season for partially mulched summer maize, the estimated crop transpiration accounted for 78.7% and 76% of the total evapotranspiration in 2016 and 2017, respectively. For non-mulched summer maize, the estimated crop transpiration accounted for 64.9% of the total evapotranspiration over the entire growing season, which implied that the soil evaporation was about 12% higher than that of the partially mulched treatments. Water consumption with partial mulching was reduced by about 10%, compared with non-mulching, which indicated that mulching improved the use of water during irrigation.
WHEN CONDUCTING LABORATORY WORK USING THE MATHEMATICAL PACKAGE MAPLE FOR THE COURSE “COMPUTATIONAL MATHEMATICS“
Authors: Төлөбаева Кылымкан , Тажикбаева Санайым , Абдугулова Гульжан
Published: May 2019

Mathematics as a science arose in connection with the need to solve practical problems: measurements on the ground, navigation, etc. Because of this, mathematics has always been numerical math, its goal was to obtain a solution in the form of a number. The greatest scientists are Newton, Euler, Gauss, Chebyshev, etc. in his writings built mathematical models of the phenomenon of nature. Research and analysis of sophisticated models required the creation of new, usually, numerical or asymptotic methods for solving problems. According to the requirements of modernity, the emergence of ECMand their rapid development in all areas of science, so in the course of computational mathematics is closely connected with the use of new computer tools. Therefore, the article presents the tasks from the part “Numerical integration” of the course “Computational Mathematics” using a mathematical package Maple15.
A Cross-Cultural Approach to Biomedical Ethics: Medical Decision Making
Authors: LEE Sang-Mok
Published: May 2019

The supremacy of individual consent and autonomy in resolving bioethical problems and medical decision making is increasingly being called into question in Eastern cultures, where long-standing customs and traditions often clash with the Western principles of autonomy, self-determination, and individual rights. In order to strengthen and promote medical ethics and bioethics in the East, a detailed understanding of the ethical traditions of both civilizations is needed. This study goes some way toward fulfilling that need by providing a cross-cultural comparison of Eastern and Western bioethics and examining Confucian and Western moral perspectives on medical decision making.
A Study on the Possibility of Rational Communication Action Theory as a Methodology of Medical Ethics Education: Focusing on Habermas' Theory
Authors: KIM Jin-Kyong
Published: May 2019

Medical ethics education plays a critical role in forming the attitudes and values of prospective physicians who will directly engage in various, complex clinical situations in the future. In this sense, today's medical ethics education should have the goals of exactly identifying many different ethical problems faced in clinical situations and, to better cope with such problems, raising the skills of moral thinking and criticizing for making most rational decisions. One way to achieve such goals lies in Habermas' Rational Communication Action Theory that can be quite meaningful as a new methodology of medical ethics education.
The theory considers language as the primary element of communication and stresses ‘context’ in which the element is used. In such context, parties of communication, the speaker and the listener, communicate with each other under a relationship of mutual respect and reciprocality. Both of them could promote a mutual understanding-oriented communication action through conversations and discussions and, as a result, reach a most ideal, universal consensus.
Actually, Rational Communication Action may be embodied into a method of communicative discussion that is practiced during medical ethics education. Such discussion in which students participate should be based on mutual recognition. With the validity claims based, the context and legitimacy of discussions under communication are determined, ultimately drawing out a universal consensus. In the process of communicative discussion, students can learn skills of communication with others as well as those of moral thinking and critical judgment against given problems. In summary, Habermas' Rational Communication Action Theory allows students to raise their?skills of critical thinking through such action and furthermore become aware and reflectively think of their problems by themselves.
Problem Design and Evaluation for Nursing Students’ Problem-Based Learning in the Protection of Patients’ Rights
Authors: KIM Ki-Kyong
Published: May 2019

This study designed and evaluated problems for nursing students’s Problem-Based Learning (PBL) in the protection of patients’ rights. The study involved a cross-sectional, descriptive survey with nonrandom, convenience sampling. The subjects, 113 senior students from two colleges of nursing, all agreed to participate in the study. Cho’s (2003) Procedure for Problem Design was applied and a measuring instrument of problem evaluation consisting of 7 items and 5 scenarios was developed by the author. Data was analyzed using a mean, t-test with the SPSS program. The mean scores for motivation were high, and statistically significant differences were not found between the two groups of students evaluated. The results suggest that PBL modules should be developed and applied to clinical conferences for students in order to improve the application of PBL. In addition, patients’ rights education through experiential learning should be implemented to change nursing students’ attitudes and improve their protective behaviors.
Medical Ethics Education in North-American Medical Schools
Authors: CHEONG Yoo-Seock
Published: May 2019

Medical schools in the United States and Canada now include medical ethics education as an essential part of their curricula. Despite this, recent studies point to deep shortcomings in the literature on medical ethics education. Deficits exist in all areas of the literature: in the theoretical work done on the overall goals of medical ethics education, in the empirical studies that attempt to examine outcomes for students, and in the studies evaluating the effectiveness of various teaching methods. This article summarizes the main findings of three important articles concerning medical ethics education that were originally published in the journal Academic Medicine. This article also discusses the implications of these findings for medical ethics education in Korea. It is argued that further progress in medical ethics education may depend on the willingness of medical schools to devote more curricular time and funding to medical ethics.
The Development of a Research Ethics Curriculum for the Life Sciences
Authors: HONG Suk-Young
Published: May 2019

This study was designed to develop a research ethics curriculum for the life sciences at the undergraduate level. The aims of research ethics education should support the aims of the life sciences. Therefore, research ethics education should, in the first place, help to prevent research misconduct; secondly, it should respect the dignity of life. The educational program developed in this study places emphasis on the teaching of fundamental values related to research ethics. It is argued, furthermore, that for pedagogical purposes, good examples of research ethics are preferable to examples of misconduct.
A Legal Examination of Medical Professionalism
Authors: RYOO Hwa-Shin
Published: May 2019

This paper examines the conception of medical professionalism reflected in the Korean Medical Act. Several articles of the Korean Medical Act dictate that physicians should adhere to improved medical techniques or higher ethical standards in their field. The authority of professionals is grounded in their knowledge and expertise; indeed it is the nature of their authority that makes their professionalism necessary. The values of professionalism(expertise, morality, self-regulation, patient welfare) have traditionally been different from the values of commerce. In this article I argue that medical professionalism will be challenged if physicians must prove their innocence in medical malpractice litigation, as a current legislative bill stipulates. This article also reviews the problems associated with the burden of proof in such cases.
Shared Decision-Making as a Model of Medical Decision-Making
Authors: KIM Jin Kyong
Published: May 2019

Matters related to human life and death and medical healing are the concerns of patients, physicians, and other related persons, including family members of the patients. Existing medical decision-making models include paternalism and informed consent. However, these models have the limitation of being one-sided or unidirectional. Accordingly, shared decision-making is now emerging as a superior model of medical decision-making. In this model, physicians, who have medical knowledge, patients, and family members, who may have the best understanding of the patients’ life, jointly participate in making medical decisions. As a medical decision-making model, shared decision-making is often regarded as a process based on mutual respect and partnership between physicians and patients. A goal of medicine is to remove pain brought about by disease. In making medical decisions for individual patients, not only physicians, but also the patients themselves and their family members can play an important role. Family members can play such a role because of their familiarity with the patient and knowledge of his or her values. This is especially true in times of medical crisis when individual patients may have difficulties in making reasonable decisions. Thus, shared decision-making is an ideal method of decision-making, one in which patients, physicians, and family members work together to choose the best course of medical treatment for the patient.
Ethical and Legal Considerations Regarding the Confidentiality of Research on Illegal Activities
Authors: CHOI Eun Kyung , KIM Dokyun , KIM Ock-Joo
Published: May 2019

Confidentiality has been regarded as one of the most important ethical principles for research on human subjects. Protecting research subjects’ confidentiality derives from the principle of respect for persons. As it is essential to maintain trust between researchers and subjects, research on human subjects cannot be conducted without protecting confidentiality, although it is not always easy to do so. Research that involves recording and observing illegal activities, including illegal drug studies, demands an especially high degree of confidentiality. Breach of research confidentiality can result in criminal or civil liability for the subjects in such research. When the researchers are subpoenaed, they are forced to provide information on their subjects. Most countries have no legal framework to protect both subjects and researchers from breaches of confidentiality. This paper discusses the ethical and legal considerations regarding the confidentiality of research on illegal activities. After examining domestic and international cases in which confidentiality and court orders were in conflict, the authors examine relevant policies and legal frameworks, including the Certificate of Confidentiality issued by the U.S. National Institute of Health (NIH). The authors argue that legal assurance to protect confidentiality should be provided to research subjects and researchers, especially considering the recent increase in research on illegal activities in Korea.
The Process of Medical Decision-making for Cancer Patients
Authors: Lee Sang-Mok , Kim Seongyeon , Lee Hyung-Sik
Published: May 2019

Purpose: This study was performed to evaluate the perception and attitudes of cancer patients regarding medical decision-making.
Method: A clinical survey was conducted using questionnaires consisting of 8 items for cancer patients and 11 items for dependents. Both patients and dependents were interviewed. Two hundred and ninety-four people (147 pairs) participated in this survey. The results of the survey were evaluated to see how attitudes concerning medical decision-making differ.
Results: The majority of both patients and dependents (more than 90% for each group) gave positive answers to the question of whether the doctor explained the patient’s condition. Also, the majority of both patients and dependents (approximately 90%) were informed about treatment options. Fifty eight percent of the patients and 73% of dependents think that the family is entitled to be informed about the course of treatment and treatment options. In response to the question of which person should decide the course of treatment in the case of disagreement, about 47% of patients and dependents think that the patient should decide, but 14% and 22%, respectively, think that the family should. When making decisions regarding treatment, both patients and dependents consider that improvement in health is the main consideration, followed by the alleviation or avoidance of pain. The lack of information and the pain of the patient are the source of most difficulties.
Conclusion: The survey results show that the majority of both cancer patients and their family members think that family members are entitled to be informed of treatment options and have a right to make decisions regarding treatment. The survey also indicates that the majority of patients and family members believe that patients themselves should make treatment decisions in the event of disagreements between patients and family members.
Attitudes and Practices of Critical Care Physicians in End-of-life Decisions in Korean Intensive Care Units
Authors: Kim So Yoon , Kang Hyun Hee , Koh Younsuck , Koh Shin Ok
Published: May 2019

Purpose: This study was performed to evaluate both the attitudes and practices of critical care physicians in Korean ICUs regarding end-of-life care decisions as well as the factors that influence those attitudes and practices.
Methods: A questionnaire was developed and delivered to 100 members of the Korean Society of Critical Care Medicine in September 2007. The questionnaire was divided into six parts including personal information, decision-making processes, the withdrawing and withholding of life-sustaining treatment, informed consent, consultation with ethics committees, and guidelines.
Results: Eighty eight responses from 53 different institutions were received. The results of the questionnaire include the following. There was a significant difference between the attitude and practices of respondents concerning family consent and patient’s consent. Attitudes toward patient and family consent differed significantly according to the clinical experiences of the respondents (p<.05). There was a significant difference between the attitudes and practices of respondents concerning how often caregivers effectively communicated with patients and family members. Attitudes toward family participation in decision-making processes differed significantly according to the respondents’ gender. There was also a significance difference between the attitudes and practices of respondents regarding the withdrawal of life-sustaining treatment. Attitudes and practices on this issue varied according to the type of ICU where the respondents worked and their medical specialty. Practices concerning informed consent for “do not resuscitate” orders varied significantly according to respondent’s age and type of ICU. Finally, attitudes on the participation of ethics committees in decision-making processes varied significantly according to respondent’s clinical experiences (p<.05).
Conclusions: This study found significant differences in the attitudes and practices of critical care physicians in Korean ICUs concerning end-of-life care decisions and the withdrawing and withholding of life-sustaining treatment. The study also found that the factors influencing these attitudes and practices include age, specialty, clinical experiences, and the types of ICU in which physicians work. However, there are some limitations in generalizing these findings.
Validating the Korean Version of the Preferences for Care near the End of Life (PCEOL-K) Scale
Authors: Lee Yunjung , Kim Shinmi
Published: May 2019

The purpose of this study was to validate the Korean version of the Preferences for Care near the End of Life (PCEOL-K) scale. Original items on the PCEOL scale were translated from English into Korean and polished by means of retranslation back into English with editorial supervision by experts. A convenience sample of 247 nursing students participated in the study. Content validity and test-retest reliability tests were performed and descriptive statistics, factor analysis, Cronbach’s alpha and Pearson Correlation Coefficient were utilized. Five factors from the original PCEOL were validated with minor variations. Reliability estimates (internal consistency) for the factors ranged from 0.42 to 0.89. Retest stability estimates for PCEOL-K showed correlations of p=.000 for factor scores over a 2-week interval. As a result, PCEOL-K is a reliable, valid, and useful instrument for evaluating preferences regarding care near the end of life.
Death with Dignity and Voluntary Passive Euthanasia
Authors: Choi Kyungsuk
Published: May 2019

The concept of “death with dignity” has received a great deal of attention in South Korea recently. While some believe that death with dignity is different from euthanasia, others maintain that it is a form of voluntary passive euthanasia. Medical futility and autonomy clearly play an important role in the moral justification of death with dignity. This article argues for the necessity of introducing a new criterion of medical futility into the classification of euthanasia, for there may be moral differences between medically futile treatment and basic treatment such as antibiotics, hydration, and nutrition. The patient’s views on what constitutes medical futility may also be relevant. One notion of death with dignity examined in this article is the idea of not interfering with “natural death.” This notion of death with dignity is distinct from any form of euthanasia defined as hastening a patient’s death for him/herself. However, as is shown in this article, this notion is impractical due to the vagueness of the concept of “natural death.” Thus, this article defends the claim that death with dignity is a form of euthanasia.
The Efficacy of Ethics Education on the Moral Judgment of Nursing Students
Authors: LEE Mi-Aie
Published: May 2019

This study was performed to evaluate the efficacy of ethics education on nursing students. The study used the Korean version of the Defining Issues Test (DIT) and a nonequivalent control group, pretest-posttest design. Sixty-one nursing students were assigned to either an experimental (n=35) or control (n=26) group. Students who scored higher than the mean were classified as high-level students, while those who scored lower than the mean were classified as low-level students. The efficacy of ethics education on nursing students was not identified in the experimental and control groups but was partially identified in the higher and the lower moral judgment subgroups. P scores turned out to be more suitable than 4 stage scores in evaluating the efficacy of ethics education on undergraduate nursing students. It is concluded that ethics education does have an effect on nursing students’ moral judgment. Further research is needed to explain why 4 stage scores were raised for members of the lower moral judgment subgroup and to determine the effect of the field practices of nursing students on their moral judgment.
Quantitative Analysis of Ethics Research within the Korean Nursing Community
Authors: AHN Sung-Hee
Published: May 2019

Purpose: The objective of this study was to analyze the evolution and nature of ethics research within the Korean nursing community.
Method: For this retrospective quantitative study, articles related to biomedical issues published by nurses or nursing students in peer-reviewed Korean journals and master theses and doctoral dissertations written in Korea from 1968 to 2008 were collected via the databases at The Korean Nurses Association, The Korean Education and Research Information Service, The Korean Studies Information Service System, and The Korean Medical Database.
Results: In total, 110 were articles published and 75 master theses and doctoral dissertations presented. Of these, 148 (80%) studies used an empirical design. The period 2001-2005 presented a higher number of studies (n=71, 38.4%). Eighteen peer-reviewed journals in the field of nursing published ethical studies. The main topics of research were professional ethics for nurses (25.4%, n=47), do-not-resuscitate orders (n=21), and ethical dilemmas (n=19). Most empirical studies employed quantitative designs (79.7%, n=118).
Conclusion: The findings of this study highlight important issues for the development of nursing ethics research, including the diversity of research topics, subjects, and design, the selection and convergence of research topics, researcher training, and international multidisciplinary collaboration.
A Statistical Analysis of 102 Articles Published in The Korean Journal of Medical Ethics
Authors: KIM Sang-Deuk
Published: May 2019

This article attempts to evaluate Korean research on medical ethics today and propose a reasonable direction for future research. The evaluation is based on an analysis of the 102 articles published in The Korean Journal of Medical Ethics from 2003 to 2009. First, I classify the articles into philosophy, pedagogy, law, sociology, and the politics of medical ethics. Second, I show how interdisciplinary research on medical ethics is carried out today. Third, I analyze the 22 articles that are classified as philosophical articles with regard to their subject matter and the author’s major field of study. Forth, I subdivide the 102 articles with regard to the method of research employed. Fifth, I classify the 212 members of The Korean Society for Medical Ethics into moral philosopher, medical scientist, legal scholar, educator, and nurse. In addition, I show how many articles they produce and how much they contribute to the development of medical ethics. Finally, this article provides a philosophical critique of the concept of “medical ethics.” I argue that one should not confuse the ethical study of medical practice with the academic study of medical ethics; the first examines medical ethics philosophically; the other involves legal, political, and social studies.
Ethics and Law in Medicine
Authors: Joo Ho-No , Bae Hyuna
Published: May 2019

Ethical issues in medicine are often accompanied by legal issues. While it is important to take the legal aspects of a medical ethical problem into consideration, following the law does not always ensure an ethical outcome. Moreover, not all ethical issues in medical practice have a legal component, and the law is limited procedurally as a means of dispute resolution. In this article we argue that medical professionals should have a general understanding of both medical ethics and medical law and have the ability to analyze the ethical and legal issues involved in medical practice. Furthermore, we claim that improving physician-patient communication is an important goal of medical ethics education not only from an ethical point of view, but also from a legal point of view, insofar as it may help to prevent future lawsuits against physicians.
의료분야에서의 역할 개념 정립에 관한 연구
Authors: Kang Yunjung
Published: May 2019

의료 전문인들에 대한 역할 개념의 탐색은 주로 철학적 관점에서 진행되고 있다. 한국 의료분야에서도 예외는 아니다. 본 연구는 의료분야에 종사하는 전문인들의 역할 개념을 철학적, 심리학적 관점에서 탐색해보는 것이다. 철학적 관점에 근거해서 본 역할개념으로는 권위와 책임감, 심리학적 관점에서는 개인적 효능감, 대인관계 통제감, 사회정치적 통제감이 역할 개념으로 제안되었다. 본 연구에서 제안한 다섯가지 역할 개념은 다음과 같다. 첫째, 권위는 환자들에게 서비스를 제공하기 위해 필요한 특별한 정보와 지식를 소유한 의료 전문인으로서의 질로 정의되었고, 둘째, 책임감은 환자의 사회적 신분과는 무관하게 환자를 위해 제공해야 할 서비스를 공정하게 제공하는 의무감으로 정의되었으며, 셋째, 개인적 효능감은 의료 전문인의 심리적 특성의 하나로서 의료 전문인의 성격과 삶을 통제함으로써 얻게 되는 자기 성취감과 자기 확심감으로 정의되었다. 넷째, 대인관계 통제감은 환자나 환자의 가족등을 포함해서 의료 활동에 관여하는 모든 사람들과의 관계를 통제하고 관리할 수 있는 능력, 다섯째, 사회정치적 통제감은 사회정치적 체계의 목표와 전문인으로서의 개인적 목표사이의 갈등 혹은 차이를 해결하는 능력으로 정의되었다. 본 연구를 통해 몇가지 제안을 하면 다음과 같다. 첫째, 역할 개념을 탐색하는 방법을 철학적 관점이외의 심리학적 관점 더 나아가 다른 관점들에 비추어 폭넓게 역할 개념을 조명해볼 수 있을 것이다. 둘째, 본 연구에서 제안한 다섯 가지 역할 개념을 기초로 해서 의료 전문인들의 역할 개념과 윤리의식을 측정할 수 있는 타당한 검사지를 개발할 수 있을 것이다. 셋째, 의료 전문인이외의 다른 전문가 집단의 역할 개념을 탐색하고 설명하는 데에도 도움이 될 것이다.
Evaluating the Quality of Informed Consent in Clinical Research
Authors: JEONG Ihn Sook , SHOH Ji Hong , SHIN Jae Gook
Published: May 2019

This study was designed to assess the quality of the informed consent process in clinical research by measuring subjects’ understanding of informed consent. A convenience sample of 188 subjects aged 20 and above participated in bioequivalence studies at the Inje regional clinical trial center in Busan (South Korea). The study instruments were self-reported questionnaires, which were modified versions of the Quality of IC (QuIC) questionnaire developed by Joffe et al. (2001) and the Informed Consent Questionnaire-4 items (ICQ-4) developed by Guarino et al. (2006). The data were collected from February to May, 2007 and analyzed with descriptive statistics to assess the quality of the informed consent process and also with a t-test, X2 test, and paired t-test to identify correlates of increased understanding of informed consent. Prior to the subjects’ participation in these clinical trials, the mean QuIC objective knowledge score (QuIC-A) was 68.7 points (maximum: 100 points) and the perceived (subjective) understanding score (QuIC-B) was 78.7; after the clinical trials were completed, the mean scores for (QuIC-A) and (QuIC-B) were 68.7 and 80.4 respectively. The general quality of informed consent (ICQ-4) was measured after the clinical trials were completed; the score was 78.3 points (maximum: 100 points). Higher objective knowledge (QuIC-A) scores were associated with age (25 years old and above, p=0.043), and education (college and above, p=0.001). Higher QuIC-B scores were associated with previous experience with clinical trials (p=0.028) and memorization of the date of the signed consent (p=0.037). The quality of informed consent measured in this study is significantly lower than that reported in similar studies conducted in the US and Australia. Thus, this study suggests that it is there is a need to develop strategies to improve subjects’ understanding of informed consent.
The Meaning and Characteristics of Death from a Traditional Korean Perspective
Authors: LEE Kook Bong
Published: May 2019

Recent advancements in medical treatment have led to a new understanding of death, which diverges from the understanding of death in traditional Korean culture. As human life can now be prolonged through new medical treatments and technologies, such as respirators, the distinction between death by nature and death by human means has become blurred. This has resulted in public interest and debate in Korea concerning “death with dignity” and a patient’s “right to die.” This article contends that the concept of “death with dignity” actually undermines a patient’s dignity and the concept of a “right to die” reduces a patient’s rights. Furthermore, it is argued that there is a need to redefine the legal definition and meaning of “natural-death” and “artificialdeath” in the context of Korean ethics, which cannot be decoupled from Korean thought and culture with its deep roots in Confucianism. This article sheds light on the meaning and characteristics of death from the point of view of Korean Confucianism. An account is also given of the associated notion of “sympathy” as developed by the philosopher Mencius. This account is intended to provide an understanding of death from a traditional Korean perspective.
An Examination of the Current Legislation and Policies Concerning the Use of ART in Korea
Authors: Kim Eun-Ae
Published: May 2019

The Korean Bioethics and Safety Act contains specific laws concerning the buying and selling of gametes, egg donations, and compensation for egg donors. This legislation helps to protect the human rights of those who use assisted reproductive technology (hereafter, ART). However, this article argues that the laws outlined in the Bioethics and Safety Act are insufficient to deal with all of the ethical and policy issues raised by the use of ART. Additional laws or policies are needed to establish good criteria for the number of embryos created in ART procedures, limitations (if any) on surrogate parenting and posthumous reproduction, the exact requirements of informed consent, and procedures enabling individuals to determine how their embryos or gametes are used.
Critical Consideration of ‘Autonomy’ in Biomedical Ethics
Authors: CHOI Kyungsuk
Published: May 2019

The principle of autonomy has been introduced in lots of bioethics references explaining Kant’s conception of autonomy. “Autonomy in bioethics” is different from “autonomy in Kant.”The former is almost the same as principle of freedom. I examine the meaning of autonomy through the review of Beauchamp and Childress’ analysis and Miller’s, which do not reach Kant’s conception. I also try to propose some practical suggestion after this examination. Autonomy is different from freedom in that autonomy should include moral reflection. The aspect of moral reflection in autonomy may reflect cultural and/or relational consideration beyond individualistic conception of autonomy. This may contribute to establish a new conception of autonomy. Even a new conception of autonomy is still different from Kant’s in that the principle of autonomy is one of principles whereas Kant’s autonomy is one to produce moral norms. Thus principle of autonomy in bioethics cannot be considered to be the supreme one to resolve bioethical issues. Autonomy may not be respected when respecting one autonomy does harm to others or violates the principle of justice. In this respect, autonomy as a value may conflict other values such as life or justice. Which value is preserved is still a difficult question when we are faced with conflicts of values.
Re-conceptualization of vulnerability in clinical trials and the role of Institutional Review Board
Authors: Hyuna Bae
Published: May 2019

Vulnerability typically has been understood in terms of the ability to give or withhold informed consent and the likelihood of being misled, mistreated, or otherwise taken advantage of in research. The re-conceptualization of vulnerability from something that emerges primarily from membership in a specific population to a reality that emerges from characteristics of persons or the environment in which research is conducted also can inform IRB(Institutional Review Board)s’ interpretation and application of the regulations and guidelines on clinical trials. Vulnerability should be evaluated by IRBs, which have the responsibility of identifying those persons who may require additional protections. This article argues that the widespread and inconsistent use of the concept of vulnerability in Korea has hindered the development of substantive ethical guidance and concrete regulations. It is argued, furthermore, that in order to protect patient welfare and justice, the category of vulnerability should be specified at the time at which a subject consents to participate in medical research.
Ethical Principles in Physician-Pharmaceutical Industry Interactions
Authors: Lee Ilhak , Koo Young-Mo
Published: May 2019

This article examines the four principles of biomedical ethics introduced by Beauchamp and Childress for possible use in deliberating ethical issues that arise in the context of physician-pharmaceutical industry interactions (PPII). PPII is regarded as a threat to the ideal physician-patient relationship because it blurs the scientific, objective, and altruistic ideals of professional medical practice. Several guidelines have been proposed to redress the undesirable effects of PPII, but few have provided any ethical justification or mechanism to resolve possible internal conflicts. The principle-based approach is a good starting point because it focuses on practical solutions for decision-making as well as on theoretical justifications. This article shows how the four ethical principles can be specified and applied in three hypothetical cases of PPII, and how two practical rules, the rule of transparency and avoidance, can be assimilated.
The Impact of Physician-Pharmaceutical Industry Interactions on Physician Prescriptions
Authors: Hong Jin Pyo , Park Sang Eun , Koh Younsuck
Published: May 2019

The relationship between the medical profession and the pharmaceutical industry has received considerable attention in recent years in Korea. In this article we examine the impact of physicianpharmaceutical industry interaction (PPII) on physician prescriptions. While physicians’ decisions concerning prescriptions are influenced by many factors, two of the most influential are the visits of sales representatives from pharmaceutical companies and the gifts and other enticements that pharmaceutical companies provide for physicians. Patients regard gifts from pharmaceutical companies as less appropriate and more influential than do physicians. Inappropriate relations between physicians and pharmaceutical companies can damage physician-patient relationships and harm the medical profession as a whole. Recent investigations in the United States and Korea have found many illegalities in physician-pharmaceutical industry interaction. The article argues for the urgent need to develop clear ethical codes and compliance mechanisms concerning PPII.
Ethical Issues Concerning the Relationship between Medical Students/Residents and the Pharmaceutical Industry
Authors: CHEONG Yoo-Seock , PARK Jae-Hyun , Koh Younsuck
Published: May 2019

The pharmaceutical industry interacts with the medical profession by supporting clinical research and assisting in medical education activities in academic medical centers. Medical students and residents spend years establishing patterns of prescribing and making relationships with pharmaceutical companies. The pharmaceutical industry has a significant presence during residency training, gaining the overall acceptance of trainees, and appears to influence prescribing behavior. Contact with pharmaceutical representatives is common among medical students and residents. Residents acknowledge the potential for industry influence in others, but generally not in themselves, despite evidence that they themselves are influenced as well. The prescriptions written by residents are associated with pharmaceutical representative visits and the availability of samples. A variety of policy and educational guidelines appear to influence residents’ attitudes toward interactions with industry representatives, although data on the long-term effects of these interventions are limited. This article contends that medical training programs can benefit from policies and curricula that teach medical students and residents about the influence of marketing and how to critically evaluate the information they receive from industry representatives.
The Level of Awareness among Korean Physicians of the Consensus Guidelines to Withhold or Withdraw Life-Sustaining Therapies
Authors: MOON Jae Young , LIM Chae-Man , KOH Younsuck
Published: May 2019

In order to promote the dignity of terminal patients and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The goal of this study was to assess the level of awareness of the guideline among physicians working in intensive care units (ICUs) in Korea and to identify barriers to the application of the guidelines. We surveyed 81 physicians working in ICUs in Korea. 32.1% of respondents were unaware of the guideline and 65.4% of respondents thought that the guidelines were not practical in the context of their ICUs. This study found that the biggest obstacle to the application of the guidelines was the lack of legal support. Ethical reasoning does not often work to resolve issues surrounding EOL care in Korean culture. In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the national health care system, more practical guidelines, and further social consultation are needed.
Issues Regarding Stem Cell Therapy in Korea
Authors: KIM Soojung
Published: May 2019

This paper examines the current status of, and issues surrounding, stem cell research in Korea. It is noted that ordinary citizens in Korea are being misled into spending large sums of money on unverified claims regarding stem cell research and that procedures are being prepared to protect people from such unverified claims. It is argued that scientists have responsibilities to provide correct information to the public regarding their research results and professional societies should establish a verification system in which the efficacy and safety of stem cell therapy can be assessed accurately. In addition, it is claimed that governmental authorities have a role to play in developing this line research and delivering accurate information on it so that citizens can form more reasonable expectations concerning scientific progress in the area of stem cell research.
The Jurisprudential Point at Issue in the Provision of Dual Punishment in the “Medical Law” in Korea
Authors: SHIN Eunhee , KIM Ken-Won , JANG Woo-Ick , SON Young-Soo
Published: May 2019

The recently revised “Medical Law” in Korea gives rise to at least three questions. First, should doctors be subject to criminal punishment on the grounds that that the “Monopoly Regulation and Fair Trade Act” has not been effective in regulating the circulation of medicine and medical supplies? Second, will the provision of dual punishment in the new law achieve the desired results? Third, will social justice and ethics be promoted through the threat of criminal punishment? In this article we address these questions and argue for the following claims: (1) that the provision of dual punishment in the new law is illegitimate from a jurisprudential point of view, (2) that the provision of dual punishment will impede medical progress, and (3) that the tyranny of the majority and the problem of procedure in lawmaking will hinder the establishment of political justice and respect for the rule of law in Korea. The overall view defended in this article is that doctors and professional medical organizations should be granted autonomy in developing codes of conduct and professional ethics to regulate and promote the practice of medicine in Korea.
Experiences with Case-based Small Group Discussions in Medical Ethics Education during Residency Training
Authors: OH Hye-Young , CHEONG Yoo-Seock , YOO Sang-Ho
Published: May 2019

Background: Residents struggle with the evaluation and management of inpatient clinical ethical dilemmas. However, few residency programs include medical ethics education as part of their graduate medical training. This study aims to explore the perceived effectiveness, benefits, and learning experiences of residents with small group discussions about ethical dilemmas. Method: We instituted weekly residency ethical conferences to clarify residents’ understanding of medical ethics and to improve their medical ethics competence. Six to nine residents and two or more professors attended the ethical conferences and participated in the discussions. Each participant was given at least five minutes to share their thoughts and reasoning concerning a designated ethical dilemma. In the course of these meetings we also surveyed participants’ self-confidence, level of satisfaction, communication skills, moral motivation, attitudes, reasoning, and moral sensitivity. Result: Teaching residents by means of small group discussions on ethical dilemmas can enhance their ability to address these issues directly and to resolve clinical ethical dilemmas appropriately. Additionally, these group discussions were found to improve participants’ level of satisfaction and ability to communicate. Conclusion: Our experience with small group discussions based on cases involving moral dilemmas shows that discussion can be an effective and practical method of ethics education for residents. The results of this study may have implications for the future improvement of graduate medical education.
Cardiopulmonary Criteria for Organ Procurement: An Analysis of the First Case of the Pittsburgh Protocol
Authors: KIM Jang Han
Published: May 2019

While organ transplantation is accepted medical practice, it is hampered by the shortage of available donor organs. In an attempt to resolve the imbalance between the supply of, and demand for, organs for transplantation, a non-heart beating donor (NHBD) program was started by the University of Pittsburgh Medical Center in 1992. While this program has had desirable patient outcomes, concerns have been raised that it may jeopardize professional and public confidence in the field. This article examines the clinical, ethical, and legal issues in organ transplantation with a focus on the first case of the NHBD program at the University of Pittsburgh Medical Center. The article also considers what implications this case might have for organ transplantation in Korea. It is argued that the public, law enforcement agencies, and the media in Korea should assist the medical community in making explicit regulations that are medically, ethically, and legally defensible.