Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

Consensus guidelines for the definition of the end stage of disease and last days of life and criteria for medical judgment

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of ‘the end stage of disease’ and ‘last days of life’ and the criteria for medical judgment are presented and summarized. According to the guidelines, the term ‘end stage of disease’ refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms ‘the last days of life’ and ‘the final days of life’ refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either ‘end stage of disease’ for hospice/palliative care or ‘the last days of life’ for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or ‘end stage of disease’ care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes.

“It All Started from Worms”: Korea-Japan Parasite Control Cooperation and Asian Network, 1960s – 1980s / 의사학

The Korea Association of Health Promotion and Japanese Organization for International Cooperation in Family Planning (JOICFP), and Taiwan's Chinese Foundation of Health all originated from parasite control organizations. Currently these organizations hold no apparent relations to parasite control activities. However, many of the senior leaderships of these organizations including presidents, have parasitology as their background. Kunii Chojiro (the founder of Japan Association of Parasite Control (JAPC) and JOICFP) explained it as “it all started from worms.” In 1949, Kunii Chojiro established JAPC after personally experienced intestinal parasite infection. The JAPC people conducted mass examination and mass chemotherapy focusing on school children, which allowed them to have sustainable income. In 1965, the Korea Association of Parasite Eradication (KAPE) requested JAPC to assist Korea's parasite control activity. In 1968, when Korea-Japan cooperation for parasite control activity established, Japan's operating procedures were directly absorbed by KAPE. With support from JAPC and official development aid through Overseas Technical Cooperation Agency in Japan (now Japan International Cooperation Agency), Korea successfully controlled parasite infection. Post-war and cold-war geopolitics had a significant impact on Korea-Japan cooperation. In 1960s the president of KAPE, Chong-Chin Lee and Kunii Chojiro were well known figures in population control network. They did understand the importance of population control, but did not agree with the approaches taken by western population control experts. From their point of view, it had to be self-initiated, economically self sustainable grass-root activities rather than top-down activities, as experienced in their parasite control in Japan and Korea. This lead to a new Asian model named “Integrated Program”. Together with their influence in population control network, Kunii and Lee manage to secure the fund from IPPF. Emergence of Integrated Program showed how collective experience of Asia, as well as overlap of networking formed ‘Asian Model’ of public health activities. Kunii and Lee shared the same agenda to enable people to have better life through public health measures. While they funneled money from global population control network, they were more interested in securing sustainability of the parasite control activities. This paper focuses on activities and experiences of Kunii Chojiro and Chong-Chin Lee to show interplay of Cold War geopolitics in Asia led to emergence of Asian network.

Development of the codes and guidelines of medical ethics in Korea

Medical ethics, autonomy, and self-regulation form the core of medical professionalism. Therefore, codes and guidelines regarding ethics are key documents that demonstrate the identity of physicians as a professional group in a society. In Korea, foreign declarations such as the Hippocratic Oath and the Geneva Declaration have been translated and introduced, while medical ethics guidelines have been introduced from developed countries. In 1961, 1965, and 1979, the Code of Medical Ethics was created and revised, but only in 1997 did Korean doctors develop their own ethics guidelines and codes reflecting their identity in Korean society. In order for these guidelines and codes to be effective living documents, they should be regularly modified to reflect changes in the medical environment and the field of medicine. In response to the urgent need to establish strict norms of medical professionalism in the 21st century due to internal and external problems in Korean society, the Korean Medical Association worked to revise the Ethics Code and Guidelines in 2016. This article reviews the history of how the Korean Code of Ethics and Guidelines has changed and examines the contents of the Code of Ethics and Guidelines as amended in 2016.

Ethical Perspectives on the Middle East Respiratory Syndrome Coronavirus Epidemic in Korea / 예방의학회지

Ethical considerations are essential in planning for and responding to outbreaks of infectious diseases. During the outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Republic of Korea in 2015, serious challenges emerged regarding important ethical issues, such as transparency and the protection of privacy. The development of bioethics in Korea has been influenced by individualistic perspectives applied in clinical contexts, leading to a paucity of ethical perspectives relevant to population-level phenomena such as outbreaks. Alternative theories of public health ethics include the perspectives of relational autonomy and the patient as victim and vector. Public health actions need to incorporate clear and systematic procedures founded upon ethical principles. The MERS-CoV epidemic in Korea created significant public support for more aggressive early interventions in future outbreaks. This trend makes it all the more imperative for ethical principles and procedures to be implemented in future planning and responses to outbreaks in order to promote perceptions of legitimacy and civic participation.

A Social History of Ascariasis in the 1960s Korea: From a Norm to a Shameful Disease / 의사학

Until the 1950s, Ascaris was regarded as an essential part of life which controls every aspect of human physiology among Koreans. Therefore, Ascaris should not be removed from human body. Efforts from medical professionals and the Korean government officials who wished to push forward the parasite control program, had to constantly contest with this perception of Ascaris among ordinary Koreans. In 1966, the 'Parasitic Disease Prevention Act' was promulgated and 'the Korean Association for Parasite Eradication (KAPE)' established in Korea. From the 1970s, Korea mobilized 15 million people each year to achieve the eradication goal. Such mass mobilization could not be possible without public awareness on necessity of parasite eradication. Until the early 1960s, however, Korean people were not sympathetic to the needs of eradication of parasites, especially that of Ascaris. Then, what changed the social perception towards Ascaris during the 1960s? What contributing factors allowed the mass mobilization and public involvement for that campaign? Employing newspaper articles and periodicals, this paper analyzes how social perception on Ascariasis changed during the 1960s, when the 'Parasitic Disease Prevention Act' was established. During the 1960s, Ascariasis became a shameful disease for Koreans. A series of events made Ascariasis more visible and shameful to Koreans. First event happened with Korean miners who were dispatched to Germany in 1963. When the miners turned out to have been infected with intestinal parasites, they were prohibited from work at the mines by the authorities in Germany and quarantined for several weeks. This humiliating experience of Korean expatriate people having bodies swarmed with parasites became a national shame to Koreans. The parasite infected bodies of Korean workers were revealed to the World through German newspapers. Second event happened when a child died of intestinal obstruction due to Ascariasis. The doctor retrieved 1,063 Ascaris from the bowel of the 9 year-old girl, and the photo of the 1,063 worms was published in several newspapers. It was a shocking visualization of Ascariasis in Korean society. Through these visualizations of Ascariasis, the Korean society began to perceive Ascariasis as a shame of the nation as well as that of an individual.

"If I Only Touch Her Cloak": The Sisters of Charity of St. Joseph in New Orleans' Charity Hospital, 1834-1860 / 의사학

This study is about the Sisters of Charity of St. Joseph in New Orleans' Charity Hospital during the years between 1834 and 1860. The Sisters of Charity of St. Joseph was founded in 1809 by Saint Elizabeth Ann Bailey Seton (first native-born North American canonized in 1975) in Emmitsburg, Maryland. Seton's Sisters of Charity was the first community for religious women to be established in the United States and was later incorporated with the French Daughters of Charity of St. Vincent de Paul in 1850. A call to work in New Orleans' Charity Hospital in the 1830s meant a significant achievement for the Sisters of Charity, since it was the second oldest continuously operating public hospitals in the United States until 2005, bearing the same name over the decades. In 1834, Sister Regina Smith and other sisters were officially called to Charity Hospital, in order to supersede the existing "nurses, attendants, and servants," and take a complete charge of the internal management of the Charity Hospital. The existing scholarship on the history of hospitals and Catholic nursing has not integrated the concrete stories of the Sisters of Charity into the broader histories of institutionalized medicine, gender, and religion. Along with a variety of primary sources, this study primarily relies on the Charity Hospital History Folder stored at the Daughters of Charity West Center Province Archives. Located in the "Queen city of the South," Charity Hospital was the center of the southern medical profession and the world's fair of people and diseases. Charity Hospital provided the sisters with a unique situation that religion and medicine became intertwined. The Sisters, as nurses, constructed a new atmosphere of caring for patients and even their families inside and outside the hospital, and built their own separate space within the hospital walls. As hospital managers, the Sisters of Charity were put in complete charge of the hospital, which was never seen in other hospitals. By wearing a distinctive religious garment, they eschewed female dependence and sexuality. As medical and religious attendants at the sick wards, the sisters played a vital role in preparing the patients for a "good death" as well as spiritual wellness. By waging their own war on the Protestant influences, the sisters did their best to build their own sacred place in caring for sick bodies and saving souls. Through the research on the Sisters of Charity at Charity Hospital, this study ultimately sheds light on the ways in which a nineteenth-century southern hospital functioned as a unique environment for the recovery of wellness of the body and soul, shaped and envisioned by the Catholic sister-nurses' gender and religious identities.

Ki-rye Jang, a practitioner of love and compassion overcoming the suffering due to the division of Korea

Born in 1911 to a wealthy Christian family in Korea, Ki-rye Jang graduated from Kyungsung Medical School and married Bong-sook Kim in 1932. Serving as an assistant of surgery under Dr. In-je Paik from 1932-1938, Dr. Jang also worked as a lecturer in surgery. In 1940 he obtained his Ph.D. from Nagoya University, Japan. After the Liberation of Korea, Dr. Jang was appointed as the General Director of Pyongyang District Hospital in 1946 and as a professor at Kim Il-sung Medical School in 1947, and became the first Ph.D. awardee in North Korea in 1948. In December 1950, during the Korean War, Dr. Jang fled with his second son, Ka-yong, and arrived in Busan. In 1951, he established Gospel Hospital. In 1958, Dr. Jang founded the Busan Local Surgical Association, and in 1959, he successfully performed the first liver lobectomy in Korea and received the Academic Award (presidential award) from the Korea Academy of Medical Sciences. In 1968 he founded Gospel Professional Nursing School and the Busan Blue Cross Insurance Union and was elected as the first head of the union. In 1974, he founded the Korea Liver Research Association and was inaugurated as the first president. In 1976, he was awarded the Order of National Service Merit - Dongbaekjang, and in 1987 the Ramon Magsaysay Award for Public Service. On December 25, 1995, at the age of 84, he passed away. Throughout his life, he missed his wife and children from whom he was separated due to the division of Korea. Beyond his suffering due to the division of Korea, Dr. Jang was a practitioner of love and compassion. Love of Christianity, compassion for the poor, living together in solidarity, excellence in creativity, commitment to peace and non-violence, generosity and non-possession, and freedom in truth were the key concepts that ran throughout Dr. Jang's life.

Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behavior-related issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-of-life (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behavior-related issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

The Role of Pavlov's Theory in North Korea in the Late 1950s: Ideological Struggle in Medicine and Scientification of Traditional Medicine / 의사학

This paper deals with Pavlov theory in North Korea in the late 1950s, focusing on its role in ideological struggle in medicine and in reinterpretation of traditional medicine. In North Korean Ministry of Health found Pavlov theory to have rich resources which could be used in the construction of the North Korea's socialist medicine. First of all, Pavlov theory provided the North Korean Communist Party with a powerful ideological weapon against capitalist medical thoughts, representing superior socialist medicine based upon Marx-Leninism and dialectical materialism. This paper examines the contents of Pavlov theory introduced in the North Korea from the Soviet Union in the late 1950s. Pavlov theory in the North Korea was not merely a political slogan but a unified medical system of thought, ranging from biological theory on the organism and pathogenesis to clinical theory. Nonetheless, Pavlov theory became Pavlov doctrine in the ideological struggle in healthcare field initiated by Kim Il Sung and the Communist Party. In the process of the ideological struggle, the abducted surgeon Kim Si-Chang was accused and purged of counter-revolutionary and refusal to conform to Pavlov doctrines by the Communist Party in 1959. Interestingly, Pavlov theory was used in reinterpretation of Traditional Medicine in North Korea from unscientific practice to a rich and scientific complementary medicine by connecting the two with common theoretical components such as Pavlov's typology. By the enthusiastic Communist Party members, Pavlov doctrine was introduced, transformed and exploited to build monolithic ideology system in medicine in North Korea in the late 1950s.

Application of Oral History to Contemporary History of Medicine in Korea: With a Focus on Medical Scientists / 의사학

The oral history helps researchers to fill the gap in historical documents in research on the contemporary history of medicine in Korea. More and more studies in history of contemporary medicine in Korea have come out using oral history of doctors and patients. Based upon the author's research on development of neurosurgery in late 20th century Korea, this paper discusses how to apply oral history to contemporary history of medicine, focusing on oral history of doctors in Korea. In this paper the author describes how to do and use oral history of key doctors and medical scientists in the contemporary history of medicine in Korea. The oral history can be a powerful tool to complement the written documents as following. First, from their interview, doctors and medical scientists often provide valuable information which historians cannot get from documents and written sources. As intelligent interviewees, they not only understand the purpose of research but also help actively the historian-researcher-interviewer. Second, the oral history facilitates further searches and often it leads to more findings of informants, and written and image material. More often than not, doctors and medical scientists do their own research on the topic and provide the historian with valuable historical source material from their laboratories, bedsides, family and friends. Third, interviews with medical scientists and oral material produced by doctors and medical scientists helped the researcher to understand and interpret the papers and written documents. Fourth, the subjective stories told by the medical scientists provide perspectives and historical source as narrative truth. Before a historian attempts to use the oral material as complementary historial evidence, he or she needs to cross-check the validity and of objectivity of the oral material. Oral material is produced through bidirectional intersubjective interaction between the interviewer and interviewee, and critical reflection over the relationship between the two is crucial. Especially the researcher should keep an eye on the possible bias and strive for the objectivity of the oral material with discernment and reflection, when she or he found the interviewees of doctors and medical scientists closely connected together and tied together in a web of relationship with a common interest or agenda.

A Social History of Carbon Monoxide Poisoning in Korea in 1960s: from an Accident due to Carelessness to a Social Disease / 의사학

This paper deals with social history of carbon monoxide poisoning in Korea in 1960s. From the mid 1950s, Korean society began to use coal briquettes (Yeontan) for fuel for cooking and heating in the winter, especially in urban area. As the use of coal briquettes replaced fire woods which had been used as fuel in traditional Korean society for centuries, incidence and deaths from carbon monoxide poisoning increased dramatically during the 1960s. The coal briquettes were used to heat the living rooms through "Ondol" arrangement. The coal briquettes at the kitchen place make the heated air and smoke, which pass through the horizontal space under a stone floor of the room and escape through chimney at the opposite site of the kitchen. This Ondol system could make leakage of carbon monoxide easily and thereby kill people who sleep in the room. In the 1960s, carbon monoxide poisoning by briquettes gas was a serious health problem to kill more people than all of the infectious diseases. It was a unique and very serious health hazard in 1960s Korea. No other place in the world has experienced such a high mortality and incidence from the briquettes gas as in Korea. Employing newspaper articles and epidemiological papers, this paper analyzes how the Korean society experienced and perceived carbon monoxide poisoning (CO poisoning) in 1960s. It also follows how the perception changed over time and how the changes affected social responses to CO poisoning. In the early 1960s, the CO poisoning was perceived as an accident due to carelessness of the people who did not fix the leakages of the Ondol system or that of the people who built the Ondol improperly. Mostly CO poisoning was the casualty caused by carelessness and ignorance of the poor class. The prevention measure was mainly education which would enlighten the ignorant so that they care about CO poisoning and their lives. It was the victims who were to be blamed, for they caused the their poisoning with their own carelessness. Since CO poisoning was perceived as preventable with a good care, people were optimistic about the prevention of the CO poisoning. In the late 1960s, however, the perception of CO poisoning changed as the epidemiological studies demonstrated meteorological, social, economical, and cultural factors were related to the poisoning. As CO poisoning was regarded not as an accident due to carelessness but as a social disease, the Korean government began to take various measures for its control including surveillance and punishment, education and certification of those who made Ondol, and funding research for detoxification of the poisoning. In spite of the state's intervention, the number of CO poisoning cases drastically increased every year. At the end of 1960s, in contrast to the optimism of the early 1960s, the outlook of CO poisoning control was grim. It was merely a beginning of huge epidemic of CO poisoning in 1970s and 1980s in Korea.

Development of Modern Medical Doctors in Japan from Late Edo to Early Meiji / 의사학

Western medicine began to be introduced to Japan since late 16th century. Japanese encounter with Western medicine centered on Dejima in Nagasaki in the seventeenth and eighteenth century and the initial process of introduction was gradual and slow. In the mid-nineteenth century, facing threats from Western countries, Tokugawa bakufu asked Dutch naval surgeon, J. L. C. Pompe van Meerdervoort to teach western medicine at the Kaigun Denshujo naval academy in Nagasaki. The government also supported the western medical school in Edo. This paper deals with how modern western medical doctors were developed in Japan from late Edo to early Meiji. The publication of the New Text on Anatomy in 1774 translated by Sugita Genpaku and his colleagues stimulated Japanese doctors and scholars to study western medicine, called Rangaku. During the Edo period, western medicine spread into major cities and countryside in Japan through Rangaku doctors. In 1838, for example, Dr. Ogata Koan established the Rangaku school named Tekijuku and educated many people with western medicine. When smallpox vaccination was introduced in Japan in 1849, Rangaku doctors played an important role in practiving the vaccination in cities and in countryside. After the Edo bakufu and the feudal lords of han(han) actively pursued to introduce western medicine to their hans by sending their Samurai to Edo or Nagasaki or abroad and by establishing medical schools and hospitals until their abolition in 1871. In late Edo and early Meiii military doctors were the main focus of training to meet the urgent need of military doctors in the battle fields of civil wars. The new Meiji government initiated a series of top-down reformations concerning army recruitment, national school system, public health and medical system. In 1874, the government introduced a law on medicine to adopt western medicine only and to launch a national licence system for medical doctors. Issuing supplementary regulations in the following years, the Meiji government settled down a dual-track medical licensing system: one for the graduates from medical schools with certain quality and the other for the graduate from less qualified schools who should take the licensing examination.

The Trend and Prospect of Studies on the History of Western Medicine in Korea / 의사학

Studies on the history of Western medicine in Korea began to be actively conducted and published since the restart of the Korean Society for the History of Medicine in 1991, which had been originally inaugurated in 1947, and the publication of its official journal, the Korean Journal of Medical History in 1992. In 1970s and 1980s, even before the start of the Journal, articles on a history of Western medicine were published mainly written by physicians in medical journals. This paper aims to provide an overview of the publications on the history of Western medicine in Korea, comparing papers published in the Journal with those published in other journals. Authors of the papers in the Journal are those who majored in history of medicine or history science whose initial educational backgrounds were medicine or science, whereas authors of the papers in other journals majored in Western history, economic history, social history, religious history, or women's history. While a large portion of papers in the Journal deal with medicine in ancient Greek or in modern America with no paper on medieval medicine, the papers in other journals deal with more various periods including ancient, medieval and modern periods and with diverse areas including France, Britain, Germany, Europe etc. Recent trends in 2000s show an increase in the number of researchers who published the history of Western medicine in other journals, total number of their publications, and the topics that they dealt with in their papers. In contrast, however, the number of researchers published in the Journal, the number of the papers and its topics - all decreased in recent years. Only three papers on the history of diseases have been published in the Journal, while eleven published in other journals. In order to stimulate research on the history of Western medicine in Korea, concerted efforts are necessary including academic communication among various disciplines, formulation of a long term plan to enlarge the pool of researchers and readers of the history of Western medicine, and development of strategic educational programs for both graduates and undergraduates including students of medicine and of humanities in Korea.

Effect of Patient Safety Education in Surgical Clerkship to Develop Competencies for Managing and Preventing Medical Errors / 한국의학교육

PURPOSE: The aims of this study were to define the necessity and effectiveness of patient safety education during surgical clerkship to develop competency for managing and preventing medical errors. METHODS: Fifty 3rd-year students participated in the patient safety education program during a 4-week surgical clerkship. The students were divided into 4 groups: control group, pretest-only group, education-only group, and pretest and education group. Students were assessed using short essays and an oral exam for reasoning skills, clinical performance exams for patient education and communication skills, and multisource feedback and direct observation of error reporting for real-world problem-solving skills. The results were analyzed with SPSS 14.0K. The reliability (Cronbach alpha) of the entire assessment was 0.893. RESULTS: There was no difference in scores between early and late clerkship groups. Reasoning skills were improved by the pretest. Reasoning, patient education, and error reporting skills were much more developed by patient safety education. Real-world error identification, reporting, and communication did not change after the 4-week course. CONCLUSIONS: Patient safety education during surgical clerkship is necessary and effective. Error prevention and competency management in the real world should developed.

Ethical Issues in Stem Cell Therapy

With uncertainty and the possibility of serious risks, stem cell based therapies should be introduced to clinical practice only after clinical trials demonstrate their efficacy and safety. The ethical issues related to current stem cell based therapies are examined based upon ethical principles. For the ethical conduct of clinical trials using stem cells, the guidelines for all clinical research should be followed. Because of highly innovative nature of such trials, special attention must be paid to rigorous scientific and ethics review in comparison of currently available treatments, assurance of voluntary informed consent and publication of findings of the clinical trial including negative results and adverse effects. International guidelines and Korean regulations are surveyed for justifiable medical use of unproven stem cell-based interventions. Key features include application of such innovative intervention only to a very small number of seriously ill patients, following a written protocol, approval from an ethics committee, informed consent, safety monitoring, follow-up data collection to evaluate effectiveness and adverse effects and transition to a formal clinical trial in a timely fashion after experiencing a few patients.

Experiment at Bedside: Harvey Cushing's Neurophysiological Research / 의사학

No abstract in English.

Physical Anthropology Studies at Keijo Imperial University Medical School / 의사학

Medical research during the Japanese Colonial Period became systematic and active after the Keijo Imperial University Medical School was established in 1926. Various kinds of research were conducted there including pharmacological, physiological, pathological and parasitological research. The Keijo Imperial University was give a mission to study about Korea. Urgent topics for medical research included control of infectious diseases, hygiene and environmental health that might have affected colonizing bodies of the Japanese as well as the colonized. The bodies of Koreans had been studied by Japanese even before the establishment of the University. The Keijo Imperial University research team, however, organized several field studies for physical anthropology and blood typing research at the national scale to get representative sampling of the people from its north to its south of the Korean peninsula. In the filed, they relied upon the local police and administrative power to gather reluctant women and men to measure them in a great detail. The physical anthropology and blood typing research by the Japanese researchers was related to their eagerness to place Korean people in the geography of the races in the world. Using racial index R.I.(= A%+AB%/B%+AB%), the Japanese researchers put Koreans as a race between the Mongolian and the Japanese. The preoccupation with constitution and race also pervasively affected the medical practice: race (Japanese, Korean, or Japanese living in Korea) must be written in every kind of medical chart as a default. After the breakout of Chinese-Japanese War in 1937, the Keijo Imperial University researchers extended its physical anthropology field study to Manchuria and China to get data on physics of the people in 1940. The Japanese government and research foundations financially well supported the Keijo Imperial University researchers and the field studies for physical anthropology in Korea, Manchuria and China. The physical anthropology research was actively conducted hand in hand with imperialistic expansion, and driven by zeal for measuring the body.

Ethical Considerations in Genomic Cohort Study / 예방의학회지

During the last decade, genomic cohort study has been developed in many countries by linking health data and genetic data in stored samples. Genomic cohort study is expected to find key genetic components that contribute to common diseases, thereby promising great advance in genome medicine. While many countries endeavor to build biobank systems, biobank-based genome research has raised important ethical concerns including genetic privacy, confidentiality, discrimination, and informed consent. Informed consent for biobank poses an important question: whether true informed consent is possible in populationbased genomic cohort research where the nature of future studies is unforeseeable when consent is obtained. Due to the sensitive character of genetic information, protecting privacy and keeping confidentiality become important topics. To minimize ethical problems and achieve scientific goals to its maximum degree, each country strives to build population-based genomic cohort research project, by organizing public consultation, trying public and expert consensus in research, and providing safeguards to protect privacy and confidentiality.

Bioethics and Protection of Personal Information in Experimental Studies / 한국역학회지

Experimental studies involve intervention and manipulation of study elements such as randomization of the participating groups. In general, experimental studies involving human are riskier than observational studies, demanding robust ethical vigilance and compliance among such stakeholders as investigators, sponsors, IRBs and health authorities. Social values of research should be counted as a primary ethical consideration in experimental research. It is unethical to put human subjects into uncertain and risky conditions if the study does not pursue valuable knowledge. Sound scientific design is prerequisite for good ethics. Risk-benefit ratio of the study must be carefully evaluated study. Not only risks from physical harms but also socio-economical and psychological harms from the study should be considered as risk of the study. Risks from the design of the study such as randomization and placebo must be carefully examined. Voluntary informed consent is essential in experimental studies involving human. Human subjects, before they decide to participate in the study, must be informed the followings: risks, benefits, experimental procedures, alternative treatment, compensation for injury, and participants' voluntariness and right to withdraw at anytime. Experimental studies are usually required written consent documentation and full institutional review board (IRB) review. Other elements of experimental research ethics includes special protection for high risk groups and various vulnerable groups, and protection of privacy and confidentiality.