Challenges and Opportunities in Clinical Ethics with the Implementation of Korea's End-of-Life Act / Desafíos y oportunidades en ética clínica con la implementación de la Ley de fin de vida de Corea / Desafios e oportunidades em ética clínica com a implementação do Ato de Fim-da-Vida na Córeia

Abstract: This paper examines the possible impacts of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life in Korea (Korea's end-of-life act), legislated in 2016, on the development of hospital ethics committees and clinical ethics consultation services in South Korea. Clinical ethics in Korea has not made much progress in comparison to other subdisciplines of biomedical ethics. While the enactment of this law may give rise to beneficial clinical ethics services, it is possible that customary practices and traditional authorities in Korean society will come into conflict with the norms of clinical ethics. This paper examines how the three main agents of Korean society—family, government, and medical professionals—may clash with end-of-life stage norms in clinical ethics, thus posing obstacles to the development of hospital committees and consultation services. A brief outline of what lies ahead for the progress of clinical ethics practice is explored.

Resumen: Este documento examina los posibles impactos de la Ley de decisiones sobre el tratamiento de soporte vital para pacientes en hospicios y cuidados paliativos, o al final de la vida en Corea (Ley de Corea del Final de la Vida), legislada en 2016, sobre el desarrollo de comités de ética hospitalaria y servicios de consulta de ética clínica en Corea del Sur. La ética clínica en Corea no ha avanzado mucho en comparación con otras subdisciplinas de la ética biomédica. Si bien la promulgación de esta ley puede dar lugar a servicios de ética clínica beneficiosos, es posible que las prácticas tradicionales y las autoridades tradicionales en la sociedad coreana entren en conflicto con las normas de ética clínica. Este documento examina cómo los tres agentes principales de la sociedad coreana —familia, gobierno y profesionales médicos— pueden chocar con las normas de ética clínica al final de la vida, lo que plantea obstáculos para el desarrollo de comités hospitalarios y servicios de consulta. Se explora un breve resumen de lo que queda por delante para el progreso de la práctica de la ética clínica.

Resumo: Este artigo examina os possíveis impactos que o Ato sobre Decisões Relacionadas a Tratamento de Manutenção da Vida para Pacientes em Casas de Idosos e de Cuidados Paliativos ou ao Fim da Vida na Coréia (ato de fim da vida da Coréia), aprovado pelo legislativo em 2016, sobre o desenvolvimento de comitês de ética de hospitais e serviços de consulta sobre ética clínica na Coréia do Sul. Ética clínica na Coréia não sofreu muito progresso em comparação com outras subdisciplinas da ética biomédica. Enquanto a promulgação desta lei pode dar origem a serviços de ética clínica proveitosos, é possível que práticas usuais e autoridades tradicionais na sociedade coreana entrarão em conflito com as normas da ética clínica. Este artigo examina como os três principais agentes da sociedade coreana - família, governo e profissionais médicos - podem se chocar com normas de estágios de fim da vida em ética clínica, colocando assim obstáculos para o desenvolvimento de comitês hospitalares e serviços de consulta. Um breve esboço do que vem pela frente para o progresso da prática de ética clínica é explorado.

Analysis of Ethical Review Work of Ethics Committee in a Top Three Hospital and Experience / 中国医学伦理学

This paper summarized the construction of ethics committee in a top three hospital and analyzed its operation from three aspects of project review, review conference and training of member. And on the basis of ana-lyzing the practice of ethical review work in the past five years, this paper put forward that it can provide reference for the standardization of ethics committee from four aspects of strengthening ethics training, establishing ethics re-view exchange mechanism, accelerating legislating and standardizing review process.

Analysis of the Current Management Situation of Hospital Ethics Committee Based on CRA / 中国医学伦理学

Taking CRA as the research object,and using the method of questionnaire investigation to collect the evaluation results of CRA to the operation status of the hospital ethics committee,this paper found that the review efficiency of ethics committee and the professional level of ethics staffs existed insufficiency.Aiming at this,this paper put forward to strengthen the connotation construction from the perspectives of information disclosure,system construction,committee training,improvement of staff internal quality and professional level and so on,in order to improve the efficiency and quality of ethical review.

Investigation on the Ethical Cognition of Clinical Research among Medical Staff in Hospitals of Qinghai Province / 中国医学伦理学

Objective:To investigate the ethical cognition of clinical research among medical staff working at different grades of hospitals in Qinghai Province and thus to provide references for the construction of medical ethics organization in hospitals.Methods:A questionnaire survey was conducted to investigate the knowledge of hospital ethics among medical staff from 11 hospitals of different grades in Qinghai Province.Results:Among the 611 med-ical staff,329 (53.8％) received medical ethics education in continuing education and 378 (61.9％) knew that the ethics committee had been set up in their hospitals.The medical staff in different grades of hospitals showed a statistical difference (P ＜ 0.05) in the medical behavior cognition of ethical laws and regulations and the need for ethical review.Conclusion:Hospitals in Qinghai province need to strengthen the training of medical ethics knowl-edge,improve medical staff's awareness of ethics committee,and promote the efficient operation of hospital ethics.

Analysis on setbacks found in hospital ethics review / 中华医院管理杂志

Given the rapid progress in recent years,hospital ethics review remains a weak link.This study started from the nature and role of the hospital ethics committee to probe into setbacks found in hospital ethics review practice.Viewpoints in the paper covered the access system,review system,training system,and the conflicts of interest between researchers and subjects,in an effort to further improve the quality of ethic review,and to better protect the rights and interests of subjects.

La bioética y de los comités hospitalarios de ética: una introducción / Bioethics and hospital ethics committees: an introduction

La bioética comienza a conformarse como disciplina especializada hace casi cinco décadas. Los importantes avances experimentados por las ciencias biológicas y médicas, junto con el surgimiento de innovadoras biotecnologías, tornan urgente la adopción de criterios para la toma de decisiones moralmente complejas relacionadas con el ámbitode la salud. Los organismos gubernamentales y los diferentes centros de salud, frente a esta realidad,comprenden la importancia de la tarea de implementación de diversos mecanismos formales para abordar y analizar los problemas éticos que surgen de estos avances dinámicos y cambiantes en el campo de los cuidados médicos. Como resultado se produjo la creación de los comités de bioética, que tienen como finalidad principal alentar el diálogo y el debate sobre cuestiones dilemáticas relacionadas con la éticadel cuidado de la salud. Estos comités son grupos interdisciplinarios en los cuales expertos de diferentes profesiones (médicos, enfermeras, psicólogos, filósofos, abogados y otros) analizan diferentes cuestiones de orden bioético con el fin de lograr un acuerdo teniendo siempre como fin la protección de los derechos del paciente. Este presente trabajo, que posee un carácter introductorio a estas temáticas, presentará una breve introducción al surgimiento y posterior desarrollo de la bioética como disciplina y luego se expondrán las funciones y composición de los comités hospitalarios de ética.

The birth of bioethics as a discipline can be set approximately five decades ago. The significant scientific progress achieved by biological and medical sciences, along with the emergence of innovative biotechnology, brought to light the need to set criteria for the morally complex decisions that emerged from the health care and medical fields.Government agencies and health centers, faced with this reality, began to understand the importance of the task of implementing formal mechanisms to address and analyze ethical issues arising from these dynamic and ever changing developments in the healthcare field. The result was the establishment of bioethics committees, which are intended to encourage dialogue and debate on issues related to ethics of health care. These committees are interdisciplinary groups in which experts from different professions(doctors, nurses, psychologists, philosophers, lawyers and others) discuss various bioethical issues in order to reach an agreement with the purpose of protecting patient´s rights.This paper, which has an introductory character, presents a brief introduction to the emergence and development of bioethics as a discipline and explains the functions and composition of hospital ethics committees.

The Implications and Significance of the Case at Severance Hospital

This year on May 21st, the full panel of the Supreme Court in Korea had first made a judgment on 'withdrawal of life-sustaining management'. In this case, where a 76 -year-old patient was represented by her children, while being in a persistent vegetative status, the Supreme Court ruled that if a patient is in an irreversible condition with imminent death and the discontinuation of treatment can be approved as the patient's self -determination, while such action will not be allowed in any other special circumstances. This judgement presented the general criteria and process of withdrawal of life -sustaining management in Korea for the first time. The Supreme Court also brought about the specific requirements of advance directives and decided that in case where legal proceedings are not taken, the hospital ethic committee constiting of medical specialists should decide whether the patient is in an irreversible condition. However, the judgment vaguely defined the concept of 'irreversible death-imminent condition' and did not clearly examine the relations between the patient's right on self-determination and the duty of the national government to protect the life of the people, and the discretionary power of the doctor.

Analysis of Cases Requested to the Ethics Committee of an University Hospital for the Discontinuation of Therapy / 대한구급학회지

BACKGROUND: A hospital ethics committee (HEC) handles ethics problems in a hospital and mediates conflicts between patients and caregivers. The role of HEC on treatment withdrawal has increased after Boramae-hospital's case on 1997 in Korea. This study is an analysis of cases referred to the HEC of Asan Medical Center for the discontinuation of patient therapy. METHODS: The conference records of the HEC from January 1998 to December 2003 and the relevant patient charts were reviewed retrospectively. RESULTS: Twenty-seven cases related to treatment withdrawal were referred to the HEC during the study period. Based on the number of admitted ICU patients during the study period, the case request rate was 0.05%. The bimodal distribution of the cases in terms of age was neonate, 13 (48%); infant, 6 (22%); adult, 8 (30%). The major causes of treatment withdrawal were futile management, financial difficulty and patient suffering. The HEC recommended the continuation of treatment in 7 cases (25.9%); treatment withdrawal in 11 (40.7%); treatment withholding in 8 (29.6%); transfer to another hospital in one case (3.8%). Of the seven recommendations for treatment continuation, only three were accepted by their families. These three patients were eventually discharged alive. Treatment was withdrawn within one week in all eleven cases recommended for that by the HEC. Treatment was withheld in seven of those eight such recommended cases. CONCLUSIONS: The case referral rate was low in the studied hospital. In all cases, the patients' families requested the case to the HEC. Although the committee's recommendations to withhold or withdraw the treatment were followed by the families, the recommendation to continue therapy was often refused.

Discussion on the Role of Medical Ethics in Large-Scale Hospitals / 中国医学伦理学

This paper describes the role,method and experience,and working model of medical ethics in large-scale hospitals,and holds that the modern hospital management mode has transformed from scientific management to humanism-based management,whose essence is the transformation of managing concept,and the embody of management ethics and management culture.Important connotations and primary task including employing virtue in hospital management,obeying legal regulations in medical practice,and conducting humanistic medicine should be emphasized and concerned in hospital management.