Korean Journal of Medical Ethics

The Korean Society for Medical Ethics

Korean J Med Ethics 2009; 12(1):15-28

pISSN: 2005-8284, eISSN: 2234-3598

DOI: https://doi.org/10.35301/ksme.2009.12.1.15

Article

연명치료중단과 유보 결정에 대한 한국 중환자 전담의사 인식과 실행

김소윤¹, 강현희², 고윤석³, 고신옥⁴^,^†

Attitudes and Practices of Critical Care Physicians in End-of-life Decisions in Korean Intensive Care Units

So Yoon Kim¹, Hyun Hee Kang², Younsuck Koh³, Shin Ok Koh⁴^,^†

¹연세대학교 의과대학 의료법윤리학과

²연세대학교 의료법윤리학연구소

³울산대학교 의과대학 내과학교실

⁴연세대학교 의과대학 마취통증의학교실

¹Department of Medical Law & Ethics, Yonsei University College of Medicine

²Yonsei University, The Asian Institute for Bioethics and Health Law

³Department of Internal Medicine, University of Ulsan College of Medicine

⁴Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute Yonsei University College of Medicine

^†교신저자: 고신옥. 연세대학교 의과대학 마취통증의학교실. 마취통증의학 연구소. 02-2228-2420. sokoh@yuhs.ac

ⓒ Copyright 2009 The Korean Society for Medical Ethics. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Published Online: Mar 31, 2009

ABSTRACT

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.

Keywords: 연명치료중단 결정; 윤리위원회; 주치의; 연명치료 및 연명치료중단

Keywords: End-of-life care decision; Korean ICU; Critical care physician; Withholding and withdrawing life sustaining treatment