의과대학병원 임상교수들의 의료윤리

Professional and personal ethical problem-solving abilities importantly influence patient care, the integrity of the patient-physician relationship, as well as fostering public trust for physicians. The patient-physician relationship has deteriorated in Korea as medicine provides more advanced and complicated therapies to patients without accompanying and appropriate communications between the patient and professional. We reported previously that most of residents working in university hospitals had experienced a serious ethical dilemma or intimidation from patients or their families during their practice in Korea. Moreover, most residents experience difficulty managing ethical issues encountered during medical practices without help from their medical Professor tutors. We hypothesized that Korean Medical Professors in university hospitals would have similar difficulties addressing these ethical dilemmas. In the summer of 2000, we surveyed 403 randomly selected Professors at 21 university hospitals around Seoul. We administered a questionnaire to assess ethics of care including doctor-patient relationship (8), clinical investigation (8)，gifts from patients (4)，gifts or rebates from drug companies or medical industries (3), conflicts between hospital profits and patients' potential benefits (3)，conflicts between physicians (3)，and ethics education (6). Two hundred and two Professors (male 95.1%) in 21 hospitals returned the survey. We found that some ethical points of view were different depending on the rank of Professor, their major specialty (medical vs. surgical), or hospital where they work. Younger Professors had experienced more conflicts regarding authorship in the publication of scientific papers, the discrepancy between the hospital’s income and patient s potential benefit under managed care, and the issue of gifts from patients, drug companies or medical industries. Physicians who work in hospitals that have an active institutional review board appeared to perform more appropriately from an ethical standpoint. Most of the respondents (91.6%) provided ethical consultation to students and residents depending on their clinical experiences. Most respondents desired to be involved in ethics training for the medical trainee. The difficulties in providing ethics education were time shortage (66.0%), doubt about the educational effect (16.0%), or lack of ethics knowledge (15.0%). Most (79.1%) considered that the education in medical school and during residency training is currently inadequate in Korea. In summary. Professors in university hospitals experience many ethical dilemmas involving patients care, clinical investigations, gifts, and hospital profits. Therefore, continuing ethics education programs, a well organized and active institutional review board, and a hospital ethics committee should be provided for physicians in Korea in order to address the complex ethical obligations that arise in the context of health care.