우리나라 의과대학병원 교수들의 의료윤리 문제들에 대한 견해*

Medical ethics education in medical schools has grown rapidly since 1990 in Korea, the Professors may also have a difficulty to resolve the encountered ethical conflicts. However, the opinions for ethical subjects experienced by the Professors remain largely unaddressed in Korea. The aims of the study were to describe the Professors opinions regarding commonly encountered ethical conflicts and current situation of medical ethics education in Korea.

We administered a questionnaire to the randomly selected 403 physicians, whose rank was more than full time instructor in university hospitals located in Seoul and Gyeonggi Province.

Two hundreds two Professors (192 of male) responded at 21 hospitals. 56.9% of the respondents explained the patient's condition always by themselves. When selecting an expensive therapy, 53.5% of the respondents depended on patients or their families' decision. and 20.3% of them decided the alternative by themselves considering patients' economic status.

73.9% of the respondents had an experience of clinical investigations. 78.1% of them always got an informed consent from the subjects or their relatives for the clinical investigations. 45.0% of the respondents always requested their investigation proposals to their institutional review board (IRB). The hospitals with active IRB had higher frequency of IRB request and the frequency to get an informed consent than the hospitals with inactive IRB (p< 0.05 in each).

56.2% of the respondents had an ethical dilemma to accept the colleagues as co-authors, who had not been participated in a publishing paper. Assistant Professors and full time instructors (54.9%) had more negative opinion to the acceptance than Professors (34.4%) and Associate Professors (37.5%)(p< 0.05). The respondents had experienced an ethical dilemma by patients' gifts sometimes (48.0%) and frequently (3.5%). The frequency of the reply, which answered patient's gift should not be received, was higher among the respondents, who requested always research proposals to IRB, and who work in the hospital with active IRB than the others (p< 0.05 in each).

53.9% of the respondents got an experience to be asked a favor for the selection of an equipment or a drug by the companies. 46.0% of the respondents were not influenced by the any request to raise their hospitals' income. 67.2% of the respondents had been never experienced an unethical asking from their colleagues. 72.8% of the respondents had an experience to change the content of a medical certificate from a patient. The frequency to decline the request always was higher in the Professors working at the hospitals with active IRB than the others (57.4% vs. 35.5%, p< 0.05).

84.2% of the respondents thought the ethical education still insufficient in Korean medical universities. 91.6% of the respondents answered ethical questions from the residents depending on the personal ethical knowledge and clinical experiences. 47.3% of the respondents did an ethical education to the trainee frequently. The frequency of frequent ethical education was higher in Professors (57.0%) than assistant Professors and full time instructors (39.2%)(p< 0.05). 79.1% of the respondent had an intention to perform an ethical education for the trainee.

Korean Professors in university hospitals frequently encountered various medical ethic's dilemmas. The opinion on the ethic's related subjects were different depending on the rank of the Professors and the activity of IRB of the hospitals.