연명치료중지시 의사의 역할과 의무 (Physician’s Role and Obligation in the Withdrawal of Life-sustaining Management)

서지정보

· 발행기관 : 대한의사협회
· 수록지 정보 : 대한의사협회지 / 52권 / 9호 / 871 ~ 879페이지
· 저자명 : 고윤석

초록

Patients should be treated with dignity and respect toward the end of their lives, being freed
from unnecessary and painful life-sustaining therapy in hospitals. In Korea, the quality of endof-
life (EOL) care has been variable, a major factor being the physicians’ perception to the care. A
firm consensus of EOL care decision-making has not yet explicitly stated in Korean law and ethics
until recently. However, movements to make a law of so-called “the death with dignity act” are
presently making its way to the National Assembly, initiated by a law case that allowed the
hospital to withdraw mechanical ventilator support per request by the patients’ family of a
permanently vegetative patient. Socially agreed guidelines for EOL care can facilitate clinical
decision process and communication between health service provider and the patient or his/her
family. At the same time, EOL care should be individualized also in the same line of guideline to
meet patient’ and patient’ family wish regarding the withdrawal of life-sustaining therapy. The
painful EOL care experience of the loved one remains in the memory of the relatives who live on.
Physicians should identify, document, respect, and act on behalf of the hospitalized patients’
needs, priorities, and preference for EOL care. It has been advocated that competent patients can
express their right of self-determination on EOL care through advance directives in Western
countries. Advance directives are considered as a tool to facilitate EOL decision making. However,
there are barriers to adopt the advance directives as a legitimate tool for an EOL decision making
in Korea. For one thing, the reality of death and dying is rarely discussed in our society. In
addition, the discussion about EOL care with chronically and critically ill patients has been
considered as a taboo in the hospitals. In spite of these difficulties, physicians could do better EOL
care by the open communication with patients or with their surrogates. Through the
communication, physician should set a goal how to manage the EOL patient. The set goal should
be shared among the caregivers to achieve the maximum benefit of the patient. The lack of open
discussion with patient prior to EOL care results in inappropriate protraction of a patient’s dying
process. In summary, physicians, who know the clinical significance of delivering treatments to
EOL patients, should play a central role in assisting patients’ and their families’ to make the best
decision on EOL care. Moreover, the concerted actions to improve EOL care in our society among
general public, professionals, stakeholders for EOL care, and governmental organizations are
required to address ongoing social requests, although a policy or a guideline is made in this time.

영어초록

Patients should be treated with dignity and respect toward the end of their lives, being freed
from unnecessary and painful life-sustaining therapy in hospitals. In Korea, the quality of endof-
life (EOL) care has been variable, a major factor being the physicians’ perception to the care. A
firm consensus of EOL care decision-making has not yet explicitly stated in Korean law and ethics
until recently. However, movements to make a law of so-called “the death with dignity act” are
presently making its way to the National Assembly, initiated by a law case that allowed the
hospital to withdraw mechanical ventilator support per request by the patients’ family of a
permanently vegetative patient. Socially agreed guidelines for EOL care can facilitate clinical
decision process and communication between health service provider and the patient or his/her
family. At the same time, EOL care should be individualized also in the same line of guideline to
meet patient’ and patient’ family wish regarding the withdrawal of life-sustaining therapy. The
painful EOL care experience of the loved one remains in the memory of the relatives who live on.
Physicians should identify, document, respect, and act on behalf of the hospitalized patients’
needs, priorities, and preference for EOL care. It has been advocated that competent patients can
express their right of self-determination on EOL care through advance directives in Western
countries. Advance directives are considered as a tool to facilitate EOL decision making. However,
there are barriers to adopt the advance directives as a legitimate tool for an EOL decision making
in Korea. For one thing, the reality of death and dying is rarely discussed in our society. In
addition, the discussion about EOL care with chronically and critically ill patients has been
considered as a taboo in the hospitals. In spite of these difficulties, physicians could do better EOL
care by the open communication with patients or with their surrogates. Through the
communication, physician should set a goal how to manage the EOL patient. The set goal should
be shared among the caregivers to achieve the maximum benefit of the patient. The lack of open
discussion with patient prior to EOL care results in inappropriate protraction of a patient’s dying
process. In summary, physicians, who know the clinical significance of delivering treatments to
EOL patients, should play a central role in assisting patients’ and their families’ to make the best
decision on EOL care. Moreover, the concerted actions to improve EOL care in our society among
general public, professionals, stakeholders for EOL care, and governmental organizations are
required to address ongoing social requests, although a policy or a guideline is made in this time.

참고자료

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