With development of new techniques for medical intervention, there has been a big dilemma for physicians about their decision when to stop treatment. Application of life-sustaining device sometimes results in a prolongation of painful period (dying process) for patients. Regarding the role of physician in the end-of-life decision, there could be two extremes : euthanasia vs. therapeutic tenacity (futility or accanimento terapeutico). Either extreme has its own limitations. One of possible solutions is an appropriate application of withholding and withdrawing interventions. However, several considerations are necessary for this. First, the clinical aspect of decision is whether a certain management is proportionate or non-proportionate for a given situation. If there is a chemotherapy regimen that has an efficacy of 15% partial response rate with side effects in the previous study, is it propotionate or non-proportionate treatment for advanced cancer patients? Other aspects of decision is regarding ethical, economical, and legal issues. One type of circumstances that may prompt claims of futility is the discrepancy between the values or goals of involved parties. Other concerns on futility issues are ① is it easy to break the bad news to dying patients in Korean culture? (communication problems at various levels) ② is social welfare system adequate enough not to interfere with a fair decision? Values on the issues like therapeutic decision and withholding life-sustaining treatments in terminally ill cancer patients are discordant between physicians and family members. To resolve controversies on the role of physicians as well as those of patients and their family members should be considered in the final decision.
Drug Therapy ; Euthanasia ; Humans ; Medical Futility ; Social Welfare ; Terminally Ill*

No abstract available.
Delivery of Health Care ; Health Care Reform ; Health Policy* ; Human ; Korea

No abstract available.
Palliative Care*

National Evidence-based Healthcare Collaborating Agency (NECA) is established in Dec, 2008 to implement evidence-based healthcare system in Korea. Transition from management-based to evidence-based system is expected. Evidence will be evaluated in terms of efficacy and toxicity as well as social values. It can be considered as an 'essential' health technology in case of good evidence and high social values, but it will be 'optional' with low social values in spite of good evidence. Conditional coverage with evidence development program will help to accept new technology in case of insufficient evidence despite high social values.
Biomedical Technology ; Delivery of Health Care ; Korea ; Social Values

There are more than 65,000 cancer deaths per year in Korea. To what extent should we continue aggressive treatment in terminal patients? In the course of clinical care of a critically ill patient it may become clear that the patient is inevitably dying, the goal of medical treatment should not be to prolong the dying process without benefit to the patient or to others. Further intervention which will do no more than prolong the active dying process is often described as "futile." Even though hospice is widely accepted in Korea, there is still controversy about withholding or withdrawing life-sustaining treatment. Conflicts between the parties may interrupt satisfactory decision-making and adversely affect patient care, family satisfaction, and physicianclinical team functioning. When further intervention to prolong the life of a patient becomes futile, physicians have an obligation to shift the intent of care toward comfort and closure. However, there are necessary value judgments involved in coming to the assessment of futility. In this context, Korean society needs consensus agreement on futility issue, based on our own social values.
Consensus ; Critical Illness ; Hospices ; Humans ; Judgment ; Korea ; Medical Futility ; Patient Care

There has been a controversy in Korea regarding a 'death with dignity' in comparison to a 'natural death'. However, the issue of patient autonomy is often overlooked. Decision on withholding or withdrawing life-sustaining treatment should be based on the patients' selfdetermination, prefereably in the form of advance directives. Consensus developed by the National Evidence -based Healthcare Collaborating Agency is as follows: (1) a doctor should offer a detailed explanation to patients, including about hospice-palliative care and advance directives, (2) when a terminally ill patient expresses reluctance regarding cardiopulmonary resuscitation or an artificial respirator in advance, such medical actions can be removed, with basic nutrition supply and pain control maintained. However, more discussions should be made in the case of a patient in "persistent vegetative state".
Advance Directives ; Cardiopulmonary Resuscitation ; Consensus ; Delivery of Health Care ; Humans ; Korea ; Terminally Ill ; Ventilators, Mechanical

Calciphylaxsis is a rare and life-threatening condition of progressive cutaneous necrosis secondary to calcification of small and medium-sized blood vessels. It is seen almost exclusively in patients with end-stage renal disease, in a setting of secondary hyperparathyroidism and hypercalcemia resulting in metastatic vascular calcification, We experienced a case of calciphylaxsis manifested with chara- cteristic cutaneous lesions that began as tender violaceous livedoid discolorations and subsequent ulceration on the proximal aspect of the extremities and on the lower part of the abdomen. Histologically, calcification is found in small and medium-sized blood vessels in the deep dermis and subcutaneous tissue. The patient had been treated for hypercalcemia, not complicating renal failure, but the cause of hypercalcemia was not found. However, the hypercalcemia was contolled and the skin lesions also improved after oral prednisolone therapy. Our case is a rare presentation of calciphylaxsis in the absence of renal failure, reversibly improved.
Abdomen ; Blood Vessels ; Dermis ; Extremities ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Kidney Failure, Chronic ; Necrosis ; Prednisolone ; Renal Insufficiency ; Skin ; Subcutaneous Tissue ; Ulcer ; Vascular Calcification

No abstract available.
Decision Making ; Euthanasia, Passive/legislation & jurisprudence/*psychology ; Humans ; Life Support Care/legislation & jurisprudence/*psychology ; Neoplasms/psychology ; Republic of Korea ; Terminally Ill/legislation & jurisprudence/psychology

No abstract available.
Drug Therapy ; Lymphoma*

No abstract available.
Genes, Neoplasm*