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

Although Korea was the first country to provide hospice services in Asia, in 1965, a hospice-palliative care system has not yet been firmly established. Because of controversies surrounding end-of-life decision-making, the passage of the Hospice-Palliative Care and End-of-Life Decision Act was delayed in the National Assembly. It will finally be implemented in August 2017. For this new legislation to be successful, regulatory support from the government is essential, because there are many pitfalls in the law. In addition, a cultural movement towards ‘death with dignity’ is necessary, and the National Health Insurance system should support the cost of providing adequate care to terminal patients.
Asia ; Hospices ; Humans ; Jurisprudence ; Korea* ; National Health Programs

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

According to Organization of Economic Co-operation and Development health statistics data, out-of-pocket expenditures account for 36.8% of current health expenditures in Korea, in contrast to the Organization of Economic Co-operation and Development average of 20.3%. The government has announced the implementation of a new healthcare policy to reduce out-of-pocket expenditures. Korea already has a universal coverage system for most essential health care services. Even though health services based on out-of-pocket expenditures are usually optional, and are supported by lower levels of evidence, the National Health Insurance program has promised to cover all medical services except for cosmetic plastic surgery. This will drive more demand for optional health services and drain healthcare resources. Korea needs improvement of its quality care system instead of high-cost optional services, because of the rapid transition to an aging society.
Aging ; Delivery of Health Care* ; Fantasy* ; Health Expenditures ; Health Services ; Insurance Coverage ; Korea* ; National Health Programs ; Surgery, Plastic ; Universal Coverage

Lung cancer is a leading cause of cancer deaths in Korea. In spite of some improvements, conventional treatments (surgery, radiotherapy and chemotherapy) did not bring satisfactory solution of this fatal disease. Recent progress in molecular biology gave us better understanding of pathophysiology of lung cancer. It showed the basic elements of carcinogenesis at the molecular level. New anticancer drugs against molecular targets of cancer cells demonstrated treatment efficacy with acceptable toxicity. As STI-571 (Gleevec) is effective in chronic myelogenous leukemia, inhibitors of epidermal growth factor receptor (Iressa and Cetuximab) showed promising results in non-small cell lung cancer. Numerous new drugs against various molecular targets, such as oncogenes or extra-cellular matrix or angiogenesis or COX-2, are under investigation. Despite numerous obstacles to overcome, there are high hopes that these kinds of molecular targeted therapy will open a new horizon in lung cancer treatment.
Carcinogenesis ; Carcinoma, Non-Small-Cell Lung ; Genetic Therapy ; Hope ; Imatinib Mesylate ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Lung Neoplasms* ; Lung* ; Molecular Biology ; Molecular Targeted Therapy* ; Oncogenes ; Radiotherapy ; Receptor, Epidermal Growth Factor ; Treatment Outcome

Most cancers have oncogenes and tumor suppressor genes. First successful drug targeting a oncogene is imatinib. It was very effective for chronic myelogenous leukemia as well as gastrointestinal stromal tumors. Many other targeted agents showed good response: trastuzumab for breast cancer, epidermal growth factor receptor tyrosine kinase inhibitors for non-small cell lung cancer, etc. Tests for EGFR and ALK gene mutation are routinely recommended for adenocarcinoma of lung cancer for selection of anticancer treatment. In addition, large-scale genomic data generation (next generation sequencing) is feasible in a clinical setting and gives us high hope for personalized cancer medicine. However, there are many hurdles to overcome. Driver genes must be distinguished from the passenger genes that are present in tumor DNA. In case of targeted cancer therapy, emergence of drug resistance due to tumor cell heterogeneity and clonal evolution is difficult to manage. Genetic testing for cancer risk showed some success in preventing familial breast or ovarian cancers, but it cannot be generalized in other tumors. Application of genetic information in cancer medicine showed promise but evidence-based approach is needed in clinical practice.
Adenocarcinoma ; Breast ; Breast Neoplasms ; Carcinoma, Non-Small-Cell Lung ; Clonal Evolution ; DNA ; Drug Delivery Systems ; Drug Resistance ; Gastrointestinal Stromal Tumors ; Genes, Tumor Suppressor ; Genetic Testing ; Hope ; Humans ; Imatinib Mesylate ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Lung Neoplasms ; Oncogenes ; Ovarian Neoplasms ; Population Characteristics ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Trastuzumab

No abstract available.
Genes, Neoplasm*