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.
Palliative Care*

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

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

No abstract available.
Drug Therapy ; Lymphoma*

Flexibility is important in managing cancer pain. As patients vary in diagnosis, stage of disease, responses to pain and treatments, and personal likes and dislikes, management of cancer pain must be individualized. Patients, their families, and their health care providers must work together closely to manage a patient's pain effectively. The World Health Organization (WHO) developed a 3 step approach for pain management based on the severity of the pain: (1 For mild to moderate pain, the doctor may prescribe a Step 1 pain medication such as aspirin, acetaminophen, or a nonsteroidal antiinflammatory drug (NSAID). 20 When pain lasts or increases, the doctor may change the prescription to a Step 2 or Step 3 pain medication. Most patients with cancerrelated pain will need a Step 2 or Step 3 medication. The doctor may skip Step 1 medications if the patient initially has moderate to severe pain. (3 The patient should take doses regularly, "by mouth, by the clock" (at scheduled times), to maintain a constant level of the drug in the body; this will help prevent recurrence of pain. If the patient is unable to swallow, the drugs are given by other routes (for example, by infusion or injection).
Acetaminophen ; Analgesics ; Aspirin ; Diagnosis ; Health Personnel ; Humans ; Morphine ; Mouth ; Pain Management ; Pliability ; Prescriptions ; Recurrence ; World Health Organization

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

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