BACKGROUND: Recently, the legal and ethical issues relative to euthanasia are becoming controversial in Korea. This study was designed to verify the differences of the attitudes on euthanasia between judicial apprentices and residents. METHODS: The questionnaire was conducted on the 35th-group of the judicial apprentices on March 24, 2004, and on the residents from April 2 to May 22, 2004. The respondents were 636 in total consisting of 460 judicial apprentices and 176 residents. RESULTS: Of the total 636 subjects, 373 (81.1%) of the judicial apprentices and 149 (84.7%) of residents agreed that allowing euthanasia is moral, without any significant difference (P>0.05). The number of residents was greater (59 people, 33.5%) than that of judicial apprentices (112 people, 24.4%) who agreed with active euthanasia (P<0.05). Among the total, 397 (86.3%) of the judicial apprentices and 160 (91.4%) of the residents answered that the law for euthanasia was necessary, without any significant difference (P>0.05). But, among these supporters, the respondents who agreed on active euthanasia were significantly different in number between judicial apprentices (n=93, 23.4%) and residents (n=54, 33.8%) (P<0.05). CONCLUSION: This study did not find any significant differences between the two groups in the necessity of the law for euthanasia, but the rate of agreement on active euthanasia was higher in residents group than in judicial apprentices group.
Surveys and Questionnaires ; Ethics ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Jurisprudence ; Korea

BACKGROUND: Medical decisions concerning the prolongation of life, the right to die and euthanasia are among the most extensively discussed issues within medicine and law today. The purpose of this study was to evaluate the attitudes of medical students and housestaff toward euthanasia. METHODS: From July 15 to September 15 of the 1998, the responses of 180 medical students and 132 housestaff to a self-administered questionnaire were analyzed to identify attitudes toward euthanasia. Over 312 respondents about attitudes toward euthanasia, the analysis of differences between proportions was made by the Chi-square test. RESULTS: About 69.9% of the respondents thought euthanasia should be legalized. The findings suggest that Buddhists (77.5%) and non-religious groups (88.1%) tend to support euthanasia more than Christians. Futhermore, medical students (74.4%) support euthanasia more than housestaffs(63.6%), male(75.1%) more often than female(57.9%). About 73.1% of the respondents said that active euthanasia is not justifiable, and 79.2% said that they do not like performing active euthanasia. In respect to passive euthanasia, 69.0% said that it is not ethically justifiable, but 63.0% would perform this as if it were legal. Housestaffs of internal medicine (76.9%) were more willing to do euthanasia than pediatrics (70.0%), surgery (63.6%), family practice (53.8%) and Ob/Gyn (33.3%). CONCLUSION: Respondents have positive attitudes toward legalization of euthanasia.. Most considered that passive euthanasia is not morally justifiable. But if it were legalized, they would be willing to do euthanasia, while they would still be disturbed by active euthanasia. The opinions of physician and medical students directly affect patient care and their attitudes must be considered if clear policies are to be developed concerning euthanasia.
Surveys and Questionnaires ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Family Practice ; Humans ; Internal Medicine ; Jurisprudence ; Life Support Care ; Patient Care ; Pediatrics ; Right to Die ; Students, Medical*

Although the word 'euthanasia', a compound word of eu- (good, well) and thanatos (death) is widely known, it is greatly misunderstood. With regard to end-of-life medicine, several phrases, including death with dignity, passive euthanasia, and natural death also need to be clarified. A review of their meanings and connotations is provided along with a brief history of the discussion in Korea on forgoing life support. Korea has no law regarding the cessation of artificial ventilation, but several judgments of law courts provide us with a general principle that cessation could be applied if the patient is in an irreversible or dying condition medically, and has presented his or her intention with something like an advance directives, or is reasonably presumed to have such a will.
Advance Directives ; Euthanasia ; Euthanasia, Passive ; Humans ; Intention ; Judgment ; Jurisprudence ; Korea ; Right to Die ; Suicide, Assisted ; Ventilation

The purpose of this study was to explore the attitude of student nurses to euthanasia. The convenient sample for this study consisted of 293 nursing students at a nursing college in Kyeongi Province. The data were collected from Oct. 15, 2002 to Oct. 30, 2002 and were analyzed using frequency, percentage, and X2-test with the SAS package. The results of this study are as follow :77.1% of students agreed to passive euthanasia and 70.6% subjects agreed to legalization of passive euthanasia.78.5% of students can given an exact explanation of the concept of hospice. They obtained information about hospice from the mass media (1.1%), books (30.0%), friends and neighbors (3.4%), and religious groups (2.4%). The preferred place for death was reported to be home (75.4%), hospital (9.4%) or a peaceful place (6.3%).Fears of facing death were suffering in death (23.4%), grief of remaining family (21.2%), unknown about the other world (10.0%), separation from people who are loved (9.7%), forgotten from the people's memory(6.3%). In conclusion, the attitude of student nurses toward passive euthanasia approached a positive direction. But euthanasia was seen as dangerous and having multiple problems. Therefore the training for student nurses as health professionals should include content on dealing with hospice care and euthanasia.
Euthanasia* ; Euthanasia, Passive ; Friends ; Grief ; Health Occupations ; Hospice Care ; Hospices ; Humans ; Love ; Mass Media ; Nursing ; Students, Nursing

PURPOSE: This study was conducted to identify clinical characteristics of oncologic patients at a point when they signed their do-not-resuscitate (DNR) orders. METHODS: From January through December 2014, we retrospectively analyzed the records of 197 patients who passed away after agreeing to a DNR order in the hemato-oncology department of a tertiary hospital. RESULTS: Of all, 121 patients (61.4%) were male and 76 (38.6%) were female, and their average age was 58.7 years. Ninety-four patients (47.7%) had gastrointestinal cancer. The ECOG performance status at admission was grade 3 in 76 patients (36.5%) and grade 4 in 11 (5.6%). The patients' mean hospital stay was 20 days. The mean duration from the admission to DNR decision was 13 days, and the mean duration from DNR decision to death was seven days. CONCLUSION: Study results indicate that a decision on signing or refusing a DNR order was made by medical staff mostly based on the opinions of patients' guardians rather than the patients themselves. This suggests that patients' own wishes are not well respected. Thus, it is urgent to establish institutional devices to enhance cancer patients' autonomy regarding DNR and to define an adequate timing for withdrawal of treatments.
Female ; Gastrointestinal Neoplasms ; Hospice Care ; Humans ; Length of Stay ; Male ; Medical Staff ; Resuscitation Orders ; Retrospective Studies ; Terminal Care ; Terminally Ill ; Tertiary Care Centers*

PURPOSE: Most medical schools in Korea do not provide adequate education in end-of-life care. This study was designed to illustrate the need to improve end-of-life care education and to assess the effect of the education on fourth-year medical students' awareness and attitude towards hospice and palliative care for terminally ill patients. METHODS: One hundred sixty six fourth-year medical students were surveyed with questionnaires on end-of-life care before and after they received the education. RESULTS: Before receiving the education, students most frequently answered "at the end of life" (33.6%) was appropriate time to write an advance medical directive. After the education, the most frequent answer was "in healthy status" (58.7%). More students agreed to withholding or withdrawing futile life-sustaining treatment increased after the education (48.1% vs. 92.5% (P<0.001) for cardiopulmonary resuscitation, 38.3% vs. 92.5% (P<0.001) for intubation and mechanical ventilation, 39.1% vs. 85.8% (P<0.001) for inotropics, 60.9% vs. 94.8% (P<0.001) for dialysis and 27.8% vs. 56.0% (P<0.001) for total parenteral nutrition). Significantly more students opposed euthanasia after the education (46.6% vs. 82.1%, P<0.001). All students agreed to the need for education in end-of-life care. CONCLUSION: After reflecting on the meaning of death through the end-of-life care education, most students recognized the need for the education. The education brought remarkable changes in students' awareness and attitude towards patients at the end of life. We suggest end-of-life care education should be included in the regular curriculum of all medical schools in Korea.
Cardiopulmonary Resuscitation ; Curriculum ; Dialysis ; Euthanasia ; Hospice Care ; Hospices ; Humans ; Intubation ; Korea ; Palliative Care ; Respiration, Artificial ; Schools, Medical ; Students, Medical ; Terminal Care ; Terminally Ill

Hospice and palliative care can help terminal patients and their family members to face the natural end of life more comfortably, by providing them with an environment to address psychosocial and spiritual problems, as well as physical symptoms. However, most patients and their caregivers have the misconception that hospice care means the withdrawal of all treatments. Many physicians also consider hospice care to be a form of terminal care after all treatments are finished. Laws regulating the withdrawal of life-prolonging treatment came into effect in Korea in 2018, and these regulations also apply to most terminal stages of benign diseases. The withdrawal of futile life-prolonging treatment is quite different from euthanasia or negligence. At the last stage of disease, treatment aimed at alleviating various symptoms can make critically ill patients more comfortable and thereby help them to die with dignity. Patients with a terminal illness should receive hospice and palliative care, instead of futile life-prolonging treatment. Therefore, education and training programs to promote a proper understanding of hospice and palliative care should be considered mandatory.
Caregivers ; Critical Illness ; Education ; Euthanasia ; Hospice Care ; Hospices ; Humans ; Jurisprudence ; Korea ; Malpractice ; Palliative Care ; Social Control, Formal ; Terminal Care ; Withholding Treatment

PURPOSE: This study has been designed to identify attitudes to euthanasia held by Korean nurses. METHOD: Data were collected through a survey, and the participants in the study were 234 Korean nurses. Convenience sampling method was used and analysis of the data was done with SPSS PC for descriptive statistics, t-test and ANOVA. RESULTS: 1. The mean score for euthanasia was 2.80, and the sub dimension mean scores were, patients' rights, 3.24, quality of life, 2.78, respect for life, 2.68, medical ethics, 2.50. 2. With respect to the general characteristics of participants there were statistically significant difference in total score according to religion (P=.01), and degree of influence of religion on behavior (P=.00). 3. There were statistically significant difference in score of quality of life according to religion (P=.04), degree of influence of religion on behavior (P=.00), decisions in euthanasia (P=0.04), and legal permission (P=.04). 4. There was statistically significant difference in score of patient's right according to legal permission (P=.04). 5. There were statistically significant difference in the score of respect for life according to religion (P=.00), degree of influence of religion on behavior (P=.00), decision in euthnasia (P=.00), and legal permission (P=.00).
Ethics, Medical ; Euthanasia ; Euthanasia, Passive* ; Patient Rights ; Quality of Life ; Value of Life

PURPOSE: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. METHODS: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. RESULTS: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). CONCLUSION: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.
Chungcheongnam-do ; Decision Making ; Electronic Health Records ; Hematologic Tests ; Hospice Care ; Humans ; Korea ; Length of Stay ; Life Support Care ; Male ; Parenteral Nutrition ; Resuscitation Orders* ; Right to Die ; Spouses ; Terminal Care ; Terminally Ill* ; Tertiary Care Centers

INTRODUCTION

Chronic Kidney Disease (CKD) is a leading cause of morbidity and mortality in the Philippines. Most Filipino CKD patients prefer hemodialysis due to barriers such as cost and availability of Kidney Transplant. End-stage kidney disease (ESKD) patients face high symptom burden and unmet palliative care needs. Even with advancement in dialysis technology, the annual mortality rate of dialysis patients remains between 20% and 25%. While Advance Care Planning (ACP) can help align care with patient preferences by facilitating discussions about values and future decisions, its utilization in dialysis population remains low due to barriers in implementation. There is limited research specifically addressing the preferences and influencing factors of Advance Care Planning among CKD patients on hemodialysis in the Philippines.

This study aimed to determine the ACP preferences of CKD patients undergoing hemodialysis and to identify the clinicodemographic factors associated with these preferences.

An analytic cross-sectional study was conducted involving 96 chronic kidney disease (CKD) patients undergoing hemodialysis at Baguio General Hospital and Medical Center (BGHMC) from October to November 2024. Data were collected using validated questionnaires administered either through face-to-face interviews or self-administration, depending on patients’ preferences and capabilities. Descriptive and inferential statistical methods were employed for data analysis.

The study revealed limited awareness of ACP among participants (86.5%), underscoring the need for education. Family-centered decision-making was prominent, with most participants preferring family members as surrogate decision-makers and confidants. Quality of life was prioritized over life extension, and preferences for “Do Not Resuscitate” (DNR) orders were notable. Educational attainment and ethnicity significantly influenced preferences, with higher education linked to greater awareness; and Ethnicity shaping preferences for decision-makers, confidants, timing of discussions, and resuscitation choices. Additionally, duration of dialysis was linked to care setting preferences, while social support systems influenced the preferred place for discussions.

The findings highlight critical associations between clinicodemographic factors and ACP preferences among hemodialysis patients. Addressing these associations through targeted education and culturally sensitive approach can promote high-quality end-of-life care, aligned with diverse patient needs, values, and preferences.