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.
Cholecystectomy

No abstract available.
Ascites* ; Hydronephrosis*

No abstract available.

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

No abstract available.

We have noticed that several sentences in a review article by Drs. Jung and Roh published in J Clin Neurol [Circulating endothelial progenitor cells in cerebrovascular disease, J Clin Neurol 2008;4(4):139-147] are identical from those in an article by Dr. Rouhl et al. published in Stroke [Endothelial progenitor cell research in stroke: a potential shift in pathophysiological and therapeutical concepts, Stroke 2008;39(7):2158-2165]. The text of the Jung and Roh article neither mentions nor cites the article by Rouhl and colleagues. A review of this case by the editorial committee of Journal of Clinical Neurology concluded that Drs. Jung and Roh plagiarized the paper by Rouhl and colleagues. Drs. Jung and Roh have acknowledged the plagiarism in the original manuscript and given clear credit for the work of Dr. Rouhl and colleagues in a letter published in this issue as an "Apology". I regret that this has happened and that this plagiarism was not identified prior to publication.
Neurology ; Plagiarism ; Publications ; Stem Cells ; Stroke

No abstract available.
Cryopreservation* ; Trachea*