Why should physicians be ethical? First of all, it is one of the categorical imperatives (golden rules) to be an ethical person. So as a human being, all physicians should endeavor to be an ethical member of the society. However, there is another important reason for physicians to be ethical, more ethical than any other members of the society. Medicine, the so-called learned profession, is defined by the knowledge held by their members and by the application of that knowledge to the needs of fellow citizens. The relationship between physicians and patients can only be secured when physicians succeed in obtaining trust from the public. Society will accept the professional autonomy and monopoly market power held by the medical organization only if the organization shows continuing effort of self-regulation according to their strict code of ethics. At now, physicians are facing a powerful challenge from the modern society that denies professional authority and stresses independence and self-sufficiency of individual social members. There is a clear tendency that modern society no longer sees medicine as a benevolent help by the paternalistic physicians to the patients in need but as a mere trade between providers and consumers. Any unethical behavior of physicians may justify the intrusion by the third party into the traditional doctor-patient relationship in the name of fair trade. In this sense, ethics of physicians may be the best policy to defend the long tradition of Hippocratic medicine.
Codes of Ethics ; Ethics* ; Humans ; Paternalism ; Professional Autonomy ; Self-Control

Involuntary and compulsive admission can damage a patient's autonomy from a medicoethical aspect, but the patient who cannot understand information and explanations from a psychiatrist due to impaired judgment and lacks insight can have impaired judgment in certain circumstances. The decision making of a patient without substantial autonomy in a psychotic or intoxicated state can be justly neglected by the psychiatrist for the patient's sake. Compulsory admission is generally permitted only in case that a patient presents a danger to himself or others, which is not of a benefit to the patient not in danger because of the loss of the opportunity to take appropriate treatment. This enables psychiatrists not to abuse medical paternalism and to protect from the damage to patient's autonomy and civil right. Compulsive admission can be ethically justified to keep the principle of the least restrictive treatment and the patient's right to appropriate treatment. Psychiatrists should help enhance the patient's underestimated autonomy on the basis of the limited paternalism.
Civil Rights ; Decision Making ; Humans ; Judgment ; Paternalism ; Patient Rights ; Psychiatry

The Korean Mental Health Act, enacted in 1995, was entirely amended 20 years later and the amendment was passed by the National Assembly plenary session on May 19. 2015. The amended Mental Health Act reflects the recent rapid changes in the mental health environment and contributes one more step toward securing human rights for people with mental illness. However, after review of some major issues, it is doubtful whether there was sufficient discussion on the national mental health policy and whether a national consensus was obtained. This paper describes some problems within the amended Act and discusses several ways to improve the Act. Patients' autonomy and medical paternalism are typical major concerns in the field of medical ethics. Especially for patients with mental illness, it is difficult to maintain a balance between those two concerns because there is often an inability to assign responsibility for those concerns. Therefore, a revised Act should take into account these two concerns. When creating subordinate legislation ahead of the enactment of the amendments on May 30, 2016, establishment of a more reasonable and efficient system is expected ; if there has been sufficient discussion with related organizations and professionals and sufficient consideration of the realities of various medical fields. Such expectations should improve public mental health welfare.
Consensus ; Ethics, Medical ; Human Rights ; Humans ; Mental Health* ; Paternalism

The decision to withdrawal of life-sustaining management for dying patients is one of the most difficult challenges in modern medical ethics. Due to the advances in medical science and technology, terminally ill patients can survive longer than ever expected before. More specifically, artificial ventilation, nutrition, and recently developed drugs constitute the cores of life -sustaining management for dying patients. The issues of patients' autonomy, medical paternalism and sanctity of life are related with this particular problem. Korean Supreme Court recently approved the request of a permanent vegetative status patients' family to terminate the artificial ventilation and allow the patient to die. Korean Medical Association is currently seeking to establish the guideline. Korean government and parliament are also looking for a way to enact the law. However, religious sector including Catholic Church and a significant proportion of the population have opposed the legalization of euthanasia. A careful study in other countries' legislations related to the care for dying patients would help to establish the consensus in the nation.
Advance Directives ; Consensus ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Paternalism ; Right to Die ; Terminally Ill ; Value of Life ; Ventilation

OBJECTIVES: Based on the debate between paternalism and rights-driven view, to investigate the effects of coercion on the recovery attitudes of patients with mental illness. METHODS: The participants were 352 patients with schizophrenia (79.8%) and mood disorders (major depressive disorder 9.1%, bipolar 11.1%), who were in hospital or who were enrolled in a community mental health center or a social rehabilitation center. All were interviewed. Coercion was divided into family and experts, depending on coercer and was divided into positive and negative coercion such as persuasion, inducement, asked preference, threat, physical force and so on, depending on types of coercion. Recovery attitudes were subdivided into subjective clinical recovery attitudes and life recovery attitudes. RESULTS: When socio-demographic and disorder characteristics were controlled, positive coercion by family and experts had a significant effect on life recovery attitudes, and positive coercion by experts had a significant effect on subjective clinical recovery attitudes. The level of symptoms was found to be an important predictor of recovery attitudes. CONCLUSION: The findings of this study propose the important of the control of mental symptoms, more realistic training in family education, the secure of human rights protection guidelines applicable in the field and so on.
Coercion ; Depressive Disorder ; Human Rights ; Humans ; Mental Health ; Mood Disorders ; Paternalism ; Persuasive Communication ; Rehabilitation Centers ; Schizophrenia

OBJECTIVES: Based on the debate between paternalism and rights-driven view, to investigate the effects of coercion on the recovery attitudes of patients with mental illness. METHODS: The participants were 352 patients with schizophrenia (79.8%) and mood disorders (major depressive disorder 9.1%, bipolar 11.1%), who were in hospital or who were enrolled in a community mental health center or a social rehabilitation center. All were interviewed. Coercion was divided into family and experts, depending on coercer and was divided into positive and negative coercion such as persuasion, inducement, asked preference, threat, physical force and so on, depending on types of coercion. Recovery attitudes were subdivided into subjective clinical recovery attitudes and life recovery attitudes. RESULTS: When socio-demographic and disorder characteristics were controlled, positive coercion by family and experts had a significant effect on life recovery attitudes, and positive coercion by experts had a significant effect on subjective clinical recovery attitudes. The level of symptoms was found to be an important predictor of recovery attitudes. CONCLUSION: The findings of this study propose the important of the control of mental symptoms, more realistic training in family education, the secure of human rights protection guidelines applicable in the field and so on.
Coercion ; Depressive Disorder ; Human Rights ; Humans ; Mental Health ; Mood Disorders ; Paternalism ; Persuasive Communication ; Rehabilitation Centers ; Schizophrenia

The doctrine of informed consent, as opposed to medical paternalism, is intended to facilitate patient autonomy by allowing patient participation in the medical decision-making process. However, regrettably, the surgical informed consent (SIC) process is invariably underestimated and reduced to a documentary procedure to protect physicians from legal liability. Moreover, residents are rarely trained in the clinical and communicative skills required for the SIC process. Accordingly, to increase professional awareness of the SIC process, a brief history and introduction to the current elements of SIC, the obstacles to patient autonomy and SIC, benefits and drawbacks of SIC, planning of an optimal SIC process, and its application to cases of an unruptured intracranial aneurysm are all presented. Optimal informed consent process can provide patients with a good comprehension of their disease and treatment, augmented autonomy, a strong therapeutic alliance with their doctors, and psychological defenses for coping with stressful surgical circumstances.
Clinical Decision-Making ; Comprehension ; Humans ; Informed Consent* ; Intracranial Aneurysm ; Liability, Legal ; Neurosurgery* ; Paternalism ; Patient Participation

The revised Mental Health Act, in which the legal status and role of “the committee for the appropriateness of hospitalization” as an administrative committee, which has been launched since June 2017, is discussed. The German and British laws were reviewed in comparison with the Korean laws, focusing on the similarities and differences among the laws and which parts require revision. This study reported that patient care should be considered not only from a constitutional point of view, but also from a health care point of view. Self-determination and medical paternalism are both important but generally incompatible values. In recent days, objective and fair diagnosis from medical experts have been challenging. The current Mental Health Act was inevitably revised to actively accept the decisions of the Constitutional Court and apparently guarantee the basic rights of people in the future. The pros and cons of “the committee for the appropriateness of hospitalization” and which parts need to be revised to perform its role properly as a guardian of the admission procedure are assessed. This should reflect the current reality of the mental health medical community. In addition, a face-to-face examination should be made in principle. Nevertheless, the basic rights of the mentally ill are not guaranteed based on current law because of the shortage of budget and human resources. The final option maybe the introduction of a judicial system on involuntary admission. Legitimacy and professionalism are engagements that should be adhered to when treating psychiatric patients.
Budgets ; Delivery of Health Care ; Diagnosis ; Hospitalization ; Humans ; Illegitimacy ; Jurisprudence ; Mental Health ; Mentally Ill Persons ; Paternalism ; Patient Care ; Professionalism