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

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: We explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea. MATERIALS AND METHODS: A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days). RESULTS: In general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewer laboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001). CONCLUSION: Earlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.
Cardiopulmonary Resuscitation ; Health Care Costs ; Humans ; Intubation ; Korea* ; Resuscitation Orders ; Retrospective Studies ; Terminal Care

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

PURPOSE: The purpose of this study is to identify the changes to nursing activities of nurses on patients with DNR (Do-Not-Resuscitate) order and factors associated to the changes. METHODS: Data were collected using a structured questionnaire for 173 nurses at general hospitals. Logistic regression analysis was performed on the data using SAS 9.4. RESULTS: With 39 nursing activities, an average of 60.4 (34.9%) nurses reported an increase in the activities, 102.4 (59.2%) no change and 10.1 (5.9%) a drop. The activity increase was the greatest in the social area, and the physical area was where the activities decreased the most. The activity increase was associated knowledge competency (9 items), attitudes (2 items), practical competency (4 items) and work load (14 items were). CONCLUSION: To offer systematical care for DNR patients, it is necessary to expand nurses' knowledge through end-of-life education and adjust their workload and provide a support system at the department level.
Education ; Hospitals, General ; Humans ; Logistic Models ; Nursing Care ; Nursing* ; Resuscitation Orders ; Terminal Care

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*

Community-based home hospice care provided by community service centers and family physician teams aims to alleviate the suffering of terminally ill patients and help them to receive end-of-life care and pass away at home.The Puhuangyu Community Health Service Center established the home hospice care model of PUMCH-Puhuangyu Coordination at the end of 2019.The model has been practiced and improved to date.This paper introduces this model of home hospice care.
Humans ; Hospice Care ; Tertiary Care Centers ; Hospices ; Home Care Services ; Terminal Care

Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.
Analgesics, Opioid ; therapeutic use ; Attitude of Health Personnel ; Death ; Deep Sedation ; ethics ; Ethics, Medical ; Euthanasia ; ethics ; legislation & jurisprudence ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Palliative Care ; ethics ; Personhood ; Philosophy, Medical ; Practice Guidelines as Topic ; Suicide, Assisted ; ethics ; legislation & jurisprudence ; Terminal Care ; ethics ; Unconsciousness